***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE This study examined racial-ethnic differences in the impact of the  Youth Partners in Care quality improvement intervention . The intervention was design ed to improve access to evidence -based depression care , primarily cognitive-behavioral therapy and medication , through primary care . Previous analyses have shown that the quality improvement intervention was associated with improved depression and quality -of-life outcomes at the end of the six-month intervention period . METHODS A r and omized controlled trial comparing quality improvement and usual care for youths from diverse racial-ethnic groups from five health care organizations , including managed care , the public sector , and academic center clinics , was conducted . Depressed youths ( N=325 ) , who self-identified as black ( N=59 ) , Latino ( N=224 ) , and white ( N=42 ) , aged 13 - 21 years , were included in these analyses . To evaluate intervention effects within racial-ethnic groups , regression models were constructed , which adjusted for baseline and study site variation in depression symptoms , mental health status , satisfaction with mental health care , and mental health service utilization . RESULTS Differential intervention effects were found across racial-ethnic groups . Black youths in the intervention group experienced significant reductions in depression symptoms and had higher rates of use of specialty mental health care at the six-month follow-up . Among Latino youths , the intervention was associated with significantly greater satisfaction with care . Intervention effects were weak among white youths . CONCLUSIONS Quality improvement interventions may help to reduce disparities in mental health care for youths from racial-ethnic minority groups . Abstract A r and omized experiment was conducted in two outpatient clinics evaluating a measurement feedback system called context ualized feedback systems . The clinicians of 257 Youth 11–18 received feedback on progress in mental health symptoms and functioning either every 6 months or as soon as the youth ’s , clinician ’s or caregiver ’s data were entered into the system . The ITT analysis showed that only one of the two participating clinics ( Clinic R ) had an enhanced outcome because of feedback , and only for the clinicians ’ ratings of youth symptom severity on the SFSS . A dose – response effect was found only for Clinic R for both the client and clinician ratings . Implementation analyses showed that Clinic R had better implementation of the feedback intervention . Clinicians ’ question naire completion rate and feedback viewing at Clinic R were 50 % higher than clinicians at Clinic U. The discussion focused on the differences in implementation at each site and how these differences may have contributed to the different outcomes of the experiment OBJECTIVE : To determine the effectiveness of a quality improvement program to improve pediatricians ' adherence to existing , evidence -based , attention-deficit/hyperactivity disorder ( ADHD ) practice guidelines . METHODS : Forty-nine community-based pediatricians at 8 practice s participated in a cluster-r and omized trial . Practice s were matched according to the numbers of pediatricians and the proportions of patients receiving Medicaid . The medical charts for a r and om sample of patients with ADHD for each of the participating pediatricians were examined at baseline and 6 months . All practice s participated in 4 sessions of training , including didactic lectures and office flow modification workshops . Practice s were then given access to an ADHD Internet portal that allowed parents , teachers , and pediatricians to input information ( eg , rating scales ) about patients , after which information was scored , interpreted , and formatted in a report style that was helpful for assessment and treatment of patients with ADHD . Physicians evaluated their practice behaviors quarterly and addressed underperforming areas . RESULTS : Pediatricians in the intervention group , compared with those in the control group , demonstrated significantly higher rates of many American Academy of Pediatrics – recommended ADHD care practice s , including collection of parent ( Cohen 's d = 0.69 ) and teacher ( d = 0.68 ) rating scales for assessment of children with ADHD , use of Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition , criteria ( d = 0.85 ) , and use of teacher rating scales to monitor treatment responses ( d = 1.01 ) . CONCLUSION : A quality improvement intervention that can be widely disseminated by using Internet-based information technology significantly improved the quality of ADHD care in community-based pediatric setting OBJECTIVE To test whether pay for performance ( P4P ) is an effective method to improve adolescent substance use disorder treatment implementation and efficacy . DESIGN Cluster r and omized trial . SETTING Community-based treatment organizations . PARTICIPANTS Twenty-nine community-based treatment organizations , 105 therapists , and 986 adolescent patients ( 953 with complete data ) . INTERVENTION Community-based treatment organizations were assigned to 1 of the following conditions : the implementation-as-usual ( IAU ) control condition or the P4P experimental condition . In addition to delivering the same evidence -based treatment ( ie , using the Adolescent Community Reinforcement Approach [ A-CRA ] ) , each organization received st and ardized levels of funding , training , and coaching from the treatment developers . Therapists in the P4P condition received US $ 50 for each month that they demonstrated competence in treatment delivery ( ie , A-CRA competence ) and US $ 200 for each patient who received a specified number of treatment procedures and sessions ( ie , target A-CRA ) that has been found to be associated with significantly improved patient outcomes . MAIN OUTCOME MEASURES Outcomes included ACRA competence ( ie , a therapist-level implementation measure ) , target A-CRA ( ie , a patient-level implementation measure ) , and remission status ( ie , a patient-level treatment effectiveness measure ) . RESULTS Relative to therapists in the IAU control condition , therapists in the P4P condition were significantly more likely to demonstrate A-CRA competence ( 24.0 % vs 8.9 % ; event rate ratio , 2.24 ; 95 % CI , 1.12- 4.48 ; P=.02 ) . Relative to patients in the IAU control condition , patients in the P4P condition were significantly more likely to receive target A-CRA ( 17.3 % vs 2.5 % ; odds ratio , 5.19 ; 95 % CI , 1.53 - 17.62 ; P=.01 ) . However , no significant differences were found between conditions with regard to patients ' end-of-treatment remission status . CONCLUSION Pay for performance can be an effective method of improving treatment implementation . TRIAL REGISTRATION clinical trials.gov Identifier : BACKGROUND Social anxiety disorder ( SAD ) typically onsets in adolescence and is associated with multiple impairments . Despite promising clinical interventions , most socially anxious adolescents remain untreated . To address this clinical neglect , we developed a school-based , 12-week group intervention for youth with SAD , Skills for Academic and Social Success ( SASS ) . When implemented by psychologists , SASS has been found effective . To promote dissemination and optimize treatment access , we tested whether school counselors could be effective treatment providers . METHOD We r and omized 138 , ninth through 11th grade rs with SAD to one of three conditions : ( a ) SASS delivered by school counselors ( C-SASS ) , ( b ) SASS delivered by psychologists ( P-SASS ) , or ( c ) a control condition , Skills for Life ( SFL ) , a nonspecific counseling program . Blind , independent , evaluations were conducted with parents and adolescents at baseline , post-intervention , and 5 months beyond treatment completion . We hypothesized that C-SASS and P-SASS would be superior to the control , immediately after treatment and at follow-up . No prediction was made about the relative efficacy of C-SASS and P-SASS . RESULTS Compared to controls , adolescents treated with C-SASS or  P-SASS  experienced significantly greater improvement and reductions of anxiety at the end of treatment and follow-up . There were no significant differences between SASS delivered by school counselors and psychologists . CONCLUSION With training , school counselors are effective treatment providers to adolescents with social anxiety , yielding benefits comparable to those obtained by specialized psychologists . Questions remain regarding means to maintain counselors ' practice st and ards without external support OBJECTIVE : To determine if implementing attention-deficit/hyperactivity disorder ( ADHD ) diagnosis and treatment guidelines in a clinical decision support system would result in better care , including higher rates of adherence to clinical care guidelines . METHODS : We conducted a cluster r and omized controlled trial in which we compared diagnosis and management of ADHD in 6- to 12-year-olds after implementation of a computer decision support system in 4 practice s. RESULTS : Eighty-four charts were review ed . In the control group , the use of  structured diagnostic assessment s  dropped from 50 % in the baseline period to 38 % in the intervention period . In the intervention group , however , it rose from 60 % to 81 % . This difference was statistically significant , even after controlling for age , gender , and race ( odds ratio of structured diagnostic assessment in intervention group versus control group = 8.0 , 95 % confidence interval 1.6–40.6 ) . Significant differences were also seen in the number of ADHD core symptoms noted at the time of diagnosis . Our study was not powered to detect changes in care and management , but the percent of patients who had documented medication adjustments , mental health referrals , and visits to mental health specialists were higher in the intervention group than the control . CONCLUSIONS : The introduction of a clinical decision support module result ed in higher quality of care with respect to ADHD diagnosis including a prospect for higher quality of ADHD management in children . Future work will examine how to further develop the ADHD module and add support for other chronic conditions OBJECTIVE A r and omized trial assessed the effectiveness of a 2-level strategy for implementing evidence -based mental health treatments for delinquent youth . METHOD A 2 x 2 design encompassing 14 rural Appalachian counties included 2 factors : ( a ) the r and om assignment of delinquent youth within each county to a multisystemic therapy ( MST ) program or usual services and ( b ) the r and om assignment of counties to the ARC ( for availability , responsiveness , and continuity ) organizational intervention for implementing effective community-based mental health services . The design created 4 treatment conditions ( MST plus ARC , MST only , ARC only , control ) . Outcome measures for 615 youth who were 69 % male , 91 % Caucasian , and aged 9 - 17 years included the Child Behavior Checklist and out-of-home placements .  RESULTS A multilevel , mixed-effects , regression analysis of 6-month treatment outcomes found that youth total problem behavior in the MST plus ARC condition was at a non clinical level and significantly lower than in other conditions . Total problem behavior was equivalent and at non clinical levels in all conditions by the 18-month follow-up , but youth in the MST plus ARC condition entered out-of-home placements at a significantly lower rate ( 16 % ) than youth in the control condition ( 34 % ) . CONCLUSIONS Two-level strategies that combine an organizational intervention such as ARC and an evidence -based treatment such as MST are promising approaches to implementing effective community-based mental health services . More research is needed to underst and how such strategies can be used effectively in a variety of organizational context s and with other types of evidence -based treatments Community clinic therapists were r and omized to ( a ) brief training and supervision in cognitive-behavioral therapy ( CBT ) for  youth depression or ( b ) usual care ( UC ) . The therapists treated 57 youths ( 56 % girls ) , ages 8 - 15 , of whom 33 % were Caucasian , 26 % were African American , and 26 % were Latino/Latina . Most youths were from low-income families and all had Diagnostic and Statistical Manual of Mental Disorders ( 4th ed . ; American Psychiatric Association , 1994 ) depressive disorders ( plus multiple comorbidities ) . All youths were r and omized to CBT or UC and treated until normal termination . Session coding showed more use of CBT by CBT therapists and more psychodynamic and family approaches by UC therapists . At posttreatment , depression symptom measures were at sub clinical levels , and 75 % of youths had no remaining depressive disorder , but CBT and UC groups did not differ on these outcomes . However , compared with UC , CBT was ( a ) briefer ( 24 vs. 39 weeks ) , ( b ) superior in parent-rated therapeutic alliance , ( c ) less likely to require additional services ( including all psychotropics combined and depression medication in particular ) , and ( d ) less costly . The findings showed advantages for CBT in parent engagement , reduced use of medication and other services , overall cost , and possibly speed of improvement -- a hypothesis that warrants testing in future research Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more OBJECTIVE Evidence -based Practice ( EBP ) implementation is likely to be most efficient and effective in organizations with positive social context s ( i.e. , organizational culture , climate , and work attitudes of clinicians ) . The study objective was to test whether an organizational intervention labeled Availability , Responsiveness and Continuity ( ARC ) could improve the organizational social context s of community-based mental health programs for youth . METHOD The study r and omly assigned 26 community-based mental health programs for youth to ARC or control conditions .  The organizational cultures , climates , and work attitudes of clinicians ( n = 197 ) in the programs were assessed with the Organizational Social Context ( OSC ) measure for mental health services at baseline and following the 18-month ARC intervention . RESULTS Hierarchical linear models ( HLM 
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We found inconsistent evidence involving strategies with educational meetings , material s , and outreach ; programs appeared to be successful in combination with reminders or providing practitioners with newly collected clinical information .
We also found low strength of evidence for no benefit for initiatives that included only educational material s or meetings ( or both ) , or only educational material s and outreach components .
Conclusions Several strategies can improve both intermediate and final health outcomes and re source use .