Solution-Focused Documentation

2022-09-19T16:45:55+00:00September 16th, 2022|

solution-focused documentation

Embedding solution-focused documentation templates within electronic health records could help build solution-focused fluency, sustain solution-focused practices within organizations, and improve care coordination, communication, and client outcomes.  Thank you for reading this article on solution-focused documentation, which I would venture to say is not the most exciting topic. How did you decide to take the time while working tirelessly on the front lines of the mental health pandemic, given how staying up to date on notes is the miserable bane of our daily grind?  As my colleagues used to say, a “note is just a note” and “a done note is a good note,” but notes (documentation) now serve so many additional purposes, including accountability to reimbursing third parties, accreditation agencies, legal records of care, informing clinical decision supports and creating a repository of information for clinical research and quality improvement initiatives. Medical and mental health professionals are required to complete all sorts of documentation such as comprehensive psychological intake assessments and ongoing documentation to determine whether a client is appropriate for counseling,  what types of treatment are indicated, formulating treatment plans, coordinating care with multiple providers, documenting when clients are ready to complete or  “graduate” from discrete treatment episodes, and whether a higher level of care is indicated, such as in emergency and crises. However, little empirical attention has been given to this intake and subsequent paperwork (Richmond et al., 2014), and there is little evidence in the literature to guide the selection of specific data entry methods according to the type of data documented (Wilbanks 2018). 

Primary care and behavioral health clinicians often differ in their reporting requirements, codes, regulations, and language. Working with clinical teams to create solution-focused customized shared templates that are unique to each practice context is essential. Providing practitioners within organizations the opportunity to review their current documentation forms, get input directly from clinicians, and test out the forms with practitioners is essential for successful implementation.  Incorporating solution-focused questions within semi-structured data entry by creating text narratives and structured data entry could harness positive aspects of electronic records (Janett & Yeracaris 2020)

At the end of this article, there are solution-focused documentation examples for an intake evaluation, a progress note with a case example, and a solution-focused safety assessment (SFSA).

How Solution-Focused Documentation Can Help Sustain This Evidenced-Based Practice (EBP)

Solution-Focused Brief Therapy entails a paradigm, order, and language shift. These components can be easily integrated into documentation templates to enhance practitioner fluency and assist in sustaining the solution-focused brief therapy approach within organizations. 

Documentation is considered static and unchanging; however, what questions are asked, how they are asked, and when they are asked all make a difference in the narrative created.  The solution-focused practitioner harnesses hope by assisting clients in developing a narrative in which they can recognize their agency and resources while developing an action plan moving forward. Solution-focused documentation can help clinicians and clients develop a hopeful report while making record keeping a little more tolerable and bearable for practitioners. 

Solution-focused brief therapy (SFBT) is fundamentally a linguistic therapeutic approach. Questions are constructed to convey confidence in the client while simultaneously recognizing their agency, strengths, and resources and creating a collaborative treatment plan with the client.  Questions are formulated to help clients articulate what has worked, what is working, and what their best hopes are so they will be confident and have the necessary “good enough” skills to graduate from defined treatment episodes.  The solution-focused practitioner attempts to highlight positive language while simultaneously conveying a belief and confidence in their client. Solution-focused documentation templates can provide friendly reminders and cues for clinicians to ask hopeful questions.  What questions we ask, what we listen to, what we ignore, how we construct questions, and what order we ask questions matter. 

Imagine if the following questions were part of an electronic record semi-structured document. 

    • “What are your best hopes?”: conveys the assumption that they do have best hopes.
    • “What has been better since we last met?: conveys something has been better and looks for positive differences/exceptions.
    • “What has been happening that you want to continue to happen?” conveys some things have been working.
    • “What do you know about your condition?”: conveys that they do have knowledge and expertise. 
    • “What do you know about your child that they will succeed in life?”:  conveys a belief that they do know their child will succeed. 
    • “Supposing ten is you are confident that your skills are good enough to graduate from this treatment episode, and 1 is the opposite; where are you now?”: conveys clients have the capabilities to develop skills and graduate from discrete treatment episodes.

How Solution-Focused Documentation Differs from Problem-Focused Documentation

Traditional intake and follow-up paperwork have relied on a medical model that requires a detailed description of the client’s problems. Problem-oriented approaches require a complete understanding of all the symptoms to make a diagnosis and then treat the client. Solution-focused brief therapy (SFBT)  stands in sharp contrast. SBFT is the only therapeutic modality not requiring a complete understanding of the problem for clients to move forward with their goals. SFBT starts by revealing a detailed understanding of the client’s best hope for their future and collaboratively looks for client-related resources, actions, and agency that build this outlook. The focus is on detailing what a client will do when their problem is solved rather than diagnosis and symptom exploration. Based on the premise that people have the necessary resources to solve their problems, SFBT amplifies these strengths and abilities by building a shared dialect that focuses on what has worked and is working in a client’s life.  

Resource activation and therapeutic interventions that reinforce the client’s agency and abilities play a central role during successful treatment (Gassmann & Grawe 2006).  Therapists who create an environment where clients perceive themselves as well-functioning and activate their resources early in the session have more successful outcomes (Gassmann & Grawe 2006). Research was done to test problem-focused versus solution-focused intake questions on pre-treatment change and compared a standard written intake form with problem-focused questions to a solution-focused brief therapy intake form (Richmond 2014). Clients answering the solution-focused questions described significantly more solutions and fewer problems than the comparison group. Clients in the SFBT intake interview improved significantly on the Outcome Questionnaire before their first therapy session, whereas those in the traditional diagnostic intake did not. This study demonstrated that intake procedures are not neutral information gathering and that strength-based questions have advantages (Richmond 2014). 

Solution-Focused Documentation Clinical Case Example:

The following is a brief example of a case and one possible way to incorporate solution-focused documentation. Of course, there are many different mandates and requirements; this example only provides one. All documentation templates need input from staff and organizations to ensure they meet requirements.

Karl is an 18y/o transgender male (preferred pronoun is he) who presented to the emergency department following a motor vehicle accident. He reportedly was texting his friends about meeting to hang out with them while driving when he didn’t realize the car in front of him had stopped. The car was totaled. Karl sustained a broken leg and back injury. He was hospitalized due to the severity of his injuries and the need for surgery on his leg. While awaiting surgery, Karl was reporting suicidal thoughts and wanting to die. Karl’s father was out of town caring for his elderly parents on the car accident day and had not yet arrived back home. Karl had a difficult time when his father was away and had a prior overdose attempt six months ago while his father was caring for his elderly parents. Karl’s mother died from cancer when Karl was 12 years old, and Karl spent much of his youth witnessing her treatments, decline, and death. The following is an excerpt from Karl’s crisis evaluation while in the hospital medical unit.

Tx: Hello Karl – is that how you like to be called?
Karl: Yes
Tx: Thank you for taking the time to meet with me. My hope is that I will be helpful to you. I will do my best. Would it be ok if I asked you a few questions in hopes of being helpful for you? Some questions may be a bit challenging.
Karl: Ok
Tx: Thank you. It must be difficult for you to be here; how have you been holding up these past few days?
Karl: It’s been hard. It’s loud, and I can never get any rest. I just want to go home.
Tx: Of course. It must be so frustrating for you to be here. What do you know has helped make things even a little bit bearable while you are here?
Karl: Getting pain medication.
Tx: How has getting pain medication been helpful for you?
Karl: It was bad after the accident. I was in so much pain. All I could think of was killing myself just to relieve my agony.

Discussion: Tone Setters and Activating Resources:

The therapist sets the tone by thanking Karl and confirming how he wants to be called, as well as providing consent for the conversation to follow. The therapist also provides plenty of “for you” responses followed by coping questions that activate Karl’s individual resources early in the conversation.

Tx: I’m glad the medications are being helpful for you. How well would you say you are tolerating your pain from 1-10 (10 being the best)?
Karl: Probably a 5.
Tx: What would be a good enough number?
Karl: A 7.
Tx: What keeps the number from being lower than a 5?
Karl: I’m able to get some sleep.
Tx: What else keeps it from being lower?
Karl: It’s gone up from a one, and I’m hoping the surgery will help even more.
Tx: What have you done that has helped the medication work, even a little bit?
Karl: I just try and distract myself by playing video games. The nurses have brought me some games, and that helps a bit.

Discussion: Scaling Pain Tolerability

The therapist attends to his pain and how well he is tolerating it demonstrating concern about his wellbeing. Scaling how well Karl is tolerating the pain and how helpful the medications are from 1-10 is a more constructive way to assess pain. It promotes his agency in managing his pain.

Tx: I’m impressed with how you are handling this. I wonder if you know whose idea it was for me to come and see you today?
Karl: I think it was the nurse.
Tx: What do you know the nurse was concerned about that asking me to come to see you would be helpful for you?

Discussion: Exploring External VIPs

Asking Karl whose idea it was for the therapist to come and framing this as concern can be helpful in exploring important VIPs in Karl’s immediate social context. Notice that the therapist did not ask “why” rather instead what the nurse was concerned about guiding the narrative to one of care and compassion.

Karl: I don’t know. (Pause) Probably because I said I wanted to die and couldn’t take it anymore.
Tx: What do you mean by “take it anymore”?
Karl: My father is in Arizona, and when he comes back, he will be furious with me. I know he will take away my driving privileges, and driving to see my friends is the only thing that helps me feel any better.

Discussion: Exploring the client’s language

Karl was able to identify the reason for the consultation – that he wanted to die. Exploring the meaning of his words provided more about Karl’s concerns and his reasons for distress. Although, it may seem to slow the conversation down, exploring the clients’ meaning often paradoxically moves the conversation forward more quickly as the therapist and client negotiate a shared understanding.

Tx: That must be very difficult for you to think about while also dealing with your pain and upcoming surgery. How have you been enduring all of this?
Karl: It’s been hard. My father is still in Arizona and won’t be home until tomorrow.
Tx: Of course, this must be hard for you. Is your father an important person in your life?
Karl: Yes. I don’t know what I would do without him.
Tx: What do you most appreciate about your father?
Karl: He’s always there for me – even when I do stupid things. He doesn’t give up on me.
Tx: What has he done to always be there for you?
Karl: He and I are close. After my mother died, we went through a lot. We helped each other.
Tx: It sounds like your father loves you a lot. Suppose I were to ask him what he most appreciates about you, what would he say?
Karl: That I’m strong, and I can deal with a lot.
Tx: What do you mean by “deal with a lot”?
Karl: My mother died when I was 12 years old, and it was so hard.
Tx: That sounds incredibly challenging. What would your father say you have done to deal with this?
Karl: He’d say that I kept going to school and kept caring about people – that I am strong.
Tx: What would he say you have done that you are strong?
Karl: That I care about people.
Tx: You both sound very strong. I’m wondering, who else are the important people in your life?
Karl: My mother. Even though she died, I think of her a lot and know she is with me.
Tx: What do you suppose your mother most appreciates about you?
Karl: She knows how much my father and I care and help each other. She would be proud of that.
Tx: What else would she say she appreciates about you?
Karl: That I don’t give up.

Discussion: Exploring VIPs

Taking the time to ask who the most important people in Karl’s life and what they most appreciate about him is critical in highlighting his relationship resources. It is often these meaningful relationships that are protective and stop people from acting on thoughts of suicide.

Tx: Supposing I asked your mother and father what their best hopes would be for you so they would know you are safe to go home, what would they say?
Karl: My father would want to make sure I don’t do anything unsafe.
Tx: What would he hope you do instead?
Karl: He would want me to let him know if I was upset and reach out for support.
Tx: What else would tell him you can keep yourself safe?
Karl: That I wouldn’t be driving and getting into accidents and wanting to end my life. I don’t want to die; it’s just sometimes I get so upset that all I can think of is the relief of being together with my mother.
Tx: Of course. These are very intense emotions you are experiencing. I’m wondering, what are your reasons for living?
Karl: I want to go to college and become a nurse.
Tx: Wow. That is impressive. Have you always wanted this, or is this different?
Karl: I’ve wanted to be a nurse for a long time. Ever since seeing how they helped my mother and our family.
Tx: Wow – you are strong. Where do you get this determination from?
Karl: Probably my father. He doesn’t give up. He keeps trying to help his parents and me.

Discussion: Exploring Best Hopes

Often clients experiencing intense emotions are more able to answer what their best hopes are from the perspectives of their VIPs. This is another reason to have some knowledge of who are the most important people in your clients’s life. Karl was able to answer what his parents’ best hopes were quite easily – to stay safe. Following this, every question or response was focused on activation of his resources including exploring his reasons for living. This is in contrast to exploring why he wants to die. Exploring his reasons for living uncovered additional resources and opportunities to compliment Karl and explore positive differences with him.

Tx: Sometimes, I ask number of questions to help me help you. Would that be ok?
Karl: Ok
Tx: Suppose ten is you are confident that you can keep yourself safe and one is the opposite; where are you now?
Karl: about a 5.
Tx: And what would be a good enough number?
Karl: A 6
Tx: What keeps the number from being lower than a 5?
Karl: Knowing that my father will be here soon.
Tx: What do you know about your father being here for you soon is helpful?
Karl: I just need to have him nearby. He knows how to calm me down.
Tx: What else keeps the number from being lower?
Karl: That I wouldn’t do anything. I wouldn’t want to hurt my father. It would kill him.
Tx: Suppose I asked your father how confident he is in terms of your ability to keep yourself safe from 1-10; what would he say?
Karl: I don’t know.
Tx: You know your father best. There is no right answer. I’m just wondering what you think?
Karl: Probably a 3
Tx: What do you think is the reason your number is a 5 and not a 3?
Karl: I think he would say he’s scared that I had another accident and did the same thing a few months back. He would probably say he’s scared that I could’ve died.
Tx: of course – I’m sure that must be frightening for him to know you could have died. What do you suppose keeps his number from being lower than a 3?
Karl: That I’m here and getting help.
Tx: What else do you think keeps his number from being lower?
Karl: That he’s on his way and will be here soon.
Tx: I’m wondering, Karl, what would you be doing when your confidence is just a bit higher, at a 6?
Karl: I would have a plan for when I leave the hospital.
Tx: What do you mean by a plan?
Karl: That my father and I would talk, and I would have someone to talk to.

Discussion: Scaling Confidence in Ability to Stay Safe

Scaling confidence in Karls’ ability to stay safe and “working the scale” is an effective way to develop a collaborative safety plan. Even though his parents were not present in the session, their perspectives could easily be incorporated into the conversation. Numbers limit language confusion and allow for a clear plan moving forward in small manageable steps. Numbers often help clients manage the intensity of their experiences safely, as working the scale provides further opportunities to highlight their agency and a plan. And Hope = agency + plan!

Documentation Examples

References

Beyebach, M., Neipp, M. C., Solanes-Puchol, Á., & Martín-del-Río, B. (2021). Bibliometric Differences Between WEIRD and Non-WEIRD Countries in the Outcome Research on Solution-Focused Brief Therapy. Frontiers in Psychology, 4926.

Gardner, C. L., & Pearce, P. F. (2013). Customization of electronic medical record templates to improve end-user satisfaction. CIN: Computers, Informatics, Nursing, 31(3), 115-121.

Gassmann, D., & Grawe, K. (2006). General change mechanisms: The relation between problem activation and resource activation in successful and unsuccessful therapeutic interactions. Clinical Psychology & Psychotherapy, 13(1), 1–11.

Janett, R. S., & Yeracaris, P. P. (2020). Electronic Medical Records in the American Health System: challenges and lessons learned. Ciencia & saude coletiva, 25, 1293-1304.

Richmond, C. J., Jordan, S. S., Bischof, G. H., & Sauer, E. M. (2014). Effects of solution-focused versus problem-focused intake questions on pre-treatment change. Journal of Systemic Therapies, 33(1), 33.

Wilbanks, B. A., & Moss, J. (2018). Evidence-based guidelines for interface design for data entry in electronic health records. CIN: Computers, Informatics, Nursing, 36(1), 35-44.

Training The Emergency Medical System And EMTs In Solution-Focused Crisis Interventions

2022-08-09T11:43:17+00:00June 28th, 2022|

A Video Conversation

Emergency Medical System, EMS professionals, handle tens of millions of calls in the United States each year and make life-altering patient decisions daily. Embedding solution-focused crisis interventions within EMS services who already work 24/7 within the medical and mental health system provides an opportunity to mitigate the mental health system crisis. Training EMS providers in Solution-Focused brief crisis interventions have the potential to deliver greater access to mental health services while conserving healthcare resources. Solution-Focused Brief Therapy has been applied successfully across a wide range of professions and fields, in a transdisciplinary manner, for a broad range of mental health conditions (Beyebech, M. et al., 2021). Specially trained paramedics have effectively employed triage algorithms to screen and select patients experiencing an acute mental health crisis for transport directly to psychiatric treatment facilities (Mackey & Qiu 2019). In this article, we are proud to share a conversation of 2 Emergency Medical Technicians, EMTs, who have successfully integrated solution-focused brief crisis interventions within their daily work. Interviewing these two dedicated and talented professionals working on the front lines of the healthcare system was a privilege and highlighted the incredible work EMTs do every day to serve communities around the nation!

The United States is in the midst of a mental health workforce pandemic. The mental health workforce is a key component of mental health care quality, access, and cost. The quality of mental health care is influenced by the skills of the people providing the care. Access to mental health care depends on appropriately skilled providers being available to render treatment. EMS professionals, with little to no training in mental health, are already providing emergency mental health triage and response. EMS practitioners provide much more than transportation while earning a median income of $17.00/hour, $35, 360 a year. They are left out of the medical system feedback loop when delivering patients to the ED, never learning the outcome of their patients, what they did successfully, or gaining learning opportunities for how to improve. EMS professionals endure a high rate of occupational violence that is about 22 times higher than the average for all other U.S. workers. As EMS professionals continue to be undervalued, their work has never been more important, especially in light of their service during the Covid-19 pandemic.

In recent years an ever greater number of patients find themselves seeking care for psychiatric illnesses in the emergency department (ED). 6-10% of ED visits present for psychiatric illness. These visits weigh heavily on the ED system. Patients with psychiatric illnesses occupy 42% more time than non-psychiatric visits. A survey of 1400 ED directors by the American College of Emergency Physicians (ACEP) found 79% having psychiatric patients boarding in their EDs with 62% reporting that no psychiatric services occur while patients are boarding in the ED. Even when services are available, there are prolonged waiting times to see clinicians. ED boarding carries a high-cost burden. In 2017, mental and substance use disorder emergency department (ED) visits had service delivery costs of more than $5.6 Billion, which represented more than 7% of the $76.3 billion in total ED visit costs (Karac & Moore 2020).

911 dispatchers are often the first point of contact after an individual is in an accident, needs emergency assistance, or witnesses a crime. A lack of high-quality training was identified by emergency service call-takers and dispatchers as contributing to increased stress levels. 911 Call Takers must be further trained to navigate police, fire, and medical emergencies, with an ever-increasing focus on crisis intervention and training. They must also be further trained in identifying and allocating the proper resources and services based on the call information that they receive.

Due to the complexities in managing many patients experiencing mental illness, according to a recent Atlanta Journal article, patients are often charged with crimes, typically “nuisance crimes” and include anything from disorderly conduct to trespassing. This often results in arrest and jail for their mental health condition. In most American cities, it is police officers who respond to such calls, an approach law enforcement experts say increases the risk of a violent encounter because they aren’t always adequately trained to deal with the mentally ill. In 2017, police officers spent 21% of their time responding to or transporting people with mental illness, according to preliminary data from a survey of 355 U.S. law enforcement agencies. At least one in every four people killed by police has a serious mental illness, according to the Treatment Advocacy Center, a nonprofit based in Arlington, Va. Basic training for U.S. police officers takes 21 weeks, on average, and rarely includes training on bias, de-escalation of tense situations, recognition of psychiatric symptoms, or mental health first aid techniques. Bringing a uniform and a weapon to the scene creates a power dynamic that is not in the best interest of either party. Even when officers undergo training in these areas, research demonstrates that it is not effective. In the United States, a police encounter with a civilian is 16 times as likely to result in that person’s death if they have an untreated mental illness when compared to someone who does not. (Rafla-Yuan et al., 2021)

Ultimately a cohesive transdisciplinary mental health system that embraces EMS practitioners within the existing mental health system is one intervention that would help address the catastrophic failures of the mental health system. Training EMS providers who already give 24/7 community triage and response interventions in solution-focused brief crisis interventions could help divert patients away from emergency rooms to other more effective and appropriate community provider locations. As can be seen from this interview, EMTs specially trained in mental health emergencies have the potential to strengthen workforce diversity and competency successfully making a difference for all patients, including those experiencing mental health conditions.

REFERENCES

Beyebach, M., Neipp, M.-C., Solanes-Puchol, Á., & Martín-del-Río, B. (2021). Bibliometric differences between weird and non-weird countries in the outcome research on solution-focused brief therapy. Frontiers in Psychology, 12

Hoge, M. A., & Hirschman, R. (1984). Psychological training of emergency medical technicians: An evaluation. American journal of community psychology, 12(1), 127.

Jacobs, G. A., Gray, B. L., Erickson, S. E., Gonzalez, E. D., & Quevillon, R. P. (2016). Disaster mental health and community-based psychological first aid: Concepts and education/training. Journal of Clinical Psychology, 72(12), 1307-1317.

Karaca, Z., & Moore, B. J. (2020). Costs of emergency department visits for mental and substance use disorders in the United States, 2017: statistical brief# 257.

Mackey, K. E., & Qiu, C. (2019). Can mobile integrated health care paramedics safely conduct medical clearance of behavioral health patients in a pilot project? A report of the first 1000 consecutive encounters. Prehospital Emergency Care, 23(1), 22-31.

Rafla-Yuan, E., Chhabra, D. K., & Mensah, M. O. (2021). Decoupling Crisis Response from Policing — A Step Toward Equitable Psychiatric Emergency Services. New England Journal of Medicine, 384(18), 1769–1773. https://doi.org/10.1056/nejmms2035710 

Riaz, I., Gal Lapid, E. M. T., Mihir Kumar, E. M. T., Trivedi, R., & Sulley Park, E. M. T. (2021). Creating a Protocol for Campus EMS Response to Mental Health Complaints. JCEMS, 4.

Waters, R. (2021). Enlisting Mental Health Workers, Not Cops, In Mobile Crisis Response: The article examines local programs that send health crisis workers and emergency medical technicians, rather than police, to people experiencing serious mental health distress.

How Solution-Focused Brief Therapy Training Can Support The Mental Health Workforce

2022-07-08T19:03:32+00:00June 24th, 2022|

mental health workforce trainingHow can the mental health workforce be sustainably and successfully trained in an evidenced-based brief treatment approach all while meeting their own needs and the mental health needs of a client? How can this be accomplished? This article attempts to provide a framework for answering this very challenging question. Training clinicians within the mental health workforce is a critical component that impacts the quality, access, and cost of mental health care. Behavioral health workforce shortages and increased demand for services have required mental health professionals and organizations to devise innovative service delivery and training strategies.

Solution-focused brief therapy (SFBT) is an evidence-based practice (EBP)  that can assist clinicians, and behavioral health organizations manage long waitlists and increase access to treatment for more clients.  Solution-Focused Brief Therapy has been applied successfully across a wide range of professions and fields, in a transdisciplinary manner, for a broad range of mental health conditions (Beyebech, M. et al., 2021).

Solution-focused brief therapy can provide a solution to open up enrollments assisting clients in “graduating” from discrete treatment episodes. SFBT can help clinicians and mental health organizations manage surging caseloads, staff retention and burnout, and increasingly complex client needs that have only worsened with the mental health COVID pandemic.

One component of caring for the mental health workforce is providing high-quality training programs. Effective training includes equipping medical and mental health professionals with brief, practical tools that clinicians can apply right away. Despite the acute need for evidence-based brief and practical therapeutic approaches, often these are not extensively taught in training programs.  Solution-focused brief therapy is an evidenced-based, hopeful, pragmatic approach that quickly engages with clients and assists them in developing a plan of action, harnessing a client’s often unrecognized resources both individually and within their social context. SFBT empowers clinicians and clients to navigate purposeful conversations to assist clients in reaching their targeted goals.

The Need for Mental Health Workforce Development

Workforce development and training must advance as an integral centerpiece of behavioral health policy and funding priorities for all policymakers to address the critical mental health needs of our nation. The COVID-19 pandemic has only worsened what were already significant challenges facing the mental health workforce. The Centers for Disease Control and Prevention (CDC) reported that the percentage of U.S. adults with recent symptoms of anxiety or a depressive disorder increased from 36.4% to 41.5% and the percentage reporting unmet mental health needs to be increased from 9.2% to 11.7%, with the largest increase seen among young adults (18-29) during August 2020 to February 2021 (Vahratian A. et al, 2021).  In the early months of the pandemic, the nation saw an 18% increase in overdoses compared with the same months in 2019. The trend only continued throughout the rest of 2020. The American Medical Association recently reported that every state had seen increases in opioid-related mortality (Petterson, S. et al 2020). The United States Surgeon General Vivek H. Murthy came out with a 53-page advisory panel on December 7th, 2021, regarding the mental health challenges in children and stated the situation is dire (Protecting Youth Mental Health: The US Surgeon General’s Advisory, 2021).  A Surgeon General’s Advisory is a public statement that calls the American people’s attention to an urgent public health issue and provides recommendations for how it should be addressed. Advisories are reserved for significant public health challenges that need immediate awareness and action.

“Mental health challenges in children, adolescents, and young adults are real and widespread. Most importantly, they are treatable and often preventable. Combined with an uptick in gun violence, a reckoning on racial justice, a climate emergency, and a divisive political landscape, the coronavirus-related hardships have taken a toll on young Americans’ mental health at a time when it was already in decline. More people seeking help have strained the ability of practitioners to provide treatment, underscoring, experts say, the need to radically change how mental health is addressed in the United States. ” (Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory).  Doctor Vivek Murphy further writes:

“Our obligation to act is not just medical—it’s moral. I believe that coming out of the COVID-19 pandemic, we have an unprecedented opportunity as a country to rebuild in a way that refocuses our identity and common values, puts people first, and strengthens our connections to each other.  If we seize this moment, step up for our children and their families in their moment of need, and lead with inclusion, kindness, and respect, we can lay the foundation for a healthier, more resilient, and more fulfilled nation.”

The reality is that individuals with mental health and substance use needs are facing challenges accessing adequate, timely, and affordable care in every state in the country. Often this leads to dire consequences such as the need for acute care services, engagement in the criminal justice system and in some cases, suicide or overdose. Furthermore, the current crisis is contributing to long documented health disparities, including significant (and avoidable) early mortality for those with behavioral health conditions (de Mooij et al, 2019). Prior to COVID -19, the addiction treatment workforce was experiencing annual turnover rates ranging from 13-52% with nearly half of all organizations operating with significant staff shortages, low recruitment, and retention success. Many workers are continuing to leave the field for higher-paying and less demanding work with young professionals often filling jobs until they are eligible for higher-paying private practice (National Council, HMA prepare recommendations for workforce crisis. Annapolis Coalition. (2022, March 30)

Access to behavioral health services is complex and impacted by systemic factors such as federal and state policy, payment, provider capacity, social determinants of health, historical disparities, and an individual’s capacity to engage in services. Limited funding streams for behavioral health contribute to non-competitive salaries for the nation’s behavioral health workforce. This forms the foundation of the workforce shortages that have developed over time and are now at a crisis point. (Behavioral Health Workforce is a National Crisis: Immediate Policy Actions for States, retrieved 2022).  In addition, the economic, political, and social context in which an organization resides as well as the structure, leadership, and culture of an organization impacts the delivery of quality healthcare. The need for evidence-based training and treatment interventions that can be implemented effectively in a sustainable way within organizations is more critical than ever.

What are the Challenges Associated with Training the Mental Health Workforce in Evidence-Based Practices?

Strategies specifically designed to facilitate the training of mental health practitioners in evidence-based practices (EBPs) have lagged behind the development of the interventions themselves. A report by the United States Surgeon General (1999) suggests that the majority of clients with mental illness do not receive EBP. There are obstacles to the dissemination and implementation of EBP being translated into clinical practice (e.g., criticism of treatment manuals, inadequate training, and unsupportive organizational climates). Understanding how to best disseminate EBP is paramount to reducing the gap between research and practice (Beidas and Kendall 2010). This gap in training mental health practitioners has resulted in a shortage of treatment providers who are adequately trained and supported to provide EBPs and is a major contributor to the “research-to-practice gap”. (Kazdin, A. E. 2008).

General themes and definitions have emerged from the theoretical and empirical literature on training. In the adult education literature, teaching and initial education have been distinguished from training or “retraining” and “mastery of action”. (Thompson 1976). Two complementary processes have been identified as essential for effective implementation of training: the methods through which professionals learn new skills and techniques and systems of ongoing feedback and support to continue to develop the newly acquired skills (Welch et al., 2006).

It has been shown consistently that a “one and done”, or single-exposure training model is limited. “One and done” trainings are inadequate in their ability to produce sustainable results. In order to provide practice related behavioral change and have it be effective, previous training on the EBP seems to be required (Fixsen et al., 2005; Beidas & Kendall 2010).

What is known regarding the implementation and sustainability of training programs?

The ability to engage and train a large, multidisciplinary workforce in the use of EBPs is a necessary but not sufficient condition to demonstrate training effectiveness. It is also necessary for the workforce, once trained, to sustain the use of the EBP (Shapiro et al., 2012). When considering the efficacy and sustainability of effective training programs, it is essential to consider the organization, system, and unique context in which training occurs. Prior research has identified a diversity of elements that affect training implementation. These include the training program, provider characteristics, and the unique social context of organizations implementing training programs (Beidas and Kendall, 2010). Program factors include the quality of an evidence-based practice, training content, and methods of training. Active learning which includes interactive processes that focus on action and reflection within a clinical context is most helpful. Active learning includes modeling, practice opportunities, building self-efficacy, interaction among learners, and role-plays. In addition, ongoing supervision and feedback that builds confidence have been shown to improve therapist adherence and competence (Henggeler et al., 2002). A practitioner’s belief that a particular treatment is useful for their client population improves successful training outcomes.  This includes having success with the treatment approach in a range of settings with “challenging cases”.

The following factors have been shown to promote sustainable transdisciplinary mental health workforce training programs (Lyon et al., 2011).

  • Provider motivation
  • Congruence with existing experience
  • Trained personnel who meet with clinicians in their work settings to discuss the use of specific practices and techniques
  • Encouraging learner participation through active, open-ended questioning
  • Delivering a small number of key empirically-derived messages
  • Distributing concise graphic reference materials
  • Repeat key messages
  • Developing specific plans for individual or group organizational behavioral change
  • Ongoing case-based consultations
  • Interprofessional learning (members of two or more professions learn together)
  • Learning by bringing together multiple disciplines for multiple contacts and exercise
  • A combination of didactics, role plays, case-based learning
  • Small group discussion
  • Web-based resources and facilitator support
  • Formation of peer-to-peer group networks
  • Coaching through direct feedback following observation
  • Reminders to engage in clinical practice behaviors such as being displayed on the screen, stickers or printouts in clinical charts, and clinical checklists
  • Self-regulated learning to help practitioners guide their own goal-setting Self-monitoring for skill acquisition

How does the Institute for Solution-Focused Therapy Develop and Provide Customized Training to Organizations and Their Staff?

The Institute for Solution-Focused Therapy provides diverse and flexible online training choices, including customized hybrid program options that combine live-interactive synchronous experiences with self-paced remote learning components maximizing training effectiveness. We offer a broad range of courses, from introductory to advanced in the practice of SFBT. We also provide ongoing enhancement programs which include solution-focused supervision.  Most of our courses are eligible for continuing education credit. Our transdisciplinary approach engages with many professional disciplines, including physicians, mental health practitioners, educators, para-professionals, nurses, child protection services, EAP organizations, military, chaplains, probation officers, crisis clinicians, and in-home therapy teams, and others.  We provide an initial one-hour free zoom consultation to learn about each unique organization and develop a customized program that meets their needs. Our customized live courses are also available as self-paced versions so staff who are new or unable to attend can be trained while also receiving continuing education credits. Our customized courses include recordings of all the training if desired, copies of slides, materials, and any customized materials that were utilized throughout the course. These customized courses can be purchased at a later date as a self-paced version for new staff or for staff who are unable to attend the entire training. The self-paced customized courses are available for continuing education and include an exam. We hope this will facilitate a sustainable training solution to workforce challenges given the high turnover of staff within many organizations.

During the past 18 months, we have had the privilege of training over 35 organizations. The following are a few training case examples to showcase how organizations have customized their training needs.

Training Case Examples

Integrative Health Care Organizations: CrescentCare

New Orleans, Louisiana

CrescentCare’s mission is to bring caregivers and the community together as partners in health and wellness for all. Their experience builds on more than 30 years of impact through their founding organization, NO/AIDS Task Force. Now, as a Federally Qualified Health Center, they are taking that expertise and expanding it! Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. They must meet stringent requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients. CrescentCare offers a broad range of health and wellness services for anyone and everyone who is seeking healthcare services in Greater New Orleans and Southeastern Louisiana. https://www.crescentcare.org/

Mainstreaming of mental health services has led to an increase in the presentation and care of mental health patients in generalist health settings. There is a well-documented lack of adequate mental health educational preparation within healthcare. Many groups, including primary care physicians, nurse practitioners, and specialty health practitioners, have been identified as ill-equipped to meet the mental and physical health needs of clients.

There are broadly two groups of patients who require mental health services within medical settings: (i) clients with an existing diagnosis of mental illness who have physical conditions requiring ongoing care and (ii) clients who have physical health conditions who develop mental health conditions ( Brunero et al., 2012).

General and specialty practitioners have tremendously demanding workloads, leading to a lack of time, interest, and motivation to attend training. In addition, there is often a lack of organizational support that creates a barrier to the effective implementation of evidence-based practices. Cost and time constraints are also common barriers. To address these issues, CrescentCare reached out to train their Integrative Behavioral Health Team. After an initial Zoom consultation,  the following customized training program was developed.

The entire primary care provider team: CrescentCare began by offering their entire primary care team the 2-hour live training “A Taste of Solution-Focused Skills and Practice”. All providers were invited to a 2-hour live interactive training program. The TASTE has unlimited participants, so the entire provider team could be introduced to the approach and learn how SFBT could help them in their practice across disciplines. This interactive introduction included an overview of the SFBT approach, video demonstrations, and interactive chat discussions with opportunities for questions. It can be used across an organization where executives, administrators, clinicians, case-workers, supervisors, and any staff interested can attend. This provided all staff with 2 hours of continuing education credits. This course can also be recorded as a customized version for new staff or staff unable to attend as a self-paced course that includes a short exam.

For supervisors and “champions” of this approach: A small group of 6 supervisors and integrative behavioral health clinicians choose a combination of more intense self-paced and synchronous training sessions to build their confidence and fluency in order to provide support for other clinicians in their organization. This group took the Foundations of Solution-Focused Online Intensive combined with a small-group BASIC Solution-Focused Skills and Practice interactive training. This small group received more intensive individualized training to support and sustain their staff and serve as “peer champions” of the SFBT approach within the organization. This hybrid intensive training approach provided clinicians with 19.5-course hours plus 12 hours of training for a total of 31.5 continuing education credits.

For the behavioral health clinical staff: A transdisciplinary group of behavioral health clinicians, nurse practitioners, and psychiatrists took the self-paced Solution-Focused Brief Therapy: An Introduction to Clinical Practice combined with the BASIC Solution-Focused Skills and Practice interactive training. This training helped build their confidence and skills in the SFBT approach.

The combination of the self-paced course with written and video demonstrations and the BASIC Solution-Focused Skills and Practice course provided hybrid training opportunities to solidify the foundations of the SFBT approach. The BASIC live course offers 12 hours of training divided into 2-hour sessions every other week. Offering continuing education training in group cohorts builds relationships. Further, it sustains a workforce while also providing a context for staff to continue practicing the skills they develop with each other. BASIC and ADVANCED small group sessions include some review of the material, an ongoing framework of the approach, role-plays, case discussions, interactive video demonstration discussions, breakout sessions, and recommended practice exercises discussed in the following session called “Success and Challenges” rounds. This hybrid training approach provided clinicians with 17 hours of training for a total of 17 continuing education credits.

A Current New Training cohort: Because of the success of the training, a new cohort of clinicians working with the homeless population is getting trained. This cohort includes a talented transdisciplinary staff of clinicians, case managers, and supervisors. They are also receiving a hybrid training approach, including Solution-Focused Brief Therapy: An Introduction to Clinical Practice combined with BASIC Solution-focused skills and practice for agencies.

Future Training options: In addition, there is the opportunity for further training, including ENHANCEMENT sessions to sustain the approach, ADVANCED Solution-focused skills further and practice online interactive sessions, and Solution-Focused SUPERVISION skills and practice. All of these offer further opportunities to sustain the approach within their organization.

Many organizations also pair the self-paced courses with the live cohort training of BASIC Solution-Focused Skills and Practice for agencies. Because we record these live interactive trainings, we now offer SELF-PACED CUSTOMIZED BASIC SKILLS AND PRACTICE  versions for each organization that new staff can take at a later time or for staff who are unavailable for the training, all while obtaining continuing education credits. Providing continual professional development with colleagues and education credits are common reasons for staff satisfaction and can help sustain the workforce and may decrease staff turnover. A combination of Solution-Focused Brief Therapy: An Introduction to Clinical Practice paired with the live or self-paced customized interactive BASIC Skills and skills and practice (that can be offered to staff at later times in a self-paced format) provides 17 continuing education credits!

Click here to see an interview with Lucy Cordts: https://solutionfocused.net/lucy-cordts-crescentcare-health-centers-success-solution-focused-brief-therapy/

Lenape Valley Foundation, Pennsylvania

The mission of Lenape Valley Foundation is to partner with members of their community encountering mental health, substance use, and intellectual or developmental challenges as they pursue their personal aspirations and an enhanced quality of life.  For over 60 years, Lenape Valley Foundation has served adults in the community with a variety of behavioral health needs. Their qualified staff work to provide individuals in our mental health programs, services for individuals with intellectual disabilities, and crisis services with the best possible care to meet their unique needs so that each person can work toward achieving their individual treatment goals. Lenape Valley Foundation also offers a full spectrum of services, dependent on the needs of the individual child and family assisting children and their families to reach their full potential by providing individualized, compassionate care. https://www.lenapevf.org/

Lenape Valley Foundation reached out for training during the COVID-19 pandemic hoping a brief evidence based treatment approach could help to manage the increased demand for mental health services and long waitlists. Their best hopes were to provide comprehensive training within their organization for their dedicated support staff, agency leaders, and full-time staff and clinicians serving on the front lines of the mental health pandemic. After an initial Zoom consultation, the following customized training program was developed.

All of the support staff and agency leaders took the self-paced course: Solution-Focused Brief Therapy: An Introduction to Clinical Practice. All of their full-time staff and therapists took the self-paced course: Foundations of Solution-Focused Practice Online Intensive. In addition, all of their full-time staff and therapists took the live synchronous BASIC Solution-focused skills and practice course.

In our final session on graduation day, we scaled how confident they are in their solution-focused skills as well as how confident they are that they will sustain their skills within their organization. All of the staff rated their confidence between 7-9 and all stated that this is “good enough”. I am summarizing a few of the comments from this dedicated and talented group of clinicians regarding what they have found most helpful from the training and what they know will help them sustain their skills.

  • Having written reminders of the “four-square” guide to the overall approach available to use as needed
  • Maintaining the “yes-set” and incorporating the client’s language within the formulation of questions
  • Incorporating scaling questions to develop a plan
  • Incorporating VIPs – including spiritual VIPs
  • Asking about Best Hopes
  • Asking coping questions and “what have you tried?”
  • Consciously incorporating solution-focused language and questions in conversations
  • Appreciating the solution-focused framework with their other skill sets
  • Listening differently while hearing the same things and choosing to ask different questions
  • Appreciating the client’s progress seeing more hope and actions
  • Having greater skills to manage clients who are “stuck”
  • Asking what do you know questions
  • Having more skills to help clients focus on their goals
  • Starting sessions with “What’s better” or “what’s been happening that you want to continue to happen?
  • Appreciating how useful the approach is with families and couples
  • Helpful in reducing vicarious trauma and increasing vicarious resilience
  • Using “for you” statements paired with coping questions to minimize power struggles and take the pressure off needing to find a solution for clients
  • Seeing the effectiveness of the approach inspires them to do more
  • Incorporating solution-focused approaches within supervision and monthly group meetings
  • Reviewing success and challenges rounds
  • Taking small steps to practice each of the skills
  • Learning the fundamentals and then taking a “deep dive” into more of the skills

Alzheimer’s Association

The Alzheimer’s Association leads the way to end Alzheimer’s and all other dementia — by accelerating global research, driving risk reduction and early detection, and maximizing quality care and support. The Alzheimer’s Association 24/7 Helpline (800.272.3900) is available around the clock, 365 days a year. Through this free service, specialists and master’s-level clinicians offer confidential support and information to people living with dementia, caregivers, families, and the public. https://www.alz.org/

The Institute for Solution-Focused Therapy has had the privilege to provide training for the Alzheimer’s Association’s 24/7 crisis call line. Their goal was to provide skills for their staff so that one 30-minute call would make a difference for those living with or caring for someone with Alzheimer’s or other forms of dementia. During the pandemic, they experienced the all too common challenges associated with managing an increase in  demand for their crisis call hotline services.

The organization had received prior solution-focused training through the Institute of Solution Focused Therapy and was now interested in providing enhancement training for their staff. New staff were offered the self-paced Solution-Focused Brief Therapy: An Introduction to Clinical Practice. Several different cohorts were put into courses based on their prior training experience. The trainings included a review of cases, role-plays, didactics, video demonstrations, and opportunities for practice and questions. All of the sessions were recorded so the organization could use these sessions for future staff training.

Click here to see an interview with David Parris, Clinical Director of the Alzheimer’s Association 24/7 Helpline: https://solutionfocused.net/solution-focused-brief-therapy-alzheimer/

Seacoast Mental Health Center, New Hampshire

Seacoast Mental Health Center’s mission is to provide a broad, comprehensive array of high-quality, effective and accessible mental health services to residents of the eastern half of Rockingham County in New Hampshire. They are a federally qualified health center (FQHC). Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients. Services are available to all individuals in their large service region throughout every stage of life. Services can be accessed in a variety of ways: in their two offices and various community settings, including schools, primary care offices, and telehealth in your own home. https://smhc-nh.org/

Seacoast Mental Health Center reached out for training during the COVID-19 pandemic hoping a brief evidenced treatment approach could help to manage the increased demand for mental health services and long waitlists. Their best hopes were to provide comprehensive training within their organization for their dedicated support staff, agency leaders, and full-time staff and clinicians serving on the front lines of the mental health pandemic. After an initial Zoom consultation,  the following customized training program was developed.

Seacoast Mental Health Center invested in training their entire clinical staff of approximately 125  clinicians. Clinicians were provided a hybrid training approach including a combination of the self-paced course Solution-Focused Brief Therapy: An Introduction to Clinical Practice with the live interactive course BASIC Skills and Practice for Agencies. They invested in 5 separate cohorts so clinicians could experience more personalized training including role-plays, breakout sessions, case discussions, opportunities for consultation with challenging cases, video observation discussions, and between-session practice exercises. All the synchronous training sessions were recorded and available for new hires as a self-paced course with options to earn continuing education credits.

Northwest Human Services, Salem Oregon

Northwest Human Services has been providing residents of Marion and Polk counties with comprehensive medical, dental, mental health, and social services for 50 years. They are a federally qualified health center (FQHC). Federally Qualified Health Centers are community-based health care providers that receive funds from the HRSA Health Center Program to provide primary care services in underserved areas. They must meet a stringent set of requirements, including providing care on a sliding fee scale based on ability to pay and operating under a governing board that includes patients. Their programs are integrated and designed to help support those in our community who need it most. They offer medical, dental, and mental health services on a sliding fee scale based on family size and income.  No one is turned away due to their inability to pay. Homeless youth and adults at our HOST and HOAP Programs access basic needs services, case management, peer support, and health care at our Community Health Centers. Their Crisis & Information Hotline provides 24-hour crisis support and suicide intervention as well as limited emergency financial assistance for rent, utilities, and prescription medications. As long as there is a need, Northwest Human Services will continue to be a safety net providing health care and social services in our community. http://www.northwesthumanservices.org/

Northwest Human Services reached out for training during the COVID-19 pandemic hoping a brief evidenced treatment approach could help to manage the increased demand for mental health services within their integrated behavioral health organization. In particular, they were interested in learning how solution-focused brief therapy could be applied with clients who have experienced trauma.  After an initial Zoom consultation, the following customized training program was developed.

They choose to provide their 16 staff with the self-paced cours:e Solution-focused therapy for the treatment of trauma. They found this helpful and then, a few months later, provided both current and new staff with the self-paced course: Solution-Focused Brief Therapy: An Introduction to Clinical Practice. They also added our self paced introductory course as part of the onboarding process for newly hired staff. Providing faculty with consistent training that can be offered at different times can help to cement an equitable and fluent education to this specific approach of therapy within an organization.

Conclusion

Training with a one-shot method is largely ineffective. The use of traditional workshop models or any single strategy is unlikely to be successful. Instead, a combination of approaches that comprise overlapping techniques and interventions such as interactive didactics, goal identification, small group discussion, critical thinking, self-reflection, peer collaboration, independent access to information, direct feedback, and follow-up have been found to be the most effective. Successful training is complex and involves attention to clinician engagement, active methods of promoting skill acquisition and providing ongoing support to solidify skills and build confidence. Transdisciplinary training emphasizing real-world clinical examples in practice and promoting self-regulated learning is essential. Of course, there is a need for implementation training to be studied including intervention fidelity, client outcomes, provider confidence, and the mechanisms for training effectiveness. Comprehensive training programs are essential to achieve implementation. Providers will need time and resource allocation to solidify their skills and acquisition. We invite all clinicians to complete evaluations and post-training feedback surveys to continue to improve and develop engaging, evidence-based, cost- and time-effective training.

References

Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17(1), 1-30.

Behavioral Health Workforce is a national crisis: Immediate policy … (n.d.). Retrieved June 20, 2022, from https://www.thenationalcouncil.org/wp-content/uploads/2022/01/Behavioral-Health-Workforce-is-a-National-Crisis

Beyebach, M., Neipp, M.-C., Solanes-Puchol, Á., & Martín-del-Río, B. (2021). Bibliometric differences between weird and non-weird countries in the outcome research on solution-focused brief therapy. Frontiers in Psychology, 12

Brunero, S., Jeon, Y. H., & Foster, K. (2012). Mental health education programmes for generalist health professionals: An integrative review. International Journal of Mental Health Nursing, 21(5), 428-444.

De Mooij, L. D., Kikkert, M., Theunissen, J., Beekman, A. T., De Haan, L., Duurkoop, P. W., … & Dekker, J. J. (2019). Dying too soon: Excess mortality in severe mental illness. Frontiers in Psychiatry, 10, 855.

Druss, B. G., Cohen, A. N., Brister, T., Cotes, R. O., Hendry, P., Rolin, D.,  & Gorrindo, T. (2021). Supporting the mental health workforce during and after COVID-19. Psychiatric services, 72(10), 1222-1224.

Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., Wallace, F., Burns, B., … & Shern, D. (2005). Implementation research: A synthesis of the literature.

Guiding principles for workforce development – national council. (n.d.). Retrieved June 20, 2022, from https://www.thenationalcouncil.org/wp-content/uploads/2020/01/Guiding_Principles_for_Workforce_Development.pdf?daf=375ateTbd56 

Heisler, E. J., The Mental Health Workforce: A Primer https://sgp.fas.org/crs/misc/R43255.pdf. 2021.

Henggeler, S. W., Schoenwald, S. K., Liao, J. G., Letourneau, E. J., & Edwards, D. L. (2002). Transporting efficacious treatments to field settings: The link between supervisory practices and therapist fidelity in MST programs. Journal of Clinical Child and Adolescent Psychology, 31(2), 155-167.

Kalani, S. D., Azadfallah, P., Oreyzi, H., & Adibi, P. (2018). Interventions for physician burnout: A systematic review of systematic reviews. International journal of preventive medicine, 9.

Kazdin, A. E. (2008). Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American psychologist, 63(3), 146.

Lyon, A. R., Stirman, S. W., Kerns, S. E., & Bruns, E. J. (2011). Developing the mental health workforce: Review and application of training approaches from multiple disciplines. Administration and Policy in Mental Health and Mental Health Services Research, 38(4), 238-253.

National Council, HMA prepare recommendations for workforce crisis. Annapolis Coalition. (2022, March 30). Retrieved June 20, 2022, from https://annapoliscoalition.org/national-council-hma-prepare-recommendations-for-workforce-crisis

Panagioti, M., Geraghty, K., Johnson, J., Zhou, A., Panagopoulou, E., Chew-Graham, C., & Esmail, A. (2018). Association between physician burnout and patient safety, professionalism, and patient satisfaction: a systematic review and meta-analysis. JAMA internal medicine, 178(10), 1317-1331.

Petterson, S., Westfall, J. M., & Miller, B. F. (2020). Projected deaths of despair during the coronavirus recession. Well Being Trust, 8, 2020.

Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory

Click here for the full report: Surgeon General Youth Mental Health Advisory 2021

Romppanen, J., & Häggman-Laitila, A. (2017). Interventions for nurses’ well‐being at work: a quantitative systematic review. Journal of advanced nursing, 73(7), 1555-1569.

Ruzycki, S. M., & Lemaire, J. B. (2018). Physician burnout. CMAJ, 190(2), E53-E53.

Shapiro, C. J., Prinz, R. J., & Sanders, M. R. (2012). Facilitators and barriers to implementation of an evidence-based parenting intervention to prevent child maltreatment: the Triple P-Positive Parenting Program. Child Maltreatment, 17(1), 86-95.

Swain, K., Whitley, R., McHugo, G. J., & Drake, R. E. (2010). The sustainability of evidence-based practices in routine mental health agencies. Community mental health journal, 46(2), 119-129.

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Vahratian, A., Blumberg, S. J., Terlizzi, E. P., & Schiller, J. S. (2021). Symptoms of anxiety or depressive disorder and use of mental health care among adults during the COVID-19 pandemic—United States, August 2020–February 2021. Morbidity and Mortality Weekly Report, 70(13), 490.

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Solution-Focused Article List Evidence 2019 updated

2020-07-21T19:36:08+00:00February 5th, 2020|

Brockman, Mariah, et al. “Managing Child Behavior Problems in Children With Autism Spectrum Disorders: Utilizing Structural and Solution Focused Therapy With Primary Caregivers.” The American Journal of Family Therapy, vol. 44, no. 1, 2015, pp. 1–10., doi:10.1080/01926187.2015.1099414.

Carr, Alan, et al. “Parents Plus Systemic, Solution-Focused Parent Training Programs: Description, Review of the Evidence Base, and Meta-Analysis.Family Process, vol. 56, no. 3, 2016, pp. 652–668., doi:10.1111/famp.12225.

Corcoran, Jacqueline. “A Comparison Group Study of Solution-Focused Therapy versus ‘Treatment-as-Usual’ for Behavior Problems in Children.Journal of Social Service Research, vol. 33, no. 1, 2006, pp. 69–81., doi:10.1300/j079v33n01_07.

Creswell, Cathy, et al. “Clinical Outcomes and Cost-Effectiveness of Brief Guided Parent-Delivered Cognitive Behavioural Therapy and Solution-Focused Brief Therapy for Treatment of Childhood Anxiety Disorders: a Randomised Controlled Trial.The Lancet Psychiatry, vol. 4, no. 7, 2017, pp. 529–539., doi:10.1016/s2215-0366(17)30149-9.

Franklin, Cynthia, et al. “Solution Focused Brief Therapy: A Systematic Review and Meta-Summary of Process Research.Journal of Marital and Family Therapy, vol. 43, no. 1, 2016, pp. 16–30., doi:10.1111/jmft.12193.

Franklin, Cynthia, et al. Solution-Focused Brief Therapy: a Handbook of Evidence-Based Practice. Oxford University Press, 2012.

Froeschle, Janet, et al. “The Efficacy of a Systematic Substance Abuse Program for Adolescent Females.Professional School Counseling, vol. 10, no. 5, 2007, pp. 498–505., doi:10.5330/prsc.10.5.a458605px1u57217.

Gassmann, Daniel, and Klaus Grawe. “General Change Mechanisms: the Relation between Problem Activation and Resource Activation in Successful and Unsuccessful Therapeutic Interactions.Clinical Psychology & Psychotherapy, vol. 13, no. 1, 2006, pp. 1–11., doi:10.1002/cpp.442.

Gingerich, W. J., and L. T. Peterson. “Effectiveness of Solution-Focused Brief Therapy: A Systematic Qualitative Review of Controlled Outcome Studies.Research on Social Work Practice, 2013, doi:10.1177/1049731512470859.

Gong, Huoliang, and Weisu Hsu. “The Effectiveness of Solution-Focused Group Therapy in Ethnic Chinese School Settings: A Meta-Analysis.International Journal of Group Psychotherapy, vol. 67, no. 3, 2016, pp. 383–409., doi:10.1080/00207284.2016.1240588.

Hosany, Z., et al. “Fostering a Culture of Engagement: a Pilot Study of the Outcomes of Training Mental Health Nurses Working in Two UK Acute Admission Units in Brief Solution-Focused Therapy Techniques.Journal of Psychiatric and Mental Health Nursing, vol. 14, no. 7, 2007, pp. 688–695., doi:10.1111/j.1365-2850.2007.01161.x.

Kim, Johnny S. “Examining the Effectiveness of Solution-Focused Brief Therapy: A Meta-Analysis.Research on Social Work Practice, vol. 18, no. 2, 2007, pp. 107–116., doi:10.1177/1049731507307807.

Kim, Johnny S., et al. “Solution-Focused Brief Therapy in China: A Meta-Analysis.Journal of Ethnic & Cultural Diversity in Social Work, vol. 24, no. 3, 2015, pp. 187–201., doi:10.1080/15313204.2014.991983.

Kim, Johnny S., et al. “Solution-Focused Brief Therapy to Improve Child Well-Being and Family Functioning Outcomes with Substance Using Parents in the Child Welfare System.Developmental Child Welfare, vol. 1, no. 2, 2019, pp. 124–142., doi:10.1177/2516103219829479.

Kim, Johnny S., et al. “Solution-Focused Brief Therapy With Substance-Using Individuals.Research on Social Work Practice, 2016, p. 104973151665051., doi:10.1177/1049731516650517.

Kim, Johnny, et al. “Is Solution-Focused Brief Therapy Evidence-Based? An Update 10 Years Later.Families in Society: The Journal of Contemporary Social Services, vol. 100, no. 2, 2019, pp. 127–138., doi:10.1177/1044389419841688.

Kramer, Jeannet, et al. “Effectiveness of a Web-Based Solution-Focused Brief Chat Treatment for Depressed Adolescents and Young Adults: Randomized Controlled Trial.Journal of Medical Internet Research, vol. 16, no. 5, 2014, doi:10.2196/jmir.3261.

Mache, Stefanie, et al. “Evaluation of Self-Care Skills Training and Solution-Focused Counselling for Health Professionals in Psychiatric Medicine: a Pilot Study.International Journal of Psychiatry in Clinical Practice, vol. 20, no. 4, 2016, pp. 239–244., doi:10.1080/13651501.2016.1207085.

Panayotov, Plamen A., et al. “Solution-Focused Brief Therapy and Medication Adherence with Schizophrenic Patients.Solution-Focused Brief Therapy, 2011, pp. 196–202., doi:10.1093/acprof:oso/9780195385724.003.0078.

Roeden, J. M., et al. “Processes and Effects of Solution-Focused Brief Therapy in People with Intellectual Disabilities: a Controlled Study.Journal of Intellectual Disability Research, vol. 58, no. 4, 2013, pp. 307–320., doi:10.1111/jir.12038.

Schmit, Erika L., et al. “Meta-Analysis of Solution-Focused Brief Therapy for Treating Symptoms of Internalizing Disorders.Counseling Outcome Research and Evaluation, vol. 7, no. 1, 2016, pp. 21–39., doi:10.1177/2150137815623836.

Smock, Sara A. “A Review of Solution-Focused, Standardized Outcome Measures and Other Strengths-Oriented Outcome Measures.Solution-Focused Brief Therapy, 2011, pp. 55–72., doi:10.1093/acprof:oso/9780195385724.003.0026.

Smock, Sara A., et al. “Solution-Focused Group Therapy for Level 1 Substance Abusers.Journal of Marital and Family Therapy, vol. 34, no. 1, 2008, pp. 107–120., doi:10.1111/j.1752-0606.2008.00056.x.

Stermensky, Gage, and Kristinas Brown. “The Perfect Marriage: Solution-Focused Therapy and Motivational Interviewing in Medical Family Therapy.” Journal of Family Medicine and Primary Care, vol. 3, no. 4, 2014, p. 384., doi:10.4103/2249-4863.148117.

Trepper, Terry S., et al. “Solution-Focused Brief Therapy Treatment Manual.Solution-Focused Brief Therapy, 2011, pp. 20–36., doi:10.1093/acprof:oso/9780195385724.003.0015.

Zhang, Anao, et al. “The Effectiveness of Strength-Based, Solution-Focused Brief Therapy in Medical Settings: a Systematic Review and Meta-Analysis of Randomized Controlled Trials.Journal of Behavioral Medicine, vol. 41, no. 2, 2017, pp. 139–151., doi:10.1007/s10865-017-9888-1.

Solution-Based Therapy Finding More Prominent Role

2020-01-31T19:42:04+00:00January 31st, 2020|

As physicians shift care from a disease-centered to a patient-centered clinical method, there is a need for a compatible counseling paradigm. Solution-focused therapy is a competency-based model that minimizes emphasis on past problems and failings and instead focuses on patient strengths and resources (Trepper et al., 2006).

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