PHILADELPHIA -Many mental health therapists use treatments that have little evidence to support them. A new multi-institution study led by Penn Medicine has found that an organization's culture and climate are better predictors of the use of evidence-based practices than an individual therapist's characteristics in the treatment of children and adolescents with psychiatric disorders. The study, published in the February 16th issue of JAMA Pediatrics, is the first comprehensive investigation of its kind.
"Therapists employ many different treatment methods when working with young people, even though research indicates that evidence-based practices such as cognitive behavioral therapy (CBT) and family therapy are more effective than others, such as psychodynamic techniques," explains lead author, Rinad Beidas, PhD, assistant professor of Psychology in the department of Psychiatry at the Perelman School of Medicine at the University of Pennsylvania.
Beidas and colleagues surveyed 188 therapists, supervisors, and administrators at 23 community mental health organizations in Philadelphia about their knowledge, attitudes, use of therapy strategies, organizational culture and climate, and leadership. This study was performed in close partnership with the city of Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) and its system-wide efforts to implement evidence-based practices. Philadelphia, under DBHIDS Commissioner, Arthur C. Evans, Jr., PhD, clinical associate in the department of Psychiatry, is a national leader in deploying evidence-based practices for youth and adults with psychiatric disorders in publicly-funded mental health agencies.
Study results showed that organizational culture and climate and implementation climate and leadership, as reported by therapists and agency leadership, more fully explained therapist's use of CBT (23 percent) and family therapy techniques (19 percent) when compared to individual therapist factors. Conversely, individual factors, including knowledge and attitude more fully explained therapists' use of psychodynamic therapy (20 percent) compared to organizational factors.
CBT emphasizes problem-solving and teaching youth specific skills to correct distorted thinking and change behavior. Family therapy convenes families to promote changes in both individual behavior and relationships. Both forms of therapy have been shown to be effective in hundreds of studies. In contrast, there is little evidence to support the use of psychodynamic psychotherapy, a form of psychoanalysis focused on revealing the unconscious content of the psyche, in youth.
"Our research shows that targeting organizational culture and climate may increase the use of evidence-based therapy strategies. But we will still need to change therapists' knowledge and attitudes to help them stop using less effective treatment strategies."
Further, Beidas suggests that "improving the way our youth are treated requires knowing what levers to pull. Do we engage in organizational change or do we work directly with the clinicians? Our results suggest that we should target organizational culture and climate changes that will improve the effectiveness of services, while also working directly with clinicians to reduce use of ineffective treatment techniques."
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Additional authors from Penn include Matthew Hurford, Trevor Hadley, Lucia Walsh, Danielle Adams, David Mandell, Steven Marcus, and Frances Barg.
The study was supported by a grant from the National Institute of Mental Health.
Penn Medicine is one of the world's leading academic medical centers, dedicated to the related missions of medical education, biomedical research, and excellence in patient care. Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise. The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 17 years, according to U.S. News & World Report's survey of research-oriented medical schools. The School is consistently among the nation's top recipients of funding from the National Institutes of Health, with $392 million awarded in the 2013 fiscal year.
The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania -- recognized as one of the nation's top "Honor Roll" hospitals by U.S. News & World Report; Penn Presbyterian Medical Center; Chester County Hospital; Penn Wissahickon Hospice; and Pennsylvania Hospital -- the nation's first hospital, founded in 1751. Additional affiliated inpatient care facilities and services throughout the Philadelphia region include Chestnut Hill Hospital and Good Shepherd Penn Partners, a partnership between Good Shepherd Rehabilitation Network and Penn Medicine. Penn Medicine is committed to improving lives and health through a variety of community-based programs and activities. In fiscal year 2013, Penn Medicine provided $814 million to benefit our community.
Journal
JAMA Pediatrics