Breakout T – May 17, 2013
1. Team-Based Exposure & Ritual Prevention for Adults with Obsessive Compulsive Disorder: An Open Trial Implemented in a Community Mental Health Center
Presenter: Marie Mancebo, PhD
Authors: Maria Mancebo, PhD, Gail Steketee, PhD, Jordana Muroff, PhD, Steven Rasmussen, MD, & Caron Zlotnick, PhD, Butler Hospital, Alpert Medical School at Brown University
Abstract: This study assessed the acceptability and feasibility of a portable training program and team-based approach to delivering Exposure and Ritual Prevention (Ex/RP) for OCD in a community mental health center (CMHC). Method: Group Ex/RP for OCD was adapted to meet the needs of low-income adults receiving treatment in a CMHC. A training program, treatment manual, and fidelity ratings were developed to train community therapists and case managers to deliver Ex/RP. Low-income individuals with OCD were included if they: identified OCD as their primary DSM-IV disorder, had at least moderate OCD symptoms, were on a stable psychotropic medication regiment, and had never received a trial of Ex/RP. Participants received 14 group therapy sessions with a therapist and 10 individual coaching sessions with a case manager. Results: Nine participants entered active treatment. Feasibility and acceptability of the intervention were high, with two-thirds (n=6) of patients completing treatment, 89% of scheduled sessions attended, and high treatment satisfaction ratings. Two therapists and six case managers completed the training program. Fidelity ratings indicated staff were able to effectively deliver manualized Ex/RP. Treatment completers experienced significant reductions in symptoms on the Yale-Brown Obsessive-Compulsive Scale at Posttreatment. Conclusions: Team-based Ex/RP appears to be a feasible and acceptable intervention for individuals receiving treatment for OCD at CMHCs.
2. Implementation of the Family Check-Up in Community Mental Health Agencies: Clinical Effectiveness, Fidelity, & Other Outcomes
Presenter: Justin Smith, PhD
Authors: Justin D. Smith, PhD, Elizabeth A. Stormshak, PhD, & Katherine Kavanagh, Child & Family Center, University of Oregon
Abstract: We examine the process and outcomes of implementation of the Family Check-Up (FCU; Dishion & Stormshak, 2007) in low resource community mental health agencies serving high-risk families. The FCU is a family-based intervention shown to improve family management practices and reduce problem behaviors in youth ages 2-18 (e.g., Dishion et al, 2008; Stormshak & Dishion, 2009). The model was also designed for implementation in community settings serving families, such as schools, primary care, and community mental health. Method: Of the 36 therapists engaged in the study, 17 were randomly assigned to the FCU condition and 19 to TAU. Therapists in the FCU condition received intensive training followed by ongoing implementation support to promote uptake and counter drift. Families were pseudo-randomly assigned to a therapist in one of the conditions: 42 families received the FCU while 32 received community treatment as usual (TAU). Results: ITT analysis revealed intervention effects on youths’ conduct problems and increased parental monitoring, which differed for male and female youth. Interventionists were found to have positive attitudes toward evidence-based practices, a desire to learn evidence-based approaches, and acceptable implementation fidelity, assessed using the COACH observational rating system. Furthermore, variations in fidelity were associated with change in specific parenting behaviors. Conclusions: The FCU is a viable and effective family-based community intervention as a precursor to typical community mental health services. The implications of these findings for future scale-up efforts of the FCU will be discussed.
3. Cognitive Retraining (CR) for Attention & Working Memory for Older Adults: What to Train, to Whom, & How Long?
Presenter: Lee Hyer, PhD, ABPP
Authors: Lee Hyer, PhD, ABPP,1 Christine Mullin,2 & Laura McKensie2
1Georgia Neurosurgical Institute & Mercer School of Medicine; 2Mercer School of Medicine
Abstract: It is now accepted that cognitive retraining (CR) improves attention and working memory for older adults. What to train, to whom, and how long are now important questions. We conducted three independent clinical studies in a medical school addressing different memory programs; cogmed, memory/attention training, and brainwaveR. These studies were distinctive, one being computer based (N=64), one attention/memory focused and holistic (N=112), and one a structured memory class (N= 24). All subjects had memory complaints ranging from AAMI to mild dementia. Pre and post testing were applied in all studies. We had a sham or control group in all three studies; cogmed used sham and control; memory/attention used control, and brainwaveR had a control group. We also separated the Memory Group by Risk Status, Low, Medium and High. Targets addressed new learning, memory and executive functioning, and memory habits, function, and affect. Results showed that the interventions improved on most outcomes, especially cognitive and adjustment markers, emphasizing far transfer. We discuss the research and practical aspects of the three studies, implementation issues, and lessons learned.