May 16, 2007 Can you imagine an archer trying to improve her accuracy by practicing blindfolded, never seeing how close she was to hitting her target, never getting any information to help correct her aim"
Until now, doctors and clinicians treating teens with mental health concerns were in the same position as that blindfolded archer, providing services week after week with no objective and systematic feedback about the effects of their treatment. A new tool developed by Vanderbilt Peabody College of education and human development researchers will remove that blindfold by providing ongoing feedback to service providers, with a goal of enabling mid-course treatment corrections. The tool is called the Peabody Treatment Progress Battery, or PTPB.
"There are laboratory studies that show treatments are very effective with youth who have mental health concerns, but when we look in the real treatment world we are hard pressed to identify services that are effective," Leonard Bickman, director of the Center for Evaluation and Program Improvement and associate dean for research at Peabody College, said. Bickman led the team that developed the PTPB. "The PTPB offers a revolutionary opportunity to improve mental health services. Mental health professionals need to know if they are succeeding during treatment and, if they are not, they need to know what to change. The PTPB gives them that information."
The PTPB includes 10 measures of the responses of youth aged 11-18 years to mental health interventions. All were rigorously evaluated to ensure their clinical relevance. They include factors such as a child's sense of hopefulness, their relationship with the therapist, their expectations of treatment and their satisfaction with services.
"Providers of children's mental health services have long expressed their frustration to the research community at the lack of a comprehensive, feasible and scientifically developed set of measures for assessing process and outcome. Existing measures have been too time consuming, too limited in the domains and perspectives assessed, too costly, or insufficient with regard to scientific validity," Abram Rosenblatt, professor and researcher in the Department of Psychiatry at University of California, San Francisco, said. "The PTPB is the first comprehensive set of measures that can be used routinely to assess process and outcomes of treatment services across multiple domains and perspectives and it meets the highest level of scientific rigor. This is a landmark contribution to children's mental health services and research."
In addition to monitoring the teen's response to treatment, the PTPB also evaluates how the child's caregiver is managing stress and their perception of treatment progress, as well as the clinician's own evaluation of progress. It is this comparison of what the clinician thinks is effective with what the child and his or her caregiver reports that Bickman believes makes the battery an especially powerful tool.
"Therapy isn't carpentry -- you can't just look at your work and determine if you've met your goals. You can't get accurate feedback from the task itself, so you need to collect feedback in a systematic way," he said. "Use of the PTPB will provide feedback that is hard to disregard, and will also insert some accountability for producing results into the mental health system that currently is not there."
The PTPB takes approximately five to eight minutes a week per patient. It was designed to apply to most types of treatment and was written at a fourth-grade reading level in English and Spanish. It is available online free of charge from Vanderbilt at http://peabody.vanderbilt.edu/PTPB.
"After years of trying to find a clinical measurement system that was both practical and valid, the PTPB is both of those and more," Natasha S. Walsh, vice president of Clinical Services for Providence Service Corporation, said. "Our clinicians are getting information they are able to use to inform and enhance treatment. Our supervisors are getting information they can use to help the clinicians grow into better clinicians. Our agency is getting the information on clinical outcomes and processes needed to improve the quality of our services. Our counselors have said 'it's giving me information I never would have gotten.'"
Development of the PTPB was partially funded by the National Institute of Mental Health. Bickman is a Vanderbilt Kennedy Center for Research on Human Development investigator.
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