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Removing very low-performing therapists: A simulation of performance-based retention in psychotherapy.

ABSTRACT: Therapists can impact the likelihood a given patient will benefit from psychotherapy. However, therapists are rarely held accountable for their patients' outcomes. As a result, low-performing providers likely continue to practice alongside providers with high response rates. In the current study, we conducted a Monte Carlo simulation to illustrate a thought experiment-what happens to patient outcomes if therapists with the worst outcomes were removed from practice? We drew initial samples of 50 therapists from 3 simulated populations of 1,000 therapists with a mean patient response rate of 50% and different effect sizes for therapist variability in outcomes. We simulated 30 patient outcomes for each therapist, with outcome defined as response to treatment versus no response. We removed therapists with response rates in the bottom 5% and replaced them with a random sample of therapists from the population. Over 10 years, the difference in responses between the lowest and highest performing therapists was substantial (between 697 and 997 additional responses to treatment). After repeatedly removing the lowest performing providers 40 times (simulating a 10-year time span), response rates increased substantially. The cumulative number of patient responses (i.e., summing the total number of responses across 10 years) increased by 4,266, 6,404, and 9,307 when therapists accounted for 5%, 10%, or 20% of the patient outcome variance, respectively. These findings indicate that performance-based retention of therapists could improve the quality of psychotherapy in health systems by improving the average response rate and decreasing the probability that a patient will be treated by a therapist who consistently has poor outcomes.

SUBMITTER: Imel ZE

PROVIDER: S-EPMC5032628 | biostudies-literature | 2015 Sep

REPOSITORIES: biostudies-literature

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Removing very low-performing therapists: A simulation of performance-based retention in psychotherapy.

Imel Zac E ZE Sheng Elisa E Baldwin Scott A SA Atkins David C DC

Psychotherapy (Chicago, Ill.) 20150901 3

Therapists can impact the likelihood a given patient will benefit from psychotherapy. However, therapists are rarely held accountable for their patients' outcomes. As a result, low-performing providers likely continue to practice alongside providers with high response rates. In the current study, we conducted a Monte Carlo simulation to illustrate a thought experiment-what happens to patient outcomes if therapists with the worst outcomes were removed from practice? We drew initial samples of 50 ...[more]

PMID: 26301424

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Project description:BackgroundWhile adverse impacts of climate change on physical health are well-known, research on its effects on mental health is still scarce. Thus, it is unclear whether potential impacts have already reached treatment practice. Our study aimed to quantify psychotherapists' experiences with patients reporting climate change-related concerns and their views on dealing with this topic in psychotherapy.MethodsIn a nationwide online survey, responses were collected from 573 psychotherapists from Germany. Therapists reported on the presence of such patients, their socio-demographic characteristics, and climate change-related reactions. Psychotherapists' views on dealing with this topic in psychotherapy were also assessed. Descriptive statistics were used to analyse the responses.ResultsAbout 72% (410/573) of psychotherapists indicated having had patients expressing concerns about climate change during treatment. Out of these therapists, 41% (166/410) stated that at least one patient sought treatment deliberately because of such concerns. Patients were mainly young adults with higher education. Most frequent primary diagnoses were depression, adjustment disorder, and generalized anxiety disorder. Psychotherapists having encountered such patients differed from those without such encounters in their views on potential functional impairment and the necessity to target the concerns in treatment. Although 79% (326/415) of all respondents felt adequately prepared by their current therapeutic skills, 50% (209/414) reported a lack of information on how to deal with such concerns in therapy.ConclusionsResults indicate that psychotherapists are frequently confronted with climate change-related concerns and regard the mental health impact of climate change on their patients as meaningful to psychotherapeutic care. Regular care could be improved by a continuous refinement of the conceptualization and knowledge of the mental health influences of climate change. This would allow providing tailored methods of assessing and addressing climate change-related concerns in practice.

Project description:Soil volumetric water content ( V W C ) is a vital parameter to understand several ecohydrological and environmental processes. Its cost-effective measurement can potentially drive various technological tools to promote data-driven sustainable agriculture through supplemental irrigation solutions, the lack of which has contributed to severe agricultural distress, particularly for smallholder farmers. The cost of commercially available V W C sensors varies over four orders of magnitude. A laboratory study characterizing and testing sensors from this wide range of cost categories, which is a prerequisite to explore their applicability for irrigation management, has not been conducted. Within this context, two low-cost capacitive sensors-SMEC300 and SM100-manufactured by Spectrum Technologies Inc. (Aurora, IL, USA), and two very low-cost resistive sensors-the Soil Hygrometer Detection Module Soil Moisture Sensor (YL100) by Electronicfans and the Generic Soil Moisture Sensor Module (YL69) by KitsGuru-were tested for performance in laboratory conditions. Each sensor was calibrated in different repacked soils, and tested to evaluate accuracy, precision and sensitivity to variations in temperature and salinity. The capacitive sensors were additionally tested for their performance in liquids of known dielectric constants, and a comparative analysis of the calibration equations developed in-house and provided by the manufacturer was carried out. The value for money of the sensors is reflected in their precision performance, i.e., the precision performance largely follows sensor costs. The other aspects of sensor performance do not necessarily follow sensor costs. The low-cost capacitive sensors were more accurate than manufacturer specifications, and could match the performance of the secondary standard sensor, after soil specific calibration. SMEC300 is accurate ( M A E , R M S E , and R A E of 2.12%, 2.88% and 0.28 respectively), precise, and performed well considering its price as well as multi-purpose sensing capabilities. The less-expensive SM100 sensor had a better accuracy ( M A E , R M S E , and R A E of 1.67%, 2.36% and 0.21 respectively) but poorer precision than the SMEC300. However, it was established as a robust, field ready, low-cost sensor due to its more consistent performance in soils (particularly the field soil) and superior performance in fluids. Both the capacitive sensors responded reasonably to variations in temperature and salinity conditions. Though the resistive sensors were less accurate and precise compared to the capacitive sensors, they performed well considering their cost category. The YL100 was more accurate ( M A E , R M S E , and R A E of 3.51%, 5.21% and 0.37 respectively) than YL69 ( M A E , R M S E , and R A E of 4.13%, 5.54%, and 0.41, respectively). However, YL69 outperformed YL100 in terms of precision, and response to temperature and salinity variations, to emerge as a more robust resistive sensor. These very low-cost sensors may be used in combination with more accurate sensors to better characterize the spatiotemporal variability of field scale soil moisture. The laboratory characterization conducted in this study is a prerequisite to estimate the effect of low- and very low-cost sensor measurements on the efficiency of soil moisture based irrigation scheduling systems.

Project description:Introduction:Blended therapies (BT) combine face-to-face (f2f) sessions with internet- and mobile-based interventions (IMIs). However, the use of blended interventions in routine care is still rare and depends on the acceptance of key health care professionals such as the therapists. Little is yet known about the therapists' perspective on and experiences with blended approaches. The aim of this pilot study was to identify barriers and facilitators, as perceived by psychotherapists, for implementing a blended therapy for depression. Methods:Semi-structured expert interviews were conducted with five therapists, who were part of the German study arm of the FP7-project E-Compared (www.e-compared.eu). All patients (N?=?173) were treated in the context of a registered RCT (DRKS00006866) in which the clinical and cost-effectiveness of BT for depression, consisting of ten internet- and mobile-based cognitive behavioral therapy modules and six f2f sessions, was compared to the treatment usually provided by general practitioners. To identify barriers and facilitators an interview guide based on the theoretical domains framework (TDF) was developed. The interviews were audio-recorded, transcribed verbatim and analyzed using a qualitative content analysis by two independent coders. Results:The results revealed 29 barriers and 33 facilitators, which are hindering or enabling factors on the levels of 'implementation in the health care system', 'therapy', 'therapists' and 'patients'. Key barriers stated by all therapists were 'Limited customizability and autonomy of decisions concerning blending the therapy' (number of statements, k?=?44); 'Disease-related contraindications for BT' (k?=?25); 'Negative affect was caused by burden through technical problems' (k?=?18); 'Limited number of f2f sessions hindered the therapy process'; and 'Establishment of therapeutic alliance was burdened by technical issues' (each k?=?15). Key facilitators stated by all therapists were: 'Patients' interest, willingness and motivation to participate' (k?=?22); 'Patients' access to online content between f2f sessions and after therapy end' (k?=?20); 'Preset structure of IMI-part guided the treatment course of BT' (k?=?18); and 'Effective help with BT in a short time frame' (k?=?15), as well as 'Reduction of the treatment gap' (k?=?13). Discussion:Therapists supported the implementation of BT for depression. Results indicated the consideration of a wide range of determinants: among others, the possibility of individualizing the treatment; the autonomy of decision making in respect to the ratio and number of online and f2f sessions; the necessity of providing training; the need to develop a concept of embedding BT in the health care system and funding the additional effort; and the use of sophisticated technical solutions.

Project description:ImportancePsychotherapists possess strengths and weaknesses in treating different mental health problems, yet performance information is rarely harnessed in mental health care (MHC). To our knowledge, no prior studies have tested the causal efficacy of prospectively matching patients to therapists with empirically derived strengths in treating patients' specific concerns.ObjectiveTo test the effect of measurement-based matching vs case assignment as usual (CAU) on psychotherapy outcomes.Design, setting, and participantsIn this randomized clinical trial, adult outpatients were recruited between November 2017 and April 2019. Assessments occurred at baseline and repeatedly during treatment at 6 community MHC clinics in Cleveland, Ohio. To be eligible, patients had to make their own MHC decisions. Of 1329 individuals screened, 288 were randomized. Excluding those who withdrew or provided no assessments beyond baseline, 218 patients treated by 48 therapists were included in the primary modified intent-to-treat analyses.InterventionsTherapist performance was assessed pretrial across 15 or more historical cases based on patients' pre-post reporting across 12 problem domains of the routinely administered Treatment Outcome Package (TOP). Therapists were classified in each domain as effective (on average, patients' symptoms reliably improved), neutral (on average, patients' symptoms neither reliably improved nor deteriorated), or ineffective (on average, patients' symptoms reliably deteriorated). Trial patients were randomly assigned to good-fitting therapists (matched group) or were assigned to therapists pragmatically (CAU group). There were multiple match levels, ranging from therapists being effective on the 3 most elevated domains reported by patients and not ineffective on any others (highest) to not effective on the most elevated domains reported by patients but also not ineffective on any domain (lowest). Therapists treated patients in the matched and CAU groups, and treatment was unmanipulated.Main outcomes and measuresGeneral symptomatic and functional impairment across all TOP domains (average z scores relative to the general population mean; higher scores indicate greater impairment), global distress (Symptom Checklist-10; higher scores indicate greater distress), and domain-specific impairment on each individual's most elevated TOP-assessed problem.ResultsOf 218 patients, 147 (67.4%) were female, and 193 (88.5%) were White. The mean (SD) age was 33.9 (11.2) years. Multilevel modeling indicated a match effect on reductions in weekly general symptomatic and functional impairment (γ110 = -0.03; 95% CI, -0.05 to -0.01; d = 0.75), global distress (γ110 = -0.16; 95% CI, -0.30 to -0.02; d = 0.50), and domain-specific impairment (γ110 = -0.01; 95% CI -0.01 to -0.006; d = 0.60), with no adverse events.Conclusions and relevanceMatching patients with therapists based on therapists' performance strengths can improve MHC outcomes.Trial registrationClinicalTrials.gov Identifier: NCT02990000.

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Removing very low-performing therapists: A simulation of performance-based retention in psychotherapy.

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Removing very low-performing therapists: A simulation of performance-based retention in psychotherapy.

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