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Biomedical subjects

Kimberly Eaton Hoagwood

Publications and source records attributed to Kimberly Eaton Hoagwood.

6 recordsLinked to original sources
PubMed2007

Barriers to the identification and management of psychosocial issues in children and maternal depression.

CONTEXT: Child psychosocial issues and maternal depression are underidentified and undertreated, but we know surprisingly little about the barriers to identification and treatment of these problems by primary care pediatricians. OBJECTIVES: The purpose of this work was to determine whether (1) perceived barriers to care for children's psychosocial issues and maternal depression aggregate into patient, physician, and organizational domains, (2) barrier domains are distinct for mothers and children, and (3) physician, patient, and practice/organizational characteristics are associated with different barrier domains for children and mothers. METHODS: We conducted a cross-sectional survey of the 50,818 US nonretired members of the American Academy of Pediatrics. Of a random sample of 1600 members, 832 (745 nontrainee members) responded. This was a mailed 8-page survey with no patients and no intervention. We measured physician assessment of barriers to providing psychosocial care for children's psychosocial problems and maternal depression. RESULTS: Pediatricians frequently endorse the lack of time to treat mental health problems (77.0%) and long waiting periods to see mental health providers (74.0%) as the most important barriers to the identification and treatment of children's psychosocial problems. For maternal depression, pediatricians most often endorsed lack of training in treatment (74.5%) and lack of time to treat (64.3%) as important barriers. Pediatricians' reports of barriers clustered into physician and organizational domains. Physician domains were distinct for children and mothers, but organizational domains were not. Several physician and practice characteristics are significantly associated with the 4 barrier scales, and different characteristics (eg, sociodemographic, attitudinal, and practice features) were related to each barrier area. CONCLUSIONS: Pediatricians endorse a wide range of barriers with respect to the diagnosis and treatment of children's mental health problems and maternal depression. The specificity of factors relating to various barrier areas suggests that overcoming barriers to the identification and treatment of child mental health problems and maternal depression in primary care pediatrics is likely to require a multifaceted approach that spans organizational, physician, and patient issues. In addition, comprehensive interventions will likely require social marketing approaches designed to engage diverse audiences of clinicians and their patients to participate.

Child↗
PubMed2005

What is the evidence for evidence-based treatments? A hard look at our soft underbelly.

In the rising quest for evidence-based interventions, recent research often does not give adequate attention to "nonspecific therapeutic factors," including the effects of attention, positive regard, and therapeutic alliance, as well as the effects of treatment dose, intensity and actual processes mediating therapeutic change. To determine the extent to which recent clinical trial designs fully this problem, the authors conducted a systematic review of Psych-Lit/Medline of all controlled child psychotherapy treatment studies from 1995 to 2004. A total of 52 studies were identified that met review criteria: two or more therapy conditions and random assignment of participants to intervention groups. Of the 52 studies, one group (n = 29) compared a presumably active treatment with 1 or more similarly intensive treatments (often an attention control group) presumably not containing the active therapeutic ingredients. Of these, 14 studies found evidence of consistent differences between the two groups, whereas 15 did not. An additional group of studies (n = 27) compared therapy groups with different levels of intensity and "dose" of the putatively active treatment; 13 of these found evidence of the effects of different levels of treatment dose/intensity on outcomes and 14 did not. Four studies met criteria for inclusion in both groups. Across both groups of studies, when positive effects were found, few studies systematically explored whether the presumed active therapeutic ingredients actually accounted for the degree of change, nor did they often address plausible alternative explanations, such as nonspecific therapeutic factors of positive expectancies, therapeutic alliance, or attention. Findings suggest that many child psychotherapy treatment studies have not inadequately controlled for nonspecific factors such as attention and treatment intensity and have failed to assess specific mediators of change. Specific recommendations for future studies are offered, specifically: 1. Initial specification in study design how investigators will test if the intervention is efficacious over and above the effects of positive expectancies, positive regard, or attention; 2. Planned (rather than post hoc) analyses to explore whether and how a given treatment's specific ingredients or the overall intensity of its "dose" are related to treatment outcomes; 3. More studies conducting head-to-head tests of different types but equally credible forms of treatment, with planned analyses testing different mechanisms of change 4. When positive effects of a treatment vs. a control are found, systematic elimination of specific, competing hypotheses of reasons for treatment efficacy (e.g., attention, therapeutic alliance, face validity of treatment and client's treatment expectations, changes in self-efficacy), and 5. When negative effects are reported, appropriate analyses to address alternative explanations (lack of power, floor or ceiling effects, mediator analyses to address possible fidelity or adherence problems, therapist effects, absence of main effects but possible subgroup/moderator effects, etc.).

Attitude of Health Personnel↗
PubMed2005

Family-based services in children's mental health: a research review and synthesis.

A systematic review was undertaken of scientifically rigorous studies of family-based services in children's health and mental health. From a pool of over 4000 articles since 1980 in health and mental health that examined either specific family-based interventions for families of children or the processes of involvement, 41 studies were identified that met the methodological criteria for inclusion. These 41 studies encompassed 3 distinct categories: families as recipients of interventions (e.g., family education, support, engagement, empowerment); (b) families as co-therapists; and (c) studies of the processes of involvement (e.g., therapeutic alliance, engagement, empowerment, expectancies, and choice). Too few experimental studies exist to conclude decisively that family-based services improve youth clinical outcomes. However, those studies that have been rigorously examined demonstrate unequivocal improvements in other types of outcomes, such as retention in services, knowledge about mental health issues, self-efficacy, and improved family interactions - all outcomes that are essential ingredients of quality care. Four implications are drawn from this review. (1) Effective family education and support interventions from studies of adults with mental illnesses and from studies of families of high-risk infants exist and can be imported into the field of children's mental health. (2) The range of outcomes that are typically assessed in clinical treatment studies is too narrow to afford an adequate view of the impact of family-based interventions. A broader view of outcomes is needed. (3) The absence of a robust literature on process variables other than therapeutic alliance limits conclusions about how and why interventions are effective. Attention to the processes by which families become involved in services will require a more robust and nuanced range of studies that attend simultaneously to processes of change and to outcome improvement. (4) Linkage of effective family-based interventions to delivery of evidence-based services is likely to amplify the impact of those services and improve outcomes for youth and families.

Adolescent↗
PubMed2004

The services for children and adolescents-parent interview: development and performance characteristics.

OBJECTIVE: To date, no instrument has been developed that captures children's services use across primary care, specialty mental health, and other settings, including setting, treatment type, provider discipline, and length and intensity of specific interventions over varying follow-up periods. The authors developed a highly structured services assessment measure [Services for Children and Adolescents-Parent Interview (SCAPI)] for use in the National Institute of Mental Health Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder (MTA). METHOD: After successfully piloting and refining the SCAPI during initial phases of the MTA, the authors used this measure at 24 months post-randomization to ascertain the previous 6 months of services use for all participating (516 of 579) MTA children and families and 285 age- and gender-matched classroom control children. RESULTS: Findings revealed meaningful, face-valid differences between MTA and control children in levels and types of services used during the previous 6-month period. Services use data reported by parents was substantially in accord with data independently gathered by the research data center. Site variations were found in the level and use of several specific services, such as individual child psychotherapy (sites ranged from 0% to 6.8% among classroom controls compared with 9.7% to 46.1% among MTA participants) and special education services (0% to 14.6% among classroom controls, 27.5% to 34.8% among MTA participants), consistent with differences reported in other studies. CONCLUSIONS: These data support the descriptive validity of SCAPI-ascertained services use data and indicate that the SCAPI can provide investigators and policymakers a valid means of assessing services type, intensity, onset and offset, provider type, and content.

Adolescent↗
PubMed2004

Reliability of the services for children and adolescents-parent interview.

OBJECTIVE: To describe the psychometric properties and test the reliability of a new instrument designed to measure mental health services use within pediatric clinical samples, the Services for Children and Adolescents-Parent Interview (SCAPI), which was developed by the National Institute of Mental Health Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder (MTA). METHOD: Similarities and differences with other measures of services use are described. Ten types of services are measured by the SCAPI. Formal test-retest reliability testing was carried out in 104 subjects with a mean time between tests of 18 days. RESULTS: Test-retest kappa values ranged from 0.49 to 1.00, with an overall kappa value for all services of 0.97. Seven of the 10 service types had kappa values of 0.75 or higher, indicating excellent reliability. In addition, matched responses on specific questions about reasons for seeking services, starting and ending dates, number and length of visits, and type of provider seen were more than 75% for most service categories, consistently so for reporting of medications and school services. CONCLUSIONS: The SCAPI is a reliable instrument for assessing mental health and related services use and may be an especially valuable adjunct in studies involving clinical samples, especially clinical trials.

Adolescent↗