Burnout, Quality of Care
Conditions
Brief summary
Healthcare providers play an important role in helping patients be actively involved in treatment and recover from mental illness. But mental health clinicians, like other healthcare providers, are at risk for experiencing burnout-feeling emotionally drained from their work, having cynical thoughts toward patients and others, and feeling little accomplishment in their work. Burnout can lead to problems for the clinician including poor overall health, depression, and lower job satisfaction. Burnout also can impact how clinicians perform on the job; for example, people with high levels of burnout take more time off, show lower commitment to their job, and are more likely to quit or be fired. There is some evidence that burnout can affect the quality of care for patients, but very little rigorous research has tested this assumption. The purpose of our study is threefold. First, we will investigate how patients perceive burnout in clinicians and whether (and/or how) burnout impacts the care they receive. Next, we will test an intervention to reduce clinician burnout called Burnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE). BREATHE brings together tools that mental health clinicians are already familiar with, including relaxation and mindfulness exercises, setting boundaries, using social supports, and changing negative thought patterns and replacing them with more helpful ways of thinking. We have found this intervention effective in reducing burnout in other organizations, but have yet to study whether it also can improve patient outcomes. Clinicians (approximately 200) who participate will receive either the BREATHE intervention or training in motivational interviewing, which could also improve patient involvement in treatment and patient outcomes, but is unlikely to significantly reduce clinician burnout. We will also recruit up to 600 adult patients served by participating clinicians. We will survey clinicians and interview patients over a 12-month period after the intervention to determine how the intervention impacts clinician burnout and patient perceptions of care (relationship with the clinician, degree of autonomy in decision making), patient involvement in care, and outcomes (confidence in managing mental health, symptoms, functioning, and hope). Finally, this study will use a statistical procedure called Structural Equation Modeling to test a theoretical model of the relationship between burnout and patient outcomes. Findings from this study will show whether reducing clinician burnout can improve patient outcomes and the quality of care that patients receive. Our intervention will have the potential to be easily implemented in a variety of settings where burnout is a problem. Knowing how clinician burnout impacts patient outcomes, and whether improving burnout can improve patient care, can help improve the healthcare system.
Interventions
BEHAVIORALMotivational Interviewing (MI)
MI is a common counseling technique. It was offered as an 8-9 hour workshop across 3 sessions to mental health agency staff who were randomly assigned to MI. Each session occurred approximately one month apart.
BEHAVIORALBurnout Reduction: Enhanced Awareness, Tools, Handouts, and Education (BREATHE)
BREATHE is a program developed to attempt to improve or prevent the symptoms of burnout. It was offered as an 8-9 hour workshop across 3 sessions to mental health agency staff who were randomly assigned to BREATHE. Each session occurred approximately one month apart.
Sponsors
Four County Counseling Center
Places for People
Patient-Centered Outcomes Research Institute
Indiana University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* A staff member with client contact at either Four County Counseling or Places for People. * Randomly chosen client from the participating staff lists. Must be 18 years old or older.
Exclusion criteria
* Clients younger than 18 years old.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maslach Burnout Inventory (MBI): Emotional Exhaustion | Measured with staff at baseline, 3 months, 6 months, and 12 months | Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were asked to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996. |
| Maslach Burnout Inventory (MBI): Depersonalization | Measured with staff at baseline, 3 months, 6 months, and 12 months | Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996. |
| Maslach Burnout Inventory (MBI): Personal Accomplishment | Measured with staff at baseline, 3 months, 6 months, and 12 months | Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Work Interference With Home Life | Measured with staff at baseline, 3 months, 6 months, and 12 months | Work-Life Balance was assessed with a six-item measure adapted from an 18-item measure developed by Carlson et al. The measure assesses three types (time-, strain-, and behavior-based) and two directions (work conflict with family and family conflict with work) of balance. The outcome described here is work conflict with family. The measure consists of a series of statements regarding one's work and family situation, to which participants are asked to indicate their level of agreement or disagreement on a 5-point Likert-type scale: 1 (Strongly disagree) to 5 (Strongly agree). The item scores were averaged. Carlson DS, Kacmar KM, Williams LJ. Construction and initial validation of a multidimensional measure of work-family conflict. Journal of Vocational Behavior. 2000;56(2):249-276. |
| Home Life Interference With Work | Measured with staff at baseline, 3 months, 6 months, and 12 months | Work-Life Balance was assessed with a six-item measure adapted from an 18-item measure developed by Carlson et al. The measure assesses three types (time-, strain-, and behavior-based) and two directions (work conflict with family and family conflict with work) of balance. The outcome described here is family conflict with work. The measure consists of a series of statements regarding one's work and family situation, to which participants are asked to indicate their level of agreement or disagreement on a 5-point Likert-type scale: 1 (Strongly disagree) to 5 (Strongly agree). The item scores were averaged. Carlson DS, Kacmar KM, Williams LJ. Construction and initial validation of a multidimensional measure of work-family conflict. Journal of Vocational Behavior. 2000;56(2):249-276. |
| Emotional Labor Scale: Surface Acting | Measured with staff at baseline, 3 months, 6 months, and 12 months | The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Surface Acting is a subset of these questions (e.g., I put on an act in order to deal with clients in an appropriate way). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree) |
| Emotional Labor Scale: Deep Acting | Measured with staff at baseline, 3 months, 6 months, and 12 months | The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Deep Acting is a subset of these questions (e.g., I try to actually experience the emotions that I must show to clients). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree) |
| Emotional Labor Scale: Genuine Emotions | Measured with staff at baseline, 3 months, 6 months, and 12 months | The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Genuine Emotions is a subset of these questions (e.g., The emotions that I express to clients are genuine). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree) |
| Importance: Reduce Work-Related Stress | Measured with staff at baseline, 3 months, 6 months, and 12 months | Staff were asked, How important is it for you to reduce your work-related stress right now? This single item score was averaged. Scale: 1 (not at all important) to 10 (extremely important) |
| Confidence: Reduce Work-Related Stress | Measured with staff at baseline, 3 months, 6 months, and 12 months | Staff were asked, How confident are you that you can reduce your work-related stress in your life? Scale: 1 (not at all confident) to 10 (extremely confident) |
| Importance: Client Interaction | Measured with staff at baseline, 3 months, 6 months, and 12 months | Staff were asked, How important is it for you to consistently interact with consumers/clients in a relaxed, non-judgmental way? Scale: 1 (not at all important) to 10 (extremely important) |
| Confidence: Client Interaction | Measured with staff at baseline, 3 months, 6 months, and 12 months | Staff were asked, How confident are you that you can consistently interact with consumers/clients in a relaxed, non-judgmental way? Scale: 1 (not at all confident) to 10 (extremely confident) |
| Quality of Care: Person Centered Care | Measured with staff at baseline, 3 months, 6 months, and 12 months | Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies as part of this project. Person Centered Care was measured with a subset of questions from this scale (e.g., I felt like I was able to really show compassion to a client.). The item scores were averaged. Scale: 0 (never) to 5 (always) |
| Quality of Care: Discordant Care | Measured with staff at baseline, 3 months, 6 months, and 12 months | Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies as part of this project. Discordant Care was measured with a subset of questions from this scale (e.g., I had conflicts with clients.). The item scores were averaged. Scale: 0 (never) to 5 (always) |
| Quality of Care-Total | Measured with staff at baseline, 3 months, 6 months, and 12 months | Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies participating in this project and then refined to 22 items through data collected and analyzed in this study. Items were related to person or client centered care, work conscientiousness, errors, interactions with clients, and how stress affects client interactions or outcomes. The item scores were averaged. Scale: 0 (never) to 5 (always) |
| Perceptions of Supervisory Support | Measured with staff at baseline, 3 months, 6 months, and 12 months | The 19 item Perceptions of Supervisory Support Scale was used to gather information on staff's experience of interactions with their supervisors (e.g., How often did you think supervision improved your relationship with your supervisor?). The item scores were averaged. Scale: 1 (never) to 6 (always) |
| Staff Turnover | Measured with staff at 12 months | Number of staff participants who separated from their respective agency before their anticipated study completion date. The mental health agencies provided separation dates, if applicable, for staff study participants. |
| Adult State Hope Scale | Measured with clients at baseline, 6 months, and 12 months | Hope was assessed with clients using the 12-item Adult State Hope Scale (e.g., I can think of many ways to get the things in life that are most important to me.). The item scores were averaged. Scale: 1 (Definitely False) to 8 (Definitely True) Snyder CR, Sympson SC, Ybasco FC, Borders TF, Babyak MA, Higgins RL. Development and validation of the State Hope Scale. Journal of Personality and Social Psychology. 1996;70(2):321 - 335. |
| Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item | Measured with clients at baseline, 6 months, and 12 months | Medication adherence (for clients who are prescribed medications for their mental health) was rated with a subset of 4 items from the MARS, a 10-item scale assessing attitudes toward medication (e.g., Do you ever forget to take your medication? Are you careless at times about taking your medicine?). The item scores were summed and averaged (range: 0-4). Scale: 0 (No) to 1 (Yes) Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research. May 5 2000;42(3):241-247. |
| Job Satisfaction | Measured with staff at baseline, 3 months, 6 months, and 12 months | Job satisfaction was assessed with one item from the Job Diagnostics Survey: Overall, I am satisfied with my job. Scale: 1 (Strongly Disagree) to 7 (Strongly Agree) Hackman JR, Oldham GR. The Job Diagnostic Survey: An Instrument for the Diagnosis of Jobs and the Evaluation of Job Redesign Projects. 1974. |
| Health-Care Climate Questionnaire | Measured with clients at baseline, 6 months, and 12 months | Perceived autonomy support was assessed with this 15-item scale (e.g., I am able to be open with \[name\] at our meetings.). Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were averaged. Scale: 1 (Strongly Disagree) to 7 (Strongly Agree) Williams GC, McGregor HA, King D, Nelson CC, Glasgow RE. Variation in perceived competence, glycemic control, and patient satisfaction: relationship to autonomy support from physicians. Patient Education & Counseling. Apr 2005;57(1):39-45. |
| Working Alliance Inventory (WAI) | Measured with clients at baseline, 6 months, and 12 months | Perceived relatedness was assessed with this short form of the patient version of the WAI and is 12 items (e.g., We agree on what is important for me to work on.). Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were averaged. Scale: 1 (Never) to 7 (Always) Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207. |
| Working Alliance Inventory (WAI) - Tasks Subscale | Measured with clients at baseline, 6 months, and 12 months | Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the tasks subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always) Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207. |
| Working Alliance Inventory (WAI) - Goals Subscale | Measured with clients at baseline, 6 months, and 12 months | Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the goals subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The items scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always) Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207. |
| Working Alliance Inventory (WAI) - Bonds Subscale | Measured with clients at baseline, 6 months, and 12 months | Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the bonds subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The items scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always) Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207. |
| Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale | Measured with clients at baseline, 6 months, and 12 months | Competence related to mental health management was assessed with the 13-item Patient Activation Measure-Mental Health (PAM-MH) (e.g., I know what each of my prescribed mental health medications does.). Each question was answered on a 4-point Likert-type scale: 1 (Strongly Disagree) to 4 (Strongly Agree). Higher scores=greater activation. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Services Research. Dec 2005;40(6 Pt 1):1918-1930. |
| Short-Form Health Survey (SF-12)-Physical Health Functioning | Measured with clients at baseline, 6 months, and 12 months | Physical and mental health functioning was assessed with the Short Form 12-Item Health Survey (SF-12). The SF-12 is a health-related quality of life measure, derived from the 36-item Medical Outcomes Study survey and containing items yielding a Mental Health Component Score and a Physical Health Component Score. Higher composite scores indicate higher health-related quality of life. Items are weighted and then transformed into norm-based scores (range: 0-100). Ware JE, Jr. , Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996;34(3):220 -233. |
| Short-Form Health Survey (SF-12)-Mental Health Functioning | Measured with clients at baseline, 6 months, and 12 months | Physical and mental health functioning was assessed with the Short Form 12-Item Health Survey (SF-12). The SF-12 is a health-related quality of life measure, derived from the 36-item Medical Outcomes Study survey and containing items yielding a Mental Health Component Score and a Physical Health Component Score. Higher composite scores indicate higher health-related quality of life. Items are weighted and then transformed into norm-based scores (range: 0-100). Ware JE, Jr. , Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996;34(3):220 -233. |
| Patient Health Questionnaire 9-item (PHQ-9) | Measured with clients at baseline, 6 months, and 12 months | The PHQ-9 is a brief, self-report assessment. It provides a summed total score that indicates likelihood of major depressive disorder. Scores ≥10 are considered a positive screen (sensitivity 88%, specificity 88%) and also effectively measures response to treatment (\<5 indicate remission, of 5-9 indicate partial response, and ≥10 indicates no response). Item scores are summed and averaged (range: 0-27). Scale: 0 (Not at all), 1 (Several days), 2 (More than half the days), 4 (Nearly every day). When problems are identified, the difficulty of those problems are rated on 4 point scale (Not difficult at all to Extremely difficult). Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. Sep 2001;16(9):606-613. American Psychiatric Association. Diagnostic and statistical manual of mental disorders - Text Revision (4th ed.). Washington, DC: American Psychiatric Association; 2000. |
| Generalized Anxiety Disorder (GAD-7) | Measured with clients at baseline, 6 months, and 12 months | Anxiety was assessed with the 7-item Generalized Anxiety Disorder (GAD-7). It can be scored continuously on a 0-21 severity scale and cutpoints have been established for estimating the probability of the 4 most common and clinically relevant anxiety disorders - generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder. Scale: 0 (not at all), 1 (several days), 2 (more than half the days), 3 (nearly every day) Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. May 22 2006;166(10):1092-1097. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. Mar 6 2007;146(5):317-325. |
| Client Satisfaction Questionnaire | Measured with clients at baseline, 6 months, and 12 months | Engagement was assessed with patient satisfaction using the Client Satisfaction Questionnaire, an 8-item satisfaction checklist (e.g., How would you rate the quality of service you have received? and, If a friend were in need of similar help, would you recommend \[name of agency\] to him or her?). The item scores were averaged. Scale: 1 to 4 with response text dependent upon the question (e.g., 1-Poor to 4-Excellent, 1-No, definitely not to 4-Yes, definitely, or 1-Quite dissatisfied to 4-Very satisfied). |
| Quality of Care-Person Centered Care | Measured with clients at baseline, 6 months, and 12 months | Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Person Centered Care was measured with a subset of questions from this scale. The item scores were averaged. Scale: 0 (never) to 5 (always) |
| Quality of Care-Negative Interactions | Measured with clients at baseline, 6 months, and 12 months | Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Negative Interactions were measured with a subset of questions from this scale. Item scores were averaged. Scale: 0 (never) to 5 (always) |
| Quality of Care-Inattentive Care | Measured with clients at baseline, 6 months, and 12 months | Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Inattentive care was measured with a subset of questions from this scale. Item scores were averaged. Scale: 0 (never) to 5 (always) |
| Quality of Care Total | Measured with clients at baseline, 6 months, and 12 months | Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.) and then refined to 22 items through data collected and analyzed in this study. This scale for clients was adapted from the one developed for staff. Item scores were averaged. Scale: 0 (never) to 5 (always) |
| Patient Engagement-Missed Appointments | Measured with clients at baseline, 6 months, and 12 months | Patient engagement was assessed by the proportion of missed appointments (when the client cancelled or did not show for a scheduled appointment divided by the total scheduled). This data was retrieved from client medical records at the agencies. Data from 3 time periods were analyzed (6 months prior to baseline through baseline, baseline to 6 months, and 6 months to 12 months). The below table illustrates the missed appointments for each time period. |
| Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item | Measured with clients at baseline, 6 months, and 12 months | Medication attitudes (for clients who are prescribed medications for their mental health) was rated with the MARS, a 10-item scale assessing attitudes toward medication (e.g., It is unnatural for my mind and body to be controlled by medication.). The items scores were summed and averaged (range: 0-10). Scale: 0 (No) to 1 (Yes) Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research. May 5 2000;42(3):241-247. |
| Turnover Intentions-Considered Leaving | Measured with staff at baseline, 3 months, 6 months, and 12 months | This is the first of two questions in which staff were asked about turnover intentions. Staff were asked, How often have you seriously considered leaving your job in the past six months? Scale: 1 (Never), 2 (Once every few months), 3 (Once a month), 4 (several times a month), 5 (Once a week), 6 (Several times a week) |
| Turnover Intentions-Likely to Leave | Measured with staff at baseline, 3 months, 6 months, and 12 months | This is the second of two questions in which staff were asked about turnover intentions. Staff were asked, How likely are you to leave your job in the next six months? Scale: 1 (Not likely at all), 2 (Not very likely), 3 (Somewhat likely), 4 (Very likely) |
Countries
United States
Participant flow
Recruitment details
Staff and clients were recruited from 2 community mental health centers. Up to 5 clients for each participating staff with adult caseloads were recruited. Enrollment occurred over 3 waves of recruitment at 2 sites between 2/24/2014 and 3/18/2016. Totals of 206 staff and 473 clients completed informed consent to participate.
Pre-assignment details
Mental Health Care Staff: 206 completed informed consent: 14 were not randomized (12 did not complete the baseline survey, 1 withdrew, 1 resigned), 192 staff were randomized Mental Health Clients: 473 clients completed informed consent: 4 were not linked to randomized staff (3 screen failures, 1 linked to staff not randomized),
Participants by arm
| Arm | Count |
|---|---|
| BREATHE-Mental Health Care Staff Mental Health Care Staff randomized to the BREATHE intervention: Staff were invited to attend an 8-9 hour BREATHE workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months. | 89 |
| Motivational Interviewing-Mental Health Care Staff Mental Health Care Staff randomized to the MI intervention: Staff were invited to attend an 8-9 hour MI workshop delivered in 3 sessions, each about one month apart. Staff were asked to complete online surveys at the following time points: Baseline, 3 months, 6 months, and 12 months. | 103 |
| BREATHE-Clients Clients linked to staff randomized to the BREATHE intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months. | 211 |
| Motivational Interviewing-Clients Clients linked to staff randomized to the MI intervention: Clients were invited to be interviewed at the following time points: Baseline, 6 months, and 12 months. | 258 |
| Total | 661 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 | FG003 |
|---|---|---|---|---|---|
| Overall Study | Death | 0 | 0 | 4 | 4 |
| Overall Study | Incarcerated | 0 | 0 | 3 | 8 |
| Overall Study | Lost to Follow-up | 3 | 3 | 11 | 19 |
| Overall Study | Separated from mental health center | 23 | 33 | 0 | 0 |
| Overall Study | Unable to complete interview | 0 | 0 | 10 | 6 |
| Overall Study | Withdrawal by Subject | 2 | 1 | 15 | 11 |
Baseline characteristics
| Characteristic | Motivational Interviewing-Mental Health Care Staff | BREATHE-Mental Health Care Staff | Total | Motivational Interviewing-Clients | BREATHE-Clients |
|---|---|---|---|---|---|
| Actual number of work hours (Staff) | 41.6 hours STANDARD_DEVIATION 7 | 41.6 hours STANDARD_DEVIATION 6.4 | 41.6 hours STANDARD_DEVIATION 6.7 | — | — |
| Age, Continuous | 39.5 years STANDARD_DEVIATION 12 | 41.3 years STANDARD_DEVIATION 12.5 | 40.3 years STANDARD_DEVIATION 12.2 | 45.2 years STANDARD_DEVIATION 12.7 | 45.2 years STANDARD_DEVIATION 13.6 |
| Education (Clients) Completed at least high school/GED | — | — | 328 Participants | 178 Participants | 150 Participants |
| Education (Clients) Less than high school/GED | — | — | 141 Participants | 80 Participants | 61 Participants |
| Education (Staff) Bachelors degree or above | 88 Participants | 69 Participants | 157 Participants | — | — |
| Education (Staff) Less than bachelors degree | 14 Participants | 20 Participants | 34 Participants | — | — |
| Education (Staff) Missing/Unknown | 1 Participants | 0 Participants | 1 Participants | — | — |
| Employment (Clients) Other | — | — | 407 Participants | 222 Participants | 185 Participants |
| Employment (Clients) Paid employment | — | — | 62 Participants | 36 Participants | 26 Participants |
| Hours of burnout training in past year (Staff) | 0.8 hours STANDARD_DEVIATION 2.4 | 0.7 hours STANDARD_DEVIATION 3.4 | 0.8 hours STANDARD_DEVIATION 2.9 | — | — |
| Hours of motivational interviewing training in past year (Staff) | 1.9 hours STANDARD_DEVIATION 4.5 | 3.1 hours STANDARD_DEVIATION 8.2 | 2.5 hours STANDARD_DEVIATION 6.5 | — | — |
| Housing (Clients) Independent living | — | — | 304 Participants | 161 Participants | 143 Participants |
| Housing (Clients) Other | — | — | 165 Participants | 97 Participants | 68 Participants |
| Official number of work hours (Staff) | 38.5 hours STANDARD_DEVIATION 5.4 | 39.1 hours STANDARD_DEVIATION 4.6 | 38.8 hours STANDARD_DEVIATION 5 | — | — |
| Percentage of interactions with adult clients (Staff) | 94 Participants | 80 Participants | 174 Participants | — | — |
| Primary Diagnosis Category (Clients) Anxiety Disorder | — | — | 31 Participants | 12 Participants | 19 Participants |
| Primary Diagnosis Category (Clients) Bipolar Disorder | — | — | 80 Participants | 45 Participants | 35 Participants |
| Primary Diagnosis Category (Clients) Major Depression | — | — | 108 Participants | 53 Participants | 55 Participants |
| Primary Diagnosis Category (Clients) Missing/Unknown | — | — | 17 Participants | 9 Participants | 8 Participants |
| Primary Diagnosis Category (Clients) Other | — | — | 20 Participants | 12 Participants | 8 Participants |
| Primary Diagnosis Category (Clients) Schizophrenia | — | — | 213 Participants | 127 Participants | 86 Participants |
| Race/Ethnicity, Customized African American | 6 Participants | 13 Participants | 221 Participants | 118 Participants | 84 Participants |
| Race/Ethnicity, Customized Missing/Unknown | 0 Participants | 1 Participants | 1 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Other | 6 Participants | 4 Participants | 31 Participants | 9 Participants | 12 Participants |
| Race/Ethnicity, Customized White | 91 Participants | 71 Participants | 406 Participants | 129 Participants | 115 Participants |
| Required to attend treatment (Clients) No, not required or unknown/refused | 0 Participants | 0 Participants | 389 Participants | 208 Participants | 181 Participants |
| Required to attend treatment (Clients) Yes, required to attend treatment | 0 Participants | 0 Participants | 80 Participants | 50 Participants | 30 Participants |
| Sex: Female, Male Female | 89 Participants | 64 Participants | 395 Participants | 138 Participants | 104 Participants |
| Sex: Female, Male Male | 14 Participants | 25 Participants | 266 Participants | 120 Participants | 107 Participants |
| Substance Use (Clients) Missing/Unknown | — | — | 18 Participants | 9 Participants | 9 Participants |
| Substance Use (Clients) Substance Use Not Present | — | — | 311 Participants | 169 Participants | 142 Participants |
| Substance Use (Clients) Substance Use Present | — | — | 140 Participants | 80 Participants | 60 Participants |
| Wants to attend treatment (Clients) No, does not want or unknown/refused | 0 Participants | 0 Participants | 36 Participants | 22 Participants | 14 Participants |
| Wants to attend treatment (Clients) Yes, want to attend treatment | 0 Participants | 0 Participants | 433 Participants | 236 Participants | 197 Participants |
| Years at agency (Staff) | 5.3 years STANDARD_DEVIATION 6.7 | 4.8 years STANDARD_DEVIATION 5.7 | 5.0 years STANDARD_DEVIATION 6.3 | — | — |
| Years in field (Staff) | 8.4 years STANDARD_DEVIATION 8.8 | 9.4 years STANDARD_DEVIATION 9.2 | 8.9 years STANDARD_DEVIATION 9 | — | — |
| Years in position (Staff) | 3.1 years STANDARD_DEVIATION 4.7 | 3.5 years STANDARD_DEVIATION 4.7 | 3.3 years STANDARD_DEVIATION 4.7 | — | — |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk | EG003 affected / at risk |
|---|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 89 | 0 / 103 | 4 / 211 | 4 / 258 |
| other Total, other adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
| serious Total, serious adverse events | 0 / 0 | 0 / 0 | 0 / 0 | 0 / 0 |
Outcome results
Primary
Maslach Burnout Inventory (MBI): Depersonalization
Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Depersonalization | Baseline | 1.3 units on a scale | Standard Deviation 0.9 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Depersonalization | 6 months | 1.3 units on a scale | Standard Deviation 0.9 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Depersonalization | 3 months | 1.2 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Depersonalization | 12 months | 1.3 units on a scale | Standard Deviation 1.1 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Depersonalization | 3 months | 1.4 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Depersonalization | Baseline | 1.5 units on a scale | Standard Deviation 1.1 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Depersonalization | 12 months | 1.3 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Depersonalization | 6 months | 1.5 units on a scale | Standard Deviation 1.2 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.8Mixed Models Analysis
Primary
Maslach Burnout Inventory (MBI): Emotional Exhaustion
Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were asked to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Emotional Exhaustion | Baseline | 2.3 units on a scale | Standard Deviation 1.3 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Emotional Exhaustion | 3 months | 2.3 units on a scale | Standard Deviation 1.2 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Emotional Exhaustion | 6 months | 2.5 units on a scale | Standard Deviation 1.4 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Emotional Exhaustion | 12 months | 2.4 units on a scale | Standard Deviation 1.2 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Emotional Exhaustion | 12 months | 2.5 units on a scale | Standard Deviation 1.3 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Emotional Exhaustion | Baseline | 2.7 units on a scale | Standard Deviation 1.3 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Emotional Exhaustion | 6 months | 2.6 units on a scale | Standard Deviation 1.3 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Emotional Exhaustion | 3 months | 2.7 units on a scale | Standard Deviation 1.4 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.8Mixed Models Analysis
Primary
Maslach Burnout Inventory (MBI): Personal Accomplishment
Burnout was assessed with the Maslach Burnout Inventory (MBI), a widely-used measure of three components of burnout: emotional exhaustion, depersonalization, and personal accomplishment. The survey contains 22 statements of job-related feelings and staff were ased to read each statement and decide if they ever felt that way about their job. The item scores were averaged. Scale: 0 (Never), 1 (A few times a year or less), 2 (Once a month or less), 3 (A few times a month), 4 (Once a week), 5 (A few times a week), 6 (Every Day). Maslach C, Jackson, S. E., Leiter, M. P. Maslach Burnout Inventory Manual. 3 ed. Palo Alto, California: Consulting Psychologists Press; 1996.
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Personal Accomplishment | Baseline | 4.9 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Personal Accomplishment | 3 months | 4.9 units on a scale | Standard Deviation 0.7 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Personal Accomplishment | 6 months | 4.9 units on a scale | Standard Deviation 0.9 |
| BREATHE-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Personal Accomplishment | 12 months | 4.8 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Personal Accomplishment | 12 months | 4.8 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Personal Accomplishment | Baseline | 4.9 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Personal Accomplishment | 6 months | 4.9 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Maslach Burnout Inventory (MBI): Personal Accomplishment | 3 months | 4.9 units on a scale | Standard Deviation 0.7 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.54Mixed Models Analysis
Secondary
Adult State Hope Scale
Hope was assessed with clients using the 12-item Adult State Hope Scale (e.g., I can think of many ways to get the things in life that are most important to me.). The item scores were averaged. Scale: 1 (Definitely False) to 8 (Definitely True) Snyder CR, Sympson SC, Ybasco FC, Borders TF, Babyak MA, Higgins RL. Development and validation of the State Hope Scale. Journal of Personality and Social Psychology. 1996;70(2):321 - 335.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Adult State Hope Scale | Baseline | 5.78 units on a scale | Standard Deviation 1.3 |
| BREATHE-Clients | Adult State Hope Scale | 6 months | 5.75 units on a scale | Standard Deviation 1.3 |
| BREATHE-Clients | Adult State Hope Scale | 12 months | 5.77 units on a scale | Standard Deviation 1.3 |
| Motivational Interviewing-Clients | Adult State Hope Scale | Baseline | 5.78 units on a scale | Standard Deviation 1.2 |
| Motivational Interviewing-Clients | Adult State Hope Scale | 6 months | 5.85 units on a scale | Standard Deviation 1.2 |
| Motivational Interviewing-Clients | Adult State Hope Scale | 12 months | 5.85 units on a scale | Standard Deviation 1.1 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.67Mixed Models Analysis
Secondary
Client Satisfaction Questionnaire
Engagement was assessed with patient satisfaction using the Client Satisfaction Questionnaire, an 8-item satisfaction checklist (e.g., How would you rate the quality of service you have received? and, If a friend were in need of similar help, would you recommend \[name of agency\] to him or her?). The item scores were averaged. Scale: 1 to 4 with response text dependent upon the question (e.g., 1-Poor to 4-Excellent, 1-No, definitely not to 4-Yes, definitely, or 1-Quite dissatisfied to 4-Very satisfied).
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Client Satisfaction Questionnaire | Baseline | 3.4 units on a scale | Standard Deviation 0.6 |
| BREATHE-Clients | Client Satisfaction Questionnaire | 6 months | 3.4 units on a scale | Standard Deviation 0.6 |
| BREATHE-Clients | Client Satisfaction Questionnaire | 12 months | 3.5 units on a scale | Standard Deviation 0.5 |
| Motivational Interviewing-Clients | Client Satisfaction Questionnaire | Baseline | 3.5 units on a scale | Standard Deviation 0.5 |
| Motivational Interviewing-Clients | Client Satisfaction Questionnaire | 6 months | 3.5 units on a scale | Standard Deviation 0.5 |
| Motivational Interviewing-Clients | Client Satisfaction Questionnaire | 12 months | 3.5 units on a scale | Standard Deviation 0.5 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.64Mixed Models Analysis
Secondary
Confidence: Client Interaction
Staff were asked, How confident are you that you can consistently interact with consumers/clients in a relaxed, non-judgmental way? Scale: 1 (not at all confident) to 10 (extremely confident)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Confidence: Client Interaction | 3 months | 8.5 units on a scale | Standard Deviation 1.5 |
| BREATHE-Mental Health Care Staff | Confidence: Client Interaction | Baseline | 8.5 units on a scale | Standard Deviation 1.5 |
| BREATHE-Mental Health Care Staff | Confidence: Client Interaction | 6 months | 8.5 units on a scale | Standard Deviation 1.4 |
| BREATHE-Mental Health Care Staff | Confidence: Client Interaction | 12 months | 8.8 units on a scale | Standard Deviation 1.4 |
| Motivational Interviewing-Mental Health Care Staff | Confidence: Client Interaction | 12 months | 8.2 units on a scale | Standard Deviation 1.9 |
| Motivational Interviewing-Mental Health Care Staff | Confidence: Client Interaction | 6 months | 8.1 units on a scale | Standard Deviation 1.7 |
| Motivational Interviewing-Mental Health Care Staff | Confidence: Client Interaction | Baseline | 8.3 units on a scale | Standard Deviation 1.7 |
| Motivational Interviewing-Mental Health Care Staff | Confidence: Client Interaction | 3 months | 8.1 units on a scale | Standard Deviation 1.7 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.11Mixed Models Analysis
Secondary
Confidence: Reduce Work-Related Stress
Staff were asked, How confident are you that you can reduce your work-related stress in your life? Scale: 1 (not at all confident) to 10 (extremely confident)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Confidence: Reduce Work-Related Stress | Baseline | 7.0 units on a scale | Standard Deviation 2.3 |
| BREATHE-Mental Health Care Staff | Confidence: Reduce Work-Related Stress | 3 months | 6.5 units on a scale | Standard Deviation 2.6 |
| BREATHE-Mental Health Care Staff | Confidence: Reduce Work-Related Stress | 6 months | 6.6 units on a scale | Standard Deviation 2.5 |
| BREATHE-Mental Health Care Staff | Confidence: Reduce Work-Related Stress | 12 months | 6.5 units on a scale | Standard Deviation 2.8 |
| Motivational Interviewing-Mental Health Care Staff | Confidence: Reduce Work-Related Stress | 12 months | 5.5 units on a scale | Standard Deviation 2.6 |
| Motivational Interviewing-Mental Health Care Staff | Confidence: Reduce Work-Related Stress | Baseline | 6.0 units on a scale | Standard Deviation 2.6 |
| Motivational Interviewing-Mental Health Care Staff | Confidence: Reduce Work-Related Stress | 6 months | 5.7 units on a scale | Standard Deviation 2.5 |
| Motivational Interviewing-Mental Health Care Staff | Confidence: Reduce Work-Related Stress | 3 months | 6.3 units on a scale | Standard Deviation 2.5 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.13Mixed Models Analysis
Secondary
Emotional Labor Scale: Deep Acting
The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Deep Acting is a subset of these questions (e.g., I try to actually experience the emotions that I must show to clients). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Deep Acting | Baseline | 3.4 units on a scale | Standard Deviation 0.9 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Deep Acting | 3 months | 3.4 units on a scale | Standard Deviation 0.7 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Deep Acting | 6 months | 3.1 units on a scale | Standard Deviation 0.9 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Deep Acting | 12 months | 3.2 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Deep Acting | 12 months | 3.0 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Deep Acting | Baseline | 3.2 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Deep Acting | 6 months | 3.2 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Deep Acting | 3 months | 3.1 units on a scale | Standard Deviation 1 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.83Mixed Models Analysis
Secondary
Emotional Labor Scale: Genuine Emotions
The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Genuine Emotions is a subset of these questions (e.g., The emotions that I express to clients are genuine). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Genuine Emotions | Baseline | 4.0 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Genuine Emotions | 3 months | 4.1 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Genuine Emotions | 6 months | 3.9 units on a scale | Standard Deviation 0.7 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Genuine Emotions | 12 months | 4.0 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Genuine Emotions | 12 months | 4.1 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Genuine Emotions | Baseline | 4.0 units on a scale | Standard Deviation 0.6 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Genuine Emotions | 6 months | 4.0 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Genuine Emotions | 3 months | 4.0 units on a scale | Standard Deviation 0.7 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.64Mixed Models Analysis
Secondary
Emotional Labor Scale: Surface Acting
The Emotional Labor Scale includes 14 questions regarding the relationship between emotions and interactions with clients. Surface Acting is a subset of these questions (e.g., I put on an act in order to deal with clients in an appropriate way). The item scores were averaged. Scale: 1 (strongly disagree) to 5 (strongly agree)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Surface Acting | Baseline | 2.1 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Surface Acting | 3 months | 2.2 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Surface Acting | 6 months | 2.1 units on a scale | Standard Deviation 0.9 |
| BREATHE-Mental Health Care Staff | Emotional Labor Scale: Surface Acting | 12 months | 2.2 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Surface Acting | 12 months | 2.1 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Surface Acting | Baseline | 2.2 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Surface Acting | 6 months | 2.2 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Emotional Labor Scale: Surface Acting | 3 months | 2.3 units on a scale | Standard Deviation 0.9 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.37Mixed Models Analysis
Secondary
Generalized Anxiety Disorder (GAD-7)
Anxiety was assessed with the 7-item Generalized Anxiety Disorder (GAD-7). It can be scored continuously on a 0-21 severity scale and cutpoints have been established for estimating the probability of the 4 most common and clinically relevant anxiety disorders - generalized anxiety disorder, panic disorder, post-traumatic stress disorder, and social anxiety disorder. Scale: 0 (not at all), 1 (several days), 2 (more than half the days), 3 (nearly every day) Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine. May 22 2006;166(10):1092-1097. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. Mar 6 2007;146(5):317-325.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Generalized Anxiety Disorder (GAD-7) | Baseline | 9.4 units on a scale | Standard Deviation 5.7 |
| BREATHE-Clients | Generalized Anxiety Disorder (GAD-7) | 6 months | 8.5 units on a scale | Standard Deviation 5.7 |
| BREATHE-Clients | Generalized Anxiety Disorder (GAD-7) | 12 months | 8.5 units on a scale | Standard Deviation 5.8 |
| Motivational Interviewing-Clients | Generalized Anxiety Disorder (GAD-7) | Baseline | 9.7 units on a scale | Standard Deviation 5.9 |
| Motivational Interviewing-Clients | Generalized Anxiety Disorder (GAD-7) | 6 months | 8.4 units on a scale | Standard Deviation 5.6 |
| Motivational Interviewing-Clients | Generalized Anxiety Disorder (GAD-7) | 12 months | 8.8 units on a scale | Standard Deviation 5.5 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.59Mixed Models Analysis
Secondary
Health-Care Climate Questionnaire
Perceived autonomy support was assessed with this 15-item scale (e.g., I am able to be open with \[name\] at our meetings.). Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were averaged. Scale: 1 (Strongly Disagree) to 7 (Strongly Agree) Williams GC, McGregor HA, King D, Nelson CC, Glasgow RE. Variation in perceived competence, glycemic control, and patient satisfaction: relationship to autonomy support from physicians. Patient Education & Counseling. Apr 2005;57(1):39-45.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Health-Care Climate Questionnaire | Baseline | 6.0 units on a scale | Standard Deviation 1.2 |
| BREATHE-Clients | Health-Care Climate Questionnaire | 6 months | 5.8 units on a scale | Standard Deviation 1.5 |
| BREATHE-Clients | Health-Care Climate Questionnaire | 12 months | 6.0 units on a scale | Standard Deviation 1.2 |
| Motivational Interviewing-Clients | Health-Care Climate Questionnaire | Baseline | 5.9 units on a scale | Standard Deviation 1.1 |
| Motivational Interviewing-Clients | Health-Care Climate Questionnaire | 6 months | 5.9 units on a scale | Standard Deviation 1.2 |
| Motivational Interviewing-Clients | Health-Care Climate Questionnaire | 12 months | 5.9 units on a scale | Standard Deviation 1.3 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.71Mixed Models Analysis
Secondary
Home Life Interference With Work
Work-Life Balance was assessed with a six-item measure adapted from an 18-item measure developed by Carlson et al. The measure assesses three types (time-, strain-, and behavior-based) and two directions (work conflict with family and family conflict with work) of balance. The outcome described here is family conflict with work. The measure consists of a series of statements regarding one's work and family situation, to which participants are asked to indicate their level of agreement or disagreement on a 5-point Likert-type scale: 1 (Strongly disagree) to 5 (Strongly agree). The item scores were averaged. Carlson DS, Kacmar KM, Williams LJ. Construction and initial validation of a multidimensional measure of work-family conflict. Journal of Vocational Behavior. 2000;56(2):249-276.
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Home Life Interference With Work | Baseline | 1.9 units on a scale | Standard Deviation 0.7 |
| BREATHE-Mental Health Care Staff | Home Life Interference With Work | 3 months | 1.8 units on a scale | Standard Deviation 0.7 |
| BREATHE-Mental Health Care Staff | Home Life Interference With Work | 6 months | 1.9 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Home Life Interference With Work | 12 months | 1.9 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Home Life Interference With Work | 12 months | 1.8 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Home Life Interference With Work | Baseline | 1.9 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Home Life Interference With Work | 6 months | 1.8 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Home Life Interference With Work | 3 months | 1.9 units on a scale | Standard Deviation 0.7 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.6Mixed Models Analysis
Secondary
Importance: Client Interaction
Staff were asked, How important is it for you to consistently interact with consumers/clients in a relaxed, non-judgmental way? Scale: 1 (not at all important) to 10 (extremely important)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Importance: Client Interaction | 6 months | 9.3 units on a scale | Standard Deviation 1.2 |
| BREATHE-Mental Health Care Staff | Importance: Client Interaction | Baseline | 9.4 units on a scale | Standard Deviation 1 |
| BREATHE-Mental Health Care Staff | Importance: Client Interaction | 12 months | 9.3 units on a scale | Standard Deviation 1.2 |
| BREATHE-Mental Health Care Staff | Importance: Client Interaction | 3 months | 9.5 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Mental Health Care Staff | Importance: Client Interaction | 12 months | 9.3 units on a scale | Standard Deviation 1.7 |
| Motivational Interviewing-Mental Health Care Staff | Importance: Client Interaction | 6 months | 9.2 units on a scale | Standard Deviation 1.8 |
| Motivational Interviewing-Mental Health Care Staff | Importance: Client Interaction | 3 months | 9.3 units on a scale | Standard Deviation 1.3 |
| Motivational Interviewing-Mental Health Care Staff | Importance: Client Interaction | Baseline | 9.5 units on a scale | Standard Deviation 1.2 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.93Mixed Models Analysis
Secondary
Importance: Reduce Work-Related Stress
Staff were asked, How important is it for you to reduce your work-related stress right now? This single item score was averaged. Scale: 1 (not at all important) to 10 (extremely important)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Importance: Reduce Work-Related Stress | Baseline | 6.5 units on a scale | Standard Deviation 3 |
| BREATHE-Mental Health Care Staff | Importance: Reduce Work-Related Stress | 3 months | 6.4 units on a scale | Standard Deviation 2.9 |
| BREATHE-Mental Health Care Staff | Importance: Reduce Work-Related Stress | 6 months | 6.5 units on a scale | Standard Deviation 3 |
| BREATHE-Mental Health Care Staff | Importance: Reduce Work-Related Stress | 12 months | 6.6 units on a scale | Standard Deviation 2.8 |
| Motivational Interviewing-Mental Health Care Staff | Importance: Reduce Work-Related Stress | 12 months | 6.6 units on a scale | Standard Deviation 3 |
| Motivational Interviewing-Mental Health Care Staff | Importance: Reduce Work-Related Stress | Baseline | 6.4 units on a scale | Standard Deviation 2.8 |
| Motivational Interviewing-Mental Health Care Staff | Importance: Reduce Work-Related Stress | 6 months | 7.5 units on a scale | Standard Deviation 2.6 |
| Motivational Interviewing-Mental Health Care Staff | Importance: Reduce Work-Related Stress | 3 months | 7.3 units on a scale | Standard Deviation 2.6 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.37Mixed Models Analysis
Secondary
Job Satisfaction
Job satisfaction was assessed with one item from the Job Diagnostics Survey: Overall, I am satisfied with my job. Scale: 1 (Strongly Disagree) to 7 (Strongly Agree) Hackman JR, Oldham GR. The Job Diagnostic Survey: An Instrument for the Diagnosis of Jobs and the Evaluation of Job Redesign Projects. 1974.
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Job Satisfaction | Baseline | 5.7 units on a scale | Standard Deviation 1.4 |
| BREATHE-Mental Health Care Staff | Job Satisfaction | 3 months | 5.4 units on a scale | Standard Deviation 1.6 |
| BREATHE-Mental Health Care Staff | Job Satisfaction | 6 months | 5.3 units on a scale | Standard Deviation 1.7 |
| BREATHE-Mental Health Care Staff | Job Satisfaction | 12 months | 5.6 units on a scale | Standard Deviation 1.4 |
| Motivational Interviewing-Mental Health Care Staff | Job Satisfaction | 12 months | 5.2 units on a scale | Standard Deviation 1.5 |
| Motivational Interviewing-Mental Health Care Staff | Job Satisfaction | Baseline | 5.2 units on a scale | Standard Deviation 1.6 |
| Motivational Interviewing-Mental Health Care Staff | Job Satisfaction | 6 months | 4.9 units on a scale | Standard Deviation 1.7 |
| Motivational Interviewing-Mental Health Care Staff | Job Satisfaction | 3 months | 5.1 units on a scale | Standard Deviation 1.5 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.94Mixed Models Analysis
Secondary
Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item
Medication adherence (for clients who are prescribed medications for their mental health) was rated with a subset of 4 items from the MARS, a 10-item scale assessing attitudes toward medication (e.g., Do you ever forget to take your medication? Are you careless at times about taking your medicine?). The item scores were summed and averaged (range: 0-4). Scale: 0 (No) to 1 (Yes) Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research. May 5 2000;42(3):241-247.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out, clients reporting they are not prescribed medications for their mental health, and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item | Baseline | 1.9 units on a scale | Standard Deviation 1 |
| BREATHE-Clients | Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item | 6 months | 1.8 units on a scale | Standard Deviation 1 |
| BREATHE-Clients | Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item | 12 months | 1.6 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Clients | Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item | Baseline | 2.0 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Clients | Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item | 6 months | 2.0 units on a scale | Standard Deviation 1.1 |
| Motivational Interviewing-Clients | Medication Adherence Rating Scale (MARS) - Medication Adherence - 4-item | 12 months | 1.9 units on a scale | Standard Deviation 1.1 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.04Mixed Models Analysis
Secondary
Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item
Medication attitudes (for clients who are prescribed medications for their mental health) was rated with the MARS, a 10-item scale assessing attitudes toward medication (e.g., It is unnatural for my mind and body to be controlled by medication.). The items scores were summed and averaged (range: 0-10). Scale: 0 (No) to 1 (Yes) Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophrenia Research. May 5 2000;42(3):241-247.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out, clients who reported they are not prescribed medications for their mental health, and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item | Baseline | 3.0 units on a scale | Standard Deviation 1.7 |
| BREATHE-Clients | Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item | 6 months | 2.9 units on a scale | Standard Deviation 1.9 |
| BREATHE-Clients | Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item | 12 months | 2.8 units on a scale | Standard Deviation 1.7 |
| Motivational Interviewing-Clients | Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item | Baseline | 3.3 units on a scale | Standard Deviation 1.9 |
| Motivational Interviewing-Clients | Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item | 6 months | 3.2 units on a scale | Standard Deviation 2.1 |
| Motivational Interviewing-Clients | Medication Adherence Rating Scale (MARS) - Medication Attitudes - 10-item | 12 months | 3.1 units on a scale | Standard Deviation 1.9 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.34Mixed Models Analysis
Secondary
Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale
Competence related to mental health management was assessed with the 13-item Patient Activation Measure-Mental Health (PAM-MH) (e.g., I know what each of my prescribed mental health medications does.). Each question was answered on a 4-point Likert-type scale: 1 (Strongly Disagree) to 4 (Strongly Agree). Higher scores=greater activation. Hibbard JH, Mahoney ER, Stockard J, Tusler M. Development and testing of a short form of the patient activation measure. Health Services Research. Dec 2005;40(6 Pt 1):1918-1930.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale | Baseline | 62.5 units on a scale | Standard Deviation 15.6 |
| BREATHE-Clients | Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale | 6 months | 63.6 units on a scale | Standard Deviation 16.8 |
| BREATHE-Clients | Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale | 12 months | 64.8 units on a scale | Standard Deviation 15.4 |
| Motivational Interviewing-Clients | Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale | Baseline | 61.3 units on a scale | Standard Deviation 14.8 |
| Motivational Interviewing-Clients | Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale | 6 months | 62.1 units on a scale | Standard Deviation 17.3 |
| Motivational Interviewing-Clients | Patient Activation Measure-Mental Health (PAM-MH)-0 to 100 Scale | 12 months | 65.2 units on a scale | Standard Deviation 16.9 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.91Mixed Models Analysis
Secondary
Patient Engagement-Missed Appointments
Patient engagement was assessed by the proportion of missed appointments (when the client cancelled or did not show for a scheduled appointment divided by the total scheduled). This data was retrieved from client medical records at the agencies. Data from 3 time periods were analyzed (6 months prior to baseline through baseline, baseline to 6 months, and 6 months to 12 months). The below table illustrates the missed appointments for each time period.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to missing data (medical records not available) and clients discontinuing treatment at their respective agency.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Patient Engagement-Missed Appointments | 6 months | 14.47 appointments at mental health agency | Standard Deviation 15.93 |
| BREATHE-Clients | Patient Engagement-Missed Appointments | 12 months | 14.52 appointments at mental health agency | Standard Deviation 15.85 |
| BREATHE-Clients | Patient Engagement-Missed Appointments | Baseline | 11.96 appointments at mental health agency | Standard Deviation 12.51 |
| Motivational Interviewing-Clients | Patient Engagement-Missed Appointments | Baseline | 11.02 appointments at mental health agency | Standard Deviation 12.68 |
| Motivational Interviewing-Clients | Patient Engagement-Missed Appointments | 6 months | 12.20 appointments at mental health agency | Standard Deviation 14.91 |
| Motivational Interviewing-Clients | Patient Engagement-Missed Appointments | 12 months | 11.50 appointments at mental health agency | Standard Deviation 16.08 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.45Mixed Models Analysis
Secondary
Patient Health Questionnaire 9-item (PHQ-9)
The PHQ-9 is a brief, self-report assessment. It provides a summed total score that indicates likelihood of major depressive disorder. Scores ≥10 are considered a positive screen (sensitivity 88%, specificity 88%) and also effectively measures response to treatment (\<5 indicate remission, of 5-9 indicate partial response, and ≥10 indicates no response). Item scores are summed and averaged (range: 0-27). Scale: 0 (Not at all), 1 (Several days), 2 (More than half the days), 4 (Nearly every day). When problems are identified, the difficulty of those problems are rated on 4 point scale (Not difficult at all to Extremely difficult). Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine. Sep 2001;16(9):606-613. American Psychiatric Association. Diagnostic and statistical manual of mental disorders - Text Revision (4th ed.). Washington, DC: American Psychiatric Association; 2000.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Patient Health Questionnaire 9-item (PHQ-9) | Baseline | 9.6 units on a scale | Standard Deviation 5.9 |
| BREATHE-Clients | Patient Health Questionnaire 9-item (PHQ-9) | 6 months | 8.8 units on a scale | Standard Deviation 6.1 |
| BREATHE-Clients | Patient Health Questionnaire 9-item (PHQ-9) | 12 months | 9.1 units on a scale | Standard Deviation 6 |
| Motivational Interviewing-Clients | Patient Health Questionnaire 9-item (PHQ-9) | Baseline | 10.0 units on a scale | Standard Deviation 6 |
| Motivational Interviewing-Clients | Patient Health Questionnaire 9-item (PHQ-9) | 6 months | 9.8 units on a scale | Standard Deviation 6.3 |
| Motivational Interviewing-Clients | Patient Health Questionnaire 9-item (PHQ-9) | 12 months | 9.4 units on a scale | Standard Deviation 5.8 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.77Mixed Models Analysis
Secondary
Perceptions of Supervisory Support
The 19 item Perceptions of Supervisory Support Scale was used to gather information on staff's experience of interactions with their supervisors (e.g., How often did you think supervision improved your relationship with your supervisor?). The item scores were averaged. Scale: 1 (never) to 6 (always)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Perceptions of Supervisory Support | Baseline | 4.1 units on a scale | Standard Deviation 1.1 |
| BREATHE-Mental Health Care Staff | Perceptions of Supervisory Support | 3 months | 4.0 units on a scale | Standard Deviation 1.2 |
| BREATHE-Mental Health Care Staff | Perceptions of Supervisory Support | 6 months | 3.9 units on a scale | Standard Deviation 1.2 |
| BREATHE-Mental Health Care Staff | Perceptions of Supervisory Support | 12 months | 4.0 units on a scale | Standard Deviation 1.1 |
| Motivational Interviewing-Mental Health Care Staff | Perceptions of Supervisory Support | 12 months | 4.0 units on a scale | Standard Deviation 1.2 |
| Motivational Interviewing-Mental Health Care Staff | Perceptions of Supervisory Support | Baseline | 3.9 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Perceptions of Supervisory Support | 6 months | 3.8 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Perceptions of Supervisory Support | 3 months | 3.9 units on a scale | Standard Deviation 1 |
p-value: 0.24Mixed Models Analysis
Secondary
Quality of Care: Discordant Care
Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies as part of this project. Discordant Care was measured with a subset of questions from this scale (e.g., I had conflicts with clients.). The item scores were averaged. Scale: 0 (never) to 5 (always)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Quality of Care: Discordant Care | Baseline | 3.8 units on a scale | Standard Deviation 0.5 |
| BREATHE-Mental Health Care Staff | Quality of Care: Discordant Care | 3 months | 3.8 units on a scale | Standard Deviation 0.5 |
| BREATHE-Mental Health Care Staff | Quality of Care: Discordant Care | 6 months | 3.9 units on a scale | Standard Deviation 0.5 |
| BREATHE-Mental Health Care Staff | Quality of Care: Discordant Care | 12 months | 3.8 units on a scale | Standard Deviation 0.6 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care: Discordant Care | 12 months | 3.9 units on a scale | Standard Deviation 0.5 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care: Discordant Care | Baseline | 3.8 units on a scale | Standard Deviation 0.5 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care: Discordant Care | 6 months | 3.8 units on a scale | Standard Deviation 0.7 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care: Discordant Care | 3 months | 3.8 units on a scale | Standard Deviation 0.6 |
Secondary
Quality of Care-Inattentive Care
Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Inattentive care was measured with a subset of questions from this scale. Item scores were averaged. Scale: 0 (never) to 5 (always)
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Quality of Care-Inattentive Care | Baseline | 4.2 units on a scale | Standard Deviation 0.9 |
| BREATHE-Clients | Quality of Care-Inattentive Care | 6 months | 4.3 units on a scale | Standard Deviation 0.7 |
| BREATHE-Clients | Quality of Care-Inattentive Care | 12 months | 4.2 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Clients | Quality of Care-Inattentive Care | Baseline | 4.2 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Clients | Quality of Care-Inattentive Care | 6 months | 4.3 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Clients | Quality of Care-Inattentive Care | 12 months | 4.3 units on a scale | Standard Deviation 0.8 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.84Mixed Models Analysis
Secondary
Quality of Care-Negative Interactions
Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Negative Interactions were measured with a subset of questions from this scale. Item scores were averaged. Scale: 0 (never) to 5 (always)
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Quality of Care-Negative Interactions | Baseline | 4.3 units on a scale | Standard Deviation 0.9 |
| BREATHE-Clients | Quality of Care-Negative Interactions | 6 months | 4.8 units on a scale | Standard Deviation 0.8 |
| BREATHE-Clients | Quality of Care-Negative Interactions | 12 months | 4.3 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Clients | Quality of Care-Negative Interactions | Baseline | 4.3 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Clients | Quality of Care-Negative Interactions | 6 months | 4.3 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Clients | Quality of Care-Negative Interactions | 12 months | 4.4 units on a scale | Standard Deviation 0.9 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.06Mixed Models Analysis
Secondary
Quality of Care-Person Centered Care
Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.). This scale for clients was adapted from the one developed for staff. Person Centered Care was measured with a subset of questions from this scale. The item scores were averaged. Scale: 0 (never) to 5 (always)
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Quality of Care-Person Centered Care | Baseline | 3.8 units on a scale | Standard Deviation 1.1 |
| BREATHE-Clients | Quality of Care-Person Centered Care | 6 months | 3.7 units on a scale | Standard Deviation 1.1 |
| BREATHE-Clients | Quality of Care-Person Centered Care | 12 months | 3.6 units on a scale | Standard Deviation 1.1 |
| Motivational Interviewing-Clients | Quality of Care-Person Centered Care | Baseline | 3.8 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Clients | Quality of Care-Person Centered Care | 6 months | 3.8 units on a scale | Standard Deviation 1.1 |
| Motivational Interviewing-Clients | Quality of Care-Person Centered Care | 12 months | 3.9 units on a scale | Standard Deviation 1.1 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.05Mixed Models Analysis
Secondary
Quality of Care: Person Centered Care
Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies as part of this project. Person Centered Care was measured with a subset of questions from this scale (e.g., I felt like I was able to really show compassion to a client.). The item scores were averaged. Scale: 0 (never) to 5 (always)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Quality of Care: Person Centered Care | Baseline | 3.7 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Quality of Care: Person Centered Care | 3 months | 3.8 units on a scale | Standard Deviation 0.6 |
| BREATHE-Mental Health Care Staff | Quality of Care: Person Centered Care | 6 months | 3.8 units on a scale | Standard Deviation 0.6 |
| BREATHE-Mental Health Care Staff | Quality of Care: Person Centered Care | 12 months | 3.8 units on a scale | Standard Deviation 0.6 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care: Person Centered Care | 12 months | 3.8 units on a scale | Standard Deviation 0.6 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care: Person Centered Care | Baseline | 3.6 units on a scale | Standard Deviation 0.6 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care: Person Centered Care | 6 months | 3.8 units on a scale | Standard Deviation 0.6 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care: Person Centered Care | 3 months | 3.7 units on a scale | Standard Deviation 0.6 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.21Mixed Models Analysis
Secondary
Quality of Care Total
Perceived Quality of Care was assessed with a 31 item scale (e.g., Staff spent extra time with me when I needed them.) and then refined to 22 items through data collected and analyzed in this study. This scale for clients was adapted from the one developed for staff. Item scores were averaged. Scale: 0 (never) to 5 (always)
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Quality of Care Total | Baseline | 4.0 units on a scale | Standard Deviation 0.8 |
| BREATHE-Clients | Quality of Care Total | 6 months | 4.0 units on a scale | Standard Deviation 0.8 |
| BREATHE-Clients | Quality of Care Total | 12 months | 3.9 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Clients | Quality of Care Total | Baseline | 4.0 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Clients | Quality of Care Total | 6 months | 4.0 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Clients | Quality of Care Total | 12 months | 4.1 units on a scale | Standard Deviation 0.8 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.14Mixed Models Analysis
Secondary
Quality of Care-Total
Perceived Quality of Care was assessed with a 31 item scale developed with one of the mental health agencies participating in this project and then refined to 22 items through data collected and analyzed in this study. Items were related to person or client centered care, work conscientiousness, errors, interactions with clients, and how stress affects client interactions or outcomes. The item scores were averaged. Scale: 0 (never) to 5 (always)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Quality of Care-Total | Baseline | 3.8 units on a scale | Standard Deviation 0.5 |
| BREATHE-Mental Health Care Staff | Quality of Care-Total | 3 months | 3.8 units on a scale | Standard Deviation 0.4 |
| BREATHE-Mental Health Care Staff | Quality of Care-Total | 6 months | 3.8 units on a scale | Standard Deviation 0.5 |
| BREATHE-Mental Health Care Staff | Quality of Care-Total | 12 months | 3.8 units on a scale | Standard Deviation 0.5 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care-Total | 12 months | 3.9 units on a scale | Standard Deviation 0.4 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care-Total | Baseline | 3.7 units on a scale | Standard Deviation 0.5 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care-Total | 6 months | 3.8 units on a scale | Standard Deviation 0.5 |
| Motivational Interviewing-Mental Health Care Staff | Quality of Care-Total | 3 months | 3.7 units on a scale | Standard Deviation 0.5 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.17Mixed Models Analysis
Secondary
Short-Form Health Survey (SF-12)-Mental Health Functioning
Physical and mental health functioning was assessed with the Short Form 12-Item Health Survey (SF-12). The SF-12 is a health-related quality of life measure, derived from the 36-item Medical Outcomes Study survey and containing items yielding a Mental Health Component Score and a Physical Health Component Score. Higher composite scores indicate higher health-related quality of life. Items are weighted and then transformed into norm-based scores (range: 0-100). Ware JE, Jr. , Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996;34(3):220 -233.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Short-Form Health Survey (SF-12)-Mental Health Functioning | Baseline | 42.6 units on a scale | Standard Deviation 7.8 |
| BREATHE-Clients | Short-Form Health Survey (SF-12)-Mental Health Functioning | 6 months | 42.7 units on a scale | Standard Deviation 7.7 |
| BREATHE-Clients | Short-Form Health Survey (SF-12)-Mental Health Functioning | 12 months | 43.2 units on a scale | Standard Deviation 7.2 |
| Motivational Interviewing-Clients | Short-Form Health Survey (SF-12)-Mental Health Functioning | Baseline | 42.0 units on a scale | Standard Deviation 8.1 |
| Motivational Interviewing-Clients | Short-Form Health Survey (SF-12)-Mental Health Functioning | 6 months | 43.0 units on a scale | Standard Deviation 8 |
| Motivational Interviewing-Clients | Short-Form Health Survey (SF-12)-Mental Health Functioning | 12 months | 43.4 units on a scale | Standard Deviation 8 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.67Mixed Models Analysis
Secondary
Short-Form Health Survey (SF-12)-Physical Health Functioning
Physical and mental health functioning was assessed with the Short Form 12-Item Health Survey (SF-12). The SF-12 is a health-related quality of life measure, derived from the 36-item Medical Outcomes Study survey and containing items yielding a Mental Health Component Score and a Physical Health Component Score. Higher composite scores indicate higher health-related quality of life. Items are weighted and then transformed into norm-based scores (range: 0-100). Ware JE, Jr. , Kosinski M, Keller SD. A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care. 1996;34(3):220 -233.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Short-Form Health Survey (SF-12)-Physical Health Functioning | Baseline | 41.4 units on a scale | Standard Deviation 8.7 |
| BREATHE-Clients | Short-Form Health Survey (SF-12)-Physical Health Functioning | 6 months | 42.3 units on a scale | Standard Deviation 8.3 |
| BREATHE-Clients | Short-Form Health Survey (SF-12)-Physical Health Functioning | 12 months | 42.0 units on a scale | Standard Deviation 7.9 |
| Motivational Interviewing-Clients | Short-Form Health Survey (SF-12)-Physical Health Functioning | Baseline | 41.9 units on a scale | Standard Deviation 7.9 |
| Motivational Interviewing-Clients | Short-Form Health Survey (SF-12)-Physical Health Functioning | 6 months | 41.8 units on a scale | Standard Deviation 7.8 |
| Motivational Interviewing-Clients | Short-Form Health Survey (SF-12)-Physical Health Functioning | 12 months | 41.7 units on a scale | Standard Deviation 7.8 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.48Mixed Models Analysis
Secondary
Staff Turnover
Number of staff participants who separated from their respective agency before their anticipated study completion date. The mental health agencies provided separation dates, if applicable, for staff study participants.
Time frame: Measured with staff at 12 months
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| BREATHE-Mental Health Care Staff | Staff Turnover | Separated from Agency | 23 Participants |
| BREATHE-Mental Health Care Staff | Staff Turnover | Not Separated from Agency | 66 Participants |
| Motivational Interviewing-Mental Health Care Staff | Staff Turnover | Separated from Agency | 33 Participants |
| Motivational Interviewing-Mental Health Care Staff | Staff Turnover | Not Separated from Agency | 70 Participants |
p-value: 0.35Chi-squared
Secondary
Turnover Intentions-Considered Leaving
This is the first of two questions in which staff were asked about turnover intentions. Staff were asked, How often have you seriously considered leaving your job in the past six months? Scale: 1 (Never), 2 (Once every few months), 3 (Once a month), 4 (several times a month), 5 (Once a week), 6 (Several times a week)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Turnover Intentions-Considered Leaving | Baseline | 2.0 units on a scale | Standard Deviation 1.2 |
| BREATHE-Mental Health Care Staff | Turnover Intentions-Considered Leaving | 3 months | 2.4 units on a scale | Standard Deviation 1.4 |
| BREATHE-Mental Health Care Staff | Turnover Intentions-Considered Leaving | 6 months | 2.5 units on a scale | Standard Deviation 1.7 |
| BREATHE-Mental Health Care Staff | Turnover Intentions-Considered Leaving | 12 months | 2.6 units on a scale | Standard Deviation 1.5 |
| Motivational Interviewing-Mental Health Care Staff | Turnover Intentions-Considered Leaving | 12 months | 2.7 units on a scale | Standard Deviation 1.6 |
| Motivational Interviewing-Mental Health Care Staff | Turnover Intentions-Considered Leaving | Baseline | 2.6 units on a scale | Standard Deviation 1.7 |
| Motivational Interviewing-Mental Health Care Staff | Turnover Intentions-Considered Leaving | 6 months | 2.8 units on a scale | Standard Deviation 1.8 |
| Motivational Interviewing-Mental Health Care Staff | Turnover Intentions-Considered Leaving | 3 months | 2.6 units on a scale | Standard Deviation 1.6 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.96Mixed Models Analysis
Secondary
Turnover Intentions-Likely to Leave
This is the second of two questions in which staff were asked about turnover intentions. Staff were asked, How likely are you to leave your job in the next six months? Scale: 1 (Not likely at all), 2 (Not very likely), 3 (Somewhat likely), 4 (Very likely)
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Turnover Intentions-Likely to Leave | Baseline | 1.6 units on a scale | Standard Deviation 0.8 |
| BREATHE-Mental Health Care Staff | Turnover Intentions-Likely to Leave | 3 months | 1.8 units on a scale | Standard Deviation 1 |
| BREATHE-Mental Health Care Staff | Turnover Intentions-Likely to Leave | 6 months | 1.9 units on a scale | Standard Deviation 1 |
| BREATHE-Mental Health Care Staff | Turnover Intentions-Likely to Leave | 12 months | 1.8 units on a scale | Standard Deviation 0.9 |
| Motivational Interviewing-Mental Health Care Staff | Turnover Intentions-Likely to Leave | 12 months | 2.1 units on a scale | Standard Deviation 1.1 |
| Motivational Interviewing-Mental Health Care Staff | Turnover Intentions-Likely to Leave | Baseline | 1.9 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Turnover Intentions-Likely to Leave | 6 months | 2.2 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Turnover Intentions-Likely to Leave | 3 months | 2.0 units on a scale | Standard Deviation 1 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.17Mixed Models Analysis
Secondary
Working Alliance Inventory (WAI)
Perceived relatedness was assessed with this short form of the patient version of the WAI and is 12 items (e.g., We agree on what is important for me to work on.). Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were averaged. Scale: 1 (Never) to 7 (Always) Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Working Alliance Inventory (WAI) | Baseline | 5.6 units on a scale | Standard Deviation 1.2 |
| BREATHE-Clients | Working Alliance Inventory (WAI) | 6 months | 5.4 units on a scale | Standard Deviation 1.4 |
| BREATHE-Clients | Working Alliance Inventory (WAI) | 12 months | 5.7 units on a scale | Standard Deviation 1.3 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) | Baseline | 5.5 units on a scale | Standard Deviation 1.2 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) | 6 months | 5.6 units on a scale | Standard Deviation 1.2 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) | 12 months | 5.6 units on a scale | Standard Deviation 1.3 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.22Mixed Models Analysis
Secondary
Working Alliance Inventory (WAI) - Bonds Subscale
Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the bonds subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The items scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always) Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Working Alliance Inventory (WAI) - Bonds Subscale | Baseline | 23.2 units on a scale | Standard Deviation 5.1 |
| BREATHE-Clients | Working Alliance Inventory (WAI) - Bonds Subscale | 6 months | 22.6 units on a scale | Standard Deviation 6.5 |
| BREATHE-Clients | Working Alliance Inventory (WAI) - Bonds Subscale | 12 months | 23.3 units on a scale | Standard Deviation 5.5 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Bonds Subscale | Baseline | 23.0 units on a scale | Standard Deviation 5.1 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Bonds Subscale | 6 months | 23.0 units on a scale | Standard Deviation 5.4 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Bonds Subscale | 12 months | 22.8 units on a scale | Standard Deviation 6.1 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.55Mixed Models Analysis
Secondary
Working Alliance Inventory (WAI) - Goals Subscale
Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the goals subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The items scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always) Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Working Alliance Inventory (WAI) - Goals Subscale | Baseline | 21.8 units on a scale | Standard Deviation 5.1 |
| BREATHE-Clients | Working Alliance Inventory (WAI) - Goals Subscale | 6 months | 21.0 units on a scale | Standard Deviation 5.4 |
| BREATHE-Clients | Working Alliance Inventory (WAI) - Goals Subscale | 12 months | 22.4 units on a scale | Standard Deviation 5 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Goals Subscale | Baseline | 21.4 units on a scale | Standard Deviation 4.8 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Goals Subscale | 6 months | 21.8 units on a scale | Standard Deviation 4.9 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Goals Subscale | 12 months | 21.7 units on a scale | Standard Deviation 5.3 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.14Mixed Models Analysis
Secondary
Working Alliance Inventory (WAI) - Tasks Subscale
Perceived relatedness was assessed with this short form of the patient version of the WAI and has 12 items in total. This outcome is for the tasks subscale. Clients were prompted to report on the specific clinician from whose caseload they were randomly selected. The item scores were summed and averaged (range: 4-28). Scale: 1 (Never) to 7 (Always) Tracey TJ, Kokotovic AM. Factor structure of the Working Alliance Inventory. Psychological Assessment: A Journal of Consulting and Clinical Psychology. 1989;1(3):207.
Time frame: Measured with clients at baseline, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data. Some clients did not recall the clinician being asked about and/or discontinued treatment with that clinician during their study participation.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Clients | Working Alliance Inventory (WAI) - Tasks Subscale | Baseline | 22.0 units on a scale | Standard Deviation 5.4 |
| BREATHE-Clients | Working Alliance Inventory (WAI) - Tasks Subscale | 6 months | 21.3 units on a scale | Standard Deviation 6.4 |
| BREATHE-Clients | Working Alliance Inventory (WAI) - Tasks Subscale | 12 months | 22.6 units on a scale | Standard Deviation 5.6 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Tasks Subscale | Baseline | 21.5 units on a scale | Standard Deviation 5.3 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Tasks Subscale | 6 months | 22.2 units on a scale | Standard Deviation 5.3 |
| Motivational Interviewing-Clients | Working Alliance Inventory (WAI) - Tasks Subscale | 12 months | 22.4 units on a scale | Standard Deviation 5.1 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.11Mixed Models Analysis
Secondary
Work Interference With Home Life
Work-Life Balance was assessed with a six-item measure adapted from an 18-item measure developed by Carlson et al. The measure assesses three types (time-, strain-, and behavior-based) and two directions (work conflict with family and family conflict with work) of balance. The outcome described here is work conflict with family. The measure consists of a series of statements regarding one's work and family situation, to which participants are asked to indicate their level of agreement or disagreement on a 5-point Likert-type scale: 1 (Strongly disagree) to 5 (Strongly agree). The item scores were averaged. Carlson DS, Kacmar KM, Williams LJ. Construction and initial validation of a multidimensional measure of work-family conflict. Journal of Vocational Behavior. 2000;56(2):249-276.
Time frame: Measured with staff at baseline, 3 months, 6 months, and 12 months
Population: The number analyzed at each time point differs from the overall number enrolled due to participant drop out and/or missing data.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| BREATHE-Mental Health Care Staff | Work Interference With Home Life | Baseline | 2.7 units on a scale | Standard Deviation 0.9 |
| BREATHE-Mental Health Care Staff | Work Interference With Home Life | 3 months | 2.7 units on a scale | Standard Deviation 0.9 |
| BREATHE-Mental Health Care Staff | Work Interference With Home Life | 6 months | 2.7 units on a scale | Standard Deviation 1 |
| BREATHE-Mental Health Care Staff | Work Interference With Home Life | 12 months | 2.7 units on a scale | Standard Deviation 0.8 |
| Motivational Interviewing-Mental Health Care Staff | Work Interference With Home Life | 12 months | 2.9 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Work Interference With Home Life | Baseline | 2.9 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Work Interference With Home Life | 6 months | 2.9 units on a scale | Standard Deviation 1 |
| Motivational Interviewing-Mental Health Care Staff | Work Interference With Home Life | 3 months | 2.9 units on a scale | Standard Deviation 1.1 |
Comparison: Mixed effects regression analysis was used to examine the BREATHE intervention effect on clinician burnout and patient processes, engagement, and outcomes as compared to MI after the intervention by adjusting for the baseline scores and the implementation site.p-value: 0.47Mixed Models Analysis