The Behavior Rating Inventory of Executive Functioning (BRIEF) is a parent report measure designe... more The Behavior Rating Inventory of Executive Functioning (BRIEF) is a parent report measure designed to assess executive skills in everyday life. The present study employed a confirmatory factor analysis (CFA) to evaluate three alternative models of the factor structure of the BRIEF. Given the executive functioning difficulties that commonly co-occur with attention-deficit/hyperactivity disorder (ADHD), the participants included 181 children and adolescents with a diagnosis of ADHD. The results indicated that an oblique two-factor model, in which the Monitor subscale loaded on both factors (i.e., Behavioral Regulation, Metacognition) and measurement errors for the Monitor and Inhibit subscales were allowed to correlate, provided an acceptable goodness-of-fit to the data. This two-factor model is consistent with previous research indicating that the Monitor subscale reflects two dimensions (i.e., monitoring of task-related activities and monitoring of personal behavioral activities) and thus loads on multiple factors. These findings support the clinical relevance of the BRIEF in children with ADHD, as well as the multidimensional nature of executive functioning.
Your article is protected by copyright and all rights are held exclusively by Springer Science +B... more Your article is protected by copyright and all rights are held exclusively by Springer Science +Business Media New York. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".
Bronfenbrenner's framework highlights the importance of considering ecological systems to und... more Bronfenbrenner's framework highlights the importance of considering ecological systems to understand child well-being. Children entering foster care often experience disruption across systems. Yet, prior research has focused on specific disruptions linked to outcomes. This longitudinal study examined the impact of multiple ecological disruptions (i.e., changes in or separation from siblings, friends, school, church, community) on children's internalizing symptoms and externalizing behaviors over time. This study included 211 children between the ages of 6 and 13 years (M = 10.23, SD = 2.37; 55.0% female; 57.3% African American). Children entered foster care for up to four reasons: Neglect (73.9%), physical abuse (29.4%), dependency (10%), and/or sexual abuse (9.5%). Most of the children experienced a change in school (64.0%), 46.9% were separated from siblings, 25.1% lost friends, 12.8% experienced community disruptions, and 10.0% were separated from church. Hierarchical Linear Modeling was employed to examine the association between ecological disruptions and longitudinal internalizing symptoms and externalizing behaviors, while controlling for baseline internalizing and externalizing, demographic variables (i.e., child age, gender, and race), and maltreatment severity. Maltreatment severity, along with school and community disruptions related to the presence of internalizing symptoms. Loss of friends was associated with the absence of externalizing behaviors, while community disruption was associated with the presence of externalizing behaviors. This study suggests that maintaining children's connections to their school and community is important for well-being. Under certain circumstances, separation from friends may relate to improved behavioral functioning. Future research should explore additional and interacting facets of children's ecological systems and related outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
This study examined the relation between paternal criminal justice involvement (i.e., biological ... more This study examined the relation between paternal criminal justice involvement (i.e., biological fathers incarcerated upon children's entry into foster care) and emotional and behavioral outcomes among children in foster care; gender and racial differences were considered. Further, this study investigated whether in-person visits with fathers with and without criminal justice involvement related to children's outcomes. The sample included 274 children (M = 10.18, SD = 2.36 years) who entered foster care in 2011-2014 and whose fathers were allowed to have contact with them. About 15.7% of children had fathers who were incarcerated in a jail or prison when they entered foster care. Hierarchical Generalized Linear Modeling showed that paternal incarceration related to higher rates of externalizing behaviors but not internalizing symptoms. A significant interaction revealed the detrimental effects of incarceration were less pronounced among African American children. Finally, a significant interaction indicated that the association between paternal incarceration and externalizing behaviors was attenuated among children who had at least one visit with their fathers. These results support efforts to promote the psychological adjustment of children of color while also working to eliminate racial disparities in contact with the criminal justice system and promote health equity, along with encourage visits between fathers involved in the criminal justice system and children in foster care. 1.1. Foster care involvement and parental incarceration Research about children's experiences in both of the contexts of
This longitudinal study explored the unique profiles of maltreatment among youth in the child wel... more This longitudinal study explored the unique profiles of maltreatment among youth in the child welfare system and examined their relation to mental health outcomes over time. We additionally examined the moderating role of age. Participants included 316 youth in the foster care system (age range: 6–13 years). Data were collected through the Department of Children and Family Services upon youths’ entry into foster care, then quarterly for the duration of care. A latent profile analysis identified five profiles of maltreatment, categorized as primary neglect (PN), neglect and physical abuse (PA), complex trauma, complex trauma with severe sexual abuse (SA), and neglect with SA. A hierarchical general linear model applied to the data revealed that all four classes predicted higher internalizing symptom trajectories compared with the PN reference class, event rate ratios (eRRs) = 1.19–1.37, but none of these associations were significantly moderated by age. Membership in the two classes ...
Abstract The child welfare system has focused on kinship placements, which have been found to pro... more Abstract The child welfare system has focused on kinship placements, which have been found to protect against disruption. The current study used survival analysis to investigate whether the type of placement (kin versus non-kin) related to the number of placement disruptions over time. Participants included 447 youth aged 5-15 years (M = 9.94, SD = 2.40; 50.8% female) from a larger project examining the outcomes of a family finding intervention. Using survival analysis, we examined the role of a kinship placement on placement disruptions across up to four placements while controlling for demographics, externalizing behaviors upon entry into care, treatment group (family finding versus control), and kin involvement outside of the placement. Results revealed that kin placements contributed to fewer disruptions across the first three placements. Findings align with policies prioritizing kin placements and suggest that the benefits of kinship care hold even for later disruptions. Thus, caseworkers should continue to consider kinship care, even if prior kin placements have disrupted.
Nonresident fathers can have a significant impact on children's behavioral outcomes. Unfortun... more Nonresident fathers can have a significant impact on children's behavioral outcomes. Unfortunately, the impact of nonresident father involvement on the behavioral outcomes of children with child welfare involvement has received scant attention in the literature, a limitation the current study sought to address. A sample of 333 children in state custody in Illinois between the ages of six and 13 participated and were assessed using the externalizing behavior scale of the Child and Adolescent Needs and Strengths (CANS) at regular intervals throughout their time in care. Father involvement was measured through a review of case files and interviews with child welfare workers. Growth trajectories were fit to children's externalizing behavior across time and were predicted using Time 1 characteristics. Father involvement, total non-father relative involvement, and gender (girls) was associated with lower baseline externalizing behavior and the African American children in the samp...
OBJECTIVE Clinical presentations of children and adolescents admitted to eight psychiatric hospit... more OBJECTIVE Clinical presentations of children and adolescents admitted to eight psychiatric hospitals were examined to determine variation in symptoms and severity of illness. METHODS A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI) scale, a reliable measure of psychiatric severity and factors thought to affect decision making about mental health services. The CSPI was completed by mobile crisis workers after interviews with 875 children and adolescents to assess whether hospitalization was appropriate. All the children were wards of the state in Cook County, Illinois, and all were subsequently hospitalized. RESULTS A factor analysis of the CSPI revealed three distinct factors: caregiver problems, externalizing symptoms, and internalizing symptoms. Children were classified as having mild, moderate, or severe problems or symptoms in the areas covered by the three factors. Chi square analyses revealed that significant variation existed between hospitals in the proportions of children with problems or symptoms in the three factor areas and in the severity of their problems or symptoms. CONCLUSIONS The major finding of variation among the eight hospitals on measures of severity of children's psychiatric illness and caregiver problems empirically supports the importance of adjusting for severity before implementing initiatives to manage performance and outcome across a system of hospitals.
Objective. Despite increased recognition of the importance of development and growth of young chi... more Objective. Despite increased recognition of the importance of development and growth of young children, formal developmental and behavioral screening often is not included in general pediatric practice. Barriers to the provision of developmental and behavioral screening are considerable; among them are the need for specialized training and uncertain reimbursement. This article develops a model for estimating the cost of providing pediatric developmental and behavioral screening that can be scaled to reflect a pediatric practice's patient population and choice of screening offered. Methods. The framework for our scaleable cost model was drawn from work done in estimating the Resource-Based Relative Value Scale (RBRVS). RBRVS provides estimates of the work effort involved in the provision of health care services for individual Current Procedural Terminology codes. The American Academy of Pediatrics has assigned descriptions of pediatric services, including developmental and behavi...
Journal of the American Academy of Child & Adolescent Psychiatry, 2000
To examine differences in risk levels of psychiatric hospital referrals received from residential... more To examine differences in risk levels of psychiatric hospital referrals received from residential treatment centers (RTCs) as a measure of service quality. This prospective study used the Childhood Severity of Psychiatric Illness (CSPI), a reliable measure of psychiatric severity and factors thought to affect decision-making. Psychiatric referrals were wards of the state from the 10 largest RTCs in one metropolitan county and were screened by mobile crisis workers for admission appropriateness. After interviewing clients, the independent crisis workers completed the CSPI. Referrals were placed into 1 of 2 categories based on CSPI ratings: high-risk or low-risk. Referrals were deemed high-risk if they displayed moderate or severe levels of suicidality, dangerousness to others, or psychotic symptoms on the CSPI. Results showed statistically significant variation in the level of risk of referrals received from the 10 RTCs. In addition, RTCs that had high rates of low-risk referrals were rated by crisis workers as demonstrating poorer supervision of their clients. The residential treatment providers in our sample are expected to provide intensive treatment to children and adolescents with serious emotional and behavioral problems. Our finding that some RTCs are making low-risk referrals suggests that they are struggling to meet the needs of some of their clients. Our findings can be used to inform quality improvement efforts at RTCs that are currently struggling.
Journal of the American Academy of Child & Adolescent Psychiatry, 1999
To examine factors related to psychiatric hospitalization decision and length of stay of wards of... more To examine factors related to psychiatric hospitalization decision and length of stay of wards of the illinois Department of Child and Family Services. A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI), a reliable, quantitative measure of psychiatric severity and its mediating factors. The CSPI was completed by hospital screeners upon conclusion of their crisis interviews. In addition to completing the CSPI, workers reported on demographic information, DSM-IV diagnoses, prescreening living arrangements, and length of hospital stay. CSPI variables could effectively predict decision to admit versus deflect. The overall accuracy of this statistically significant prediction model was 77.9%, which was replicated on a new sample. Factors associated with decision to hospitalize are clinical in nature; ratings of suicidality, dangerousness, and impulsivity contributed the most to the model. Predicting length of stay was only moderately successful. Despite achieving significance, the model accounted for just 15.1% of length of stay variance using a multiple regression. Factors associated with length of stay were largely nonclinical in nature: living arrangement stability, region of the hospitalization, and age. These results can be used to assess how decisions regarding level and duration of care are currently being made as a point of departure for quality improvement efforts.
Evidence suggests that a moderate amount of variance in patient outcomes is attributable to thera... more Evidence suggests that a moderate amount of variance in patient outcomes is attributable to therapist differences. However, explained variance estimates vary widely, perhaps because some therapists achieve greater success with certain kinds of patients. This study assessed the amount of variance in across-session change in symptom intensity scores explained by therapist differences in a large naturalistic data set (1,198 patients and 60 therapists, who each treated 10-77 of the patients). Results indicated that approximately 8% of the total variance and approximately 17% of the variance in rates of patient improvement could be attributed to the therapists. Cross-validation and extreme group analyses validated the existence of these therapist effects.
To make use of psychotherapy research in practice, therapists need realtime access to valid clini... more To make use of psychotherapy research in practice, therapists need realtime access to valid clinically relevant information about patients. The dose-effect and phase models of psychotherapy provide a theoretical background for empirically based psychotherapy management by describing the systematic nature of progress in therapy and guiding the selection of outcome criteria. Given this theoretical background, it is possible to derive appropriate models for monitoring cases in ongoing therapies (patient profiling) and identifying therapists' relative strengths and weaknesses (severity-adjusted provider profiling). These applied methods may be used Parts of this paper were presented at the 17th World Congress of Psychotherapy,
The Journal of Behavioral Health Services & Research, 2002
With the growing emphasis on accountability in mental health services, outcomes management strate... more With the growing emphasis on accountability in mental health services, outcomes management strategies are gaining popularity. However, for these techniques to be credible, it is necessary to ensure the reliability of clinical data. In other words, outcomes measures must accurately reflect the actual status of service recipients. This article presents the use of the measurement audit as one means of monitoring and improving the reliability of outcomes measurements. The methods and findings from an audit of crisis assessment workers for children in state custody are presented. Clinical assessments completed at the time of service were compared with assessments using the same measure completed via retrospective file review. Findings suggest generally good reliability, 0.72 overall, with some variation by provider and type of information.
The Behavior Rating Inventory of Executive Functioning (BRIEF) is a parent report measure designe... more The Behavior Rating Inventory of Executive Functioning (BRIEF) is a parent report measure designed to assess executive skills in everyday life. The present study employed a confirmatory factor analysis (CFA) to evaluate three alternative models of the factor structure of the BRIEF. Given the executive functioning difficulties that commonly co-occur with attention-deficit/hyperactivity disorder (ADHD), the participants included 181 children and adolescents with a diagnosis of ADHD. The results indicated that an oblique two-factor model, in which the Monitor subscale loaded on both factors (i.e., Behavioral Regulation, Metacognition) and measurement errors for the Monitor and Inhibit subscales were allowed to correlate, provided an acceptable goodness-of-fit to the data. This two-factor model is consistent with previous research indicating that the Monitor subscale reflects two dimensions (i.e., monitoring of task-related activities and monitoring of personal behavioral activities) and thus loads on multiple factors. These findings support the clinical relevance of the BRIEF in children with ADHD, as well as the multidimensional nature of executive functioning.
Your article is protected by copyright and all rights are held exclusively by Springer Science +B... more Your article is protected by copyright and all rights are held exclusively by Springer Science +Business Media New York. This e-offprint is for personal use only and shall not be selfarchived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".
Bronfenbrenner's framework highlights the importance of considering ecological systems to und... more Bronfenbrenner's framework highlights the importance of considering ecological systems to understand child well-being. Children entering foster care often experience disruption across systems. Yet, prior research has focused on specific disruptions linked to outcomes. This longitudinal study examined the impact of multiple ecological disruptions (i.e., changes in or separation from siblings, friends, school, church, community) on children's internalizing symptoms and externalizing behaviors over time. This study included 211 children between the ages of 6 and 13 years (M = 10.23, SD = 2.37; 55.0% female; 57.3% African American). Children entered foster care for up to four reasons: Neglect (73.9%), physical abuse (29.4%), dependency (10%), and/or sexual abuse (9.5%). Most of the children experienced a change in school (64.0%), 46.9% were separated from siblings, 25.1% lost friends, 12.8% experienced community disruptions, and 10.0% were separated from church. Hierarchical Linear Modeling was employed to examine the association between ecological disruptions and longitudinal internalizing symptoms and externalizing behaviors, while controlling for baseline internalizing and externalizing, demographic variables (i.e., child age, gender, and race), and maltreatment severity. Maltreatment severity, along with school and community disruptions related to the presence of internalizing symptoms. Loss of friends was associated with the absence of externalizing behaviors, while community disruption was associated with the presence of externalizing behaviors. This study suggests that maintaining children's connections to their school and community is important for well-being. Under certain circumstances, separation from friends may relate to improved behavioral functioning. Future research should explore additional and interacting facets of children's ecological systems and related outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
This study examined the relation between paternal criminal justice involvement (i.e., biological ... more This study examined the relation between paternal criminal justice involvement (i.e., biological fathers incarcerated upon children's entry into foster care) and emotional and behavioral outcomes among children in foster care; gender and racial differences were considered. Further, this study investigated whether in-person visits with fathers with and without criminal justice involvement related to children's outcomes. The sample included 274 children (M = 10.18, SD = 2.36 years) who entered foster care in 2011-2014 and whose fathers were allowed to have contact with them. About 15.7% of children had fathers who were incarcerated in a jail or prison when they entered foster care. Hierarchical Generalized Linear Modeling showed that paternal incarceration related to higher rates of externalizing behaviors but not internalizing symptoms. A significant interaction revealed the detrimental effects of incarceration were less pronounced among African American children. Finally, a significant interaction indicated that the association between paternal incarceration and externalizing behaviors was attenuated among children who had at least one visit with their fathers. These results support efforts to promote the psychological adjustment of children of color while also working to eliminate racial disparities in contact with the criminal justice system and promote health equity, along with encourage visits between fathers involved in the criminal justice system and children in foster care. 1.1. Foster care involvement and parental incarceration Research about children's experiences in both of the contexts of
This longitudinal study explored the unique profiles of maltreatment among youth in the child wel... more This longitudinal study explored the unique profiles of maltreatment among youth in the child welfare system and examined their relation to mental health outcomes over time. We additionally examined the moderating role of age. Participants included 316 youth in the foster care system (age range: 6–13 years). Data were collected through the Department of Children and Family Services upon youths’ entry into foster care, then quarterly for the duration of care. A latent profile analysis identified five profiles of maltreatment, categorized as primary neglect (PN), neglect and physical abuse (PA), complex trauma, complex trauma with severe sexual abuse (SA), and neglect with SA. A hierarchical general linear model applied to the data revealed that all four classes predicted higher internalizing symptom trajectories compared with the PN reference class, event rate ratios (eRRs) = 1.19–1.37, but none of these associations were significantly moderated by age. Membership in the two classes ...
Abstract The child welfare system has focused on kinship placements, which have been found to pro... more Abstract The child welfare system has focused on kinship placements, which have been found to protect against disruption. The current study used survival analysis to investigate whether the type of placement (kin versus non-kin) related to the number of placement disruptions over time. Participants included 447 youth aged 5-15 years (M = 9.94, SD = 2.40; 50.8% female) from a larger project examining the outcomes of a family finding intervention. Using survival analysis, we examined the role of a kinship placement on placement disruptions across up to four placements while controlling for demographics, externalizing behaviors upon entry into care, treatment group (family finding versus control), and kin involvement outside of the placement. Results revealed that kin placements contributed to fewer disruptions across the first three placements. Findings align with policies prioritizing kin placements and suggest that the benefits of kinship care hold even for later disruptions. Thus, caseworkers should continue to consider kinship care, even if prior kin placements have disrupted.
Nonresident fathers can have a significant impact on children's behavioral outcomes. Unfortun... more Nonresident fathers can have a significant impact on children's behavioral outcomes. Unfortunately, the impact of nonresident father involvement on the behavioral outcomes of children with child welfare involvement has received scant attention in the literature, a limitation the current study sought to address. A sample of 333 children in state custody in Illinois between the ages of six and 13 participated and were assessed using the externalizing behavior scale of the Child and Adolescent Needs and Strengths (CANS) at regular intervals throughout their time in care. Father involvement was measured through a review of case files and interviews with child welfare workers. Growth trajectories were fit to children's externalizing behavior across time and were predicted using Time 1 characteristics. Father involvement, total non-father relative involvement, and gender (girls) was associated with lower baseline externalizing behavior and the African American children in the samp...
OBJECTIVE Clinical presentations of children and adolescents admitted to eight psychiatric hospit... more OBJECTIVE Clinical presentations of children and adolescents admitted to eight psychiatric hospitals were examined to determine variation in symptoms and severity of illness. METHODS A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI) scale, a reliable measure of psychiatric severity and factors thought to affect decision making about mental health services. The CSPI was completed by mobile crisis workers after interviews with 875 children and adolescents to assess whether hospitalization was appropriate. All the children were wards of the state in Cook County, Illinois, and all were subsequently hospitalized. RESULTS A factor analysis of the CSPI revealed three distinct factors: caregiver problems, externalizing symptoms, and internalizing symptoms. Children were classified as having mild, moderate, or severe problems or symptoms in the areas covered by the three factors. Chi square analyses revealed that significant variation existed between hospitals in the proportions of children with problems or symptoms in the three factor areas and in the severity of their problems or symptoms. CONCLUSIONS The major finding of variation among the eight hospitals on measures of severity of children's psychiatric illness and caregiver problems empirically supports the importance of adjusting for severity before implementing initiatives to manage performance and outcome across a system of hospitals.
Objective. Despite increased recognition of the importance of development and growth of young chi... more Objective. Despite increased recognition of the importance of development and growth of young children, formal developmental and behavioral screening often is not included in general pediatric practice. Barriers to the provision of developmental and behavioral screening are considerable; among them are the need for specialized training and uncertain reimbursement. This article develops a model for estimating the cost of providing pediatric developmental and behavioral screening that can be scaled to reflect a pediatric practice's patient population and choice of screening offered. Methods. The framework for our scaleable cost model was drawn from work done in estimating the Resource-Based Relative Value Scale (RBRVS). RBRVS provides estimates of the work effort involved in the provision of health care services for individual Current Procedural Terminology codes. The American Academy of Pediatrics has assigned descriptions of pediatric services, including developmental and behavi...
Journal of the American Academy of Child & Adolescent Psychiatry, 2000
To examine differences in risk levels of psychiatric hospital referrals received from residential... more To examine differences in risk levels of psychiatric hospital referrals received from residential treatment centers (RTCs) as a measure of service quality. This prospective study used the Childhood Severity of Psychiatric Illness (CSPI), a reliable measure of psychiatric severity and factors thought to affect decision-making. Psychiatric referrals were wards of the state from the 10 largest RTCs in one metropolitan county and were screened by mobile crisis workers for admission appropriateness. After interviewing clients, the independent crisis workers completed the CSPI. Referrals were placed into 1 of 2 categories based on CSPI ratings: high-risk or low-risk. Referrals were deemed high-risk if they displayed moderate or severe levels of suicidality, dangerousness to others, or psychotic symptoms on the CSPI. Results showed statistically significant variation in the level of risk of referrals received from the 10 RTCs. In addition, RTCs that had high rates of low-risk referrals were rated by crisis workers as demonstrating poorer supervision of their clients. The residential treatment providers in our sample are expected to provide intensive treatment to children and adolescents with serious emotional and behavioral problems. Our finding that some RTCs are making low-risk referrals suggests that they are struggling to meet the needs of some of their clients. Our findings can be used to inform quality improvement efforts at RTCs that are currently struggling.
Journal of the American Academy of Child & Adolescent Psychiatry, 1999
To examine factors related to psychiatric hospitalization decision and length of stay of wards of... more To examine factors related to psychiatric hospitalization decision and length of stay of wards of the illinois Department of Child and Family Services. A prospective design was implemented using the Childhood Severity of Psychiatric Illness (CSPI), a reliable, quantitative measure of psychiatric severity and its mediating factors. The CSPI was completed by hospital screeners upon conclusion of their crisis interviews. In addition to completing the CSPI, workers reported on demographic information, DSM-IV diagnoses, prescreening living arrangements, and length of hospital stay. CSPI variables could effectively predict decision to admit versus deflect. The overall accuracy of this statistically significant prediction model was 77.9%, which was replicated on a new sample. Factors associated with decision to hospitalize are clinical in nature; ratings of suicidality, dangerousness, and impulsivity contributed the most to the model. Predicting length of stay was only moderately successful. Despite achieving significance, the model accounted for just 15.1% of length of stay variance using a multiple regression. Factors associated with length of stay were largely nonclinical in nature: living arrangement stability, region of the hospitalization, and age. These results can be used to assess how decisions regarding level and duration of care are currently being made as a point of departure for quality improvement efforts.
Evidence suggests that a moderate amount of variance in patient outcomes is attributable to thera... more Evidence suggests that a moderate amount of variance in patient outcomes is attributable to therapist differences. However, explained variance estimates vary widely, perhaps because some therapists achieve greater success with certain kinds of patients. This study assessed the amount of variance in across-session change in symptom intensity scores explained by therapist differences in a large naturalistic data set (1,198 patients and 60 therapists, who each treated 10-77 of the patients). Results indicated that approximately 8% of the total variance and approximately 17% of the variance in rates of patient improvement could be attributed to the therapists. Cross-validation and extreme group analyses validated the existence of these therapist effects.
To make use of psychotherapy research in practice, therapists need realtime access to valid clini... more To make use of psychotherapy research in practice, therapists need realtime access to valid clinically relevant information about patients. The dose-effect and phase models of psychotherapy provide a theoretical background for empirically based psychotherapy management by describing the systematic nature of progress in therapy and guiding the selection of outcome criteria. Given this theoretical background, it is possible to derive appropriate models for monitoring cases in ongoing therapies (patient profiling) and identifying therapists' relative strengths and weaknesses (severity-adjusted provider profiling). These applied methods may be used Parts of this paper were presented at the 17th World Congress of Psychotherapy,
The Journal of Behavioral Health Services & Research, 2002
With the growing emphasis on accountability in mental health services, outcomes management strate... more With the growing emphasis on accountability in mental health services, outcomes management strategies are gaining popularity. However, for these techniques to be credible, it is necessary to ensure the reliability of clinical data. In other words, outcomes measures must accurately reflect the actual status of service recipients. This article presents the use of the measurement audit as one means of monitoring and improving the reliability of outcomes measurements. The methods and findings from an audit of crisis assessment workers for children in state custody are presented. Clinical assessments completed at the time of service were compared with assessments using the same measure completed via retrospective file review. Findings suggest generally good reliability, 0.72 overall, with some variation by provider and type of information.
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