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Biomedical subjects

K I Howard

Publications and source records attributed to K I Howard.

At least 19 recordsLinked to original sources
PubMed1996

Patterns of mental health service utilization.

How many and which individuals, with which psychiatric disorders, receive (and do not receive) mental health services from which professionals in what settings? This question falls within the purview of mental health services research, which is a multidisciplinary field that brings together the methodologies of epidemiology, econometrics, and clinical research. First, in this article, we present an explication of what is known about those individuals in need of psychotherapy and how they access services. Next, we describe the numbers, professional affiliations, and service sites of professionals who are engaged in the practice of psychotherapy. We summarize our current knowledge about the actual utilization of psychotherapy services relative to the needs of patients and the professional background of therapists. Finally, we identify aspects of psychotherapy service utilization that are, as yet, unaddressed.

Adolescent↗
PubMed1996

Evaluation of psychotherapy. Efficacy, effectiveness, and patient progress.

Treatment-focused research is concerned with the establishment of the comparative efficacy and effectiveness of clinical interventions, aggregated over groups of patients. The authors introduce and illustrate a new paradigm-patient-focused research-that is concerned with the monitoring of an individual's progress over the course of treatment and the feedback of this information to the practitioner, supervisor, or case manager.

Adult↗
PubMed1994

Introduction to the special section on seeking new methods in mental health services research.

Mental health services research aims ultimately to improve the quality, impact, and cost-effectiveness of services. Experience during the past decade suggests that the goals and study conditions of mental health services research require special methods. This special section presents 7 articles that give a flavor of the issues addressed and some of the methods that characterize this emerging research area. Although the series cannot explicate the full breadth or all the nuances of these methods, our goal is to entice colleagues to join us in developing methods for addressing services research questions.

Humans↗
PubMed1994

The clinician's illusion and the psychotherapy practice: an application of stochastic modeling.

The caseload of practicing clinicians tends to be unrepresentative of the population of psychotherapy patients. This results from the fact that, although the majority of patients use relatively few treatment sessions, the majority of a clinician's time is spent with longer term cases--a minority of patients consume the majority of services. Here, a stochastic model is used to describe the development of caseloads under 4 different treatment regimens. It is shown that a psychotherapy practice will reach a steady state (a stable case mix) in relatively short time and at that this will limit the open appointment slots available each week to serve new patients. Implications for training and clinic staffing are discussed.

Humans↗
PubMed1994

Patterns of symptomatic recovery in psychotherapy.

Using the psychotherapy dosage model in which effect was probability of recovery, this study compared treatment response rates for psychological symptoms. Symptom checklists were administered to 854 psychotherapy outpatients at intake and during treatment. Sixty-two symptoms were grouped into 3 classes on the basis of probit analysis results. Chronic distress symptoms demonstrated the fastest average response rate, whereas characterological symptoms demonstrated the slowest. Acute distress symptoms showed the highest average percentage of patients recovered across doses. A typical outpatient needed about a year of psychotherapy to have a 75% chance of symptomatic recovery. The model holds promise for establishing guidelines for the financing of psychotherapy.

Adolescent↗
PubMed1993

A phase model of psychotherapy outcome: causal mediation of change.

A 3-phase model of psychotherapy outcome is proposed that entails progressive improvement of subjectively experienced well-being, reduction in symptomatology, and enhancement of life functioning. The model also predicts that movement into a later phase of treatment depends on whether progress has been made in an earlier phase. Thus, clinical improvement in subjective well-being potentiates symptomatic improvement, and clinical reduction in symptomatic distress potentiates life-functioning improvement. A large sample of psychotherapy patients provided self-reports of subjective well-being, symptomatic distress, and life functioning before beginning individual psychotherapy and after Sessions 2, 4, and 17 when possible. Changes in well-being, symptomatic distress, and life functioning means over this period were consistent with the 3-phase model. Measures of patient status on these 3 variables were converted into dichotomous improvement-nonimprovement scores between intake and each of Sessions 2, 4, and 17. An analysis of 2 x 2 cross-classification tables generated from these dichotomous measures suggested that improvement in well-being precedes and is a probabilistically necessary condition for reduction in symptomatic distress and that symptomatic improvement precedes and is a probabilistically necessary condition for improvement in life functioning.

Adult↗
PubMed1991

Main effects analysis in clinical research: statistical guidelines for disaggregating treatment groups.

Treatment outcome research generally relies on main effects analysis of variance to determine whether treatments are differentially effective. Bryk and Raudenbush (1988) developed a decision strategy for disaggregating treatment groups under conditions of heterogeneity of variance. There is, however, reason to consider disaggregating main effects even when this assumption is not violated. The potential statistical significance of disaggregation can be shown to be a function of the reliability of the dependent measure. With this reliability, residual variance can be partitioned into a systematic (individual differences) component and a random error component. It is then possible to calculate an F test of the ratio of these variances. When this F is statistically significant and the proportion of within-cell systematic variance to total variance is large, disaggregation should be undertaken to search for important individual or treatment difference variables (i.e., interactions).

Adult↗
PubMed1991

Introduction to the special section on seeking new clinical research methods.

This Special Section introduces a new section of the Journal of Consulting and Clinical Psychology that will be periodically offered in future issues under the title "Clinical Research Methods." This introduction describes (a) the section's goals, (b) a conceptual framework and potential areas of methodological development, (c) a summary of the articles in the current Special Section and their evaluation in terms of the conceptual framework, and (d) editorial policies and procedures used to foster innovative development of clinical research methods.

Behavior Therapy↗
PubMed1991

To whom do adolescents turn for help? Differences between disturbed and nondisturbed adolescents.

The focus of this investigation was to 1) identify those adolescents experiencing distress; 2) examine the formal and informal helping agents that adolescents seek out for help for emotional problems; and 3) describe adolescents' perceptions of the helpfulness of selected helping agents. Adolescents (N = 497) from three high schools in a large metropolitan area in the Midwest, representing a broad socioeconomic spectrum, were administered instruments related to self-image, delinquency, symptomatology, and help seeking. The prevalence rate of disturbance was 22.3%. Results show that disturbed adolescents sought help from alcohol/drug abuse centers, teenage drop-in centers, and mental health professionals more frequently than nondisturbed adolescents. In additional, both groups frequently sought help from parents and friends and perceived this help as beneficial. Implications of these findings for the development of adolescent mental health services are discussed.

Adaptation, Psychological↗
PubMed1990

Normality and adolescence.

Diagnostic work with adolescents has always been difficult. The problem is to distinguish serious psychopathology from mild crisis. We can now say, however, that a severe identity crisis and emotional turmoil are just not part of normal growing up. Our belief is that we do not help adolescents who experience such crises or turmoil when we tell them not to worry about their problems because they are a normal part of adolescence and because they will "grow out of it." In summary, we have presented data on the self-image of a large number of adolescents. We have stressed three things. First, we used self-administered questionnaires to collect our data. Most important, our data are consistent, and they are congruent with results obtained from use of other psychologic instruments such as interviews or parents' evaluations of their children. Second, we found that the normal groups of adolescents we studied were characterized more by their similarities than by their differences. The continuity of values for all our samples over an 18-year period and across cultures was especially impressive. Third, we stressed the diversity of adolescents' view of their psychologic worlds. These youths define normal functioning and development. They reside in our communities, and before we can help their disturbed peers who need professional help, we need to know what the norm is. Only then can we correctly diagnose and successfully treat the adolescents who do seek our help.

Adaptation, Psychological↗
PubMed1989

Initial contact and engagement in psychotherapy.

This study addressed whether the fact that the initial screening interview was with the treating therapist or with another clinician differentially affected engagement in treatment for those patients who actually entered psychotherapy. Patients (N = 418) accepted for individual psychotherapy were separated into two groups: (1) those who entered therapy with the same clinician who did the intake screening (same); and, (2) those who saw one clinician for intake screening and were subsequently assigned to another clinician for therapy (different). Chi-square was used to test the hypothesis that a greater proportion of patients who saw the same clinician from the beginning would complete at least 8 sessions of psychotherapy than would those who saw a different clinician. The results indicated that a greater proportion of patients who were assigned to therapy with the same clinician who conducted the initial screening evaluation returned for their next appointment. However, a greater proportion of patients who saw one clinician for intake screening and were assigned another clinician for therapy continued beyond eight sessions.

Adolescent↗