Putting empirically supported treatment into practice: Lessons learned in a children's mental health center.

With the increasing focus on service accountability, there is an urgent need to identify empirically supported treatments (ESTs) and disseminate their use in the daily practice of mental health organizations. This article describes the authors' experiences of implementing an EST at a children's mental health center by involving the collaboration of clinicians, administrators, and innovator(s). Initially, a small group of clinicians voluntarily commit to pilot test the EST, with the intention of evaluating the adoption and integration of the treatment model into the organization's full-service delivery system. Using E. A Rogers's (1995) work on the diffusion of innovations, the current case study example suggests that ESTs can be flexibly and successfully implemented with integrity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Experimental Assessment of Wireless Construction Technologies

Wireless technology offers a first efficient avenue to communicate data within a construction site in real time. This paper presents the integrated wireless site (IWS) concept that is based on a meshed communication network that not only reaches almost every location of a site but is also connected to the World Wide Web. Lessons learned from installing and evaluating wireless mobile and fixed video devices during ongoing construction are shared. The relevance of this study to both practitioners and researchers are the experimental field data that assert technical feasibility as well as a series of benefits such as reduced non-value-added activities, quick response to safety hazards, and automatic as-it-was-built for documentation and training. Equally important was the finding that the success of this technology in the long run depends on trust, collaboration, and information sharing among participants. Expanding the IWS by incorporating a semantic network that integrates individual equipment, tools, specialty devices, and construction personnel promises to provide the necessary incentives for a revolutionary change in the way construction resources communicate.     

Empirically supported psychological treatments: A natural extension of the scientist–practitioner paradigm.

The impact on Canadian professional psychological treatment practices of the American Psychological Association's Division 12 (Clinical Psychology) Task Force's development of criteria and listings for empirically supported psychological treatments, along with other industrial efforts to standardize the identification of treatments with established efficacy is described in the article by J. Hunsley et al (see record 1999-01869-001). C. M. Morin voices comments on some aspects of the article which may need further thought. The reasons for, and utility of such a movement toward empirically supported treatment (ESTs) is investigated. The defining characteristics of an EST (from the Task Force's perspective) are subject for debate. Why have only 2 categories of ESTs (well established empirical support vs probably efficacious)? The implications of the adoption of EST-based systems will reverberate throughout training, practice, and public health policies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Empirical Study on the Merit of Web-Based 4D Visualization in Collaborative Construction Planning and Scheduling

This paper reports an empirical study that tested the usefulness of Web-based four-dimensional (4D) construction visualization in collaborative construction planning and scheduling. Several recent construction projects have employed 4D visualization to better understand the construction schedule and make proactive decisions to prevent logical errors in the construction sequence. Other groups have shown that construction information management with asynchronous Web-based communication can improve decision making among dispersed industry practitioners. It seems reasonable to anticipate that combining 4D visualization with Web-based information management would facilitate dispersed industry practitioners to make collaborative decisions for construction planning and scheduling. The empirical study presented here reports how experiment participants at separate locations collaboratively detected logical errors in a construction schedule when the 4D visualization model of the schedule was represented on the Web browser. Our results show that teams using 4D models detected logical errors more frequently, faster, with fewer mistakes, and with less team communication, than teams using 2D drawings and bar charts. These findings show industry practitioners empirical evidence that Web-based 4D construction visualization can improve team collaboration on construction planning and scheduling.     

An exploratory survey on empirically supported treatments: Implications for internship training.

Is training in empirically supported treatments (ESTs) necessary for internship? Are all internship sites embracing EST training equally? An exploratory survey reports training practices and attitudes toward use of ESTs in internship sites accredited by the American Psychological Association. Training practices during an internship year varied across type of setting, but only 28% reported offering more than 15 hr of training. Lack of managed care demands, flexibility in session limits, and perceived mismatch between client needs and treatment options were reasons endorsed for not doing more training and supervision with ESTs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues.

There is an increasing demand for psychotherapy among ethnic minority populations. Yet, there is not adequate evidence that empirically supported therapies (ESTs) are effective with ethnic minorities. Ethical guidelines suggest that psychotherapies be modified to become culturally appropriate for ethnic minority persons. Conceptual approaches have identified interdependence, spirituality, and discrimination as considerations for culturally sensitive therapy (CST). However, there is no more empirical support for the efficacy of CSTs than there is for the efficacy of ESTs with ethnic minority populations. The chasm between EST and CST research is a function of differences between methods and researchers in these 2 traditions. Specific recommendations for research collaboration between CST and EST researchers are offered. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Analysis of EST-driven gene annotation in human genomic sequence

We have performed a systematic analysis of gene identification in genomic sequence by similarity search against expressed sequence tags (ESTs) to assess the suitability of this method for automated annotation of the human genome. A BLAST-based strategy was constructed to examine the potential of this approach, and was applied to test sets containing all human genomic sequences longer than 5 kb in public databases, plus 300 kb of exhaustively characterized benchmark sequence. At high stringency, 70%-90% of all annotated genes are detected by near-identity to EST sequence; >95% of ESTs aligning with well-annotated sequences overlap a gene. These ESTs provide immediate access to the corresponding cDNA clones for follow-up laboratory verification and subsequent biologic analysis. At lower stringency, up to 97% of annotated genes were identified by similarity to ESTs. The apparent false-positive rate rose to 55% of ESTs among all sequences and 20% among benchmark sequences at the lowest stringency, indicating that many genes in public database entries are unannotated. Approximately half of the alignments span multiple exons, and thus aid in the construction of gene predictions and elucidation of alternative splicing. In addition, ESTs from multiple cDNA libraries frequently cluster over genes, providing a starting point for crude expression profiles. Clone IDs may be used to form EST pairs, and particularly to extend models by associating alignments of lower stringency with high-quality alignments. These results demonstrate that EST similarity search is a practical general-purpose annotation technique that complements pattern recognition methods as a tool for gene characterization.     

A Therapist-Assisted Internet Self-Help Program for Traumatic Stress.

The authors describe a therapist-assisted, Internet-based self-help intervention to treat posttraumatic stress disorder (PTSD) and discuss how it can be used as an efficient tool to treat large numbers of traumatized individuals. The intervention uses a modified form of stress inoculation training, promoted through daily homework assignments completed in vivo, using fewer therapist resources than standard face-to-face therapy. The process and structure of the treatment program (and structure of the Web site) and clinical and Internet security safeguards are described to introduce practitioners to a unique therapist-assisted self-management model of PTSD. It is hoped that the method described will lead to other novel, efficient methods of delivering interventions and treatment for PTSD in primary care and other outpatient and private practice settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The utility of empirically supported treatments.

How does a psychotherapist decide what treatment approach is most appropriate for a client? This issue has been addressed by the Division 12 Task Force on Promotion and Dissemination of Psychological Procedures (1995) and has stimulated considerable debate among psychologists about the importance of identifying, teaching, and practicing empirically supported treatments (ESTs). This article examines recent literature supporting both sides of this issue in an attempt to identify and understand the arguments in favor of and against the movement to identify and implement ESTs and their treatment manuals. On the basis of current research related to ESTs, recommendations are offered pertaining to practice, research, and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of enhanced resources on anticipatory stress and adjustment to new information technology: A field-experimental test of conservation of resources theory.

An intervention based on conservation of resources theory was conducted in an organization installing new information technology (IT) to enhance participants’ psychological resources and thereby reduce anticipated stress and facilitate adjustment to the new IT. Before installation, 218 IT users in 25 units participated in 5 days of technical training; only the randomly assigned experimental group also participated in a “resource workshop.” All participants filled out questionnaires before the workshop, 2 weeks later, and 2 months after the IT installation. ANOVA detected a significant increase in users’ means efficacy in the experimental group and a decline in the control group. The new IT caused the control users more dissatisfaction and exhaustion, whereas the experimental users were spared these increases in strain, as predicted. Implications for theory and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

It's the genes! EST access to human genome content

ESTs or 'expressed sequence tags' are DNA sequences read from both ends of expressed gene fragments. The Merck-WashU EST Project and several other public EST projects are being performed to rapidly discover the complement of human genes, and make them easily accessible. These ESTs are widely used to discover novel members of gene families, to map genes to chromosomes as 'sequence-tagged sites' (STSs), and to identify mutations leading to heritable diseases. Informatic strategies for querying the EST databases are discussed, as well as the strengths and weaknesses of the EST data. There is a compelling need to build on the informatic synthesis of human gene data, and to devise facile methods for determining gene functions.     

Factors predicting the use of technology: Findings from the center for research and education on aging and technology enhancement (create).

The successful adoption of technology is becoming increasingly important to functional independence. The present article reports findings from the Center for Research and Education on Aging and Technology Enhancement (CREATE) on the use of technology among community-dwelling adults. The sample included 1,204 individuals ranging in age from 18-91 years. All participants completed a battery that included measures of demographic characteristics, self-rated health, experience with technology, attitudes toward computers, and component cognitive abilities. Findings indicate that the older adults were less likely than younger adults to use technology in general, computers, and the World Wide Web. The results also indicate that computer anxiety, fluid intelligence, and crystallized intelligence were important predictors of the use of technology. The relationship between age and adoption of technology was mediated by cognitive abilities, computer self-efficacy, and computer anxiety. These findings are discussed in terms of training strategies to promote technology adoption. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some ethical issues in sensitivity training.

Presents sensitivity training and encounter as having evolved over the past two decades into popular psychoeducational experiences. Diverse group experiences are conducted by "trainers," "facilitators," or simply leaders, with gross differences in professional preparation. The "encounter group" appears to be purely therapeutic in intent. Early goals of training were democratic change and the study of facilitating or obstructing group processes. Many current practitioners either disavow or are ignorant of original purposes and emphasize emotional expressiveness. Hence, the original aim of training is subverted, and pressures are exerted upon participants for emotional expressivity regardless of psychological statuses. Inadequate preparation of many "trainers" to deal with personality problems, inadequate cognizance of group influences exerted as pressures upon participants, and a premium placed upon emotionality (a) undermine the socially useful values of learning and understanding of group and interactional processes, and (b) raise pressing ethical practice issues. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using predictive models of behavior change to promote evidence-based treatment for PTSD.

While there is a strong evidence base regarding effective treatment of Posttraumatic Stress Disorder (PTSD), and an increased number of treatment guidelines available internationally, research indicates that there is significant variation in clinical practice. This study aimed to identify effective ways to promote adoption of trauma-focused interventions in community services offering mental health care to people who have experienced trauma. The study sought to do so by identifying factors influencing the uptake of evidence-based practice at both an individual and organizational level, and trialing competency training and support strategies based on these factors across 6 community trauma services. The effectiveness of the training and support strategies was investigated using self-report surveys and prospective recording of clinicians' treatment planning for PTSD clients. The study found that while lack of skills and confidence were identified as significant barriers to the uptake of trauma-focused interventions, expectations about treatment outcomes and organizational factors also influenced clinical behavior. This finding highlighted the importance of considering factors other than knowledge and skills when developing training and other interventions to support the implementation of evidence-based practice. Furthermore, it was found that a training and implementation process tailored to organizational and individual barriers, and based on currently recognized theories of behavior change, led to a significant increase in the use of imaginal exposure in the treatment plans of clients assessed as having PTSD. This change was maintained 6 months following training. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

25 years of endoscopic sphincterotomy in Erlangen: assessment of the experience in 3498 patients

BACKGROUND AND STUDY AIMS: The aim of the study was to investigate the evolution of endoscopic sphincterotomy (EST) over a period of 25 years at its birthplace in Erlangen, Germany. PATIENTS AND METHODS: A total of 3498 consecutive ESTs between 1973 and the end of 1997 were reviewed with respect to indications, technology, success, complications, therapy of complications and mortality. In order to demonstrate changes in the course of time, the results have been compiled separately for four time periods (A-D). RESULTS: During the 25 years' practice of EST in Erlangen the frequency of ETSs has increased constantly and significant changes have been observed concerning the spectrum of indications: Bile duct stones (total 55.1%) decreased continuously from 91.1% (period A) to 35.7% (period D). In contrast, the proportion of ESTs applied for malignant obstruction (total 22.1%) rose successively from 1.1% (period A) to more than 25% (periods B-D). Chronic pancreatitis as an indication for EST was established in period B (1.0%) and accounted for 20.2% of all procedures in period D (total 8.0%). Several new indications (summarized as "others") increased from 1.8% in period A to 11.9% in period D (total 6.7%) whereas biliary pancreatitis and scarred papillary stenosis remained constantly below 5%. Whereas the "Erlangen sphincterotome" was the only sphincterotome used in period A, it was almost completely replaced by guide-wire sphincterotomes in period D. With the introduction of the needle knife the precut technique became popular and was used with increasing frequencies: period B 31.9%, period C 34.1%, period D 41.9%. The success rate in total was 95.2%. For each time period the highest success rate of EST was obtained for bile duct stones (96-98%), whereas EST appeared to be more difficult in case of malignant obstruction (93.3%) or chronic pancreatitis (90.2%), but for both indications growing experience resulted in an increase in the success rates (85.7% to 94.9% and 90.9% to 94.0%, respectively). Complications occurred in 7.9% of cases. The complication rate declined significantly from 10.5% in period A over 7.6% in period B to 6.3% in period C. Prospective data acquisition in period D revealed a significant increase in the detection of mild forms of acute pancreatitis, resulting in a slight increase of the complication rate (8.4%). Needle-knife papillotomy did not significantly increase the complication rate. Whereas in period A 41% of all complications were managed by surgery, this value dropped over 28% (period B) and 7.5% (period C) to ultimately 1.6% in period D. The method-related mortality was nearly constant over the whole period of time (0.6%). CONCLUSIONS: Despite a continuous shift of indications and a changing mixture of learning endoscopists and EST experts over 25 years, the practice of EST at its birthplace in Erlangen has shown a constantly high success rate, a decreasing complication rate and an acceptable but mainly unchanged mortality rate. Currently, nearly all complications can be successfully managed nonoperatively.     

Training consulting psychologists to be sensitive to multicultural issues in organizational consultation.

As diversity continues to increase significantly in the workforce, training organizational consultants to be competent to effectively address issues related directly to race, ethnicity, and gender becomes essential. However, these societal changes present a challenge to many training programs, faculty, and practitioners. Given the absence of specific guidelines for ensuring competence in addressing multicultural issues in work environments, the primary purpose of this article is to present and discuss specific strategies for addressing these challenges. The training and practice of the culturally sensitive organizational consultant should include competencies in attending to diversity issues in 4 critical aspects of organizations: organizational infrastructure, job satisfaction, relationships among staff, and job performance and work productivity. Factors encouraging professionals to practice with limited competency, issues of consent for participation in research and confidentiality, and practice without multicultural training in organizational consultation are addressed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advancing the practice of online psychotherapy: An application of Rogers' diffusion of innovations theory.

With the advancements of technology and its increasing use in all spheres of life, clinicians too are faced with the decision of whether to adopt or refrain from adopting certain innovations in their practice. This article discusses the process of adopting clinical innovations within a theoretical framework, namely diffusion of innovations theory (DIT; Rogers, 2003). DIT constructs are applied to the example of online therapy adoption into clinical practice. Nine adoption barriers are identified, including issues of dehumanizing the therapeutic environment, start-up cost and reimbursement, infrastructure and training, licensure and jurisdiction concerns, ethical guidelines, both client and clinician suitability factors, and professional reputation and acceptance within the field. The authors conclude with a theory-based discussion of activities that may help to accelerate the adoption of online therapy among professional psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Physicians and other practitioners of acupuncture in Norway--education, theoretical orientation and practice

We conducted a survey for the purpose of obtaining information on training, theoretical orientation and practice among various categories of practitioners of acupuncture in Norway. Particular attention was paid to physicians, compared with other groups of practitioners. A questionnaire was sent to 161 persons who had attended Norwegian Medical Acupuncture Seminars (Norske legers akupunkturkurs) and to 274 persons found under "Acupuncture" in the Yellow Pages of the telephone directory. The response rate was 80%, questionnaires being returned by 298 practitioners. A significantly higher percentage of physicians, as opposed to other practitioners, had less than 120 hours of acupuncture training. 30% of the physicians, compared to 60% in other groups, had more than 10 acupuncture consultations a week. Physicians performed only a relatively small number of different acupuncture methods. There was a relatively high number of men among the acupuncturists. Hence, acupuncture seems to be a practice with masculine appeal. 67% of the physicians used one or more Chinese medical concepts associated with acupuncture. 45% stated that they found non-scientific explanations for how acupuncture works reliable. We therefore argue that one can identify parallel processes in the development of acupuncture. Some elements of acupuncture have been integrated in a scientifically defined reality. At the same time, this survey indicates another process: it shows that many practitioners use traditional Chinese medical concepts. This may indicate that some practitioners have changed their view on what constitutes a reliable picture of reality.