Biomedical subjects

Ashli J Sheidow

Publications and source records attributed to Ashli J Sheidow.

9 recordsLinked to original sources

PubMed2006

Predictors of workforce turnover in a transported treatment program.

This study examined relations between workforce turnover and select clinician (demographic and professional characteristics and perceptions of treatment model features and job requirements) organizational (perceptions of organizational climate and structure) and program level (salary, case mix) variables in a sample of 453 clinicians across 45 organizations participating in a transportability study of an empirically supported adolescent treatment (i.e., MST). At 20% annually, turnover was lower than in the national mental health workforce (i.e., 50-60%). Clinician demographic, professional background, and perceptions of the treatment model and demands did not predict turnover. Perceptions of an emotionally demanding organizational climate, program salary level, and program case mix of youth did predict turnover.

Adult↗

PubMed2005

The return to smoking: 1-year relapse trajectories among female smokers.

Research has demonstrated that a lapse in cigarette abstinence often leads smokers to fully relapse (i.e., return to daily smoking). However, patterns of smoking resumption beyond the point at which relapse occurs have not been examined in systematic follow-up studies. Daily cigarette intake data for 108 female adult smokers who participated in a smoking cessation trial were recorded at several points during the 365 days following the participants' quit date. SAS Proc Traj, a group-based mixture modeling procedure, was used to determine cigarette-use trajectories over time (i.e., patterns of smoking resumption). Over the 365 days, 27% of the sample maintained abstinence. Among the 73% who relapsed, four distinct trajectories emerged: low-level users (8% of the overall sample), moderate users (17%), slow-returners (15%), and quick-returners (33%). A few individual characteristics differentiated these groups. Overall, the findings illustrate that, after relapsing, smokers do not follow a unitary course of smoking resumption; rather, they exhibit more variable resumption patterns than previously assumed.

Adult↗

PubMed2004

Treatment costs for youths receiving multisystemic therapy or hospitalization after a psychiatric crisis.

OBJECTIVE: The authors conducted a cost analysis for multisystemic therapy, an evidence-based treatment that is used as an intensive community-based alternative to the hospitalization of youths presenting with psychiatric emergencies. METHODS: Data from a randomized clinical trial that compared multisystemic therapy with usual inpatient services followed by community aftercare were used to compare Medicaid costs and clinical outcomes during a four-month period postreferral and a 12-month follow-up period. Data were from 115 families receiving Medicaid (out of 156 families in the clinical trial). RESULTS: During the four months postreferral, multisystemic therapy was associated with an average net savings per youth treated of $1,617 compared with usual services. Costs during the 12-month follow-up period were similar between treatments. Multisystemic therapy demonstrated better short-term cost-effectiveness for each of the clinical outcomes (externalizing behavior, internalizing behavior, and global severity of symptoms) than did usual inpatient care and community aftercare. The two treatments demonstrated equivalent long-term cost-effectiveness. CONCLUSIONS: Among youths presenting with psychiatric emergencies, multisystemic therapy was associated with better outcomes at a lower cost during the initial postreferral period and with equivalent costs and outcomes during the 12-month follow-up period.

Adolescent↗

PubMed2004

Children and adolescents with sexual behavior problems.

Youth with substantial sexual behavior problems (n = 166) were compared with youth from the same sample with few sexual behavior problems (n = 413) and with no sexual behavior problems (n = 943). It was hypothesized that youth with significant sexual behavior problems would be characterized by higher rates of sexual and physical abuse and higher rates of internalizing problems relative to youth without sexual behavior problems and that all youth would evidence a positive treatment response to multisystemic therapy. Relative to youth with no sexual behavior problems, youth with significant sexual behavior problems were more likely to have been sexually or physically abused and had higher rates of internalizing and externalizing behavior problems. These youth were also more likely to include girls, were younger, and had more social problems than youth with no sexual behavior problems. Youth in all groups responded with clinically relevant and statistically significant reductions in problem behaviors at posttreatment.

Adolescent↗

PubMed2004

Toward effective quality assurance in evidence-based practice: links between expert consultation, therapist fidelity, and child outcomes.

This study validated a measure of expert clinical consultation and examined the association between consultation, therapist adherence, and youth outcomes in community-based settings. Consultant adherence to the multisystemic therapy (MST) consultation protocol was assessed through therapist reports, and therapist adherence to MST principles was assessed through caregiver reports in 2 samples of families (N1 = 178, N2 = 274) and therapists (N1 = 87, N2 = 162). Caregiver reports of youth behavior and functioning were obtained in the second sample pre- and posttreatment. Random effects regression models demonstrated associations between consultant behavior, therapist adherence, and posttreatment youth behavior problems and functioning. Instrumental aspects of consultation supported therapist adherence and improved youth outcomes; supportive aspects of consultation were negatively associated with adherence and outcomes. These findings suggest the availability to clinicians of expert consultation can impact clinician fidelity to a treatment model and child outcomes.

Adolescent↗

PubMed2003

Transportability of multisystemic therapy: evidence for multilevel influences.

This study examines factors associated with the implementation and short-term outcomes in dissemination sites of Multisystemic Therapy (MST), an intensive, short-term, family- and community-based treatment for serious antisocial behavior in youth. Participants were 666 children and families served by 217 therapists in 39 sites. Pre- (T1) to immediate posttreatment (T2) differences in child problems and functioning were similar in magnitude to those found in randomized trials of MST. Results of random effects regression supported direct effects of therapist adherence, organizational climate, and structure at baseline on immediate posttreatment child outcomes. However, organizational factors were unrelated to adherence; thus, a hypothesized mediation model in which organizational climate and structure affect outcomes through therapist adherence to MST was not supported. Furthermore, the direction of associations between some organizational climate variables and outcomes countered expectations. Post hoc moderation analyses clarify these findings, with organizational effects differing by level of therapist adherence during treatment. Implications for the transfer of evidence-based psychosocial treatments for youth to usual care practice settings are discussed.

Adolescent↗

PubMed2003

One-year follow-up of multisystemic therapy as an alternative to the hospitalization of youths in psychiatric crisis.

OBJECTIVE: This study presents findings from a 1-year follow-up to a randomized clinical trial comparing multisystemic therapy (MST), modified for use with youths presenting psychiatric emergencies, with inpatient psychiatric hospitalization. METHOD: One hundred fifty-six children and adolescents approved for emergency psychiatric hospitalization were randomly assigned to home-based MST or inpatient hospitalization followed by usual services. Assessments examining mental health symptoms, out-of-home placement, school attendance, and family relations were conducted at five times: within 24 hours of recruitment, shortly after the hospitalized youth was released from the hospital (1-2 weeks after recruitment), at the completion of MST (average of 4 months postrecruitment), and 10 and 16 months postrecruitment. RESULTS: Based on placement and youth-report measures, MST was initially more effective than emergency hospitalization and usual services at decreasing youths' symptoms and out-of-home placements and increasing school attendance and family structure, but these differences generally dissipated by 12 to 16 months postrecruitment. Hospitalization produced a rapid, but short-lived, decrease in externalizing symptoms based on caregiver reports. CONCLUSION: Findings suggest that youths with serious emotional disturbance might benefit from continuous access to a continuum of evidence-based practices titrated to clinical need.

Adolescent↗

PubMed2003

Conduct disorder and delinquency.

Overviews evidence-based family treatments for adolescent conduct problems. Three treatments succeed in meeting recommendations for treatment development set forth in recent evaluations by reviewers and federal entities. These treatments (Functional Family Therapy, Multisystemic Therapy, and Oregon Treatment Foster Care) have achieved their success by using the science base of known risk factors, providing an effective alternative to restrictive placements, and using scientific methods to evaluate effectiveness. Major features of these three treatments are presented, including clinical and quality assurance procedures, controlled outcome research support, cost analyses, and process research. Bases of treatment success and parallels among the three approaches are summarized, as is their transport and dissemination to practice settings. Finally, suggestions for future research and clinical implications are discussed.

Adolescent↗

PubMed2003

Medical, legal, and mental health service utilization by physically abused children and their caregivers.

The use of medical, legal, and mental health services was examined among 37 Medicaid-eligible, physically abused children and their caregivers. Fewer than half of the children received a medical examination related to the physical abuse, but the majority had received basic wellness care, including immunizations. Roughly half of the cases were heard in family court. Fewer than half of the children were receiving mental health services. Children were more likely to receive services if the maltreating caregiver was not in the home. More maltreating caregivers received mental health services than did their children, but this still only accounted for half of the parents. Caregivers were more likely to receive treatment if they acknowledged the abuse. Children who participated in treatment showed reductions in parent-reported problem behaviors but showed increases in anxiety in comparison to children who did not participate in treatment.

Adolescent↗