a Department of Psychology , University of California , Los Angeles.
b Department of Psychology , University of Hawai'i at Hilo.
J Clin Child Adolesc Psychol. 2019;48(sup1):S72-S78. doi: 10.1080/15374416.2016.1204922. Epub 2016 Sep 20.
We investigated whether a service-planning document outlining recommendations for what providers should address in treatment (i.e., targets) and the associated clinical techniques they should employ (i.e., practices) influenced the targets and practices that providers reported actually implementing during the subsequent treatment episode. Participants included 94 youths ages 4 to 17 (M = 13.57, SD = 3.59) who received community-based mental health services from the Hawai'i Child and Adolescent Mental Health Division. Data on targets and practices were compared across initial Mental Health Treatment Plans and Monthly Treatment and Progress Summaries. Data were analyzed using two-level, generalized mixed effects models with two-way cross-classification or linear mixed effects models. Providers were more likely to report the use of targets and practices in treatment if they were included within the treatment plan. In addition, the more closely targets addressed during treatment followed the recommended targets from the treatment plan, the more closely implemented practices followed the recommended practices listed in the treatment plan. Furthermore, as providers shifted their focus to different targets, a shift in their use of practices was also evident over time. Last, practices for which there is demonstrated efficacy for particular targets were more likely to be used. Service planning documents appear to help organize care; however, results also suggest possible limitations to the current system. These findings highlight potential areas for improvement in planning and care delivery.
我们调查了服务规划文件是否会影响提供者在治疗中报告的实际实施的目标和实践，该文件概述了提供者应该解决的治疗建议（即目标）和他们应该采用的相关临床技术（即实践）。参与者包括来自夏威夷儿童和青少年心理健康部的 94 名 4 至 17 岁的年轻人（M=13.57，SD=3.59）。关于目标和实践的数据在初始心理健康治疗计划和每月治疗和进展摘要中进行了比较。使用双向交叉分类或线性混合效应模型对数据进行了两级、广义混合效应模型分析。如果治疗计划中包含目标和实践，提供者更有可能报告在治疗中使用这些目标和实践。此外，治疗过程中目标的关注程度越接近治疗计划中推荐的目标，实施的实践就越接近治疗计划中列出的推荐实践。此外，随着提供者将注意力转移到不同的目标上，随着时间的推移，他们使用实践的方式也发生了变化。最后，针对特定目标显示出疗效的实践更有可能被使用。服务规划文件似乎有助于组织护理；然而，结果也表明当前系统可能存在一些局限性。这些发现强调了规划和护理提供方面的潜在改进领域。
