Susan Douglas Kelley

The longitudinal impact of psychological functioning, medical severity, and family functioning in pediatric heart transplantation

BACKGROUND Few data are available on the longitudinal psychological functioning of patients after pediatric heart transplantation. The objective of this study was to determine whether pre-transplant psychological functioning, post-transplant medical severity, and family functioning relate to the psychological functioning of pediatric patients after heart transplantation. METHODS The study included 23 patients who underwent heart transplantation between ages 3 and 20 years, survived at least 1 year after transplantation, and had been assessed previously after transplantation between 1993 and 1995. This study reports a second post-transplant assessment between 1999 and 2000. We assessed psychological functioning using the Childrens Global Assessment Scale before and after heart transplantation. We assessed medical severity using the number of outpatient visits, hospitalizations, and biopsies and using the Side Effect Severity Scale. We used the Global Assessment of Family Relational Functioning Scale to rate family functioning. RESULTS The majority of patients (15/23) were alive at the second follow-up. They had survived a median of 9.6 (6.1-12.9) years after transplantation. Similar to their first follow-up assessments, 73% demonstrated good psychological functioning after heart transplantation. Although we found no correlation between medical severity and post-transplant psychological functioning, we did find a significant correlation between family functioning during the first 2 years of transplantation and post-transplant emotional adjustment. CONCLUSIONS The majority of children and adolescents have the capacity for healthy psychological functioning after heart transplantation. Nevertheless, ongoing psychological assessment and intervention is necessary for patients and their families who face pediatric heart transplantation because >25% probably will have emotional adjustment difficulties.

Beyond outcomes monitoring: measurement feedback systems in child and adolescent clinical practice.

Purpose of review To review the literature published during the past year relevant to identifying the best measures for monitoring progress in the treatment of child and adolescent clients and their families. Recent findings The current literature shows an increasing focus on clinical utility in measure development as demonstrated by the recent emphasis on evidence-based assessment. However, there is very little research on how the inclusion of monitoring might enhance clinician practice and ultimately youth and family outcomes. There is great promise in expanding our thinking beyond mere outcome measurement to a measurement feedback system that provides timely feedback that is comprehensive and concurrent with treatment. Summary Investment in the development of measurement feedback systems is needed to enhance clinical judgment and increase effectiveness of treatment. Clinical utility and consumer appeal need to be key considerations for measures intended to be used in everyday clinical practice. Most importantly, we must harness the power of technology and advances in measurement to provide clinicians with the tools to use effectively the systematic data provided through frequent measurement with measurement feedback systems.

Exploring the black box: measuring youth treatment process and progress in usual care.

The session report form (SRF) is a 25-item self-report measure scheduled to be completed by clinicians at the end of each session. This study addresses the utility of the SRF for describing session content by exploring patterns of self-reported behavior of 235 clinicians in 7,058 sessions with 600 clients. Results indicate that the SRF has a distinct subscale of treatment process and provides an adequate range of topics related to session content while also discriminating between client and clinician influences on patterns of topics addressed. The SRF is a promising measure meeting a significant need in describing session content in usual care.

The Peabody Treatment Progress Battery: History and Methods for Developing a Comprehensive Measurement Battery for Youth Mental Health

There is increased need for comprehensive, flexible, and evidence-based approaches to measuring the process and outcomes of youth mental health treatment. This paper introduces a special issue dedicated to the Peabody Treatment Progress Battery (PTPB), a battery of measures created to meet this need. The PTPB is an integrated set of brief, reliable, and valid instruments that can be administered efficiently at low cost and can provide systematic feedback for use in treatment planning. It includes eleven measures completed by youth, caregivers, and/or clinicians that assess clinically-relevant constructs such as symptom severity, therapeutic alliance, life satisfaction, motivation for treatment, hope, treatment expectations, caregiver strain, and service satisfaction. This introductory article describes the rationale for the PTPB and its development and evaluation, detailing the specific analytic approaches utilized by the different papers in the special issue and a description of the study and samples from which the participants were taken.

Finding the Common Core: Evidence-Based Practices, Clinically Relevant Evidence, and Core Mechanisms of Change

Improving the quality of children’s mental health care can benefit from the adoption of evidence based and evidence informed treatments. However, the promise of moving science into practice is hampered by three core elements that need to be addressed in the current conversation among key stakeholders: (1) expanding our understanding of the clinical relevance of different types of evidence, (2) emphasizing the identification of core mechanisms of change, and (3) re-conceptualizing what evidence-based practice means. This paper focuses on these elements in an attempt to find a common core among stakeholders that may create opportunities for more inclusive conversation to move the field of children’s mental health care forward.

Developing Effective Research-Practice Partnerships for Creating a Culture of Evidence-Based Decision Making

With growing evidence that treatment as usual may have limited effectiveness in mental health the pressure on service providers to be accountable and produce evidence as to the effectiveness of their services has increased. Measurement Feedback Systems, such as the Contextualized Feedback System (CFS), have the potential to be powerful tools for service providers in assessing their own effectiveness at multiple levels with an organization. These systems represent an amalgamation of the data driven world of science and the experience driven world of clinical practice. However, the synthesis of these two worlds is not without significant challenges as these two very different cultures can easily clash. The key for successful collaboration in developing and implementing Measurement Feedback Systems is a good university-practice partnership that has a strong foundation in common goals and the positive relationships among its members. In addition, the partnership needs to be flexible so that it can adapt to new challenges and continuously grow with each obstacle. These are some of several lessons learned the authors of this article will share as part of their experience with developing and implementing CFS in one of the largest behavioral health service providers in the U.S.

Evaluating Mental Health Services for Children and Adolescents

Aside from a different emphasis on intervention, such as job training or housing for adults, many have characterized a split between child and adult mental health services research (e.g., Mechanic, 1996). The research, theory, knowledge, and legislation in children’s mental health services has lagged far behind that in the adult field (Institute of Medicine, 1989). This chapter provides an overview of key issues in children’s mental health services research. First, the definition and functions of mental health services research are discussed. Although the field is still developing, mental health services research serves several functions, primarily to provide an objective means of informing public policy and program decision making, and ultimately contributing to the improvement of clinical practice. A distinction is then made between efficacy research, or treatment research, and effectiveness research, which also can be called services research. The discussion focuses not only on the differences between the two, but also suggests the importance of the complementary use of both approaches in order to increase our knowledge of “what works” in children’s mental health services in applied settings.

Family functioning and posttraumatic stress symptoms in youth and their parents after unintentional pediatric injury

This study examined the association between family functioning and the development of posttraumatic stress symptoms (PTSS) in youth and parents following an unintentional traumatic injury of a child. Fifty-one parent-child dyads completed questionnaires and a structured interview assessing PTSS and family functioning. Multiple regression analyses were applied to evaluate the contribution of family functioning to the development of PTSS after controlling for demographic characteristics and known predictors. Family functioning had both direct and moderating influences on the development of PTSS in parents. We were unable to demonstrate a systematic impact of family functioning on the development of PTSS in children from the same families.