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From intention to action: A systematic literature review of provider behaviour change-focused interventions in physical health and behavioural health settings

Gupta, Brinda; Li, Dongze; Dong, Peiyu; Acri, Mary C
RATIONALE, AIMS AND OBJECTIVES/OBJECTIVE:It is clear there are significant delays in the uptake of best practices as part of routine care in the healthcare system, yet there is conflicting evidence on how to specifically align provider behaviour with best practices. METHOD/METHODS:We conducted a review of interventions utilized to change any aspect of provider behaviour. To extend prior research, studies were included in the present review if they had an active intervention targeting behaviour change of providers in health or behavioural-health settings and were published between 2001 and 2020. RESULTS:Of 1547 studies, 44 met inclusion criteria. Of 44 studies identified, 28 studies utilized contextually relevant interventions (eg, tailored to a specific provider population). Twenty six interventions with a contextually relevant approach resulted in provider behaviour change. CONCLUSIONS:Findings are promising for encouraging provider behaviour change when interventions are tailored to be contextually relevant, as both single-component and multifaceted interventions were successful when they were contextually relevant. It is critical to conduct additional research to ensure that providers sustain behaviour changes over a long-term beyond an intervention's implementation and evaluation period.
PMID: 33565177
ISSN: 1365-2753
CID: 5070002

Evaluation of a Modified Bit Device to Obtain Saliva Samples from Horses

Vincent, Aviva; Peth-Pierce, Robin Marie; Morrissey, Meghan A; Acri, Mary C; Guo, Fei; Seibel, Lauren; Hoagwood, Kimberly E
(1) Background: Accounting for the well-being of equine partners is a responsibility of those engaged in Equine-Assisted Services (EAS). Researchers took heed of this call to action by developing an innovative way to collect data to assess the physiological indicators of stress in equine participants. The collection of saliva is considered to be a minimally invasive method of data collection and is typically performed using a cotton swab; however, in equines, the introduction of a foreign object may induce stress; (2) Methods: Researchers used a modified bit to collect pooled saliva in an effort to further reduce stress during the saliva collection process. Additionally, the collection of pooled saliva, via the bit, increases the opportunity to consider additional analyses, such as oxytocin, which is more reliable in pooled saliva than site-specific saliva captured with a swab; (3) Results: A data analysis demonstrated that ample saliva was captured using the modified bit. Observational data supported that the horses demonstrated fewer physical stress signals to the bit than to the swab. Thus, the modified bit is a feasible and valid method for equine salivary sample collection; (4) Conclusions: The results suggest that the modified bit provides a viable method to collect equine saliva and supports national calls to prioritize animal welfare analysis, specifically for horses used within EAS. Future research should enhance methodological rigor, including in the process and timing, thereby contributing to the bit's validation.
PMID: 34679064
ISSN: 2306-7381
CID: 5045922

Supporting and Sustaining Nonspecialists to Deliver Mental Health Interventions in Low- And Middle-Income Countries: An Umbrella Review

Bunn, Mary; Gonzalez, Nicole; Falek, Idan; Weine, Stevan; Acri, Mary
This umbrella review used a systematic approach to examine the state of the evidence regarding the nonspecialist health worker (NSHW) workforce in mental health and psychosocial services in low- and middle-income countries (LMICs). Seventeen review articles were included in this analysis. Most reviews defined nonspecialists by their lack of formal mental health experience. Less than half of the reviews reported their qualifications and roles. Findings indicated that NSHWs were trained and supervised in a range of skills with variability in approaches, duration, format and topical focus. The evidence supporting NSHW-delivered interventions was mixed but mainly favourable, particularly for depression, anxiety and posttraumatic stress disorder; additionally, studies identified implementation challenges with the nonspecialist workforce. In conclusion, NSHWs are widely used in LMICs to address mental health needs and some indicators suggest the interventions they deliver are beneficial, yet little is known about their needs and requirements. Further work is needed to prioritise nonspecialists as a critical workforce in global mental health. This includes developing best practice models, new policies and investments and conducting further research.
ISSN: 1571-8883
CID: 5009842

Examining Organizational Factors Supporting the Adoption and Use of Evidence-Based Interventions

Flaherty, Hanni B; Bornheimer, Lindsay A; Hamovitch, Emily; Garay, Elene; Mini de Zitella, Maria L; Acri, Mary C; Mckay, Mary
The purpose of this study was to develop a greater understanding of the factors influencing the adoption of evidence-based interventions in outpatient mental health clinics serving youth. An improved understanding of these factors can potentially improve efforts to ensure effective adoption, implementation, and sustainment of evidence-based interventions, and thus improve treatment for youth in mental health settings. This explanatory cross-sectional study involves secondary data analysis of a longitudinal randomized control intervention trial. The SEM- based model that was tested supported the primary hypothesis that a more supportive organizational climate with greater readiness for change is more likely to improve the chances for the adoption of evidence-based interventions in outpatient mental health clinics serving youths.
PMID: 33387179
ISSN: 1573-2789
CID: 4751112

An Equine-Assisted Therapy for Youth with Mild to Moderate Anxiety: Manual Development and Fidelity

Acri, Mary; Morrissey, Meghan; Peth-Pierce, Robin; Seibel, Lauren; Seag, Dana; Hamovitch, Emily K.; Guo, Fei; Horwitz, Sarah; Hoagwood, Kimberly E.
Childhood anxiety is common, yet approximately half of youth do not receive treatment due to stigma, mistrust of the mental health service system, extensive wait lists for services and provider shortages. Alternative models and modes of treatment are needed. This paper describes the development of an alternative treatment that incorporates cognitive behavioral components for anxiety into an adaptive/therapeutic riding program delivered by certified riding instructors in a horse stable that offers horseback riding and therapeutic horsemanship programs. Using PracticeWise®, a well-established database of evidence-based mental health practices for youth, we identified five therapeutic elements that are the most commonly examined in rigorous research for childhood anxiety, and integrated them into a manualized program of adaptive riding sessions. Excellent fidelity to the intervention (98.7% mean score) and high inter-rater reliability (k = 0.92) were achieved. This approach has implications for expanding access to and engagement in adaptive/therapeutic riding interventions.
ISSN: 1062-1024
CID: 4962732

Family Processes and Mental Health among Children and Caregivers in a Family Strengthening Program

Bornheimer, Lindsay A.; Acri, Mary; Li Verdugo, Juliann; McKay, Mary M.
Oppositional defiant disorder (ODD) is a common mental health concern and is particularly prevalent among children living in poverty-impacted communities. A family strengthening/parent management training (PMT)-based multiple family group (MFG) program entitled, the 4 Rs and 2 Ss for Strengthening Families, focuses on the following family process variables: rules, responsibilities, relationships, respectful communication, social support, and stress. While evidence supports effectiveness of this treatment program, less is known about the specific relationship between the family process variables and mental health outcomes of children and caregivers. The current study examined these relationships among a sample of 287 caregiver/child dyads who participated in a NIMH-funded Type II hybrid effectiveness-implementation study in New York City. Data were analyzed using SPSS 27 and Mplus 8. Results indicated that two of the six family process variables related to one or more child and caregiver mental health outcome. Caregiver stress significantly related to child inattention (b = 0.034, SE = 0.01, p < 0.001), child ODD (b = 0.053, SE = 0.02, p < 0.01), and caregiver depression (b = 0.049, SE = 0.02, p < 0.01). Family rules significantly related to caregiver depression (b = 0.228, SE = 0.11, p < 0.05) over time. Findings point towards the substantial role of caregiver stress in child and caregiver mental health, in addition to the impact of inconsistent discipline with difficulty establishing rules on caregiver depression. Examinations of treatment components in relation to improvements in child and caregiver mental health can guide practitioners towards utilizing models that result in positive therapeutic outcomes and/or making adaptations with added content that has been shown to be effective.
ISSN: 1062-1024
CID: 4964342

Peer models for families involved in the child welfare system: a systematic review

Acri, Mary; Falek, Idan; Bunn, Mary; Dominguez, Joanna; Gopalan, Geetha; Chacko, Anil
This systematic review aimed to synthesize the research of peer mentor models for families involved in the child welfare system. Twelve studies were examined. Most interventions targeted birth parents to facilitate reunification and support the family, with outcomes being mainly favorable particularly for engagement in treatment and reunification outcomes. However, few studies employed rigorous research designs, suggesting several avenues for future practice and research such as advancing the rigor of the evidence and collaborating with peers to provide comprehensive services and enhance family outcomes.
ISSN: 1554-8732
CID: 5058152

Adaptive riding incorporating cognitive behavioral elements for youth with anxiety: Fidelity outcomes

Seibel, Lauren; Seag, Dana E. M; Guo, Fei; Morrissey, Meghan; Peth-Pierce, Robin; Acri, Mary; Hamovitch, Emily K; Horwitz, Sarah; Hoagwood, Kimberly E
Equine-assisted services include novel approaches for treating children's mental health disorders, one of which is anxiety (Latella & Abrams, 2019). Reining in Anxiety is a manualized approach to adaptive riding drawing on evidence-based cognitive behavioral therapy elements for youth with anxiety. This intervention was delivered by PATH Certified Therapeutic Riding Instructors (CTRIs) in a randomized pilot study. Fidelity checklists, developed to match the core components of the manualized intervention, were collected by independent observers. Fidelity scores addressed an average of 98.7% of components, well beyond the threshold for high fidelity (e.g. >80%) established in the literature (Garbancz et al., 2014). These findings show that the PATH CTRIs trained in the Reining in Anxiety intervention for this study, with supervision and implementation supports, delivered this intervention with high fidelity. This has important implications for expanding access to evidence-based community mental health services beyond traditional clinic settings and providers, and for addressing the gap between the need for and use of evidence-based youth mental health services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ISSN: 2333-522x
CID: 5212402

Adaptive riding incorporating cognitive-behavioral elements for youth with anxiety: An exploratory randomized controlled study

Hoagwood, Kimberly E; Acri, Mary; Morrissey, Meghan; Peth-Pierce, Robin; Seibel, Lauren; Seag, Dana E. M; Vincent, Aviva; Guo, Fei; Hamovitch, Emily K; Horwitz, Sarah
Between 15% to 20% of youth meet diagnostic criteria for anxiety, yet most do not receive treatment due to workforce shortages, under-detection, or barriers that dissuade families from seeking services in traditional settings. Equine-assisted services (EAS) include several promising approaches to reach populations who do not access traditional therapies. Few studies using rigorous methods have been conducted on EAS for youth. This study examined feasibility and outcomes of a 10-session Cognitive Behavioral Therapy (CBT)-based adaptive riding intervention (hereafter called Reining in Anxiety) delivered by trained equine professionals. Forty-one youth 6- 16 years of age were recruited from GallopNYC, an adaptive horseback riding center in the NYC metro area. Youth were randomized to an experimental group (n=22) or services as usual (n=19), a standard adaptive riding group (services as usual or SAU). Severity of anxiety symptoms, anxiety in close relationships, and emotional self-efficacy were assessed at baseline and at the end of treatment. Fidelity to the manual was excellent, ranging from 88.9% to 100%. There was a non-significant trend in the experimental group towards greater improvement with higher number of sessions completed. Youth in the Reining in Anxiety group displayed significant reductions in anxiety (t=4.426, df=38, p=0.042) and improvement in emotional self-efficacy at posttest (t=4.132, df=38, p=0.049) in comparison to the SAU group. No significant differences were found between groups for anxiety in close relationships. This study suggests that a CBT-based adaptive riding intervention delivered by non-mental health equine professionals following a detailed manual can reduce youth anxiety symptoms and be delivered with fidelity by riding instructors. These findings have implications for families seeking non-traditional services. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ISSN: 2333-522x
CID: 5212412

Parent peer models for families of children with mental health problems

Chapter by: Acri, Mary C; Hamovitch, Emily; Kuppinger, Anne; Burger, Susan
in: Peer support in medicine: A quick guide by Avery, Jonathan D [Ed]
Cham, Switzerland: Springer Nature Switzerland AG; Switzerland, 2021
pp. 131-143
ISBN: 978-3-030-58659-1
CID: 5296732