Failure is an option
Abstract: I believe that there is an ethical imperative to be more explicit in our communal recognition of the limits of treatment, and on the definition of treatment failure and appropriate response to it. Being unrealistic with service users about possibilities of treatment failure may mean that all too many are left feeling to blame for not having succeeded in therapy. Remaining silent on the levels of treatment failure stops service-level discussion of what should be done for these individuals. It reduces rational use of resources, stunts service development, and might contribute to forms of both therapist-blaming and patient-blaming. For these reasons, I would argue that there is a pressing need for greater research into and discussion of the limits of treatment and treatment failure, which I hope this Essay might play some part in stimulating.
Wolpert, M. (2016). Failure is an option. The Lancet Psychiatry. doi: 10.1016/s2215-0366(16)30075-x
A Qualitative Exploration of Patient and Clinician Views on Patient Reported Outcome Measures in Child Mental Health and Diabetes Services
Abstract: Patient Reported Outcome Measures (PROMs) are increasingly being recommended for use in both mental and physical health services. The present study is a qualitative exploration of the views of young people, mothers, and clinicians on PROMs. Semi-structured interviews were conducted with a sample of n = 10 participants (6 young people, 4 clinicians) from mental health services and n = 14 participants (4 young people, 7 mothers, 3 clinicians) from a diabetes service. For different reasons, young people, mothers, and clinicians saw feedback from PROMs as having the potential to alter the scope of clinical discussions.
Wolpert, M., Curtis-Tyler, K., & Edbrooke-Childs, J. (2016). A qualitative exploration of patient and clinician views on patient-reported outcome measures in child mental health and diabetes services.
Achieving Precision Mental Health through Effective Assessment, Monitoring, and Feedback Processes : Introduction to the Special Issue
Abstract: Although much of the focus of medicine to date has been on biomarkers and genetics (McCarty et al. 2011), the concept is not limited to those factors. Just as critical, but less widely elaborated, are psychosocial variables that also fit under the umbrella of precision and personalized medicine. Increasing discussion has also focused on the relevance of precision medicine to mental health.
Bickman, L., Lyon, A., & Wolpert, M. (2016). Achieving Precision Mental Health through Effective Assessment, Monitoring and Feedback Processes: Introduction to the Special Issue.
A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services
Abstract: The aim of the present research was to explore clinician attitudes to outcome measures and, in particular, the facilitators and barriers to implementing outcome measures. An up-to-date exploration of clinician attitudes is especially needed in the context of recent policies on the implementation of outcome measures in child and adolescent mental health services (CAMHS), and because evidence suggests that there is a disparity between policy recommendations and the use of outcome measures in clinical practice. Semi-structured interviews were conducted with nine CAMHS clinicians from a Mental Health Trust in South London.
Sharples, E., Qin, C., Goveas, V., Gondek, D., Deighton, J., & Edbrooke-Childs, J. (2016). A qualitative exploration of attitudes towards the use of outcome measures in child and adolescent mental health services.
Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review
Abstract: Due to recent increases in the use of feedback from outcome measures in mental health settings, we systematically reviewed evidence regarding the impact of feedback from outcome measures on treatment effectiveness, treatment efficiency, and collaborative practice. In over half of 32 studies reviewed, the feedback condition had significantly higher levels of treatment effectiveness on at least one treatment outcome variable. Feedback was particularly effective for not-on-track patients or when it was provided to both clinicians and patients. The findings for treatment efficiency and collaborative practice were less consistent. Given the heterogeneity of studies, more research is needed to determine when and for whom feedback is most effective.
Gondek, D., Edbrooke-Childs, J., Fink, E., Deighton, J., & Wolpert, M. (2016). Feedback from Outcome Measures and Treatment Effectiveness, Treatment Efficiency, and Collaborative Practice: A Systematic Review. Administration and Policy in Mental Health and Mental Health Services Research. Online first January 2016. DOI: 10.1007/s10488-015-0710-5
Measuring what matters to patients: Using goal content to inform measure choice and development
Abstract: Personalised care requires personalised outcomes and ways of feeding back clinically useful information to clinicians and practitioners, but it is not clear how to best personalise outcome measurement and feedback using existing standardised outcome measures.
Jacob, J., Edbrooke-Childs, J., Law, D., & Wolpert, M. (2015). Measuring what matters to patients: using goal content to inform measure choice and development. Clinical Child Psychology and Psychiatry. Online first December 2015. DOI: 10.1177/1359104515615642
Abstract: The Strengths and Difficulties Questionnaire (SDQ) is one of the most widely used measures of young people’s mental health difficulties in research and clinical decision-making. Although the SDQ is available in both paper and computer survey formats, cross-format equivalences have yet to be established. The current study aimed to assess the measure’s equivalence across paper- and computer-based survey formats in a community-based school setting. The study examined self-reported measures completed by a matched sample of 11–14 year olds in secondary schools in England (589 completed paper version; 589 online version). Analyses demonstrate that the factor structure, although did not vary by survey format, resulted in poorly fitting models limiting the use of model based invariance testing. Results indicate that the measure does not operate similarly across different formats, with scale-level mean differences observed for the hyperactivity scale, which also affects the total difficulties score, with higher scores seen in the paper version.
Patalay, P., Hayes, D., Deighton, J., & Wolpert, M. (2015). A Comparison of Paper and Computer Administered Strengths and Difficulties Questionnaire. Journal of Psychopathology and Behavioral Assessment. Online first August 2015. DOI: 10.1007/s10862-015-9507-9
The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data
Edbrooke-Childs, J., Jacob, J., Argent, R., Patalay, P., Deighton, J., & Wolpert, M. (2015). The relationship between child- and parent-reported shared decision making and child-, parent-, and clinician-reported treatment outcome in routinely collected child mental health services data. Clinical Child Psychology and Psychiatry.Online first June 2015. DOI: 1359104515591226
Associations between evidence-based practice and mental health outcomes in child and adolescent mental health services
Abstract: The effectiveness of evidence-based practice in the treatment of children with conduct disorder (n = 186) or emotional disorders (n = 490) in routine care was examined using naturalistic, previously collected data from 30 child and adolescent mental health services. Repeated measures analysis of covariance was used to compare the outcomes of children who received parent training for conduct disorder and cognitive behavioural therapy for emotional disorders (evidence-based practice) with children who did not receive these treatments (non-evidence-based practice). There was a relatively low occurrence of evidence-based practice, particularly for children with conduct disorder. Both the evidence-based practice and non-evidence-based practice groups improve over time, with moderate effect sizes, and there were greater improvements associated with evidence-based practice for children with emotional disorders, based on child self-reported symptoms but not on parent report. In the present sample, significant differences were not found for conduct disorder. Findings provide tentative support for evidence-based practice for the treatment of emotional disorders in routine care settings.
Deighton, J., Argent, R., De Francesco, D., Edbrooke‐Childs, J., Jacob, J., Fleming, I., Ford, T. & Wolpert, M. (2015) Associations between evidence-based practice and mental health outcomes in child and adolescent mental health services. Clinical Child Psychology and Psychiatry, DOI: 10.1177/1359104515589637
Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience?
Background: Patient Reported Outcome Measures (PROMs) are increasingly being used in Child and Adolescent Mental Health Services (CAMHS). The aim of this research was to explore change in standardized and idiographic outcome measures in CAMHS using naturalistic, routinely collected data.
Edbrooke‐Childs, J., Jacob, J., Law, D., Deighton, J., & Wolpert, M. (2015). Interpreting standardized and idiographic outcome measures in CAMHS: what does change mean and how does it relate to functioning and experience? Child and Adolescent Mental Health.
Horses for courses? A qualitative exploration of goals formulated in mental health settings by young people, parents, and clinicians
Abstract: This research sought to explore and categorise goals set by children and young people, parents/caregivers and jointly by a combination of children/young people, parents/caregivers and/or clinicians within mental health settings across the United Kingdom.
Jacob, J., Edbrooke-Childs, J., Holley, S., Law, D. & Wolpert, M. (2015) Horses for courses? A qualitative exploration of goals formulated in mental health settings by young people, parents, and clinicians. Clinical Child Psychology and Psychiatry, 1-6. DOI: 10.1177/1359104515577487
Mental Health Difficulties in Early Adolescence: A Comparison of Two Cross-Sectional Studies in England From 2009 to 2014
Abstract: To examine the changes in mental health difficulties in early adolescence between 2009 and 2014 in England. Overall, there were similar levels of mental health difficulties experienced by adolescents in 2009 and 2014. Notable exceptions were a significant increase in emotional problems in girls and a decrease in total difficulties in boys in 2014 compared to 2009. The increased prevalence of emotional problems in girls mirrors a trend found in other similar studies, and the results are discussed in the context of recent economic and societal changes. The small decrease in total difficulties in boys, although promising, clearly warrants further research.
Fink, E., Patalay, P., Sharpe, H., Holley, S., Deighton, J. & Wolpert, M. (2015). Mental health difficulties in early adolescence: A comparison of two cross-sectional studies in England from 2009 to 2014. Journal of Adolescent Mental Health, 56, 502-507.