Charmaine K. Higa-McMillan, Alayna L. Park, Eric L. Daleiden, Kimberly D. Becker, Adam Bernstein, Bruce F. Chorpita
{"title":"Getting More Out of Clinical Documentation: Can Clinical Dashboards Yield Clinically Useful Information?","authors":"Charmaine K. Higa-McMillan, Alayna L. Park, Eric L. Daleiden, Kimberly D. Becker, Adam Bernstein, Bruce F. Chorpita","doi":"10.1007/s10488-023-01329-z","DOIUrl":"10.1007/s10488-023-01329-z","url":null,"abstract":"<div><p>This study investigated coded data retrieved from clinical dashboards, which are decision-support tools that include a graphical display of clinical progress and clinical activities. Data were extracted from clinical dashboards representing 256 youth (<i>M</i> age = 11.9) from 128 practitioners who were trained in the Managing and Adapting Practice (MAP) system (Chorpita & Daleiden in BF Chorpita EL Daleiden 2014 Structuring the collaboration of science and service in pursuit of a shared vision. 43(2):323 338. 2014, Chorpita & Daleiden in BF Chorpita EL Daleiden 2018 Coordinated strategic action: Aspiring to wisdom in mental health service systems. 25(4):e12264. 2018) in 55 agencies across 5 regional mental health systems. Practitioners labeled up to 35 fields (i.e., descriptions of clinical activities), with the options of drawing from a controlled vocabulary or writing in a client-specific activity. Practitioners then noted when certain activities occurred during the episode of care. Fields from the extracted data were coded and reliability was assessed for Field Type, Practice Element Type, Target Area, and Audience (e.g., <i>Caregiver Psychoeducation: Anxiety</i> would be coded as Field Type = Practice Element; Practice Element Type = Psychoeducation; Target Area = Anxiety; Audience = Caregiver). Coders demonstrated moderate to almost perfect interrater reliability. On average, practitioners recorded two activities per session, and clients had 10 unique activities across all their sessions. Results from multilevel models showed that clinical activity characteristics and sessions accounted for the most variance in the occurrence, recurrence, and co-occurrence of clinical activities, with relatively less variance accounted for by practitioners, clients, and regional systems. Findings are consistent with patterns of practice reported in other studies and suggest that clinical dashboards may be a useful source of clinical information. More generally, the use of a controlled vocabulary for clinical activities appears to increase the retrievability and actionability of healthcare information and thus sets the stage for advancing the utility of clinical documentation.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"51 2","pages":"268 - 285"},"PeriodicalIF":2.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mila Hall, Lisa M. Lappenbusch, Emily Wiegmann, Julian A. Rubel
{"title":"To Use or Not to Use: Exploring Therapists’ Experiences with Pre-Treatment EMA-Based Personalized Feedback in the TheraNet Project","authors":"Mila Hall, Lisa M. Lappenbusch, Emily Wiegmann, Julian A. Rubel","doi":"10.1007/s10488-023-01333-3","DOIUrl":"10.1007/s10488-023-01333-3","url":null,"abstract":"<div><p>Background: Using idiographic network models in psychotherapy has been a growing area of interest. However, little is known about the perceived clinical utility of network models. The present study aims to explore therapists’ experiences with network model-based feedback within the context of the TheraNet Project. Methods: In total, 18 therapists who had received network-based feedback for at least 1 patient at least 2 months prior were invited to retrospective focus groups. The focus group questions related to how participation in the study influenced the therapeutic relationship, how the networks were used, and what might improve their clinical utility. The transcribed focus groups were analyzed descriptively using qualitative content analysis. Results: Most therapists mentioned using the feedback to support their existingtheir case concept, while fewer therapists discussed the feedback directly with the patients. Several barriers to using the feedback were discussed, as well as various suggestions for how to make it more clinically useful. Many therapists reported skepticism with regards to research in the outpatient training center in general, though they were also all pleasantly surprised by being involved, having their opinions heard, and showing a readiness to adapt research to their needs/abilities. Conclusions: This study highlights the gap between researchers’ and therapists’ perceptions about what useful feedback should look like. The TheraNet therapists’ interest in adapting the feedback and building more informative feedback systems signals a general openness to the implementation of clinically relevant research. We provide suggestions for future implementations of network-based feedback systems in the outpatient clinical training center setting.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"52 1","pages":"41 - 58"},"PeriodicalIF":2.0,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://link.springer.com/content/pdf/10.1007/s10488-023-01333-3.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139519280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Biblia S. Cha, Judith Borghouts, Elizabeth Eikey, Dana B. Mukamel, Stephen M. Schueller, Dara H. Sorkin, Nicole A. Stadnick, Xin Zhao, Kai Zheng, Margaret L. Schneider
{"title":"Variability in the Integration of Peers in a Multi-site Digital Mental Health Innovation Project","authors":"Biblia S. Cha, Judith Borghouts, Elizabeth Eikey, Dana B. Mukamel, Stephen M. Schueller, Dara H. Sorkin, Nicole A. Stadnick, Xin Zhao, Kai Zheng, Margaret L. Schneider","doi":"10.1007/s10488-023-01331-5","DOIUrl":"10.1007/s10488-023-01331-5","url":null,"abstract":"<div><p>Peer support specialists (“peers”) who have the lived experience of, and are in recovery from, mental health challenges are increasingly being integrated into mental health care as a reimbursable service across the US. This study describes the ways peers were integrated into Help@Hand, a multi-site innovation project that engaged peers throughout efforts to develop and offer digital mental health interventions across counties/cities (“sites”) in California. Using a mixed methods design, we collected quantitative data via quarterly online surveys, and qualitative data via semi-annual semi-structured phone interviews with key informants from Help@Hand sites. Quantitative data were summarized as descriptive findings and qualitative data from interviews were analyzed using rapid qualitative analysis methods. In the final analytic phase, interview quotes were used to illustrate the complex realities underlying quantitative responses. 117 quarterly surveys and 46 semi-annual interviews were completed by key informants from 14 sites between September 2020 and January 2023. Peers were integrated across diverse activities for support and implementation of digital mental health interventions, including development of training and educational materials (78.6% of sites), community outreach (64.3%), technology testing (85.7%), technology piloting (90.9%), digital literacy training (71.4%), device distribution (63.6%), technical assistance (72.7%), and cross-site collaboration (66.7%). Peer-engaged activities shifted over time, reflecting project phases. Peer-provided digital literacy training and technology-related support were key ingredients for project implementations. This study indicates the wide range of ways peers can be integrated into digital mental health intervention implementations. Considering contextual readiness for peer integration may enhance their engagement into programmatic activities.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"51 2","pages":"226 - 239"},"PeriodicalIF":2.0,"publicationDate":"2024-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10850170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139511550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joanna E. Harnett, Matthew J. Leach, Randa Karzon, Erica McIntyre
{"title":"Mental Health Literacy and Education of Complementary Medicine Practitioners: A Cross-Sectional Study","authors":"Joanna E. Harnett, Matthew J. Leach, Randa Karzon, Erica McIntyre","doi":"10.1007/s10488-023-01339-x","DOIUrl":"10.1007/s10488-023-01339-x","url":null,"abstract":"<div><p>An estimated 42% of Australians who consult complementary medicine (CM) practitioners have a mental health diagnosis. Preparedness of CM practitioners in managing such diagnoses is currently unknown. A cross-sectional survey of 257 CM practitioners who reported caring for people with a mental health diagnosis. Practitioners’ mental health literacy, educational needs, and confidence in the assessment, management, and treatment of mental health—including suicide risk—were analysed. Most (59.1%) participants had no formal qualifications in mental health and 44.3% indicated they had not completed any training in psychological therapies. Only 20% were trained in mindfulness-based techniques or goal setting. Over 50% reported their undergraduate qualification contained insufficient mental health content to prepare them for clinical practice. Over one-half had attended continuing professional education on mental health. Practitioners reported greater confidence in assessing, managing, and treating mental wellbeing over complex mental health disorders and suicide risk. These findings uncovered a deficit in the CM practitioner’s surveyed mental health education. As these CM practitioners are a primary point of contact for patients with mental health diagnoses, there is a critical need to expedite skills development in this workforce to support the delivery of safe and effective primary mental health care.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"51 2","pages":"217 - 225"},"PeriodicalIF":2.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10850010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139484982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aljoscha Rimpler, Björn S. Siepe, Carlotta L. Rieble, Ricarda K. K. Proppert, Eiko I. Fried
{"title":"Introducing FRED: Software for Generating Feedback Reports for Ecological Momentary Assessment Data","authors":"Aljoscha Rimpler, Björn S. Siepe, Carlotta L. Rieble, Ricarda K. K. Proppert, Eiko I. Fried","doi":"10.1007/s10488-023-01324-4","DOIUrl":"10.1007/s10488-023-01324-4","url":null,"abstract":"<div><p>Ecological Momentary Assessment (EMA) is a data collection approach utilizing smartphone applications or wearable devices to gather insights into daily life. EMA has advantages over traditional surveys, such as increasing ecological validity. However, especially prolonged data collection can burden participants by disrupting their everyday activities. Consequently, EMA studies can have comparably high rates of missing data and face problems of compliance. Giving participants access to their data via accessible feedback reports, as seen in citizen science initiatives, may increase participant motivation. Existing frameworks to generate such reports focus on single individuals in clinical settings and do not scale well to large datasets. Here, we introduce FRED (Feedback Reports on EMA Data) to tackle the challenge of providing personalized reports to many participants. FRED is an interactive online tool in which participants can explore their own personalized data reports. We showcase FRED using data from the WARN-D study, where 867 participants were queried for 85 consecutive days with four daily and one weekly survey, resulting in up to 352 observations per participant. FRED includes descriptive statistics, time-series visualizations, and network analyses on selected EMA variables. Participants can access the reports online as part of a Shiny app, developed via the R programming language. We make the code and infrastructure of FRED available in the hope that it will be useful for both research and clinical settings, given that it can be flexibly adapted to the needs of other projects with the goal of generating personalized data reports.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"51 4","pages":"490 - 500"},"PeriodicalIF":2.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196357/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anna M. Langener, Laura F. Bringmann, Martien J. Kas, Gert Stulp
{"title":"Predicting Mood Based on the Social Context Measured Through the Experience Sampling Method, Digital Phenotyping, and Social Networks","authors":"Anna M. Langener, Laura F. Bringmann, Martien J. Kas, Gert Stulp","doi":"10.1007/s10488-023-01328-0","DOIUrl":"10.1007/s10488-023-01328-0","url":null,"abstract":"<div><p>Social interactions are essential for well-being. Therefore, researchers increasingly attempt to capture an individual's social context to predict well-being, including mood. Different tools are used to measure various aspects of the social context. Digital phenotyping is a commonly used technology to assess a person's social behavior objectively. The experience sampling method (ESM) can capture the subjective perception of specific interactions. Lastly, egocentric networks are often used to measure specific relationship characteristics. These different methods capture different aspects of the social context over different time scales that are related to well-being, and combining them may be necessary to improve the prediction of well-being. Yet, they have rarely been combined in previous research. To address this gap, our study investigates the predictive accuracy of mood based on the social context. We collected intensive within-person data from multiple passive and self-report sources over a 28–day period in a student sample (Participants: N = 11, ESM measures: N = 1313). We trained individualized random forest machine learning models, using different predictors included in each model summarized over different time scales. Our findings revealed that even when combining social interactions data using different methods, predictive accuracy of mood remained low. The average coefficient of determination over all participants was 0.06 for positive and negative affect and ranged from − 0.08 to 0.3, indicating a large amount of variance across people. Furthermore, the optimal set of predictors varied across participants; however, predicting mood using all predictors generally yielded the best predictions. While combining different predictors improved predictive accuracy of mood for most participants, our study highlights the need for further work using larger and more diverse samples to enhance the clinical utility of these predictive modeling approaches.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"51 4","pages":"455 - 475"},"PeriodicalIF":2.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11196304/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139416029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Matthew Jay Lyons, Daniel J. Whitaker, Shannon Self-Brown, Erin A. Weeks
{"title":"A Longitudinal Analysis of Trajectories and Predictors of Fidelity Using the SafeCare Parenting Model","authors":"Matthew Jay Lyons, Daniel J. Whitaker, Shannon Self-Brown, Erin A. Weeks","doi":"10.1007/s10488-023-01336-0","DOIUrl":"10.1007/s10488-023-01336-0","url":null,"abstract":"<div><p>Evidence-based practice (EBP) fidelity, understood as the extent to which a program is implemented as the developers intended, is a key implementation variable which likely relates to consumer outcomes. However, studies that track fidelity longitudinally and at large scale are uncommon, and finding reliable predictors of fidelity has proven to be a complex challenge. Further, attitudes toward EBP are a potentially important predictor of fidelity, but results across the literature have been mixed. The purpose of the present study is to use data from the ongoing implementation and dissemination of the SafeCare model to better understand (1) the characteristics of SafeCare implementation fidelity trajectories, and (2) whether individual level factors predict differences in fidelity and fidelity trajectories, especially provider attitudes toward EBP. The analyses reported here include 14,778 observed fidelity sessions by 868 providers in 172 agencies. We use multilevel modeling to examine fidelity, fidelity trajectories over time, and several potential individual-level predictors of fidelity, including demographics, work history, and attitudes toward EBP. We found: (1) that SafeCare fidelity begins high at baseline (93.85% on average); (2) that SafeCare fidelity displays a statistically significant trend of positive linear growth, even among those with less positive attitudes; and (3) that positive attitudes are associated with slightly higher fidelity on average and at baseline, while negative attitudes are associated with slightly lower fidelity on average and at baseline. To our knowledge, this is the largest longitudinal analysis of EBP fidelity in a child welfare program to date, and our findings support the notion that intensive coaching supports which are titrated over time can be sufficient to ensure sustained high fidelity, at least in some cases. Further, these findings indicate that robust training and coaching processes can ensure high fidelity and fidelity growth even among providers with less positive attitudes toward EBP.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"51 2","pages":"240 - 253"},"PeriodicalIF":2.0,"publicationDate":"2024-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139110653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hannah E. Frank, Gracelyn Cruden, Margaret E. Crane
{"title":"Correction to: Private Practice, Private Insurance, and Private Pay Mental Health Services: An Understudied Area in Implementation Science","authors":"Hannah E. Frank, Gracelyn Cruden, Margaret E. Crane","doi":"10.1007/s10488-023-01332-4","DOIUrl":"10.1007/s10488-023-01332-4","url":null,"abstract":"","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"51 1","pages":"7 - 9"},"PeriodicalIF":2.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085424","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lang A. Duong, Eirini Zoupou, Cathryn I. Boga, Jody Kashden, Jena Fisher, Mary Beth Connolly Gibbons, Paul Crits-Christoph
{"title":"Gender, Race/Ethnicity, and Patient-Therapist Matching on Gender and Race/Ethnicity: Predictors/Moderators of the Effectiveness of Trust/Respect Feedback","authors":"Lang A. Duong, Eirini Zoupou, Cathryn I. Boga, Jody Kashden, Jena Fisher, Mary Beth Connolly Gibbons, Paul Crits-Christoph","doi":"10.1007/s10488-023-01335-1","DOIUrl":"10.1007/s10488-023-01335-1","url":null,"abstract":"<div><p>A plethora of studies has exhibited the effectiveness of using measurement-based care feedback systems within mental health services to improve treatment outcomes; however, patient gender/race and patient-therapist matching on gender and race remain relatively unexplored as predictors/moderators in feedback studies. We conducted predictor/moderator analyses focusing on the relation of gender, race/ethnicity, and patient-therapist gender and race/ethnicity matching on two outcomes: patient self-reported levels of (1) functioning and (2) trust/respect within the therapeutic relationship. We used data from a randomized controlled trial studying the effectiveness of a feedback system comparing patient-reported levels of trust and respect towards their provider (together with symptom feedback) in comparison to symptom only feedback. We found that men improved in functioning more than women when their therapists received trust/respect feedback compared to symptom only feedback (<i>F</i>[1, 902] = 9.79, <i>p</i> = .002, <i>d</i> = 0.21). We also found that dyads matched on race/ethnicity but not gender, and those matched on gender but not race/ethnicity, improved in functioning over time more than dyads mismatched on both gender and race/ethnicity and those matched on both gender and race/ethnicity (<i>F</i>[1, 897] = 8.63, <i>p</i> = .0034, <i>d</i> = 0.20). On trust/respect outcomes, we found a gender difference over time (<i>F</i>[1, 759] = 6.61, <i>p</i> = .01, <i>d</i> = 0.19), a gender matching difference by feedback condition interaction (<i>F</i>[1, 757] = 5.25, <i>p</i> = .02, <i>d</i> = 0.17), and a racial/ethnic matching difference on trust/respect scores over time (<i>F</i>[1, 785] = 3.89, <i>p</i> = .049, <i>d</i> = 0.14). Male patients showed an initial decrease followed by a steady increase in trust/respect over time while female patients showed an initial increase followed by a steady decrease. Gender-matched therapeutic dyads showed higher levels of trust/respect compared to mismatched dyads when therapists received symptom only feedback, but this difference was not apparent when trust/respect feedback was provided. Dyads mismatched on race/ethnicity improved steadily in trust/respect over time, but matched dyads decreased in trust/respect after an initial increase. Future research should focus on the use of feedback systems to enhance outcomes for patients with specific gender and racial/ethnic identities.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"52 1","pages":"59 - 73"},"PeriodicalIF":2.0,"publicationDate":"2024-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139085425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Noah S. Triplett, Rashed AlRasheed, Clara Johnson, Connor J. McCabe, Michael D. Pullmann, Shannon Dorsey
{"title":"Supervisory Alliance as a Moderator of the Effects of Behavioral Rehearsal on TF-CBT Fidelity: Results from a Randomized Trial of Supervision Strategies","authors":"Noah S. Triplett, Rashed AlRasheed, Clara Johnson, Connor J. McCabe, Michael D. Pullmann, Shannon Dorsey","doi":"10.1007/s10488-023-01334-2","DOIUrl":"10.1007/s10488-023-01334-2","url":null,"abstract":"<div><p>Exposure is an important element of treatment for many evidence-based treatments but can be challenging to implement. Supervision strategies to support exposure delivery may be an important tool to facilitate the use of exposure techniques; however, they must be considered and used in the context of the supervisory alliance. The present study examined relations between supervisory alliance and fidelity to the trauma narrative (TN; i.e., imaginal exposure) component of Trauma-Focused Cognitive Behavioral Therapy. We also examined how supervisory alliance moderated the effect of behavioral rehearsal use in supervision on TN fidelity. We analyzed data from a randomized controlled trial, in which forty-two supervisors and their clinicians (<i>N</i> = 124) from 28 Washington State community-based mental health offices participated. Clinicians were randomized to receive one of two supervision conditions—symptom and fidelity monitoring (SFM) or SFM with behavioral rehearsal (SFM + BR). Supervisory alliance alone did not predict delivery (i.e., occurrence) or extensiveness of delivery of the trauma narrative. Client-focused supervisory alliance moderated the effectiveness of behavioral rehearsal—as client-focused alliance increased, the odds of delivering the TN also increased significantly. Future research should further investigate how to appropriately match supervision techniques with supervisory dyads and explore the interplay of alliance with supervision techniques a supervisor might employ.</p></div>","PeriodicalId":7195,"journal":{"name":"Administration and Policy in Mental Health and Mental Health Services Research","volume":"51 2","pages":"254 - 267"},"PeriodicalIF":2.0,"publicationDate":"2023-12-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139072979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}