The National Mental Health Plan (1992) identified the need for regular reviews of service outcomes, the development of national outcome standards and quality assurance programs to support the reform of Australia’s mental health services. An outcome measurement system is integral to these objectives.
The purpose of this article is to review the literature on hypothesized behavioral correlates of pharmacotherapy treatment response. A particular focus is placed on what have been referred to as "common factors" across mental health treatments, including medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes. These understudied factors may provide unique explanations for mechanisms of symptom change, patient risk as a result of protocol deviation, and attenuated treatment outcomes.A literature search was conducted to evaluate the relationship between treatment processes in pediatric psychiatry and medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcomes.Substantial variability and room for improvement was identified for each common factor. Behavioral protocols have already been developed to address many aspects of common factors in pediatric psychiatric treatment, but are not yet a part of many practice parameters.Interventions to improve common factors can be used immediately in tandem with psychopharmacological interventions to provide increased symptom relief and reduce patient risk. Furthermore, incorporating instruction in common factors interventions can positively affect training of future providers and enhance understanding of the mechanisms of effect of medications. An increased focus on common factors, with a particular emphasis on quantifying the magnitude and mechanisms of their effects on psychopharmacological interventions stand to benefit child patients, their families, treatment providers, training facilities, and pharmaceutical manufacturers.
The present study examined differences in symptom presentation in screening for pediatric depression via evaluation of the Patient Health Questionnaire-9 (PHQ-9). In particular, we examined whether PHQ-9 items function differentially among deaf and hard-of-hearing (DHH; n = 75) and hearing (n = 75) youth based on participants recruited from crisis assessment services. Multiple indicators multiple causes models were used to examine whether items of the PHQ-9 functioned differently between groups as well as whether there were group differences in the mean severity of depressive symptoms. Results indicate that DHH youth were more likely to endorse psychosomatic items, and less likely to endorse an affective item. These findings indicate that the PHQ-9 functions differently when used with DHH youth. Implications of these findings are discussed, including both for future work with the PHQ-9 and with regard to the conceptualization of depression across hearing groups.
Suicide is the second leading cause of death for adolescents. Whereas school-based prevention programs are effective, obtaining active consent for youth participation in public health programming concerning sensitive topics is challenging. We explored several active consent procedures for improving participation rates.Five active consent methods (in-person, students taking forms home, mailing, mailing preceded by primers, mailing followed by reminder calls) were compared against passive consent procedures to evaluate recruitment success, as determined by participation (proportion who responded yes) and response (proportion who returned any response) rates.Participation acceptance rates ranged from 38 to 100% depending on consent method implemented. Compared with passive consent, active consent procedures were more variable in response and participation rates. In-person methods provided higher rates than less interpersonal methods, such as mailing or students taking consents home. Mailed primers before or reminder calls after consent forms were mailed increased response but not participation rates. Students taking consents home resulted in the lowest rates.Although passive consent produces the highest student participation, these methods are not always appropriate for programs addressing sensitive topics in schools. In-person active consent procedures may be the best option when prioritizing balance between parental awareness and successful student recruitment.
This chapter explores the evidence regarding the roles of common factors in anxiety disorders and how they can be used along with established procedures to improve patient outcomes and detail current controversies. Considerations of motivation for behavior change have a strong empirical foundation in substance abuse, and have recently received more attention in anxiety disorders. Despite evidence that therapeutic alliance is vital and that therapists have great responsibility in its formation, there is significant variability among therapists in the quality of alliances. Current indications, in addressing patient expectations, include evaluating patient role and outcome expectancies, setting a realistic time frame for change, explaining clearly the treatment rationale for patients, and preparing patients for the expected process of change. The predominant intervention to address patient motivation is known as motivational interviewing, which has been increasingly applied to patients with anxiety disorders.
Objective: This study evaluated the mental health characteristics and beliefs of student service members/veterans (SSM/Vs) who have been exposed to another’s death by suicide.Participants: A total of 39 SSM/Vs exposed to suicide and 32 SSM/Vs not exposed to suicide were sampled from a larger, epidemiological survey. An age- and gender-matched group of 39 civilian (C) students was drawn from a larger sample of individuals exposed to suicide.Methods: Data were collected as part of an Internet-based, campus needs survey that occurred in Fall 2014. Participants were asked to complete measures about suicide-related behaviors, suicide prevention, help-seeking, and demographics.Results: SSM/Vs exposed to suicide had more positive mental health/suicide prevention beliefs than SSM/Vs not exposed to suicide. Cs exposed to suicide were not significantly different from either group. Unique help-seeking patterns were also identified.Conclusions: The current study identifies unique characteristics of SSM/Vs exposed to suicide that may inform prevention programming.
