Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.
Hall Mercer Community Mental Health, Philadelphia, PA, USA.
BMC Psychiatry. 2019 Aug 23;19(1):257. doi: 10.1186/s12888-019-2234-0.
The behavioral health service provider population is highly heterogeneous. However, it is rarely treated as such within evidence-based practice implementation efforts. This study aimed to evaluate, as a proof of concept, the utility of latent profile analysis to identify distinct profiles of clinician practices in a large sample of youth-serving community mental health clinicians. This study also aimed to identify predictors of profile membership to inform implementation efforts.
Participants were 484 practicing clinicians (79.4% female, 45.7% White, M age = 37.1 years). As part of a larger survey, clinicians reported on their use of cognitive, behavioral, family, and psychodynamic treatment techniques with a representative client on their caseload. Latent profile analysis was used to determine the presence of clinician practice profiles. Multilevel multinomial logistic regressions examined predictors of profile membership.
Latent profile analysis indicated a 4-profile solution best fit the data, with clinicians who: 1) used generally low levels of all examined techniques and preferred cognitive techniques (Low Eclectics, 16%), 2) delivered moderate levels of all techniques (Moderate Eclectics, 53%), 3) demonstrated preference for use of family techniques (Family Preferred, 11%), and 4) used high levels of all techniques (Super Users, 20%). Clinician discipline (e.g., social work), education, and years of experience predicted profile membership.
Findings from this proof of concept study underscore the utility of latent profile analysis to characterize the complex and heterogeneous makeup of community mental health. Results extend prior work highlighting the eclectic nature of community mental health practice. Predictor analyses underscore the important influence of clinician background characteristics on practice use.
行为健康服务提供者群体高度多样化。然而，在循证实践实施工作中，很少将其视为如此。本研究旨在评估潜在剖面分析在识别大量青少年服务社区心理健康临床医生中不同临床医生实践模式的实用性，作为概念验证。本研究还旨在确定特征成员的预测因素，以为实施工作提供信息。
参与者为 484 名实践临床医生（79.4%女性，45.7%白人，M 年龄=37.1 岁）。作为一项大型调查的一部分，临床医生报告了他们在代表性客户的病例中使用认知、行为、家庭和心理动力学治疗技术的情况。潜在剖面分析用于确定临床医生实践模式的存在。多级多项逻辑回归检验了特征成员的预测因素。
潜在剖面分析表明，4 个特征模式的解决方案最适合数据，临床医生：1）普遍使用所有检查技术的低水平，更喜欢认知技术（低折衷派，16%）；2）提供所有技术的中等水平（中等折衷派，53%）；3）表现出对家庭技术使用的偏好（家庭偏好派，11%）；4）使用所有技术的高水平（超级用户派，20%）。临床医生的学科（如社会工作）、教育和工作年限预测了特征成员的身份。
本概念验证研究的结果强调了潜在剖面分析在描述社区心理健康复杂和多样化构成方面的实用性。结果扩展了先前强调社区心理健康实践折衷性质的工作。预测分析强调了临床医生背景特征对实践使用的重要影响。
