Tarlow, K. R., McCord, C. E., Nelon, J. L., & Bernhard, P. A. (in press). Comparing in-person supervision and telesupervision: A multiple-baseline single-case study. Journal of Psychotherapy Integration.
Tarlow, K. R., McCord, C. E., Du, Y., Hammett, J., & Wills, T. (in press). Rural mental health service utilization in a Texas telepsychology clinic. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.22903
Objective: To determine if service utilization behaviors varied with the remoteness of clients served by a telepsychology clinic in a predominantly rural health professional shortage area (HPSA) in Texas.
Methods: Archival data from 290 low-income clients were analyzed to test associations between service utilization behaviors and clients' distance from the nearby access points where they traveled to receive counseling services from remotely located counselors.
Results: Distance to access points did not predict differences in service utilization behaviors. However, clients in rural counties traveled farther to receive services than clients in metropolitan areas. Some utilization behaviors varied by demographic variables and depressive symptom severity.
Conclusions: A “hub and spoke” model of telehealth service delivery is an acceptable model for improving access to mental health care services in rural and underserved communities, even for clients who live relatively far from access points. Telehealth providers should consider geographic, socioeconomic, transportation, and health-related barriers to care experienced by clients when implementing services and policies.
Saenz, J. J., Sahu, A., Tarlow, K. R., & Chang, J. (in press). Telepsychology: Training perspectives. Journal of Clinical Psychology. https://doi.org/10.1002/jclp.22875
This paper is intended to discuss the authors' perspectives and experiences as current and former telepsychology trainees (ranging from current students to 3 years post-graduate) at a graduate telepsychology clinic in a rural setting. The authors of this paper all completed telepsychology training during completion of their doctoral degrees in counseling psychology at a large public university in east Texas. Telepsychology trainees delivered individual and group treatments via videoconference and telephone to clients living in a predominantly rural and historically underserved region of Texas, and they also conducted telepsychology-related research during and after their clinical training. The trainee perspectives presented in this paper are organized around the core American Psychological Association (APA) graduate training competency domains of ethics, diversity and multiculturalism, supervision, and research (American Psychological Association, 2017a). Trainees' reflections about future directions in telepsychology are also included.
Hutchins, N. S., Burke, M. D., Bowman-Perrott, L., Tarlow, K. R., & Hatton, H. (in press). The effects of social skills interventions for students with EBD and ASD: A single-case meta-analysis. Behavior Modification. https://doi.org/10.1177/0145445519846817
Social skills interventions are critical for promoting social, emotional, and behavioral competence for students with or at risk of emotional and behavioral disorders (EBD) and autism spectrum disorders (ASD). This single-case meta-analysis examined the effects of social skills interventions (SSIs) for students with EBD and ASD. Effect sizes were calculated for 78 cases across 25 included studies using a nonparametric effect size, Baseline Corrected Tau. The overall weighted mean effect size of 0.54 suggested a moderate effect across the 25 studies. The overall weighted mean effects for studies reporting maintenance and generalization data were 0.68 and 0.37, respectively. Potential moderators examined (disability, intervention design, intervention delivery, methodological quality) were not significant. As such, they did not moderate the outcomes for participants. We conducted a post hoc analysis and hypothesized that between-study differences may be more meaningful than the similarities shared by participants in the same moderator groups. Implications are discussed on using SSIs to address the social, emotional, and behavioral challenges of students with or at risk of EBD and ASD.
Tarlow, K. R., Johnson, T. A., & McCord, C. E. (2019). Rural status, suicide ideation, and telemental health: Risk assessment in a clinical sample. Journal of Rural Health, 35. 247-252. https://doi.org/10.1111/jrh.12310
Objective: Individuals living in rural areas die by suicide at higher rates than those living in metropolitan areas. Telemental health interventions provide rural residing individuals with access to needed care. Identifying telemental health clients at risk for suicide is an important task for clinicians and policymakers. This study evaluated to what degree rural status and other demographic variables predicted suicide ideation in clients seeking services at a telemental health clinic.
Methods: Study participants included 457 low-income clients residing in the medically underserved, geographically diverse Brazos Valley region of Texas. Clients completed the patient health questionnaire during their initial counseling appointment, which assessed depression severity and suicide ideation in the 2 weeks prior to assessment.
Results: Suicide ideation was common among telemental health clients, with approximately 40% of clients in all demographic groups reporting some recent thoughts of suicide. Rates of suicide ideation did not significantly differ by geographic designation (ie, rural/metropolitan status), gender, or race/ethnicity. However, depression was a strong predictor of recent suicide ideation.
Conclusions: Telemental health programs can effectively connect clinicians with rural residing clients who are otherwise isolated from health care services. However, clinicians working in high-need, historically underserved areas should be prepared to encounter a high prevalence of suicide ideation and depression. In these regions, clinical and diagnostic features may be better indicators of suicide ideation than demographic variables.
Sanchez Gonzalez, M. L., McCord, C. E., Dopp, A. R., Tarlow, K. R., Dickey, N. J., McMaughan, D. K., & Elliott, T. R. (2019). Telemental health training and delivery in primary care: A case report of interdisciplinary treatment. Journal of Clinical Psychology: In Session, 75(2), 260-270. https://doi.org/10.1002/jclp.22719
Telehealth can overcome access and availability barriers that often impede receiving needed mental health services. This case report describes an interdisciplinary approach to treatment for an individual with chronic physical health conditions and comorbid mental health concerns, which resulted in high utilization (and associated costs) of preventable emergency services. The report describes clinical case progression on anxiety symptoms and emergency service utilization while concurrently highlighting telehealth-specific practice implications, especially as they pertain to training settings.
Tarlow, K. R., & Brossart, D. F. (2018). A comprehensive method of single-case data analysis: Interrupted Time-Series Simulation (ITSSIM). School Psychology Quarterly, 33(4), 590-603. https://doi.org/10.1037/spq0000273
Single-case experimental methods are used across a range of educational and psychological research. Single-case data are analyzed with a variety of methods, but no statistic has demonstrated clear superiority over other methods. The time-series nature of single-case designs requires special consideration for baseline trend and autocorrelation when estimating intervention effect size. However, standard correction methods are limited because they assume precise statistical estimation of trend and autocorrelation. Unlike standard correction methods, Monte Carlo simulation methods can address the poor precision of single-case effect size indices. This paper presents the rationale for a new simulation method, Interrupted Time-Series Simulation (ITSSIM). A small field test was also conducted, and ITSSIM performed similarly to sophisticated multilevel methods for single-case research. ITSSIM is accessible as a free software application that requires no prior knowledge of statistical computing or syntax. ITSSIM may be used to estimate the effect size of a single interrupted time-series (AB design), and multiple ITSSIM effect size estimates may be combined via meta-analysis.
Impact Statement: A new method of single-case data analysis, ITSSIM, uses computer simulation to test the effectiveness of school/psychological interventions at the individual subject level. ITSSIM gave results similar to sophisticated multilevel modeling methods when tested on a small example data set, suggesting ITSSIM is a viable tool for single-case research. This new method of analysis is easy for all investigators to use because ITSSIM software is free to download and requires no previous statistical computing experience.
Tarlow, K. R. (2017). An improved rank correlation effect size statistic for single-case designs: Baseline Corrected Tau. Behavior Modification, 41(4), 427-467. https://doi.org/10.1177/0145445516676750
Measuring treatment effects when an individual's pretreatment performance is improving poses a challenge for single-case experimental designs. It may be difficult to determine whether improvement is due to the treatment or due to the preexisting baseline trend. Tau-U is a popular single-case effect size statistic that purports to control for baseline trend. However, despite its strengths, Tau-U has substantial limitations: Its values are inflated and not bound between −1 and +1, it cannot be visually graphed, and its relatively weak method of trend control leads to unacceptable levels of Type I error wherein ineffective treatments appear effective. An improved effect size statistic based on rank correlation and robust regression, Baseline Corrected Tau, is proposed and field-tested with both published and simulated single-case time series. A web-based calculator for Baseline Corrected Tau is also introduced for use by single-case investigators.
Tarlow, K. R., & Penland, A. (2016). Outcome assessment and inference with the Percentage of Nonoverlapping Data (PND) single-case statistic. Practice Innovations, 1(4), 221-233. https://doi.org/10.1037/pri0000029
Single-case experimental designs allow practitioners to conduct clinical outcomes research without the large samples and substantial resources required by randomized clinical trials. Single-case designs have been used to conduct outcomes research for many decades; however, the statistical measurement of treatment effect sizes remains an unresolved issue. The percentage of nonoverlapping data (PND) is one widely used statistic for effect size measurement of single-case experimental designs. Despite its limitations, PND is useful because it is easy to calculate and interpret. However, null hypothesis significance testing (i.e., the use of p values) is not currently feasible with PND because it has an unknown sampling distribution. A method to calculate p values for PND is introduced and discussed. An online calculator and statistical computing code are also made available to single-case investigators who wish to calculate p values for their data. Calculating PND and its associated p values may provide practitioners with valuable insights about their treatment outcomes when PND is used appropriately and its statistical assumptions are not violated.
Tarlow, K. R. (2016). Teaching principles of inference with ANOVA. Teaching Statistics, 38(1), 16-21. https://doi.org/10.1111/test.12085
Analysis of variance (ANOVA) is a test of mean differences, but the reference to variances in the name is often overlooked. Classroom activities are presented to illustrate how ANOVA works with emphasis on how to think critically about inferential reasoning.
Tarlow, K. R., McCord, C. E., Elliott, T. R., & Brossart, D. F. (2014). Health-related quality of life of rural clients seeking telepsychology services. International Journal of Telemedicine and Applications, 2014, 7. https://doi.org/10.1155/2014/168158
Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n = 94) had low health-related quality of life (HRQOL), often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n = 40) was associated with an improvement in mental health-related quality of life (d = 0.70, p < .001). These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.
Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (𝑛 = 94) had low health-related quality of life (HRQOL), often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (𝑛 = 40) was associated with an improvement in mental health-related quality of life (𝑑 = 0.70, 𝑃 < .001). These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.
Tarlow, K. R., Chang, J. E., McCord, C. E., Du, Y., & Hammett, J. (2018, August). Improving access to care via a hub and spoke telehealth model in rural Texas. Poster accepted for presentation at the annual meeting of the American Psychological Association, San Francisco, CA.
Ponciano, C., Philip, J., Tarlow, K. R., & McCord, C. E. (2018, July). Self-reported client concerns in telehealth counseling services with minority groups. Poster presented at the biennial meeting of the Society for the Psychological Study of Culture, Ethnicity, and Race Research (American Psychological Association Division 45), Austin, TX.
Tarlow, K. R., McCord, C. E., Du, Y., Hammett, J., & Chang, J. E. (2018, June). Overcoming geographical distances: An investigation of a hub and spoke telemental health model. Presented at the Annual Research Meeting of Academy Health, Seattle, WA.
Tarlow, K. R. (2018, February). Meta-analysis of single-case research: Applications to autism telepractice. In P. Yovanoff (Chair), Single-case research effect size estimation and meta-analysis: Issues and application. Panel conducted at the Pacific Coast Research Conference, San Diego, CA.
Kleine-Kracht, D., Kaysey, A., Giovanetti, A., Parks, T., McCord, C., & Tarlow, K. R. (2017, November). The nature and challenges of referral sources for low SES and rural populations at a telecounseling clinic. Poster presented at the annual meeting of the Texas Psychological Association, Houston, TX.
Dickey, E., Dickey, N. W., McCord, C. E., Poston, D., Tarlow, K. R. (primary author), & Watzak, B. (2017, September). A model of efficient interprofessional collaboration in a free healthcare clinic: The Health For All "Health Huddle". Poster presented at the annual meeting of the Interprofessional Education and Research Symposium, Bryan, TX. (Award: Best Interprofessional Activity)
Saenz, J., Rosner, C., Garney, W., McCord, C. E., Dornhecker, M., Dornhecker, C., Apolinar, A., & Tarlow, K. R. (2016, August). Confronting LGBTQ+ health disparities: An interdisciplinary approach for policy and practice. Poster presented at the annual meeting of the American Psychological Association, Denver, CO.
Tarlow, K. R. (2015, February). Analysis of variance or: How I learned to stop worrying about means and love the homogeneity of variance assumption. Paper presented at the annual meeting of the Southwest Educational Research Association, San Antonio, TX.
Hale, N., Tarlow, K. R., & Madkins, J. (2015, February). The art and practice of case referral in a university counseling center. Presentation at the annual Texas University and College Counseling Center Conference, Austin, TX.
Tarlow, K. R., McCord, C. E., & Elliott, T. R. (2014, August). Short-term benefits of telecounseling in a rural, low-SES Texas community. Poster presented at the annual meeting of the American Psychological Association, Washington, D.C.
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