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Biomedical subjects

Leonard Bickman

Publications and source records attributed to Leonard Bickman.

15 recordsLinked to original sources
PubMed2025

Improving Community-Based Care for Adolescents with ADHD: a Randomized Controlled Trial of Artificial Intelligence-Assisted Fidelity Supports.

Cognitive-behavioral treatments (CBTs) for adolescents with ADHD demonstrate promise of long-term effects on outcome. However, their implementation in routine care community clinics faces barriers that impact quantity, efficiency, and quality of delivery, as well as client outcomes. This study is a randomized controlled trial designed to evaluate the impact of an AI-assisted service delivery model on therapist implementation of Supporting Teens' Autonomy Daily (STAND), a CBT blended with Motivational Interviewing (MI) for adolescents with ADHD. Adolescents with ADHD (N = 51), who were clients at three community mental health agencies, received treatment from 23 therapists. There was randomization of adolescents and therapists to AI-assisted or standard implementation supports. In addition to standard supports (i.e., training, standard facilitation resources, technical assistance, case supervision), AI-assisted support package included digitized facilitation resources housed in a clinical dashboard (Care4), feedback on content fidelity, and AI-generated feedback on MI implementation quality. The AI-assisted group was associated with more efficient treatment delivery and lower number of appointments attended by the adolescent. There was also a significant decrement in MI quality over time in the AI-assisted group compared to the standard support group. Feedback in focus groups indicated that therapists perceived a task-oriented mindset to be associated with receipt of the AI-assisted support package, leading therapists to prioritize efficiency over relational aspects of therapy. Following the results of this trial, a future, larger RCT should examine the impact of the AI-assisted implementation model on mental health outcomes and cost savings to organizations, third party payers, and clients. Trial registration number: NCT05135065; https://www.clinicaltrials.gov ; Registered September 2021.

Humans↗
PubMed2005

Feedback to clinicians: theory, research, and practice.

Despite the dearth of consistent evidence for conventional feedback mechanisms in clinical practice, the primary methods of feedback for clinicians remain supervision and clinical experience. A new research approach, known as patient-focused research, provides clinicians with direct feedback regarding a client's health status and relative progress in therapy. This article briefly reviews the relation of different types of feedback (i.e., supervision, clinical experience, feedback on client health status) to clinical outcome. In contrast to the mixed results for clinical experience and supervision, providing client health status feedback to clinicians significantly improves outcome, especially for clients who are not doing well in therapy. We conclude with a description of a model that provides insight into ways that feedback interventions can work best for professionals. Characteristics of the clinician, the feedback format, and the dissonance between feedback and clinician goals all relate to the ways that feedback is interpreted and utilized.

Cognitive Behavioral Therapy↗
PubMed2005

Client expectancies about therapy.

Client expectancies about therapy are considered a common factor, that is, a feature of therapy that is not specific to any particular technique or approach. This review includes both child- and adult-focused studies from the expectancies literature, emphasizing findings about the relationship between expectancies and factors including client improvement, attrition, and therapeutic alliance (TA). Results suggest that expectancies are related to both client improvement and TA, but do not support a relationship between expectancies and attrition. We then present two preliminary hypothesized pathways of how pretreatment client characteristics and therapy outcomes relate to role and outcome expectancies. Implications of these pathways are discussed.

Attitude↗
PubMed2005

Theories related to changing clinician practice.

This article provides a theoretic exploration of the microprocesses of clinician practice change in the context of adopting and implementing evidence-based treatments. The two most important internal clinician or microlevel factors involved in behavior change are identified as motivation and ability. The authors focus on factors related to motivation and present their own theory of the cognitive-affective processes for motivation to change. In the discussion of their theory, the authors highlight leverage points for possible interventions. Finally, the authors show how their microlevel theory relates to other prominent, more macrolevel-oriented theories of clinician practice change.

Adolescent↗
PubMed2005

Impact of referral source and study applicants' preference for randomly assigned service on research enrollment, service engagement, and evaluative outcomes.

OBJECTIVE: The inability to blind research participants to their experimental conditions is the Achilles' heel of mental health services research. When one experimental condition receives more disappointed participants, or more satisfied participants, research findings can be biased in spite of random assignment. The authors explored the potential for research participants' preference for one experimental program over another to compromise the generalizability and validity of randomized controlled service evaluations as well as cross-study comparisons. METHOD: Three Cox regression analyses measured the impact of applicants' service assignment preference on research project enrollment, engagement in assigned services, and a service-related outcome, competitive employment. RESULTS: A stated service preference, referral by an agency with a low level of continuity in outpatient care, and willingness to switch from current services were significant positive predictors of research enrollment. Match to service assignment preference was a significant positive predictor of service engagement, and mismatch to assignment preference was a significant negative predictor of both service engagement and employment outcome. CONCLUSIONS: Referral source type and service assignment preference should be routinely measured and statistically controlled for in all studies of mental health service effectiveness to provide a sound empirical base for evidence-based practice.

Adult↗
PubMed2005

Intervening to improve communication between parents, teachers, and primary care providers of children with ADHD or at high risk for ADHD.

This study examines interventions designed to improve communication between individuals who take care of children with ADHD. A teacher rating of 6,171 elementary school children identifies 1,573 children with ADHD or with high risk for ADHD. Parent interviews and information from teachers are collected on 243 children who are randomized into treatment and control conditions and followed for 39 months. The interventions consisted of group workshops and single one-on-one tutorials with parents, teachers, and providers about the evaluation and treatment of ADHD that stressed the need for communication between the three parties. There are few significant effects on communication that are short lived. Results suggest that the interventions are insufficient to cause significant increase in communication. Future attempts to improve parent-teacher-provider coordination should be continuing rather than single-session interventions.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Assessing the impact of parent and teacher agreement on diagnosing attention-deficit hyperactivity disorder.

This study examines the impact of interrater reliability on the diagnosis of attention-deficit hyperactivity disorder (ADHD). A screening of 6171 elementary school children identified 1573 children with a high risk for ADHD according to teacher rating. Follow-up parent interviews and information from teachers were collected on 243 children. Before screening, health care professionals had diagnosed ADHD in 40% of the identified children. There was low agreement between the parent and teacher reports of ADHD symptoms according to DSM-IV-based questionnaires: Inattentive (r =.34, kappa = 0.27), Hyperactive/Impulsive (r =.27, kappa = 0.22), and Performance Impairment (r =.31, kappa = 0.07). When the two-setting requirement was strictly enforced, poor interrater agreement decreased diagnostic rates for all three types of ADHD in this clinical sample: Inattentive (15%-5%), Hyperactive/Impulsive (11%-3%), and Combined (23%-7%). Parent and teacher agreement was low concerning ADHD symptoms and performance. The recommendation of multiple informants significantly decreased the prevalence. Allowing for observer disagreement by using more lenient core symptom scores could reduce the effect.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

AACAP 2001 research forum: challenges and recommendations regarding recruitment and retention of participants in research investigations.

OBJECTIVE: Clinical research depends on the participation of representative samples. At the 2001 Annual Meeting of the American Academy of Child and Adolescent Psychiatry, the Workgroup on Research conducted a research forum with the purpose of improving recruitment and retention of children and adolescents in research protocols. METHOD: An interdisciplinary group of participants focused on (1) consumers and families, (2) communities, (3) professionals and health care delivery systems, (4) regulatory bodies, and (5) alternative research designs. Obstacles and challenges were identified and solutions were discussed. RESULTS: Key recommendations include the following: Investigators must become involved with community stakeholders and more explicitly communicate with families about research procedures, risks, and benefits; budgets should include explicit items for case management and referrals to families who do not meet entry criteria; the culture of clinical settings must incorporate research conducted by clinicians; regulatory bodies must streamline and coordinate protocols and procedures; designs emphasizing flexible treatment strategies and adaptive treatments should be encouraged; and health care systems should consider changing incentives for research participation, including the radical notion that reimbursement be made in terms of improvement rather than service units. CONCLUSIONS: An integrated approach is recommended, requiring direct involvement of investigators in communities where research is to be conducted.

Adolescent↗
PubMed2003

Teachers' screening for attention deficit/hyperactivity disorder: comparing multinational samples on teacher ratings of ADHD.

This study evaluates a measurement model for Attention Deficit/Hyperactivity Disorder (ADHD). The DSM-IV divides 18 symptoms into two groups, inattentive and hyperactive/impulsive. Elementary school teachers rated 21,161 children in 4 locations: Spain, Germany, urban US, and suburban US. Confirmatory factor analysis suggested that the 2-factor model (inattention, hyperactivity/impulsivity) shows the best fit. A third factor, impulsivity, was too slight to stand-alone. Children with academic performance problems were distinguished by inattention, but children with behavior problems typically had elevations in inattention, hyperactivity, and impulsivity. Between-site differences were statistically significant, but so small that we conclude that same measurement model fits all 4 samples in 2 continents.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population.

OBJECTIVE: s To determine the psychometric properties of the Vanderbilt Attention Deficit/Hyperactivity Disorder Parent Rating Scale (VADPRS), which utilizes information based on the Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (DSM-IV). The VADPRS was created to collect uniform patient data and minimize the time burden of lengthy interviews. METHODS: Participant data (N = 243) was used from the first 2 years of a longitudinal study on communication among physicians, teachers, and parents in diagnosing, treating, and managing children with attention deficit/hyperactivity disorder (ADHD). The reliability, factor structure, and concurrent validity of the VADPRS were evaluated and compared with ratings of children in clinical and nonclinical samples on the Vanderbilt ADHD Teacher Rating Scale and the Computerized Diagnostic Interview Schedule for Children-IV, Parent version. RESULTS: The internal consistency and factor structure of the VADPRS are acceptable and consistent with DSM-IV and other accepted measures of ADHD. CONCLUSION: The VADPRS is a reliable, cost-effective assessment for ADHD in clinical and research settings.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Telephone counselling for adolescent suicide prevention: changes in suicidality and mental state from beginning to end of a counselling session.

Telephone counselling is an accessible and confidential means by which distressed young people can seek help. Telephone counselling services were funded under Australia's National Youth Suicide Prevention Strategy between 1997 and 2000. In this study, the effectiveness of telephone counselling for young people seeking help in the context of suicidal ideation or intent was evaluated in an investigation of calls made by suicidal young people to a telephone counselling service. Independent raters measured callers' suicidality and mental state at the beginning and end of 100 taped counselling sessions. Changes in suicidality and mental state were measured using a reliable rating scale developed for the study. Significant decreases in suicidality and significant improvement in mental state were found to occur during the course of counselling sessions, suggesting positive immediate impact. Limitations of the study with respect to longer-term outcomes and the relevance of the results for suicide prevention are discussed. Notwithstanding the study limitations, the results lend support for continuing development of hotline services.

Adolescent↗
PubMed2002

Dose response in child and adolescent mental health services.

This study examines the dose-response relationship, the correlation between the amount of mental health treatment a child receives (dose) and the outcome (response) in a community setting. Participants were 125 children treated in the Stark County Child and Adolescent Mental Health System. Study methods include multiple outcomes, multiple-dose definitions, longitudinal hierarchical analysis of repeated measures, and instrumental variable estimation to control for possible confounding between outcome and treatment dose. Results show no statistically significant dose response. The results do not support the existence of a dose response for children and adolescents consistent enough to guide clinicians, administrators, or policymakers.

Adolescent↗
PubMedDate not supplied

Youth therapeutic alliance in intensive treatment settings.

Therapeutic alliance (TA), the helping relationship that develops between a client and clinician, has received little attention in child treatment studies until recently, though it is the factor found to be most predictive of clinical outcomes. Furthermore, TA is cited as one of the most important components to effective therapy according to practicing clinicians. This study examines the TA that develops between teacher/counselors and children in 2 settings, a partial hospital/day school and a wilderness camp. An important finding in this study is the lack of relationship between the teacher/counselor's view of TA and the youth's view. Moreover, this correlation does not improve according to how long the counselors have known or have treated the youth. The implications of this and other findings are discussed.

Adolescent↗