Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children's Mental Health Services.
Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children's Mental Health Services.
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DOI：
10.3389/fpubh.2018.00054
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发表时间：
2018
影响因子：
5.2
通讯作者：
Lau AS
中科院分区：
文献类型：
--
作者：
Brookman-Frazee L;Zhan C;Stadnick N;Sommerfeld D;Roesch S;Aarons GA;Innes-Gomberg D;Bando L;Lau AS
循证实践的实施需要大量的人力培训资源;然而，如果不能实现长期的可持续性，可能会导致投资回报率低下。有有限的研究EBP在精神卫生服务实施后很长一段时间的维持。本研究基于六种EBP的行政报销要求检查了治疗师的继续与停止实践交付[学校创伤认知行为干预（CBITS），儿童-父母心理治疗，管理和适应实践（MAP），寻求安全（SS），创伤集中认知行为治疗（TF-CBT），和积极育儿方案]，在儿童公共精神卫生服务的系统驱动的执行工作中采用。我们的目标是确定与持续EBP交付相关的机构和治疗师因素。生存分析（即，Kaplan-Meier生存函数、对数秩检验和考克斯回归）用于分析19个财政季度（即，大约57个月）的索赔数据，这些数据来自洛杉矶县精神卫生部的预防和早期干预转变。这些数据包括来自88个机构的6，873名治疗师提出的2，322，389项索赔。生存时间代表的时间从治疗师的第一次到最后索赔的每一个做法和任何六个EBP。结果表明，治疗师继续提供至少一个EBP的平均生存时间为21.73个月（中位数= 18.70）。当与其他五种EBP的生存曲线相比时，CBITS、SS和TP表现出较高的分娩中止风险，而MAP和TF-CBT表现出较低的分娩中止风险。多变量考克斯回归模型显示，机构（集中和服务设置）和治疗师（人口统计学，学科，和病例组合特征）的特点是显着相关的风险交付中断的任何六个EBP。这项研究说明了一个新的应用程序的生存分析，行政索赔数据的系统驱动的实施多个EBP。研究结果显示，在长期持续的治疗师水平提供的EBP的变化，并强调机构和劳动力的特点，在持续提供的EBP的重要性。调查结果将现场引向维持干预的潜在目标（例如，（c）由机构对治疗师进行EBP培训的战略分配和对EBP的战略选择）。
Evidence-based practice (EBP) implementation requires substantial resources in workforce training; yet, failure to achieve long-term sustainment can result in poor return on investment. There is limited research on EBP sustainment in mental health services long after implementation. This study examined therapists’ continued vs. discontinued practice delivery based on administrative claims for reimbursement for six EBPs [Cognitive Behavioral Interventions for Trauma in Schools (CBITS), Child–Parent Psychotherapy, Managing and Adapting Practices (MAP), Seeking Safety (SS), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), and Positive Parenting Program] adopted in a system-driven implementation effort in public mental health services for children. Our goal was to identify agency and therapist factors associated with a sustained EBP delivery. Survival analysis (i.e., Kaplan–Meier survival functions, log-rank tests, and Cox regressions) was used to analyze 19 fiscal quarters (i.e., approximately 57 months) of claims data from the Prevention and Early Intervention Transformation within the Los Angeles County Department of Mental Health. These data comprised 2,322,389 claims made by 6,873 therapists across 88 agencies. Survival time was represented by the time elapsed from therapists’ first to final claims for each practice and for any of the six EBPs. Results indicate that therapists continued to deliver at least one EBP for a mean survival time of 21.73 months (median = 18.70). When compared to a survival curve of the five other EBPs, CBITS, SS, and TP demonstrated a higher risk of delivery discontinuation, whereas MAP and TF-CBT demonstrated a lower risk of delivery discontinuation. A multivariate Cox regression model revealed that agency (centralization and service setting) and therapist (demographics, discipline, and case-mix characteristics) characteristics were significantly associated with risk of delivery discontinuation for any of the six EBPs. This study illustrates a novel application of survival analysis to administrative claims data in system-driven implementation of multiple EBPs. Findings reveal variability in the long-term continuation of therapist-level delivery of EBPs and highlight the importance of both agency and workforce characteristics in the sustained delivery of EBPs. Findings direct the field to potential targets of sustainment interventions (e.g., strategic assignment of therapists to EBP training and strategic selection of EBPs by agencies).
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影响因子：
5.9
作者：
Chorpita, Bruce F.;Bernstein, Adam;Daleiden, Eric L.
通讯作者：
Daleiden, Eric L.
DOI：
10.1007/s10488-016-0731-8
发表时间：
2016-11
影响因子：
2.6
作者：
Brookman-Frazee, Lauren;Stadnick, Nicole;Roesch, Scott;Regan, Jennifer;Barnett, Miya;Bando, Lillian;Innes-Gomberg, Debbie;Lau, Anna
通讯作者：
Lau, Anna
影响因子：
5.9
作者：
Aarons, Gregory A.;Sommerfeld, David H.;Hecht, Debra B.;Silovsky, Jane F.;Chaffin, Mark J.
通讯作者：
Chaffin, Mark J.
DOI：
10.1097/chi.0b013e31816485f4
发表时间：
2008-04-01
影响因子：
13.3
作者：
Bruns, Eric J.;Hoagwood, Kimberly Eaton
通讯作者：
Hoagwood, Kimberly Eaton
DOI：
10.1023/b:mhsr.0000024351.12294.65
发表时间：
2004-06-01
期刊：
Mental health services research
影响因子：
--
作者：
Aarons, Gregory A
通讯作者：
Aarons, Gregory A