Society of Clinical Psychology

A Meta-analysis of Treatment Dropout in Child and Adolescent Outpatient Care

dgrasso — Mon, 13 May 2013 18:59:18 +0000

A recent article in Clinical Psychology Review by de Haan, Boon, deJong, Hoeve, and Vermeiren, A meta-analtyic review on treatment dropout in child and adolescent outpatient mental health care, takes a comprehensive look at treatment dropout in child and adolescent outpatient mental health care using meta-analysis. As the authors point out, dropout in psychotherapy is very common. Among the studies they reviewed, there was a difference in dropout rates between efficacy and effectiveness studies with dropout in the former ranging from 16% to 50%, and dropout in effectiveness studies ranging from 17% to 72%. This may not be surprising given the more homogenous makeup of samples in efficacy trials, relative to the more ‘real-world’ context of effectiveness studies. However, one might also question whether there are differences in motivation between the therapists in efficacy vs. effectiveness studies. Do efficacy trial therapist try harder to retain study participants? There is more at stake in terms of the research. The authors also looked at predictors of dropout across the studies. Among several child factors, the only one with a medium to large effect size was having more contact with deviant peers. Among caregiver factors, four stood out with medium to large effect sizes: younger age of caregiver, homelessness, mother not knowing the child’s diagnosis, and low confidence in the child benefitting from therapy. Among therapist factors, eighteen had medium to large effect sizes which included weaker therapeutic alliance, and the therapist being directive and perceived as controlling and lacking empathy and focus. The authors discuss important implications of this work, including focusing on engagement early and throughout therapy, with particular emphasis on engaging the caregiver.

de Haan, A.M., Boon, A.E., de Jong, J.T.V.M., Hoeve, M. & Vermeiren, R.R.J.M., A meta-analytic review on treatment dropout in child and adolescent outpatient mental health care, Clinical Psychology Review (2013), doi: 10.1016/j.cpr.2013.04.005

DISCUSSION QUESTIONS FOR YOU:

1. What have been your experiences with drop-out and what do you find works best to retain patients in treatment?

2. What are your thoughts regarding the differences between efficacy and effectiveness studies?

3. What barriers exist in terms of your ability to engage patients and to retain them in therapy?

Have an interesting idea for a post? Contact the web editor, Damion Grasso and please share.

Public Mental Health Intervention Following Disaster

dgrasso — Tue, 16 Apr 2013 21:38:21 +0000

Another mass tragedy calls upon mental health professionals to apply their skills and knowledge towards helping the public cope with trauma and loss. Since 2001, we have learned a great deal about this, and as a result, there are now evidence-informed guidelines and practices for (a) conducting needs assessments, (b) screening and identifying emerging trauma-related psychopathology, (c) raising public awareness, (d) and providing evidence-based treatment when necessary. A highly informative paper published in the September 2011 volume of the American Psychologist is worth revisiting. The paper, Postdisaster Psychological Intervention Since 9/11 by Patricia Watson, Melissa Brymer, and George Bonanno summarizes the work to date in this area. Although most individuals exposed to disaster will recover naturally, a portion of affected individuals will present with clinical needs – some immediately after the event and others at a later date. As summarized in Watson, Brymer, and Bonanno (2011), we can use what we know about risk factors to inform and enhance screening. A number of these are summarized in the article and include subsequent stressors, parental response to trauma (for children), lack of social support, and degree of loss. In addition, knowledge of protective resources can inform ways of bolstering the public’s ability to cope with the trauma. This is particularly true for factors that are malleable and amendable to intervention. To borrow from Hobfoll’s Conservation of Resources (COR) theory, trauma, such as the recent bombings in Boston, precipitates individual resource loss, which may include external resources such as transportation, mobility, or co-parenting, as well as internal or psychological resources such as self-efficacy, humor, or religion. In fact, research has shown that resource loss is associated with deleterious outcomes above and beyond the effects of the trauma itself (Hobfoll, 2011). However, there is evidence that this relationship is negatively mediated by subsequent resource gain – accomplished by replacing the loss or substituting the resource with one of greater or equal value (Hobfoll, 2011). These efforts, though, are costly in that they demand utilization of existing resources, and so individuals with sufficient resources may be mobilized to maintain, acquire, and enhance resources, but those with insufficient resources may actually be more vulnerable to additional loss and negative consequences (Hobfoll, 2011). Perhaps we can focus on helping these more vulnerable individuals realize and acquire the resources they need. One of the most powerful resources is social support. The advantage of this model is that enhancing resources, like social support, does not necessitate professional mental health workers, but rather, this work can be delegated in part to families and communities and other helpers. In other words, this is knowledge that can be shared that will provide the public with tools for recovery. A good place to start is by revisiting Watson, Brymer, and Bonanno (2011), as they consolidate specific guidelines for post-disaster responses that were generated by expert consensus.

Please comment below if you have other suggestions or links to relevant literature.

Damion J. Grasso (web editor)

References Cited:

Hobfoll, S. E. “Conservation of resources theory: Its implication for stress, health, and resilience.” The Oxford handbook of stress, health, and coping(2011): 127-147.

The Clinical Psychologist – Winter 2013

dgrasso — Thu, 11 Apr 2013 00:42:43 +0000

Dear Members,

We are now up and running at near 100%! We will continue to make improvements and have some big plans for the near future – so stay tuned.

Also, our apologies for the delay – but the Winter 2013 edition of The Clinical Psychologist is up and available for download.

-Division 12

UPDATE: 1 April 2013

dgrasso — Mon, 01 Apr 2013 20:35:00 +0000

Dear Members and Prospective Members,

Although we are making progress on the site, we are not back to 100%. We are fortunate to have a dedicated web developer who has quickly become familiar with our site and is working hard to pick up the pieces. The site crashed due to a poor infrastructure – the direct consequence of a disappointing web developing company we are no longer working with.

Please know that it is currently not possible to pay for a membership online. ALL PAYMENTS MUST BE MADE OVER THE PHONE UNTIL FURTHER NOTICE.

We thank you immensely for your patience and do hope to be back to full speed in the near future.

Best -

Division 12

IMPORTANT NOTICE ABOUT WEBSITE FUNCTIONALITY

dgrasso — Tue, 19 Mar 2013 15:47:37 +0000

Dear Members,

Last week our website experienced a significant technical conundrum that caused it to crash. Importantly, no personal data were compromised. It is also important for you to know that no credit card information is stored on the site database. Since the crash, we have been working with a reputable web developer who is committed to restoring our site to 100%. Currently, the site is only partially functional. Members are still unable to login. Also, our ability to facilitate transactions via the website is on hold. If you need a file or information on the site that you cannot access – please contact me – web editor at dgrasso@uchc.edu. If you need to conduct a transaction or have membership questions, please contact Lynn Peterson at div12apa@comcast.net. We apologize for this inconvenience, but are optimistic that our site will be back online soon and will be less vulnerable to sudden shut-downs.

Best,

Damion Grasso

Your Division 12 Reps After a Long Day of Listening to Council Debates

dgrasso — Mon, 11 Mar 2013 02:20:15 +0000

[left to right] Irving Weiner, Ph.D., Danny Wedding, Ph.D., Larry Beutler, Ph.d

Call for Nominations

dgrasso — Tue, 05 Mar 2013 18:37:58 +0000

Editor of Clinical Psychology: Science and Practice

The Publications Committee of the Society of Clinical Psychology (Division 12 of the American Psychological Association) invites nominations for Editor of the Society’s flagship journal, Clinical Psychology: Science and Practice, to succeed the current editor, Edward Craighead, whose term will end December 31, 2013.

Clinical Psychology: Science and Practice presents cutting-edge developments in the science and practice of clinical psychology by publishing topical reviews of research, theory, and application to diverse areas of the field, including assessment, intervention, service delivery, and professional issues. The Journal is published quarterly by Wiley-Blackwell and is a widely respected journal with a high citation index.

Nominees must be members of the Society and should be prepared to begin receiving manuscripts in January 2014. Criteria to be considered in selecting the editor include:

Comprehensive knowledge and broad perspective on the field of clinical psychology
Understanding and appreciation of the many subdisciplines and theoretical orientations within clinical psychology
Clear professional accomplishments and identity within clinical psychology, and demonstrated research, writing, reviewing, and editing skills
A commitment to multicultural diversity both in journal content and in choice of editorial reviewers
Freedom to devote time and energy to accomplish the editorial duties, including evidence that the candidate’s institution or employment setting supports and values journal editing
Demonstrated time management skills and the ability to meet deadlines

The Editor reports to and through the Publications Committee for a 5-year nonrenewable term, and has sole control of the content of the journal. The position comes with an annual honorarium plus financial support for the operation of an editorial office.

To nominate candidates, please provide a statement in support of the nominee. Supporting material should include a curriculum vitae and the nominee’s brief statement on future directions for the Journal. Self-nominations are encouraged, as are nominations of members of underrepresented groups in clinical psychology. Deadline for nominations is April 1, 2013.

Nominations and supporting materials should be sent electronically to both: Dr. Linda Sobell, Publications Chair, Society of Clinical Psychology, at sobelll@nova.edu; and Ms. Lynn Peterson, Division 12 Central Office, at div12apa@comcast.net

The Problem of Researcher Allegiance in Psychotherapy Research

dgrasso — Sun, 24 Feb 2013 04:10:04 +0000

A new meta-meta-analysis in Clinical Psychology Review entitled, Researcher Alliance in Psychotherapy Outcome Research: An Overview of Reviews, by Munder, Brutsch, Leonhart, Gerger, and Barth (in press) addresses the problem of researcher allegiance in increasing risk of bias in psychotherapy outcome research. The analysis included 30 meta-analyses of a variety of psychotherapies. The authors report a moderate effect size suggesting a rather robust research allegiance-to-outcome relationship. They discuss ways of minimizing research allegiance bias in comparative studies of psychotherapy models.

We would like to hear your comments on this topic. Can we do a better job to prevent or minimize research allegiance bias in our work?

Contact Damion J. Grasso, Ph.D. (web editor) if you have content you would like to share on the site.

Improving Psychiatric Diagnosis: Beyond Counting Symptoms

dgrasso — Fri, 01 Feb 2013 15:50:05 +0000

A new article in Psychological Assessment, “Quantifying Diagnostic Uncertainty Using Item Response Theory: The Posterior Probability of Diagnosis Index” by Oliver Lindhiem, David Kolko, and Lan Yu from the University of Pittsburg School of Medicine describes a novel method for helping the clinician to consider the degree of uncertainty associated with a psychiatric diagnosis in terms of probability. The Posterior Probability of Diagnosis Index (PPOD) was developed using Item Response Theory. The PPOD Index takes a Bayesian approach to diagnosis, which takes into consideration a patient’s profile of symptoms. The authors illustrate the use of the PPOD Index in a sample of 321 children and adolescents with symptoms of Oppositional Defiant Disorder. Their results suggest that the PPOD Index yields more refined, and perhaps more clinically useful, information about a particular patient than does a traditional symptom count by estimating the confidence with which a diagnostic threshold is met or exceeded.

Question for Comment: How might the PPOD Index move us closer to a personalized medicine approach in the Mental Health Field?

Any ideas for content? Contact the Division 12 web editor, Damion J. Grasso, Ph.D.

SSCP Journal Club: First Reading

dgrasso — Fri, 25 Jan 2013 17:55:16 +0000

Members who are interested in becoming part of the SSCP Journal Club, the first reading is posted and commentary and discussion points will be provided on February 4. You must register (free) as a member of the journal club once you navigate to that page. Click HERE to go there now. The first reading will be Anger and Sadness in Response to an Emotionally Neutral Film: Evidence for Age-Specific Associations with Well-being by Haase, Seider, Shiota, & Levenson – a 2012 article in Psychology and Aging. Enjoy!