Example Current or Ongoing Projects
Enhancing Mental Health Care Systems
Research has shown that mental health care (MHC) providers differ significantly in their ability to help patients. In addition, providers demonstrate different patterns of effectiveness across symptom and functioning domains. Unfortunately, provider performance information is not systematically used to refer or assign a particular patient to a scientifically based best-matched provider. This PCORI-funded research aims to solve the existing non-patient-centered provider-matching problem. Specifically, we aim to demonstrate the comparative effectiveness of a scientifically-based patient-provider match system compared to status quo pragmatic case assignment. We expect in the scientific match group significantly better treatment outcomes (e.g., symptoms, quality of life) and higher patient satisfaction with treatment. We also expect to demonstrate feasibility of implementing a scientific match process in a community MHC system and broad dissemination of the easily replicated scientific match technology in diverse health care settings.
Measurement-Based Care in Residential and Intensive Outpatient Treatment for Eating Disorders
Patients with severe eating disorders and complex co-morbidity frequently receive residential treatment. However, data are lacking from empirically-supported therapies (ESTs) implemented in residential programs for eating disorders, and programming often lacks consistency or adherence to a unitary theoretical framework. Naturalistic effectiveness data are key to obtaining outcomes for ESTs in these settings; however, there are many challenges to conducting controlled research with severe patients in costly treatment funded privately or by third-party payers. This ongoing work is focused on the implementation of evidence-based practices in a network of intensive eating disorder treatment centers, including treatment program elements and measurement-based care infrastructures. Routine data derived from this effort are analyzed and interpreted, and then fed back to key stakeholders to support continuous quality improvement. Another recent project used this data to investigate PTSD comorbidity as a possible moderator of treatment outcomes.
A Comparison of Nomothetic and Idiographic Approaches to Routine Measurement and Feedback: Clinician Perceptions and Decision Making
This study explores clinicians’ perceptions and use of different types of routinely collected outcome data provided by measurement feedback systems. Compared to clinical judgment alone, routine outcome monitoring and measurement feedback systems have demonstrated superior utility in facilitating clinical responsiveness. Routine outcome monitoring and measurement feedback systems focus on the integration of routinely administered standardized measures to objectively evaluate treatment progress, while providing clinicians with valuable data-driven feedback. Nevertheless, routine outcome monitoring and measurement feedback systems utilization rates in routine practice remain low and many clinicians report reservations regarding their credibility, relevance, and usefulness. However, little is known regarding the impact of different measurement approaches on clinicians’ perceptions of the clinical utility of routine outcome monitoring and measurement feedback systems.
Clinician Self-Knowledge Study
The purpose of this APA-funded study is to (a) examine clinicians' predictive accuracy regarding their effectiveness across several different problem domains with their clients in community treatment settings; and (b) explore the influence of therapist facilitative interpersonal skill on predictive accuracy and between-therapist differences. Specifically, we are interested in whether or not clinicians perceive themselves to have a profile of relative strengths and weaknesses (rather than just being above average across the board), and whether or not these profiles are consistent with objectively measured client-reported outcomes. The factors that contribute to clinicians' perceptions of their effectiveness will be explored via qualitative interview methods.
Pay-for-Performance in Behavioral Health
As an alternative to the traditional fee-for-service model where providers are essentially treated equally, pay-for-performance initiatives build outcome-driven incentives into provider reimbursement. Essentially, a provider is paid only after demonstrating a particular outcome (rather than simply for providing a service). Pay-for-performance initiatives have received significant attention in medicine and health policy; however, clinical psychology (and behavioral health in general) has been slow to realize the implications of pay-for-performance. In order to synthesize the current state of the literature on pay-for-performance in behavioral health, including whether or not there is any evidence to show that it results in better client outcomes, we are conducting a systematic review of the literature on topic.
Outcome-Based Patient-Therapist Matching Implementation: A Study of Clinician Beliefs and Attitudes
This study investigates the relationship between clinician characteristics, attitudes toward evidence-based practices (EBPs), and implementation climate. Implementation science emphasizes the adoption of EBPs, and examining stakeholder (e.g., clinician) attitudes can inform researchers about potential barriers and facilitators to implementing EBPs in a given climate. However, previous research has yielded mixed findings on whether specific clinician characteristics such as age, gender, and education predict attitudes toward EBPs, particularly in naturalistic implementation contexts. This study aims to understand the factors that might influence clinician beliefs about outcomes-based patient-therapist matching in outpatient clinics. Findings could further inform strategies to tailor implementation efforts to clinicians working in real-world settings.