Evidence suggests that a moderate amount of variance in patient outcomes is attributable to therapist differences. However, explained variance estimates vary widely, perhaps because some therapists achieve greater success with certain kinds of patients. This study assessed the amount of variance in across-session change in symptom intensity scores explained by therapist differences in a large naturalistic data set (1,198 patients and 60 therapists, who each treated 10-77 of the patients). Results indicated that approximately 8% of the total variance and approximately 17% of the variance in rates of patient improvement could be attributed to the therapists. Cross-validation and extreme group analyses validated the existence of these therapist effects.

We examined the impact of autism severity and parental coping strategies on stress in parents of children with ASD. Children's autism symptoms and parental coping strategies (task-oriented, emotion-oriented, social diversion, and distraction) were evaluated as predictors of four types of parental stress (parent and family problems, pessimism, child characteristics, and physical incapacity). In order to examine potential buffering effects of coping strategies on stress associated with the child's symptom severity, the interactive effects of autism symptoms with coping strategies were also examined. Participants included 77 primary caregivers of a child with ASD. Using multiple regression analyses, emotion-oriented coping scores were associated with more parent and family problems, and task-oriented coping was associated with lower physical incapacity scores. The child's autism severity was the strongest and most consistent predictor of stress. Further, emotion-oriented coping moderated the relationship between pessimism stress and autism symptomatology, and distraction coping was a moderator between parent and family stress and autism symptoms. Results indicate that increasing our knowledge of the coping strategies that are more or less effective and under what conditions some coping strategies may be either beneficial or harmful for this population of parents has direct implications for treatment and parent education efforts.

Cost remains a significant barrier to greater provision of formal developmental and behavioral screening. Our scaleable cost model may be adjusted for a given practice to account for the overall level of developmental risk. The model also provides an estimate of the time and cost of providing new screening services. This model allows pediatric practices to select the mix of developmental screens most appropriate for their particular patient population at an acceptable cost.

In the delivery of clinical services, outcomes monitoring (i.e., repeated assessments of a patient's response to treatment) can be used to support clinical decision making (i.e., recurrent revisions of outcome expectations on the basis of that response). Outcomes monitoring can be particularly useful in the context of established practice research networks. This article presents a strategy to disaggregate patients into homogeneous subgroups to generate optimal expected treatment response profiles, which can be used to predict and track the progress of patients in different treatment modalities. The study was based on data from 618 diagnostically diverse patients treated with either a cognitive-behavioral treatment protocol (n = 262) or an integrative cognitive-behavioral and interpersonal treatment protocol (n = 356). The validity of expected treatment response models to predict treatment in those 2 protocols for individual patients was evaluated. The ways such a procedure might be used in outpatient centers to learn more about patients, predict treatment response, and improve clinical practice are discussed.

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This article examines the feasibility of a complex intervention designed to facilitate the transition of youth out of homelessness. It is intended to contribute to efforts to build out the youth homelessness intervention literature, which is underdeveloped relative to descriptive characterizations of risk. The 6-month intervention examined here, referred to as the Housing Outreach Program-Collaboration (HOP-C), is comprised of transitional outreach-based case management, individual and group mental health supports, and peer support. The intervention was delivered through a multiagency, interdisciplinary collaboration. Feasibility was assessed using a mixed methods design that included prepost intervention metrics and the study site was a large Canadian urban center. A total of 31 youth participated in the study with 28 completing the intervention. Overall, implementation and youth engagement was successful though patterns and intensity of engagement were quite variable. While prepost, self-report metrics improved modestly, substantial gains were observed in employment, education, and mental health service connectedness. Qualitative themes focused on the benefits of a flexible, multicomponent approach, close attention to seamless delivery and common factors, and supporting youth in the balance of isolation versus independence. These findings suggested that this tertiary prevention approach is feasible and warrants further investigation. Public Policy Relevance StatementThere is very little evidence regarding the types of services and collaborations that are necessary to support youth in transition out of homelessness. This article describes an example of a multiservice intervention that can inform growing policy-level efforts to replace crisis-oriented care systems with prevention-oriented systems. Fostering collaborations between service sectors is a priority of policymakers in many contexts and is a requirement for effective service delivery for homeless, transitionaged youth. The collaborative, codeveloped design described in this article can inform city-level

To make use of psychotherapy research in practice, therapists need real-time access to valid clinically relevant information about patients. The dose-effect and phase models of psychotherapy provide a theoretical background for empirically based psychotherapy management by describing the systematic nature of progress in therapy and guiding the selection of outcome criteria. Given this theoretical background, it is possible to derive appropriate models for monitoring cases in ongoing therapies (patient profiling) and identifying therapists' relative strengths and weaknesses (severity-adjusted provider profiling). These applied methods may be used to inform decision making in ongoing psychotherapies and to support supervision and clinical training.

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