Soo Jeong Youn

The Treatment Outcome Package: Facilitating Practice and Clinically Relevant Research

As an effort to foster the use of standardized data in clinical practice, this article discusses an outcome measure developed by clinicians for use in naturalistic settings: the treatment outcome package (TOP). In addition to describing how the TOP can be used in day-to-day practice, the article illustrates how its multidimensional structure can inform several aspects of clinical work, such as the development of case formulations, facilitation of client-therapist communication, tracking (positive and negative) change during treatment, and the documentation of specific area of therapist expertise. This article recognizes the challenges and drawbacks that are associated with the use of a standardized outcome measure and also describes three ways by which the TOP can contribute to the strengthening of the relationship between research and practice.

Treatment Outcome Package: Measuring and facilitating multidimensional change.

The Treatment Outcome Package (TOP; D. R. Kraus, Seligman, & Jordan, 2005) is a multidimensional routine progress and outcome measure developed for use in diverse naturalistic practice settings. In this article, we (a) provide a brief review and summary of the extant psychometric and research support for the TOP, (b) provide examples of the TOPs use in clinical training and practice, and (c) discuss the implications of the TOP for future psychotherapy training, research, and practice. In particular, we focus on the implications of risk-adjusted progress monitoring for systems of care and mental health care decision making.

Are we in crisis? National mental health and treatment trends in college counseling centers.

The current state of college student mental health is frequently labeled a “crisis,” as the demand for services and severity of symptomatology have appeared to increase in recent decades. Nationally representative findings are presented from the Center for Collegiate Mental Health, a practice research network based in the United States, composed of more than 340 university and college counseling centers, in an effort to illuminate trends in symptom severity and patterns in treatment utilization for the campus treatment seeking population. Clinical data collected over 5 academic years (2010–2015) showed small but significantly increasing trends for self-reported distress in generalized anxiety, depression, social anxiety, family distress, and academic distress, with the largest effect sizes observed for generalized anxiety, depression, and social anxiety. On the other hand, a significantly decreasing trend was observed for substance use. No significant changes were observed for eating concerns and hostility. Utilization data over 6 years indicated a gradual yet steady increase in the number of students seeking services (beyond the rate expected with increasing institutional enrollment), as well as increases in the number of appointments scheduled and attended, with great variation between centers. Within the context of changing national trends, we conclude that it is advisable to consider the specific needs of local centers to best accommodate distinct student bodies.

Effectiveness of routine psychotherapy: Method matters

ABSTRACT Objective: Though many studies have shown that psychotherapy can be effective, psychotherapy available in routine practice may not be adequate. Several methods have been proposed to evaluate routine psychological treatments. The aim of this paper is to demonstrate the combined utility of complementary methods, change-based benchmarking, and end-state normative comparisons, across a range of self-reported psychological symptoms. Method: Benchmarks derived from randomized controlled trials (RCTs) and normative comparisons were used to evaluate the effectiveness of psychotherapy in a large (N = 9895) sample of clients in university counseling centers (UCCs). Results: Overall, routine psychotherapy was associated with significant improvement across all symptoms examined. For clients whose initial severity was similar to RCT participants, the observed pre–post effect sizes were equivalent to those in RCTs. However, treatment tended to lead to normative end-state functioning only for those clients who were moderately, but not severely, distressed at the start of psychotherapy. Conclusions: This suggests that although psychotherapy is associated with an effective magnitude of symptom improvement in routine practice, additional services for highly distressed individuals may be necessary. The methods described here comprise a comprehensive analysis of the quality of routine care, and we recommend using both methods in concert. Clinical or methodological significance of this article: This study examines the effectiveness of routine psychotherapy provided in a large network of counseling centers. By comparing multiple established methods to define outcomes in this sample we provide a detailed understanding of typical outcomes. The findings show that, across several different problem areas, routine psychotherapy provided substantial benefit, particularly to clients in the most distress. However, there is room to improve, especially by increasing the number of clients who return to normal functioning by the end of treatment. Using distinct methods provides complementary answers to the question: How effective is routine psychotherapy?

Clinicians’ prediction and recall of therapeutic interventions: practice research network study

Abstract Conducted within a practice-research network in private practice, this exploratory study was aimed at examining whether clinicians can accurately predict and recall profiles of therapeutic interventions they used during an entire treatment for a given client. Based on a small sample (7 clinicians and 30 clients), the results tentatively suggest that the predictions that therapists made after session 3 regarding which types of techniques they would use, as well as the retrospective assessment of typical techniques they reported using in therapy, were accurate and generally discriminative. Clinical implications in line with deliberate practice are suggested and future research on complex questions related to clinical prediction is proposed.

Mental health and professional help-seeking among college students with disabilities.

OBJECTIVE Research has demonstrated that providing appropriate supports and services on campus can improve both mental health and academic outcomes for students with disabilities (Emerson, Honey, Madden, & Llewellyn, 2009; Stumbo, Martin, & Hedrick, 2009), but little is known about the specific mental health needs of this population. The purpose of this exploratory study, therefore, was to identify the mental health needs of college students with various types of disabilities. METHOD Researchers analyzed data, collected by the Center for Collegiate Mental Health, of 5,696 students with, and without, disabilities who utilized counseling services on campuses in the 2013-14 academic year. A nonclinical (students not in counseling) sample of 1,620 students with, and without, disabilities was also explored. RESULTS Compared to students without disabilities, students with disabilities report more anxiety and academic-related distress, as well as higher rates of suicide ideation, suicide attempts, and nonsuicidal self-injury among both students in counseling and not in counseling. CONCLUSIONS Although in certain areas students with disabilities show similar levels of distress as students without disabilities, students with disabilities have higher levels of distress in areas which could impact their academic success. Self-harming tendencies are higher for students with disabilities overall, but more so for specific disability types. (PsycINFO Database Record

Presenting concerns in counseling centers: The view from clinicians on the ground.

Despite growing evidence that a greater number of students are seeking counseling in college and university counseling centers throughout the United States, there is a dearth of empirical information about (a) the presenting concerns for which students seek treatment and (b) how these concerns differ according to client demographic factors. The purpose of this descriptive and exploratory study was to explore how counseling center clinicians categorize client presenting concerns, and how these concerns vary according to client demographics. Given the importance of client suicide within the field of college counseling, the frequency of suicidality as an identified presenting concern was also explored. A sample of 1,308 clinicians from 84 counseling centers rated the presenting concerns of 53,194 clients using the Clinician Index of Client Concerns (CLICC) after an initial consultation. Results of descriptive and nonparametric analyses indicated that the most prevalent concerns were anxiety, depression, stress, family, and academic performance, and that clients who belong to different demographic groups frequently present to counseling with broadly similar types of concerns. Furthermore, suicidality represented an area of concern for 8.4% of all clients, and it ranked 20 of 44 as a clinician-rated concern. Comparable rates emerged across the range of client demographic groups examined, although rates were notably higher for a handful of groups. The findings offer one of the largest and most generalizable descriptions of why college students seek counseling services, as determined by clinicians’ evaluations of presenting concerns. Implications for research and clinical applications of the findings are discussed.

Therapist effects on dropout from a college counseling center practice research network.

Dropout has been a pervasive and costly problem in psychotherapy, particularly for college counseling centers. The present study examined potential predictors of dropout using a large data set (N = 10,147 clients, 481 therapists) that was gathered through a college counseling center practice research network as a replication and extension of recent findings regarding therapist effects on dropout. The final model resulted in a dropout rate of 15.9% and a therapist effect of 9.51% on dropout variance. Therapist demographic variables were investigated, though none were found to be significant. Variables found to be predictive of increased likelihood of dropping out included higher levels of general presenting concerns, alcohol-related distress, and current financial stress. Ultimately, this study showed that therapists may play an important role in the likelihood of client dropout, and that additional research should be conducted to identify additional predictors, particularly at the therapist and center level.

Inter- and intra-group differences in psychological concerns among international students

With data gathered from 47 university counseling centers in the United States, this study addresses both inter- and intra-group differences in symptomatology at intake among international students. In Study 1, symptomatology among international students was explored in comparison to US ethnic groups. In Study 2, intra-group differences in symptomatology among international students were examined. In Study 1, data consisted of 14,421 international, White American, African American, Asian American, and Latina/Latino American counseling center clients who completed the CCAPS-62 at intake. Partially supporting our hypothesis, results indicate significant findings among international students in the social anxiety and academic distress domains of the CCAPS-62. Contrary to our expectations, Asian American students reported significantly greater concerns across many domains when compared to other groups. In Study 2, international students (n = 607) were further divided into five continents of origin: Asia, Africa, North America, South America, and Europe. Results indicate that in multiple domains, international students from Asia and Africa reported significantly greater concerns than those from Europe, North America, or South America. Implications of findings for university counseling centers and universities at large are discussed.