Music Therapists as Clients: Therapy-Seeking and Utilization of Personal Therapy by Music Therapists

The purpose of this study was to investigate factors related to personal therapy for board-certified music therapists (MT-BCs), specifically regarding the rate of past and present therapy attendance, type of therapy utilized, reason(s) music therapists seek therapy, and the role of gender identity or theoretical orientation on rates of therapy utilization. Music therapists were considered as both professional musicians and allied health professionals, potentially exposing them to both areas of occupational risk relating to psychological stress or illness. A survey was created and sent out to all MT-BCs who opted to receive research inquiries (8,493), with a return of 945 usable responses. The majority of participants indicated that they have attended therapy or counseling at some point in time during their career. The most commonly utilized form of therapy was talk therapy or verbal counseling. Common reasons for therapy attendance were to seek personal insight, address a mental health concern, address feelings of stress from work, and address a mental illness. There was no apparent difference in therapy-seeking dependent on gender identity, but participants with theoretical orientations that emphasize the importance of personal insight may have higher rates of therapy utilization. Implications from the findings of the study and recommendations for future research were discussed.

Speech-Language Therapy Experiences Across the Life Span of an Individual Who Covertly Stutters: A Thematic Analysis

Purpose The current research study investigates the speech therapy experiences of an individual who covertly stuttered for approximately 40 years; at the time of the interview, she was in her mid-40s. Method The single-case study is a qualitative thematic analysis of the speech therapy experiences of one individual across her life span. In addition to her stuttering, the participant lives with a significant primary diagnosis that she has had since birth, which impacts her activities in daily living. Interview questions were open-ended and conducted via Skype. The interview was transcribed, and a thematic analysis of the recorded transcripts was conducted to investigate her experiences in speech therapy as an individual who covertly stutters. Findings The current findings reveal five major themes regarding the speech therapy experiences of an individual who covertly stutters: (a) nonindividualized treatment and goals, (b) blaming and shaming associated with speech therapy and stuttering, (c) positive self-regard during speech therapy attendance, (d) the use of avoidance strategies and relation to speech therapy, and (e) the evolution of therapy goals. Direct quotations from the participant are used to support these themes. Discussion The significant impact of covert stuttering on an individual is discussed. Results from the participant's experiences indicate an essential need to conduct individualized speech therapy for people who stutter. Speech-language pathologists and others working with persons who stutter maintain a responsibility to recognize the role that case history and counseling play in order to appropriately serve people who covertly stutter.

Engagement in Cognitive-Behavioral Therapy for Chronic Pain Management Is Associated with Reductions in Healthcare Utilization in Pediatric Sickle Cell Disease

Introduction: Chronic pain in sickle cell disease (SCD) is a multifactorial complication that can contribute to high healthcare utilization. Multidisciplinary treatments going beyond medication alone are needed for the most effective chronic pain management. Cognitive-behavioral therapy (CBT) is effective for youth with chronic pain and focuses on improving daily functioning and coping, but the clinical effectiveness for chronic SCD pain has not been evaluated. This study examined changes in healthcare use over time for youth with chronic SCD pain who participated in CBT compared to controls with chronic SCD pain who never initiated CBT. Methods: Youth receiving care at comprehensive SCD clinics at three tertiary care locations at Children's Healthcare of Atlanta were included if they were aged 6-18 years, any SCD genotype, and referred to a pediatric psychology outpatient clinic for chronic pain management from November 2014-March 2018. Youth were excluded if they received bone marrow transplantation during the study period, had ongoing CBT past the study period, or were not actively followed for ≥1 year of medical care pre- or post-CBT. Patients were grouped based on therapy attendance: Established Care (i.e., attended ≥3 CBT sessions within 3 consecutive months); Early Termination (i.e., attended <3 CBT sessions within 3 consecutive months); or Control (i.e., did not attend any CBT visits). Patient-reported outcomes included typical pain intensity, functional disability, and coping efficacy at pre- and post-treatment. Healthcare utilization outcomes were abstracted from electronic medical records including: number of inpatient admissions for pain, total inpatient days for pain, and emergency department dependency ratio (EDR; ratio of ED visits to sum of ED and outpatient visits). For the treatment groups, utilization outcomes were calculated from 12-months prior to the first CBT visit, and from 12-months following the last CBT visit. For the control group, outcomes were calculated for 12-months prior to the referral date, and from 12-months following the average duration of CBT for treatment groups (i.e., 3.5 months) to account for passage of time. Changes over time in inpatient admissions, hospital days, and EDR were evaluated separately using linear mixed effect models with a random effect for person-specific intercepts and slopes, which were retained based on model contribution determined by Bayesian Information Criterion. Time, patient characteristics, SCD-modifying treatments, therapy attendance, number of CBT sessions, and interaction effects were initially included in the models; the most parsimonious models were chosen based on backward selection. Results: At time of referral, youth (n=101) were on average (M) 13.4 years old (SD=2.92), 56.4% female, 68.1% HbSS or HbSβ0, 63.9% prescribed hydroxyurea, and 12.6% received chronic transfusions. The Control (n=44) and Treatment Groups (n=57) did not significantly differ by age, sex, genotype, or treatment with hydroxyurea or chronic transfusion. Based on therapy attendance, 36.1% Established Care, 21.8% were Early Termination, and 42% Controls. Adjusting for age, genotype, and hydroxyurea, patients who terminated CBT early had increased admissions and total hospital days over time compared to controls; those who established care had a reduction in admissions and hospital days over time compared to controls (F's=3.27-3.61, p's<.05). EDR decreased by 0.1 over time for Established Care; for every 1 completed CBT session, EDR was further reduced by 0.01 (p<.05). Patients who completed CBT (n=18) reported decreases in typical pain intensity (Mpre= 5.47, SD=2.24; Mpost=3.76, SD=2.84; p<.01), functional disability (Mpre=26.24, SD=8.45; Mpost=15.18, SD=10.85; p<.001), and improved coping efficacy (Mpre=8.0, SD=2.21; Mpost=9.65, SD=2.94; p<.05) from pre- to post-treatment. Conclusions: Establishing care in CBT may support reductions in admissions for pain, length of stay, and ED dependency for youth with chronic SCD pain beyond the potential effects of age, genotype, and SCD-modifying treatments. Reductions in utilization may be partially supported by patient-reported improvements in functioning, coping, and lower pain intensity following CBT. Reducing barriers to access and enhancing clinical implementation of multidisciplinary treatments may optimize the health of youth with chronic SCD pain. Disclosures Lane: NHLBI: Research Funding; CDC: Research Funding; GA Dept: Other: Contract for newborn screeninjg follow-up services services; Bio Products Laboratory: Other: Sickle Cell Advisory Board; FORMA Therapeutics: Other: Clinical Advisory Board. Dampier:Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Micelle BioPharma: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Global Blood Therapeutics: Consultancy; Epizyme: Consultancy; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Katz Foundation: Research Funding; Modus Therapeutics: Consultancy; NIH: Research Funding; Merck: Research Funding.

Interconsulta psiquiátrica: fatores de encaminhamento para a terapia ocupacional em saúde mental / Consultation-liaison psychiatry: factors referral from occupational therapy in mental health

Introdução: As intervenções em terapia ocupacional associadas com serviços de interconsulta psiquiátrica não são usuais, embora contribuam para a redução do estresse do paciente e facilitem a continuidade dos cuidados. Objetivo: Identificar o perfil demográfico, clínico e psiquiátrico dos pacientes assistidos por um interconsultor psiquiatra e encaminhados a um terapeuta ocupacional de saúde mental, e os respectivos motivos. Métodos: Estudo transversal descritivo eu comparou 139 pacientes avaliados em um serviço de interconsulta psiquiátrica que foram encaminhados para o atendimento de terapia ocupacional em saúde mental com os 561 pacientes do mesmo serviço de interconsulta que não foram encaminhados. Realizou-se um modelo de analise de regressão logística no qual a variável dependente foi o fator encaminhamento para a terapia ocupacional e as demais variáveis sóciodemográficas, clinicas, psiquiátricas e ocupacionais foram avaliadas como possíveis variáveis preditoras (método backward). Resultados: Os pacientes que se aposentaram por incapacidade, com maior número de consultas anteriormente ao encaminhamento, hospitalizados em unidades de diálise, hematologia, ginecologia e clínica cirúrgica eram mais propensos a serem encaminhados à terapia ocupacional. A redução da probabilidade de encaminhamento foi associada ao aumento da idade e à presença de sintomas de psicose, confusão mental ou agressividade. Conclusão: Os pacientes encaminhados por interconsultores psiquiatras, para a terapia ocupacional em saúde mental, integravam um subgrupo com características que contribuíam com a previsão de decisões de encaminhamento. Esses pacientes apresentaram dificuldades em lidar com a doença, maior vulnerabilidade pessoal e uma série de comportamentos e atitudes de preocupação e angústia em relação a sua doença ou hospitalização que os conduziria a situações de ruptura e estresse. Abstract Background: Interventions in occupational therapy in combination with consultation-liaison psychiatry services are uncommon, although they contribute to patient's reduction of stress, and facilitate the continuity of care. Objective: To identify the demographic, clinical and psychiatric profile of patients seen by a consultation-liaison psychiatrist and referred to a mental health occupational therapist and the reasons for referral. Methods: This is a cross-sectional study which compared 139 patients under evaluation in a consultation-liaison psychiatry service and who were referral to a mental health occupational therapy attendance with 561 patients also under consultation-liaison psychiatry but not referred to occupational therapy. It was developed a logistic regression analysis in which the dependent variable was the referral to occupational therapy and the sociodemographic, clinical, psychiatric and occupational variables were predictors (backward methods). Results: Patients retired on disability, with a high number of consultations before referral, hospitalized in dialysis, hematology, gynecology and plastic surgery units, and those whose attending staff received guidance intervention were more likely to be referred to occupational therapy. Reduced likelihood for referral was associated with with higher age and presence of symptoms of psychosis/confusion or aggression. Conclusion: Patients referred by consultation-liaison psychiatrists to a mental health occupational therapy comprised a subgroup with characteristics that contribute to the prediction of referral decisions. These patients showed difficulties in dealing with the disease, personal vulnerability, and a series of behaviors and attitudes regarding their disease that may lead to rupture episodes.Keywords: General hospital; Mental health; Occupational therapy; Referral and consultation.

Concurrent and Predictive Validity of the Instrument for Forensic Treatment Evaluation: From Risk Assessment to Routine, Multidisciplinary Treatment Evaluation

Besides assessment of forensic patients’ risk of future violence and criminogenic needs, knowledge on their responsivity to treatment is equally important. However, instruments currently used for risk assessment are not sensitive enough for treatment evaluation. Therefore, the Instrument for Forensic Treatment Evaluation (IFTE) was developed. The IFTE is a treatment evaluation tool, which uses the dynamic risk items of the Dutch risk assessment tool, the HKT-R (Historical, Clinical, Future–Revised). The IFTE has an extended answering scale, which makes it more sensitive for measuring change and enables clinicians to monitor patients’ responsivity to treatment closely. This study examines the concurrent and predictive validity of the IFTE. We found moderate to strong correlations between IFTE items and HKT-30 items (the HKT-30 is the predecessor of the HKT-R), with work and therapy attendance, and positive drug tests. In addition, we found moderate to modest correlations between some IFTE items and work and therapy attendance in a 6-month follow-up period and modest to high discriminative power for some IFTE items for violence and drug use 6 months after the measurement. Given its good reliability and validity properties, and comprehensive but short-term nature, implementation of the IFTE in forensic practice likely improves individual treatment of forensic psychiatric patients and has high potential for risk management purposes.