Leonard Bickman

Vanderbilt University | Vander Bilt · Department of Psychology and Human Development

Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens' Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability...

Nine hundred and seventy million individuals across the globe are estimated to carry the burden of a mental disorder. Limited progress has been achieved in alleviating this burden over decades of effort, compared to progress achieved for many other medical disorders. Progress on outcome improvement for all medical disorders, including mental disord...

Community implementation of evidence-based practices (EBPs) for Attention Deficit/Hyperactivity Disorder (ADHD) is greatly lacking. A recent randomized community-based trial of an EBP for ADHD (Supporting Teens’ Autonomy Daily; STAND) demonstrated suboptimal implementation and effectiveness outcomes. In the present study, we conducted an Innovation...

Background Financial incentives may aid recruitment to clinical trials, but evidence regarding risk/burden-driven variability in participant preferences for incentives is limited. We developed and tested a framework to support real-world decisions on recruitment budget. Methods We included two phases: an Anchoring Survey, to ensure we could captur...

Evidence-based behavior therapy for adolescent ADHD faces implementation challenges in real-world settings. The purpose of this trial was to investigate the relationship between implementation fidelity and outcomes among adolescents receiving services in the active treatment arm (N=114; Motivational Interviewing (MI)-enhanced parent-teen behavior t...

This conceptual paper describes the current state of mental health services, identifies critical problems, and suggests how to solve them. I focus on the potential contributions of artificial intelligence and precision mental health to improving mental health services. Toward that end, I draw upon my own research, which has changed over the last ha...

Objective This study tests the effectiveness of parent-teen psychotherapy for adolescent ADHD (Supporting Teens’ Autonomy Daily; STAND) versus Usual Care (UC) in four community clinics. Method A randomized clinical trial was conducted with double randomization of adolescents and therapists to STAND vs. UC. Participants were 278 culturally-diverse...

Despite the promise of psychosocial interventions for adolescent Attention Deficit Hyperactivity Disorder (ADHD), there are no studies that examine their implementation in community mental health contexts. In this study, we evaluate the implementation of community-based Supporting Teens’ Autonomy Daily (STAND), a parent-teen Motivational Interviewi...

Introduction: With 116 000 people waiting for transplants and 8000 patients dying annually on waiting lists, the United States has a considerable organ shortage. An insufficient number of Americans have registered to become organ donors when obtaining driver's licenses or ID cards. Across states, there is considerable variability in organ donor re...

Objective: To evaluate the effectiveness of patient-centered communication training for military providers who conduct post-deployment health screening. The half-day interactive workshop included simulated Soldier patients using video technology. Methods: Using a quasi-experimental design, all health care providers at four military treatment fac...

This study explored how clinician-reported content addressed in treatment sessions was predicted by clinician feedback group and multi-informant cumulative problem alerts that appeared in computerized feedback reports for 299 clients aged 11-18 years receiving home-based community mental health treatment. Measures included a clinician report of con...

A randomized experiment was conducted in two outpatient clinics evaluating a measurement feedback system called contextualized feedback systems. The clinicians of 257 Youth 11-18 received feedback on progress in mental health symptoms and functioning either every 6 months or as soon as the youth's, clinician's or caregiver's data were entered into...

Measurement feedback systems (MFSs) have been proposed as a means of improving practice. The present study examined the implementation of a MFS, the Contextualized Feedback System (CFS), in two community-based clinic sites. Significant implementation differences across sites provided a basis for examining factors that influenced clinician uptake of...

The aim of this study is to determine the extent to which principals’ self-ratings of leadership effectiveness coincide with their teachers’ perceptions of their leadership effectiveness. Furthermore, we explore several characteristics of teachers and principals in an attempt to identify the factors that may predict congruence in perceptions of lea...

Consecutive English and Spanish speaking caregivers of 6–24 month old children were randomly assigned to either a control or intervention group. Parents in the intervention group were instructed to view at least 4 options to discipline a child in an interactive multimedia program. The control group participants received routine primary care with th...

To determine if brief primary care interventions can affect children's media viewing habits and exposure to violence. English- and Spanish-speaking parents of 2- to 12-year-old children presenting to a pediatric primary care clinic participated in a randomized controlled trial. There were 2 intervention groups; one group viewed 5 minutes from the P...

In this study we use longitudinal data from a randomized experiment to investigate the impact of a feedback and coaching intervention on principals’ leadership behaviors. In our sample of 52 elementary and middle schools, half of the principals received feedback only, while the other half received both feedback and coaching. We analyze changes in t...

Progress in patient safety improvement has been hindered by a lack of high-quality research on error prevention, poor understanding of how context influences safety strategies, and insufficient information on how best to implement evidence-based safety strategies. The Agency for Healthcare Research and Quality funded a multi-institutional effort to...

This special issue is unusual in that it contains only one empirical article. We usually have several articles in our special issues, but this issue focuses on a single paper with eight commentaries. I sought out Ann Garland and her colleagues because of their experience in conducting research on usual care for children and youth in clinic settings...

The authors explored the feasibility of providing frequent, brief client contact as a strategy for reallocating Assertive Community Treatment (ACT) staff time to new clients, while preserving relationships with current clients and ACT program fidelity standards. A retrospective analysis of 4 years of service records for a high-fidelity ACT team rev...

Usual care in the community is far from optimal. Sufficient evidence exists that dropout rates are significant, treatment is effective for only a small proportion of clients, and that the translation of evidence-based treatments to the real world is problematic. Technology has been shown to be helpful in health care in improving the effectiveness o...

This paper presents results from a three-part study on diagnosis of children with affective and behavior disorders. We examined the reliability, discriminant, and predictive validity of common diagnoses used in mental health services research using a research diagnostic interview. Results suggest four problems: a) some diagnoses demonstrate interna...

This paper presents the psychometric evaluation of brief measures of therapeutic alliance (TA) for youths, clinicians and caregivers and a longitudinal analysis of relationships between changes in TA and changes in youth symptom and functioning severity. Psychometric analyses using methods from Classical Test Theory, Item Response Theory, and Facto...

This paper describes the development and psychometric evaluation of the symptoms and functioning severity scale (SFSS), which includes three parallel forms to systematically capture clinician, youth, and caregiver perspectives of youth symptoms on a frequent basis. While there is widespread consensus that different raters of youth psychopathology v...

There is widespread need for the inclusion of service satisfaction measures in mental health services evaluation. The current paper introduces the Service Satisfaction Scale (SSS), a practical and freely available measure of global youth and adult caregiver service satisfaction. The development process, as well as results from a comprehensive psych...

This study explores the relationship between clinician-reported content addressed in sessions, measured with the Session Report Form (SRF), and multi-informant problem alerts stemming from a larger battery of treatment process and progress measures. Multilevel Multinomial Logit Models were conducted with 133 clinicians and 299 youths receiving home...

There is increased need for comprehensive, flexible, and evidence-based approaches to measuring the process and outcomes of youth mental health treatment. This paper introduces a special issue dedicated to the Peabody Treatment Progress Battery (PTPB), a battery of measures created to meet this need. The PTPB is an integrated set of brief, reliable...

Person mobility is an inescapable fact of life for most cluster-randomized (e.g., schools, hospitals, clinic, cities, state) cohort prevention trials. Mobility rates are an important substantive consideration in estimating the effects of an intervention. In cluster-randomized trials, mobility rates are often correlated with ethnicity, poverty and o...

To assess whether a multimedia program can affect counseling behavior related to one of the strongest risk factors for violence later in life, persistent early childhood aggression. The design was a controlled trial with unobtrusive measurement in a clinic setting. A researcher, pretending to be the mother of a 2 ½ year old boy, called 19 pediatric...

A randomized cluster controlled trial tested the hypothesis that weekly feedback to clinicians would improve the effectiveness of home-based mental health treatment received by youths in community settings. Youths, caregivers, and clinicians at 28 sites in ten states completed assessments of the youths' symptoms and functioning every other week. Cl...

Despite a decade's worth of effort, patient safety has improved slowly, in part because of the limited evidence base for the development and widespread dissemination of successful patient safety practices. The Agency for Healthcare Research and Quality sponsored an international group of experts in patient safety and evaluation methods to develop c...

To assess whether embedding pediatric anticipatory guidance into books read to infants is an effective way to educate low-income, first-time mothers about injury-prevention and health-promotion practices. Primiparous women (N = 168) were randomly assigned to 1 of 3 groups: an educational-book group; a noneducational-book group; or a no-book group....

The session report form (SRF) is a 25-item self-report measure scheduled to be completed by clinicians at the end of each session. This study addresses the utility of the SRF for describing session content by exploring patterns of self-reported behavior of 235 clinicians in 7,058 sessions with 600 clients. Results indicate that the SRF has a distin...

Efforts to improve community-based children's mental health care should be based on valid information about effective practices and current routine practices. Emerging research on routine care practices and outcomes has identified discrepancies between evidence-based practices and "usual care." These discrepancies highlight potentially potent quali...

This chapter addresses every researcher's nightmare: what to do when you have null results. What does it mean? How can an investigator extract value from the data and move on in one's career from that point? The chapter starts with steps toward launching scientifically valid field research. The community intervention development model includes manu...

Purpose: Preventable injuries are the leading cause of death in children. While the medical community has advocated for parent education about injury prevention during doctor visits, research has found that pediatricians often do not provide anticipatory guidance (AG) information and when they do, it is often narrow in scope, omitting many topics o...

A field study of supported employment for adults with mental illness (N=174) provided an experimental test of cognitive dissonance theory. We predicted that most work-interested individuals randomly assigned to a non-preferred program would reject services and lower their work aspirations. However, individuals who chose to pursue employment through...

To review the literature published during the past year relevant to identifying the best measures for monitoring progress in the treatment of child and adolescent clients and their families. The current literature shows an increasing focus on clinical utility in measure development as demonstrated by the recent emphasis on evidence-based assessment...

Random assignment to a preferred experimental condition can increase service engagement and enhance outcomes, while assignment to a less-preferred condition can discourage service receipt and limit outcome attainment. We examined randomized trials for one prominent psychiatric rehabilitation intervention, supported employment, to gauge how often as...

Findings from an evaluation of a model system for delivering mental health services to youth were reassessed to determine the robustness of key findings to the use of methodologies unavailable to the original analysts. These analyses address a key concern about earlier findings-that the quasi-experimental design involved the comparison of two nonco...

This chapter addresses data management concerns, focusing less on instrument formatting and more on the process of data entry choices, documentation, hiring, and naming variables. It starts with a discussion of data standards. It details issues related to getting data into an electronic format. These include budgeting money and time, the skills nee...

This article focuses on issues related to implementing school-based social and character development pro- grams in the context of a large multiprogram evaluation study funded by the Institute of Education Sciences and the Centers for Disease Control and Prevention. Implementation analysis is a relatively new but important research area. The first s...

The SAGE Handbook for Social Research Methods is a must for every social-science researcher. It charts the new and evolving terrain of social research methodology, covering qualitative, quantitative, and mixed methods in one volume The Handbook includes chapters on each phase of the research process: research design, methods of data collection, an...

This article takes the position that mental health (MH) services for youths are unlikely to improve without a system of measurement that is administered frequently, is concurrent with treatment, and provides feedback. The system, which I characterize as a measurement feedback system (MFS), should include clinical pro- cesses (mediators), contexts (...

Participants were parents of children less than 7 years of age who presented with their child for a well child visit. Viewed in the waiting room, the intervention was Play Nicely, which teaches childhood aggression management skills. A total of 138 parents were invited to view the program; 57 (41%) accepted (voluntary group). A second group of 35 p...

To determine the effectiveness of providing synthesized research evidence to inform patient care practices via an evidence based informatics program, the Clinical Informatics Consult Service (CICS). Consults were randomly assigned to one of two conditions: CICS Provided, in which clinicians received synthesized information from the biomedical liter...

This study examined how pediatrician-parent social status concordance related to communication patterns in medical encounters during which children received treatment for psychosocial problems indicating attention deficit disorder or attention deficit hyperactivity disorder. Using data from 28 pediatric medical encounters occurring in a large south...

Two major reform movements have shaped child and adolescent mental health services over the past quarter-century: the Systems of Care movement, and more recently, the movement toward evidence-based practice. Results from several studies indicate that youth served in traditional residential or inpatient care may experience difficulty re-entering the...

The effects of a helper's physical attractiveness and role on help-seeking behavior were investigated here. Eighty randomly selected Smith College students were the subjects; the helpers were two confederates selected on the basis of a separately conducted photograph evaluation. The confederate was designated either as an experimenter (Role conditi...

Two field studies investigated bystander intervention by witnesses to a staged shoplifting in a University bookstore. In the first study, a mass-media campaign was successful in communicating information and altering behavioral intentions, but not in increasing actual intervention behavior. A second study attempted to determine whether the low repo...

The degree and basis of social power of uniformed figures was investigated in two field experiments. In the first experiment, subjects were stopped in the street by an experimenter dressed in one of three ways: a civilian, a milkman, or a guard. They were asked to pick up a paper bag, or to give a dime to a stranger, or to move away from a bus stop...

Recent discontent within scientific psychology, especially social psychology, was discussed and found to be caused, at least in part, by a widespread perception among psychologists that the discipline has failed to act with social responsibility in researching and reducing areas of social concern. One such area of concern, consumer welfare, was exa...

Two field studies were conducted to assess the effect of signs describing how to report a shoplifting on bystander intervention to a staged theft. In the first study, signs providing directions and one of three rationales for reporting had a small effect on attitudes toward reporting and no effect on intervention. In the second study, a definition...

I want to describe a personal odyssey that interweaves my career with three main areas of my work: social psychology, program evaluation, and mental health services research. This essay is a personal reflection on the many social, personal, and random factors that influenced the research paths that I followed. The organization is primarily chronolo...

The failure of system reforms to affect child and family outcomes and the lack of positive findings concerning treatment as usual has led to pressure to reform treatment in the community through the adoption of evidence-based treatments. While this is generally a positive direction for the future, reformers should also consider the quality of evide...

A field experiment was conducted to study bystander reporting of a crime. The study investigated two primary dimensions upon which most programs which encourage reporting, namely, monetary reward and anonymity. Conditions of anonymity and reward were unobtrusively varied during a bogus interview conducted with shoppers before they entered a superma...

This meta-analysis examines associations between therapeutic relationship variables, and the extent to which they account for variability in treatment outcomes, in 49 youth treatment studies. Correlations between therapeutic relationship variables ranged from modest to strong. Among the best predictors of youth outcomes were counselor interpersonal...

This study examines interventions designed to improve communication between individuals who take care of children with ADHD. A teacher rating of 6,171 elementary school children identifies 1,573 children with ADHD or with high risk for ADHD. Parent interviews and information from teachers are collected on 243 children who are randomized into treatm...

A pre-post knowledge test using alternate forms was used to determine if a multimedia violence prevention program can increase knowledge about management of childhood aggression. The participants were pediatric residents and childcare workers who attended lectures about aggression management in young children. The intervention was a presentation of...

To evaluate the impact of a public poster advertising campaign for Kids Help Line, a national Australian telephone counselling service providing young people with 24-hour access to trained counsellors. Posters were displayed in the interior of 50% of all Brisbane City Council buses for a period of six months. 1,642 high school students were surveye...

The inability to blind research participants to their experimental conditions is the Achilles' heel of mental health services research. When one experimental condition receives more disappointed participants, or more satisfied participants, research findings can be biased in spite of random assignment. The authors explored the potential for researc...

This article provides a theoretic exploration of the microprocesses of clinician practice change in the context of adopting and implementing evidence-based treatments. The two most important internal clinician or microlevel factors involved in behavior change are identified as motivation and ability. The authors focus on factors related to motivati...

Client expectancies about therapy are considered a common factor, that is, a feature of therapy that is not specific to any particular technique or approach. This review includes both child- and adult-focused studies from the expectancies literature, emphasizing findings about the relationship between expectancies and factors including client impro...

Recently there has been an increasing emphasis in the youth and family mental health treatment literature on the use of empirically supported treatments (ESTs). In contrast there has been scant attention paid to more universal aspects of the therapy process that may have even greater impact upon therapy outcomes. It is likely that the success of th...

Despite the dearth of consistent evidence for conventional feedback mechanisms in clinical practice, the primary methods of feedback for clinicians remain supervision and clinical experience. A new research approach, known as patient-focused research, provides clinicians with direct feedback regarding a client's health status and relative progress...

The author summarizes the issues and concerns raised by the volume and discusses other recent developments for evaluators using program theory.

The role of theory in program evaluation is an important but neglected area in evaluation practice and theory. Program theory has several important functions that can improve our ability to generalize from particular evaluations, contribute to social science theory, and achieve consensus in evaluation planning.