ABSTBACKGROUND: Evidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or ...regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States.
In-person, group-administered surveys were conducted with a sample of 1,112 mental health service providers in a nationwide sample of 100 mental health service institutions in 26 states in the United States. The study examines these associations with a two-level Hierarchical Linear Modeling (HLM) analysis of responses to the Evidence-Based Practice Attitude Scale (EBPAS) at the individual clinician level as a function of the Organizational Social Context (OSC) measure at the organizational level, controlling for other organization and clinician characteristics.
We found that more proficient organizational cultures and more engaged and less stressful organizational climates were associated with positive clinician attitudes toward adopting evidence-based practice.
The findings suggest that organizational intervention strategies for improving the organizational social context of mental health services may contribute to the success of evidence-based practice dissemination and implementation efforts by influencing clinician attitudes.
Background: An increasing number of children are placed in foster care (i.e., a kin or nonkin family home other than the biological parent) due to experiences of physical, sexual, emotional, or ...psychological abuse, and/or neglect. Children in foster care are at increased risk for a host of negative outcomes encompassing emotional, behavioral, neurobiological, and social realms.
Methods: Areas of risk and vulnerability among foster children are described, including emotional and behavioral deficits, impaired neurobiological development, and social relationship deficits. Evidence suggesting the significance of family placement changes and prenatal exposure to substances as contributing mechanisms is presented. Based on a systematic search of the PsycINFO database (to March 2012), eight efficacious evidence‐based interventions for foster families are summarized.
Findings: Although the development of evidence‐based interventions that improve outcomes for foster children has lagged behind the delivery of interventions in other service sectors (e.g., mental health and educational sectors), several interventions across childhood and adolescence offer promise. Service system constraints offer both challenges and opportunities for more routine implementation of evidence‐based interventions.
Conclusions: Given the increased likelihood of poor outcomes for foster children, increased efforts to understand the pathways to vulnerability and to implement interventions shown to be effective in remediating risks and improving outcomes for this population are indicated. Evaluation of efficacious interventions in countries outside of the United States is also needed.
Abstract Objective To determine the relationships between adverse childhood experiences (ACEs) and mental health, chronic medical conditions, and social development among young children in the child ...welfare system. Methods This cross-sectional study used a nationally representative sample of children investigated by child welfare (National Survey of Child and Adolescent Well-Being II) from 2008 to 2009. Our analysis included caregiver interviews and caseworker reports about children aged 18 to 71 months who were not in out-of-home care (n = 912). We examined the associations between ACEs and mental health (measured by the Child Behavior Checklist CBCL), reported chronic medical conditions, and social development (measured by the Vineland Socialization Scale) in bivariate and multivariate analyses. Results Nearly all children (98.1%) were reported to have had an ACE in their lifetime; the average number of ACEs was 3.6. For every additional reported ACE, there was a 32% increased odds of having a problem score on the CBCL (odds ratio OR 1.32, 95% confidence interval CI 1.14, 1.53) and a 21% increased odds of having a chronic medical condition (OR 1.21, 95% CI 1.05, 1.40). Among children aged 36 to 71 months, for every additional reported ACE, there was a 77% increased odds of a low Vineland Socialization score (OR 1.77, 95% CI 1.12, 2.78). Conclusions ACEs were associated with poor early childhood mental health and chronic medical conditions, and, among children aged 3 to 5, social development. Efforts are needed to examine whether providing early intervention to families with multiple stressors mitigates the impact of ACEs on children's outcomes.
Abstract Objective Despite the high prevalence rates of harsh parenting, the nature of developmental change in this domain early in life and the factors that contribute to changes in harsh parenting ...over time are not well understood. The present study examined developmental patterns in maternal harsh parenting behavior from birth to age 3 years and their related longitudinal risk factors (contextual and intrapersonal). Partner aggression was also tested as a time-varying predictor to examine its time-specific influence on maternal harsh parenting. Methods Longitudinal data from 4 assessments of a community sample of 488 at-risk mothers were analyzed using latent growth curve modeling. Maternal risk factors and harsh parenting behaviors were assessed at birth and at ages 1, 2, and 3 years. Results There was a significant increase in maternal harsh parenting from birth to age 3, particularly between ages 1 and 2. There was a significant direct effect of maternal alcohol use and abuse history on maternal harsh parenting at age 3, and maternal age was positively associated with change in maternal harsh parenting over time. In addition, partner aggression was significantly and positively associated with maternal harsh parenting at each time point. Conclusions The findings suggest possible developmental trends in the emergence of maternal harsh parenting during infancy and toddlerhood. Further investigation is needed to elucidate individual differences in the developmental patterns and to differentiate predictive factors that persist across time and factors that are unique to specific developmental stages. Practice implications The overall high prevalence rates of harsh parenting behavior and growth of such behavior in infancy and toddlerhood support the need for developmentally sensitive early intervention programs.
Parent training for foster parents is mandated by federal law and supported by state statues in nearly all states; however, little is known about the efficacy of that training, and recent reviews ...underscore that the most widely used curricula in the child welfare system (CWS) have virtually no empirical support (Grimm,
Youth Law News
, April–June:3–29, 2003). On the other hand, numerous theoretically based, developmentally sensitive parent training interventions have been found to be effective in experimental clinical and prevention intervention trials (e.g., Kazdin and Wassell,
Journal of the American Academy of Child and Adolescent Psychiatry
, 39:414–420, 2000; McMahon and Forehand,
Helping the noncompliant child
, Guilford Press, New York, USA, 2003; Patterson and Forgatch,
Parents and adolescents: I. Living together
, Castalia Publishing, Eugene, OR, USA, 1987; Webster-Stratton et al.,
Journal of Clinical Child Pyschology Psychiatry
, 42:943–952, 2001). One of these, Multidimensional Treatment Foster Care (MTFC; Chamberlain,
Treating chronic juvenile offenders: Advances made through the Oregon Multidimensional Treatment Foster Care model
, American Psychological Association, Washington, DC, USA, 2003), has been used with foster parents of youth referred from juvenile justice. The effectiveness of a universal intervention, KEEP (Keeping Foster Parents Trained and Supported) based on MTFC (but less intensive) was tested in a universal randomized trial with 700 foster and kinship parents in the San Diego County CWS. The goal of the intervention was to reduce child problem behaviors through strengthening foster parents’ skills. The trial was designed to examine effects on both child behavior and parenting practices, allowing for specific assessment of the extent to which improvements in child behavior were mediated by the parenting practices targeted in the intervention. Child behavior problems were reduced significantly more in the intervention condition than in the control condition, and specific parenting practices were found to mediate these reductions, especially for high-risk children in foster families reporting more than six behavior problems per day at baseline.
OBJECTIVE: Racial and ethnic disparities in mental health service use have been identified as a major public health problem. However, the extent to which these disparities may be accounted for by ...other confounding sociodemographic or clinical predictors of service use (e.g., family income, functional impairment, caregiver strain) is relatively unexplored, especially for youth services. The goal of this study was to test for racial ethnic disparities in use of a variety of outpatient, inpatient, and informal mental health services among high-risk youths, with the effects of other predictive factors controlled. METHOD: Participants were 1,256 youths ages 6-18 years who received services in a large, publicly funded system of care (including the child welfare, juvenile justice, special education, alcohol and drug abuse, and mental health service sectors). Youths and caregivers were interviewed with established measures of mental health service use, psychiatric diagnoses, functional impairment, caregiver strain, and parental depression. RESULTS: Significant racial ethnic group differences in likelihood of receiving any mental health service and, specifically, formal outpatient services were found after the effects of potentially confounding variables were controlled. Race ethnicity did not exert a significant effect on the use of informal or 24-hour-care services. CONCLUSIONS: Racial ethnic disparities in service use remain a public health problem.
Objective: The purpose of this research was to provide a prospective look at the relationship between change in placement and problem behaviors over a 12-month period among a cohort of foster ...children.
Method: The sample contained 415 youth, and was part of a larger cohort of children who entered foster care in San Diego, California and remained in placement for at least 5 months. The Child Behavior Check List was used to assess behavior problems. Every change of placement during the first 18 months after entry into the foster care system was abstracted from case records.
Results: The results suggest that volatile placement histories contribute negatively to both internalizing and externalizing behavior of foster children, and that children who experience numerous changes in placement may be at particularly high risk for these deleterious effects. Initial externalizing behaviors proved to be the strongest predictor of placement changes for the entire sample and for a sub-sample of those who initially evidenced problem behaviors on at least one broad-band CBCL scale. Our findings also suggest that children who initially score within normal ranges on the CBCL may be particularly vulnerable to the detrimental effects of placement breakdowns.
Conclusions: On the basis of these findings we argue for an analytical approach that views behavior problems as both a cause and as a consequence of placement disruption. Children who do not evidence behavior problems may in fact constitute a neglected population that responds to multiple disruptions of their primary relationships with increasingly self-defeating behaviors.
•State behavioral health-related agencies often use evidence-based program registers on the web to select new evidence-based interventions.•Three registers out of 28 accounted for most register ...“hits” on these state agency websites.•Increasing awareness of the full range of such registers could contribute to the wider use of evidence-based programs and practices nationwide.•This study is a novel application of webscraping to assess state agencies’ extent of awareness and use of a major evaluation resource on the web.
Evidence-based program registers (EBPRs) are important tools for facilitating the use of evidence-based practices or programs (EBPs) by state statutory agencies responsible for behavioral healthcare, broadly defined as substance misuse, mental health, HIV/AIDS prevention, child welfare, and offender rehabilitation. There are currently no data on the purposes for which such state agencies reference EBPRs on their official websites.
A webscraping method was used to identify and classify relevant “hits”, defined as a state behavioral health webpage with single or multiple references to a study EBPR. A total of 778 hits (unique combinations of webpage and register) were coded. Up to three codes were applied to each hit for the “reasons for the EBPR reference” (EBPR use) dimension, one code was applied to each hit for the “purpose of the EBPR reference” and “intended audience of the webpage containing the hit” dimensions, and up to two codes were applied to each hit for the "funding mentions” dimension.
Three EBPRs out of 28 accounted for 73.6% of the hits. The most frequent reason for referencing EBPRs were as a resource for selecting EBPs or validating existing programs and practices. The references tended to appear in reports from the state, in training materials, or guidelines. The references tended to address broad groups of behavioral healthcare professionals. EBPRs were frequently referenced in the context of federal block grants or other federal funding.
Increasing state agencies’ awareness and use of the entire range of existing EBPRs may improve implementation of EBPs nationally.
Abstract Purpose To examine prevalence and correlates of five mental health (MH) problems among 12–17.5 year olds investigated by child welfare. Methods Data from the National Survey on Child and ...Adolescent Well-being (NSCAW II) were analyzed to examine depression, anxiety, substance use/abuse, suicidality, and attention deficit hyperactivity disorder (ADHD) as reported by teens and their caregivers. In a sample of 815 adolescents, prevalence for each MH problem and correlates (e.g., age, placement location) were identified using bivariate and multivariable logistic analyses. Results After investigation for maltreatment, 42.7% of teens reported at least one MH problem, regardless of placement. Nine percent reported depression, 13.9% reported suicidality, 23% had substance use/abuse, 13.5% reported anxiety, and 18.6% had ADHD. Of 332 teens with any MH problem, 52.1% reported only one problem, 28.3% had two problems, and 19.6% had ≥ three problems. Teens with prior out-of-home placement had odds 2.29 times higher of reporting a MH problem and odds 2.12 times higher of reporting substance use/abuse. Males were significantly less likely to report depression. Older teens were more likely to report substance use/abuse. Black teens were significantly less likely to report suicidality and ADHD and almost half as likely to report anxiety. Teens with a chronic health condition and teens whose caregiver reported depression had more than twice the odds of reporting anxiety. Conclusions This study highlights high rates of MH problems in teens of all ages and placement locations and suggests that all teens involved with child welfare should be screened for MH problems, regardless of initial placement status.
Background Family-based treatment (FBT) for anorexia nervosa is an evidence-based treatment, but its effectiveness is untested among socioeconomically disadvantaged and racially diverse youth. ...Adapting FBT may facilitate "scale-out" for Medicaid-insured youth served in publicly-funded settings and potentially improve outcomes for more diverse populations. Methods This mixed methods effectiveness-implementation Hybrid Type 3 pilot study protocol included a planning period in collaboration with the San Francisco Department of Public Health, culminating in a two-day in-person FBT training for 25 therapists in the county, followed by the opportunity to engage in one year of weekly supervision. The training incorporated FBT adaptations intended to improve fit for low-income families within community-based settings. Treatment appropriateness and acceptability will be measured immediately post-training. Following the training, cases referred for FBT will only be assigned to the trained clinicians who voluntarily opted into long-term group supervision. Clinicians treating at least one FBT case during the supervision period will report on implementation, adaptations, and patient weight gain. Finally, semi-structured interviews with clinician participants will be conducted, focused on implementation challenges and facilitators, local treatment adaptations, and overall satisfaction with FBT. Discussion Learning about clinician adaptations will advance knowledge about treatment of eating disorders in publicly-funded community clinics, which serve a racially/ethnically and socioeconomically diverse group of youth. This project is designed to accelerate FBT implementation in publicly-funded mental health systems, and inform service improvements for underserved youth with eating disorders. Keywords: Adaptation, Family-based treatment (FBT), Implementation, Mixed methods, Hybrid effectiveness-implementation Type 3 design, "Scale-out", Children and adolescents, Anorexia nervosa, Atypical anorexia nervosa, Publicly-funded settings, Protocol
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