The application of statistical process control to manage global client outcomes in behavioral healthcare

Green, Rex S.

doi:10.1016/s0149-7189(99)00004-x

Cited by 14 publications

(13 citation statements)

References 31 publications

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“…SPC provides a systematic means of monitoring the amount of variability in a continuous production process. It has been used in mental health settings to measure consistency of service delivery at outpatient clinics (Green, 1999) and variations in treatment staff performance over time (Dey, Sluyter, & Keating, 1994). In SPC, samples are taken from a given process under investigation (e.g., FT fidelity in RFT) and plotted on a control chart to check for patterns that suggest systematic variation within the target sample when compared to pre-established control limits (e.g., fidelity benchmark values derived from MDFT studies).…”

Section: Methodsmentioning

confidence: 99%

Assessing fidelity to evidence-based practices in usual care: The example of family therapy for adolescent behavior problems

Hogue

Dauber

2013

Evaluation and Program Planning

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This study describes a multimethod evaluation of treatment fidelity to the family therapy (FT) approach demonstrated by front-line therapists in a community behavioral health clinic that utilized FT as its routine standard of care. Study cases (N = 50) were adolescents with conduct and/or substance use problems randomly assigned to routine family therapy (RFT) or to a treatment-as-usual clinic not aligned with the FT approach (TAU). Observational analyses showed that RFT therapists consistently achieved a level of adherence to core FT techniques comparable to the adherence benchmark established during an efficacy trial of a research-based FT. Analyses of therapist-report measures found that compared to TAU, RFT demonstrated strong adherence to FT and differentiation from three other evidence-based practices: cognitive-behavioral therapy, motivational interviewing, and drug counseling. Implications for rigorous fidelity assessments of evidence-based practices in usual care settings are discussed.

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Section: Methodsmentioning

confidence: 99%

Assessing fidelity to evidence-based practices in usual care: The example of family therapy for adolescent behavior problems

Hogue

Dauber

2013

Evaluation and Program Planning

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“…Analyses employed statistical process control, a rigorous technique for detecting the timing, longevity, and Originally developed as a means of detecting the causes of variation in manufacturing processes, statistical process control has been applied to program evaluation in various health care areas, including mental health. 15 However, to our knowledge, it has not yet been used to track housing outcomes.…”

Section: Methodsmentioning

confidence: 99%

Housing Histories of Assertive Community Treatment Clients: Program Impacts and Factors Associated with Residential Stability

Kreindler

Coodin

2010

Can J Psychiatry

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W La Revue canadienne de psychiatrie, vol 55, no 3, mars 2010 150Objective: Although housing is widely recognized as a crucial issue for people with severe and persistent mental illness, there is much to learn about the ongoing housing experiences of this group of people. Using secondary data, this study examined the housing histories of 65 assertive community treatment (ACT) clients from 2 years prior until up to 7 years after intake, totalling 407 addresses. Method:We used statistical process control to assess the significance and longevity of preand post-ACT changes in residential tenure and independent living. We used multivariate survival analysis to explore participant and residence characteristics associated with residential stability.Results: After 6 months in ACT, the client population showed a significant, sustained improvement in housing stability. Similarly, shortly after ACT entry, there was a marked increase in the proportion of participants living independently. At the participant level, substance abuse was the strongest predictor of residential instability; other predictors included age (30 years or younger) and sex (female). Residence characteristics also proved important; independent housing, neighbourhood income (a proxy for housing quality), and receipt of a rental subsidy were associated with significantly longer tenure, controlling for client characteristics. Conclusions:The timing and magnitude of the observed changes imply that ACT was effective in helping clients to achieve stable housing and to live independently. The results also underscore the importance of high-quality housing in promoting residential stability.Can J Psychiatry. 2010;55(3):150-156. Clinical Implications· ACT increases housing stability over the long term. · People with cooccurring problems (severe and persistent mental illness combined with substance abuse) have ongoing difficulty attaining stable housing. · In conjunction with ACT involvement, greater access to independent, high-quality housing (for example, through subsidies) can significantly increase residential stability. Limitations· Our study was observational rather than experimental. · Our study followed the client population of only one ACT team. · There were a small number of gaps in the available data on client housing experiences.

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“…To wit: Is it justified to single out therapist 30 due to his/her lower performance on two outcomes averaged across two clients? SPC is most powerful when employed in an assembly-line context as part of a continuous production process (e.g., Dey, Sluyter, & Keating, 1994), for example tracking clinical staff within a provider system over several years, in which deviations can be detected for a given time window as well as a given therapist (Green, 1999). And because it is designed to distinguish between normal variation and systematic uncontrolled variation, SPC may be ideal for supporting line clinicians who are responsible for consistent delivery of EBTs yet also expected to show natural variation in implementation across sessions and caseloads (Delgadillo et al, 2014).…”

Section: Discussionmentioning

confidence: 99%

Benchmarking Family Therapy for Adolescent Behavior Problems in Usual Care: Fidelity, Outcomes, and Therapist Performance Differences

Hogue

Dauber

Henderson

2016

Adm Policy Ment Health

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This study evaluated whether community therapists delivering family therapy for adolescent behavior problems in usual care achieved performance benchmarks established in controlled trials for treatment fidelity and outcomes, with particular focus on individual differences in therapist performance. The study contained N = 38 adolescents (50% male; mean age 15 years) whose self-reported race/ethnicity was Hispanic (74%), African American (11%), multiracial (11%), and other (4%). Clients were treated by 13 therapists in one community mental health clinic that delivered family therapy as the routine standard of care. Therapists provided self-report data on adherence to core family therapy techniques; these scores were inflation-adjusted based on concordance with observer reports. Results showed that community therapists surpassed the fidelity benchmark for core family therapy techniques established by research therapists during a controlled trial. Regarding change in client functioning at six-month follow-up, community therapists were equivalent to the benchmark for internalizing symptoms and superior for externalizing symptoms and delinquent acts. Community therapists also demonstrated a high degree of performance uniformity: Each one approximated the fidelity benchmark, and only two produced relatively weak outcomes on any of the client change indicators. Caveats for interpreting therapist performance data, given the small sample size, are described. Recommendations are made for developing therapist-report fidelity measures and utilizing statistical process control methods to diagnose therapist differences and enhance quality assurance procedures.

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The application of statistical process control to manage global client outcomes in behavioral healthcare

Cited by 14 publications

References 31 publications

Assessing fidelity to evidence-based practices in usual care: The example of family therapy for adolescent behavior problems

Assessing fidelity to evidence-based practices in usual care: The example of family therapy for adolescent behavior problems

Housing Histories of Assertive Community Treatment Clients: Program Impacts and Factors Associated with Residential Stability

Benchmarking Family Therapy for Adolescent Behavior Problems in Usual Care: Fidelity, Outcomes, and Therapist Performance Differences

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