Quality Improvement and Clinical Psychological Science

Chapter

Abstract

Clinical psychological science (CPS) faces significant challenges including low uptake of empirically supported treatment, slow progress in improving efficacy, and low treatment seeking. Quality improvement (QI) offers a number of promising insights that may help address these challenges. This chapter discusses how key QI themes are exemplified in promising research directions within CPS and how these efforts can be further clarified and enhanced. Themes that are explored include: examining quality as a multifaceted construct, focusing on systems for improvement, identifying and targeting sources of variability in quality, focusing on consumers, reducing costs while improving quality, and using iterative improvement cycles and continuous evaluation. This chapter explores each of these QI themes within the context of promising and innovative CPS research examples. In doing so, the chapter seeks to highlight how QI principles might help guide a more progressive approach to CPS research that addresses current challenges.

Keywords

Clinical science Quality improvement Systems Behavioral health 

References

  1. Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research, 6, 61–74.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Arch, J., Deacon, B., Twohig, M. P., Bluett, E., & Landy, L. (2013). Impact of ACT vs CBT rationale for exposure therapy. Paper presented at the annual meeting of the Association for Behavioral and Cognitive Therapies in Knoxville, TN.Google Scholar
  3. Baardseth, T. P., Goldberg, S. B., Pace, B. T., Wislocki, A. P., Frost, N. D., Siddiqui, J. R., … Wampold, B. (2013). Cognitive-behavioral therapy versus other therapies: Redux. Clinical Psychology Review, 33, 395–405.Google Scholar
  4. Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17, 1–30.Google Scholar
  5. Berwick, D., & Nolan, T. (1998). Physicians as leaders in improving health care: A new series. Annals of Internal Medicine, 128(4), 289–292.CrossRefPubMedGoogle Scholar
  6. Carper, M. M., McHugh, R. K., & Barlow, D. H. (2013). The dissemination of computer-based psychological treatment: A preliminary analysis of patient and clinician perceptions. Administration and Policy in Mental Health and Mental Health Services Research, 40(2), 87–95.CrossRefPubMedGoogle Scholar
  7. Castonguay, L. G., Locke, B. D., & Hayes, J. A. (2011). The center for collegiate mental health: An example of a practice-research network in university counseling centers. Journal of College Student Psychotherapy, 25, 105–119.CrossRefGoogle Scholar
  8. Chaudoir, S. R., Dugan, A. G., & Barr, C. H. (2013). Measuring factors affecting implementation of health innovations: A systematic review of structural, organizational, provider, patient, and innovation level measures. Implementation Science, 8, 22.CrossRefPubMedPubMedCentralGoogle Scholar
  9. Collins, L. M., Murphy, S. A., & Strecher, V. (2007). The Multiphase Optimization Strategy (MOST) and the Sequential Multiple Assignment Randomized Trial (SMART): New methods for more potent ehealth interventions. American Journal of Preventive Medicine, 32, S112–S118.CrossRefPubMedPubMedCentralGoogle Scholar
  10. Craske, M. G., Rose, R. D., Lang, A., Welch, S. S., Campbell‐Sills, L., Sullivan, G., … Roy‐Byrne, P. P. (2009). Computer‐assisted delivery of cognitive behavioral therapy for anxiety disorders in primary‐care settings. Depression and anxiety, 26(3), 235–242.Google Scholar
  11. Cuijpers, P., Donker, T., van Straten, A., Li, J., & Andersson, G. (2010). Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and metaanalysis of comparative outcome studies. Psychological Medicine, 40(12), 1943–1957.CrossRefPubMedGoogle Scholar
  12. Danaher, B. G., Milgrom, J., Seeley, J. R., Stuart, S., Schembri, C., Tyler, M. S., … Lewinsohn, P. M. (2012). MomMoodBooster web-based intervention for postpartum depression: Feasibility trial results. Journal of Medical Internet Protocols, 15 e242l.Google Scholar
  13. Dimidjian, S., Hollon, S. D., Dobson, K. S., Schmaling, K. B., Kohlenberg, R. J., Addis, M. E., … Jacobson, N. S. (2006). Treatment of depression and anxiety - randomized trial of behavioral activation, cognitive therapy, and antidepressant medication in the acute treatment of adults with major depression. Journal of Consulting and Clinical Psychology, 74, 658–670.Google Scholar
  14. Ekers, D., Richards, D., McMilan, D., Bland, J. M., & Gilbody, S. (2011). Behavioural activation delivered by the non-specialist: Phase II randomized controlled trial. The British Journal of Psychiatry, 198, 66–72.CrossRefPubMedGoogle Scholar
  15. Firth, N., Barkham, M., & Kellett, S. (2015). The clinical effectiveness of stepped care systems for depression in working age adults: A systematic review. Journal of Affective Disorders, 170, 119–130.CrossRefPubMedGoogle Scholar
  16. Foa, E., Gillihan, S. J., & Bryant, R. A. (2013). Challenges and successes in dissemination of evidence-based treatments for posttraumatic stress: Lessons learned from prolonged exposure therapy for PTSD. Psychological Science in the Public Interest, 14, 65–111.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Gallo, K. P., Comer, J. S., & Barlow, D. H. (2013). Direct-to-consumer marketing of psychological treatments for anxiety disorders. Journal of Anxiety Disorders, 27(8), 793–801.CrossRefPubMedGoogle Scholar
  18. Gaudiano, B. A., & Miller, I. W. (2013). The evidence-based practice of psychotherapy: Facing the challenges that lie ahead. Clinical Psychology Review, 33, 813–824.CrossRefPubMedGoogle Scholar
  19. Gulliver, A., Griffiths, K. M., & Christensen, H. (2010). Perceived barriers and facilitators to mental health help-seeking in young people: A systematic review. BMC Psychiatry, 10, 113.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Hayes, S. C., Barlow, D. H., & Nelson-Grey, R. O. (1999). The Scientist-Practitioner: Research and accountability in the age of managed care (2nd ed.). New York, NY: Allyn & Bacon.Google Scholar
  21. Hayes, S. C., Long, D. M., Levin, M. E., & Follette, W. C. (2013). Treatment development alternatives: Can we find a better way? Clinical Psychology Review, 33, 870–882.CrossRefPubMedGoogle Scholar
  22. Hayes, S. C., Villatte, M., Levin, M., & Hildebrandt, M. (2011). Open, aware, and active: Contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annual Review of Clinical Psychology, 7, 141–168.CrossRefPubMedGoogle Scholar
  23. Hofmann, S. G., Asnaani, A., Vonk, I. J. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36, 427–440.CrossRefPubMedPubMedCentralGoogle Scholar
  24. Gogtay, N., & Insel, T. (2014). Changing NIMH Clinical Trials: Efficiency, Transparency, and Reporting. National Institute of Mental Health.Google Scholar
  25. Ioannidis, J. P. A. (1998). Effect of the statistical significance of results on the time to completion and publication of randomized efficacy trials. JAMA, 279, 281–286.CrossRefPubMedGoogle Scholar
  26. James, B. C., & Savitz, L. A. (2011). How Intermountain trimmed health care costs through robust quality improvement efforts. Health Affairs, 30, 1–7.CrossRefGoogle Scholar
  27. Karlin, B. E., & Cross, G. (2014). From the laboratory to the therapy room: National dissemination and implementation of evidence-based psychotherapies in the US Department of Veterans Affairs Health Care System. American Psychologist, 69, 19–33.CrossRefPubMedGoogle Scholar
  28. Kazdin, A. E., & Blase, S. L. (2011). Rebooting psychotherapy research and practice to reduce the burden of mental illness. Perspectives on Psychological Science, 6, 21–37.CrossRefPubMedGoogle Scholar
  29. Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E., … Zaslavsky, A. M. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352(24), 2515–2523.Google Scholar
  30. Levin, M. E., Hildebrandt, M., Lillis, J., & Hayes, S. C. (2012). The impact of treatment components suggested by the psychological flexibility model: A meta-analysis of laboratory-based component studies. Behavior Therapy, 43, 741–756.CrossRefPubMedGoogle Scholar
  31. Levin, M. E., Pistorello, J., Hayes, S. C., Seeley, J. R., & Levin, C. (2015). Feasibility of an Acceptance and Commitment Therapy adjunctive web-based program for counseling centers. Journal of Counseling Psychology, 62, 529–536.Google Scholar
  32. Lewis, C., Pearce, J., & Bisson, J. I. (2012). Efficacy, cost-effectiveness and acceptability of self-help interventions for anxiety disorders: Systematic review. The British Journal of Psychiatry, 200, 15–21.CrossRefPubMedGoogle Scholar
  33. Lilienfield, S. O. (2007). Psychological treatments that cause harm. Perspective on Psychological Science, 2, 53–70.CrossRefGoogle Scholar
  34. Lilienfield, S. O., Ritschel, L. A., Lynn, S. J., Cautin, R. L., & Latzman, R. D. (2013). Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies. Clinical Psychology Review, 33, 883–900.CrossRefGoogle Scholar
  35. Longmore, R. J., & Worrell, M. (2007). Do we need to challenge thoughts in cognitive behavior therapy? Clinical Psychology Review, 27, 173–187.CrossRefPubMedGoogle Scholar
  36. Martino, S., Canning-Ball, M., Carroll, K. M., & Rounsaville, B. J. (2011). A criterion-based stepwise approach for training counselors in motivational interviewing. Journal of Substance Abuse Treatment, 40, 357–365.CrossRefPubMedPubMedCentralGoogle Scholar
  37. Melas, C. D., Zampetakis, L. A., Dimopoulou, A., & Moustakis, V. (2012). Evaluating the properties of the evidence-based practice attitude scale (EBPAS) in health care. Psychological Assessment, 24, 867–876.CrossRefPubMedGoogle Scholar
  38. Mohr, D. C., Cheung, K., Schueller, S. M., Hendricks, B. C., & Duan, N. (2013). Continuous evaluation of evolving behavioral intervention technologies. American Journal of Preventive Medicine, 45, 517–523.CrossRefPubMedGoogle Scholar
  39. Novins, D. K., Green, A. E., Legha, R. K., & Aarons, G. A. (2013). Dissemination and implementation of evidence-based practices for child and adolescent mental health: A systematic review. Journal of the American Academy of Child & Adolescent Psychiatry, 52, 1009–1025.CrossRefGoogle Scholar
  40. O’Donohue, W. T., & Draper, C. (Eds.). (2011). Stepped care and E-health: Practical applications to behavioral disorders. New York, NY: Springer.Google Scholar
  41. O’Donohue, W. T., & Engle, J. L. (2013). Errors in psychological practice: Devising a system to improve client safety and well-being. Professional Psychology: Research and Practice, 44, 314–323.CrossRefGoogle Scholar
  42. O’Donohue, W., Snipes, C., & Maragakis, A. (2014). Increasing the productivity of the clinical psychologist: A neglected Archimedean pivot? Professional Psychology: Research and Practice, 45, 357–367.CrossRefGoogle Scholar
  43. Olfson, M., & Marcus, S. C. (2010). National trends in outpatient psychotherapy. The American Journal of Psychiatry, 167, 1456–1463.CrossRefPubMedGoogle Scholar
  44. Regier, D. A., Narrow, W. E., Clarke, D. E., Kraemer, H. C., Kuramoto, S. J., Kuhl, E.A., … Kupfer, D.J. (2013). DSM-5 field trials in the United States and Canada, part II: Test-retest reliability of selected categorical diagnoses. American Journal of Psychiatry, 170, 59–70.Google Scholar
  45. Rosen, C. S., Chow, H. C., Finney, J. F., Greenbaum, M. A., Moos, R. H., Sheikh, J. I., … Yesavage, J. A. (2004). VA practice patterns and practice guidelines for treating posttraumatic stress disorder. Journal of Traumatic Stress, 17, 213–222.Google Scholar
  46. Swift, J. K., & Callahan, J. L. (2009). The impact of client treatment preference on outcome: A meta-analysis. Journal of Clinical Psychology, 65, 368–381.CrossRefPubMedGoogle Scholar
  47. Weisz, J. R., Ng, M. Y., & Bearman, S. K. (2014). Odd couple? Reenvisioning the relation between science and practice in the dissemination-implementation era. Clinical Psychological Science, 2, 58–74.CrossRefGoogle Scholar
  48. Whipple, J. L., & Lambert, M. J. (2011). Outcome measures for practice. Annual Review of Clinical Psychology, 7, 87–111.CrossRefPubMedGoogle Scholar
  49. Whiteside, U., Lungu, A., Richards, J., Simon, G. E., Clingan, S., … Ludman, E. (2014). Designing messaging to engage patients in an online suicide prevention intervention: Survey results from patients with current suicidal ideation. Journal of Medical Internet Research, 16(2) e42.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of PsychologyUtah State UniversityLoganUSA

Personalised recommendations