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EVIDENCE BASED CARE IN BEHAVIORAL HEALTH

EVIDENCE BASED CARE IN BEHAVIORAL HEALTH. MEDIATORS OF OUTCOME. RELATIONSHIP. TOOLS. CLIENT. THERAPY. OUTCOMES. +. CLINICIAN. PROCESS. CONTEXT. EVIDENCE BASED CARE IN BEHAVIORAL HEALTH. WHAT DRIVES BEHAVIOR?. CULTURAL MORES. VALUES. OPPORTUNITY. ATTITUDES + BELIEFS. +.

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EVIDENCE BASED CARE IN BEHAVIORAL HEALTH

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  1. EVIDENCE BASED CARE IN BEHAVIORAL HEALTH MEDIATORS OF OUTCOME RELATIONSHIP TOOLS CLIENT THERAPY OUTCOMES + CLINICIAN PROCESS CONTEXT

  2. EVIDENCE BASED CARE IN BEHAVIORAL HEALTH WHAT DRIVES BEHAVIOR? CULTURAL MORES VALUES OPPORTUNITY ATTITUDES + BELIEFS + PERSONALITY + SKILLS BEHAVIOR + KNOWLEDGE CONSEQUENCES

  3. MEDIATORS OF OUTCOME CLIENT FACTORS PROBLEMS Bio-Psycho-Social Consideration Types & Number Duration & Severity ATTITUDES & BELIEFS RESOURCES Personal competencies Support Systems

  4. MEDIATORS OF OUTCOME CLINICIAN FACTORS PROFESSIONAL BACKGROUND Training & Philosophy Professional competencies Knowledge & Skills Clinical Experience PERSONAL CHARACTERISTICS ATTITUDES & BELIEFS

  5. MEDIATORS OF OUTCOME CLINICAL RELATIONSHIP THERAPEUTIC ALLIANCE Openness Trust & Confidence Empathy THERAPEUTIC CLIMATE DECISION-MAKING MODEL Directive-Shared-Autonomous

  6. MEDIATORS OF OUTCOME CLINICAL TOOLS SCREENING, ASSESSMENT & DIAGNOSIS Instruments Procedures INTERVENTION Case management Psychotherapy Pharmacotherapy Combination therapy

  7. MEDIATORS OF OUTCOME THERAPEUTIC PROCESS ACCESS & AVAILABILITY Regular, stable schedule On-demand Unfettered by distance, time etc. LOCUS OF CONTROL Client v. Clinician Centered SAFE & SECURE

  8. MEDIATORS OF OUTCOME CONTEXT OF TREATMENT CLINIC POLICIES & PROCEDURES Service eligibility Services provided Clinician-Clinic Clinician compensation AGENCY, MCO & STATE POLICIES Service mandates Funding - Levels & Streams

  9. EVIDENCE BASED CARE IN BEHAVIORAL HEALTH DESIRED OUTCOMES ADHERENCE TO PLAN Participation in Tx Meds used as prescribed No substance abuse ASYMPTOMATIC Reduced frequency/severity IMPROVED LIFE FUNCTION Family & Friends Work & Recreation

  10. Motivationally-Based Integrated Treatment for Mentally Ill Substance Abusing Patients EP Schoener, MJ Henderson, SJ Ondersma & CL Madeja Departments of Psychiatry & Psychology Wayne State University Sponsored by The Ethel and James Flinn Family Foundation

  11. NATURE OF THE PROBLEM People with co-existing MI and SA manifest: • more severe psychiatric morbidity, • greater treatment resistance, • poorer compliance & psycho-social adjustment, • greater utilization of social and health care services, • more frequent hospitalization, compared to those with MI alone.

  12. Motivationally Based Integrated Treatment for Mentally Ill Substance Abusing Patients HYPOTHESES In this effectiveness study, therapists trained in MBIT will: • Employ MBIT with fidelity and competence • Engender a stronger therapeutic alliance • Encourage greater client retention and adherence • Realize more positive and enduring treatment outcomes

  13. Motivationally Based Integrated Treatment for Mentally Ill Substance Abusing Patients METHODS/PROCEDURES • Enroll clinicians • Assess patients at baseline • Monitor participants (6-12 sessions) • Train clinicians in MBIT • Monitor participants (8 sessions) • Follow-up patients (3 & 6 months)

  14. INSTRUMENTS SCID, BSI, ASI, DTCQ, SF-36, QOLI, RTC, WAI MISC coding of individual therapy sessions TRAINING • Two day workshop + biweekly supervision • Manualized experiential + didactic learning • Focus on MI skills and their applications Motivationally Based Integrated Treatment for Mentally Ill Substance Abusing Patients

  15. Motivationally Based Integrated Treatment for Mentally Ill Substance Abusing Patients OUTCOME VARIABLES REFLECTIONS• total # of paraphrased and rephrased statements EMPATHY• global rating of therapist SPIRIT• global rating of therapist Open:Total Questions (Ratio) • # open Q’s /# open + closed Q’s ADVISE• # of advise statements without permission SMS• self-motivational statements or “change talk” (the only outcome measure of client behavior)

  16. Motivationally Based Integrated Treatment for Mentally Ill Substance Abusing Patients OVERALL FINDING FOR TIME, THERAPIST AND INTERACTION EFFECTS (N =196) Note. *p < .05; ***p < .001.

  17. MISC Scores Pre- and Post- Training

  18. Very Good Response: Pre- & Post-Training MISC Scores, Therapist #13

  19. No Response: Pre- and Post-Training MISC Scores, Therapist # 4

  20. CLINICIAN VARIABLES Therapists differ in: • Experience • Approach • Openness to new methods • Skill • Commitment to manual And thus, their ability to conduct MBIT

  21. EVIDENCE BASED CARE IN BEHAVIORAL HEALTH MEDIATORS OF OUTCOME RELATIONSHIP TOOLS CLIENT THERAPY OUTCOMES + CLINICIAN PROCESS CONTEXT

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