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Verhoog S, Eijgermans DGM, Fang Y, Bramer WM, Raat H, Jansen W. Contextual determinants associated with children's and adolescents' mental health care utilization: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:2051-2065. [PMID: 36129544 PMCID: PMC9490713 DOI: 10.1007/s00787-022-02077-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/31/2022] [Indexed: 11/19/2022]
Abstract
Determinants at the contextual level are important for children's and adolescents' mental health care utilization, as this is the level where policy makers and care providers can intervene to improve access to and provision of care. The objective of this review was to summarize the evidence on contextual determinants associated with mental health care utilization in children and adolescents. A systematic literature search in five electronic databases was conducted in August 2021 and retrieved 6439 unique records. Based on eight inclusion criteria, 74 studies were included. Most studies were rated as high quality (79.7%) and adjusted for mental health problems (66.2%). The determinants that were identified were categorized into four levels: organizational, community, public policy or macro-environmental. There was evidence of a positive association between mental health care utilization and having access to a school-based health center, region of residence, living in an urban area, living in an area with high accessibility of mental health care, living in an area with high socio-economic status, having a mental health parity law, a mental health screening program, fee-for-service plan (compared to managed care plan), extension of health insurance coverage and collaboration between organizations providing care. For the other 35 determinants, only limited evidence was available. To conclude, this systematic review identifies ten contextual determinants of children's and adolescents' mental health care utilization, which can be influenced by policymakers and care providers. Implications and future directions for research are discussedPROSPERO ID: CRD42021276033.
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Affiliation(s)
- S Verhoog
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - D G M Eijgermans
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
- The Generation R Study Group, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | - Y Fang
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W M Bramer
- Medical Library, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands
| | - H Raat
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands
| | - W Jansen
- Department of Public Health, Erasmus MC, University Medical Centre, P.O. box 2040, 3000 CA, Rotterdam, The Netherlands.
- Department of Social Development, City of Rotterdam, Rotterdam, the Netherlands.
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Zilberstein K, Brown A, Hatcher AJ, Burton J, Gau J. Providers' experiences collaborating with child welfare workers: The good, the bad, and the impacts. CHILD ABUSE & NEGLECT 2024; 152:106772. [PMID: 38574602 DOI: 10.1016/j.chiabu.2024.106772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/12/2024] [Accepted: 03/20/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Successful interprofessional collaborations have been identified as a potential solution to mitigate problems associated with negative outcomes for clients involved with the child welfare system. The barriers to collaborative relationships need to be better understood and effectively addressed. OBJECTIVE To understand the characteristics, barriers, and facilitators of collaborations between different types of providers and child welfare workers, as well as their impacts. PARTICIPANTS AND SETTING Mental health professionals, foster and kinship parents, legal professionals, and other providers responded to an online survey distributed in a Northeastern State of the United States of America. METHOD Participants (n = 208) completed the Quality of Collaboration with Child Welfare survey. Qualitative responses were analyzed by three coders using three levels of axial coding with constant comparison. RESULTS Participants identified different aspects of communication, relationships, and follow-through as key elements of successful collaborations, as well as the items most likely to interfere with their formation. Providers differed somewhat in how concerned they were with various aspects of collaborations in accordance with their professional roles. Barriers to successful collaborations included both individual and systemic factors which often resulted in negative outcomes. Overall, more negative experiences were offered than positive ones. CONCLUSIONS Strategies are needed to improve communication, promote positive relationships, and address systemic barriers to enhance collaboration and, in turn, improve outcomes for child welfare-involved clients.
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Affiliation(s)
| | - Adam Brown
- Silberman School of Social Work at Hunter College, NY, New York, USA.
| | | | - J Burton
- Clinical and Support Options, Northampton, MA, USA
| | - Jeff Gau
- Oregon Research Institute, Eugene, OR, USA.
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Connell CM, Kim HW, Shipe SL, Pittenger SL, Tebes JK. Effects of Community-Based Wraparound Services on Child and Caregiver Outcomes Following Child Protective Service Involvement. CHILD MALTREATMENT 2024; 29:190-201. [PMID: 36214073 DOI: 10.1177/10775595221125454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
This study investigated whether statewide delivery of the wraparound service model (WSM) improved child and caregiver outcomes and reduced subsequent child protective service (CPS) contact among families referred to services following a CPS report. Caregivers (n = 247) completed baseline and 6-month interviews to document self-reported engagement in WSM and non-WSM conditions and assess changes in outcomes. Kernel-weighted difference-in-difference (K-DID) models were used to assess program effects, based on reported condition. Child behavior outcomes improved among WSM-engaged families, but differences by condition were non-significant except for internalizing behaviors. Caregiver receipt of WSM was associated with greater retention of behavioral health services, but did not produce statistically significant improvements in their wellbeing. Households in the WSM condition were more likely to be reported to CPS at 6-month follow-up, but this difference was not significant at 12 months and differences in substantiation were not statistically significant. Supplemental analyses compared alternative means of contrasting group effects, highlighting some differences based on method. The WSM produced few significant differential improvements in child or caregiver outcomes and failed to prevent future CPS involvement. Inadequate program fidelity appeared to be a factor in implementation of the WSM, which may have hampered program effectiveness under real-world conditions.
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Affiliation(s)
- Christian M Connell
- Human Development and Family Studies, Pennsylvania State University, University Park, PA, USA
- Child Maltreatment Solutions Network, Pennsylvania State University, University Park, PA, USA
| | - Hyun Woo Kim
- Department of Sociology, Chungbuk National University, Chungbuk, South Korea
| | - Stacey L Shipe
- Child Maltreatment Solutions Network, Pennsylvania State University, University Park, PA, USA
- Department of Social Work, State University of New York - Binghamton University, Binghamton, NY, USA
| | - Samantha L Pittenger
- Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, CT (Dr. Pittenger is now at Centers for Medicare & Medicaid Services, Baltimore, MD, USA)
| | - Jacob Kraemer Tebes
- Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, CT (Dr. Pittenger is now at Centers for Medicare & Medicaid Services, Baltimore, MD, USA)
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Solerdelcoll M, Ilzarbe D, Fortea A, Morer A, Lazaro L, Sugranyes G, Baeza I. Psychopathology and mental health service use among youth in foster care admitted to a psychiatric inpatient unit: a 4-year retrospective controlled study. Eur Child Adolesc Psychiatry 2024; 33:39-50. [PMID: 36542199 PMCID: PMC9768764 DOI: 10.1007/s00787-022-02104-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 10/24/2022] [Indexed: 12/24/2022]
Abstract
Youth in foster care (FC) are at increased risk of poor psychosocial outcomes. The aim of this study was to assess psychopathology and mental health service use among youth living in FC who require psychiatric hospitalisation. All individuals admitted to our Children and Adolescent Inpatient Psychiatry Unit between 2014 and 2017 who were in FC were systematically reviewed. The control group was defined as all youth living with their immediate family and hospitalised in our unit throughout 2016. We identified 89 patients placed in FC and 247 controls. Socio-demographic and clinical data were retrospectively collected from computerised charts. A survival analysis of emergency department visits and readmission to the hospital was conducted. Compared to controls, the FC group presented significantly higher rates of conduct disorder (78.7% vs 14.6%; p < 0.001) and substance use disorder (49.4% vs 27.5%; p < 0.001), mainly cannabis use (34.8% vs 16.6%; p < 0.001); higher rates of comorbidity (96.6% vs 55.9%; p < 0.001) and mean number of comorbid diagnoses (3.3 ± 1.1 vs 2.3 ± 0.5; p < 0.001). The FC group had a higher number of emergency room visits before and after admission than controls. FC youth were also 2.77 times more likely to visit the emergency department after discharge, and in a shorter time period, than controls (p = 0.004). Disruptive behaviours, substance use disorder, and comorbid psychopathology were all more prevalent among FC youth than controls. Specific strategies are needed to optimize community mental health resources and address the increased use of emergency services by these youth before and after hospitalisation.
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Affiliation(s)
- Mireia Solerdelcoll
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, 16 De Crespingy Park, London, SE5 8AF, UK.
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain.
- Department of Medicine, University of Barcelona, Barcelona, Spain.
| | - Daniel Ilzarbe
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Adriana Fortea
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Astrid Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Luisa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Gisela Sugranyes
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
| | - Inmaculada Baeza
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 2017SGR881, Barcelona, Spain
- Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
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Leo HP, Folk JB, Rodriguez C, Tolou-Shams M. Implementation Considerations for Family-Based Telehealth Interventions for Youth in Foster Care: Focus Group Study With Child Welfare System Professionals. JMIR Form Res 2023; 7:e45905. [PMID: 38157238 PMCID: PMC10787329 DOI: 10.2196/45905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 11/01/2023] [Accepted: 11/05/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families. OBJECTIVE This study aims to understand child welfare system professionals' perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement. METHODS This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework. RESULTS Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68%), White individuals (n=10, 53%), and social workers (n=8, 42%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy. CONCLUSIONS Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin.
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Affiliation(s)
- Hannah P Leo
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Child and Adolescent Psychiatry, New York-Presbyterian, New York, NY, United States
| | - Johanna B Folk
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Christopher Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
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Sklar M, Kenneally R, Aarons GA, Fettes DL. Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol. Implement Sci Commun 2023; 4:121. [PMID: 37798808 PMCID: PMC10552205 DOI: 10.1186/s43058-023-00479-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Half of child-welfare-involved children and adolescents meet the criteria for at least one mental health diagnosis. This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) team effectiveness intervention to augment the child and family team (CFT) services' intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including the voice of children and families as intended. METHODS Using a parallel group trial design, with non-equivalent comparison groups, and qualitative and quantitative methodology, this study will tailor and assess the impact of the AAR on enhancing CFT outcomes. The authors will conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention in a large, publicly funded, CWS system. A qualitative inquiry consisting of interviews and focus groups with key stakeholders will result in the preparation of an action plan to address identified gaps between the current and desired CFT services intervention outcomes. The AAR implementation strategy will be adapted and tailored to address the CFT services' intervention needs. To test the effectiveness of the AAR on improving outcomes associated with the CFT services intervention, we will utilize blocked randomization of four CWS caseworkers from two CWS system regions to either the intervention condition (CFT + AAR) or standard implementation (CFT as usual). The authors will collect data from the CWS caseworkers and additional CFT members via web-based surveys. Mechanisms of the AAR team effectiveness intervention for CFT implementation will be assessed. DISCUSSION By inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with service plans and linkage to mental health treatment services for children. The knowledge gained by this randomized clinical trial has the potential to benefit service delivery and integration for CWS leaders, caseworkers, formal and informal CFT member support persons, parents/caregivers, and children with open cases. Improving intervention effectiveness, both at the system and family levels, is crucial for practice efficiencies and improved child and family outcomes. TRIAL REGISTRATION NCT05629013. Approval date: November 28, 2022 (version 1). TRIAL SPONSOR University of California, San Diego. RESPONSIBLE PARTY Danielle Fettes.
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Affiliation(s)
- Marisa Sklar
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
- ImplementatioN Science and Team Effectiveness in Practice Children's Mental Health Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Ryan Kenneally
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
- ImplementatioN Science and Team Effectiveness in Practice Children's Mental Health Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA
| | - Danielle L Fettes
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive (0812), La Jolla, CA, 92093-0812, USA.
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.
- ImplementatioN Science and Team Effectiveness in Practice Children's Mental Health Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA, 92123, USA.
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Loveridge S, Skidmore M, Shupp R, Miller PK, Cuthbertson C, Goetz S. Rural US residents recognize anxiety better than urbanites and suburbanites but hold similar stigma. J Rural Health 2023; 39:860-869. [PMID: 36988517 DOI: 10.1111/jrh.12757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
PURPOSE Recognizing signs of psychological distress is a critical first step in assisting people who are struggling with poor mental health to access help. However, community-level factors that impact recognition and stigma are underexplored. The purpose of this study is to investigate the relationship between rurality, other community-level variables, and individual variables with regard to the recognition and stigma of anxiety. METHODS We use a survey of US adults (N = 627), including a rural oversample, and a cloaked vignette approach. We assess the ability to identify anxiety and measure associated stigma. The analysis applies an ecological model in multinomial logistic regressions. FINDINGS About half of the respondents recognize anxiety from a list of possibilities when provided with a vignette detailing common anxiety symptoms. Respondents living in rural areas are nearly twice as likely to correctly identify anxiety than nonrural respondents. About one-fifth of respondents agree with a statement designed to measure stigma: that exhibiting the symptoms is a sign of personal weakness. Respondents able to identify anxiety show less stigma. Respondents from counties with high mental health provider access were less likely to endorse the stigma statement. CONCLUSIONS Rural areas seem poised to reduce the stigma associated with anxiety, because residents are more adept at identifying anxiety than people living elsewhere. Future work could focus on effective mechanisms for reducing stigma associated with anxiety in rural areas, and whether anxiety recognition and stigma are changing.
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Affiliation(s)
- Scott Loveridge
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, Michigan, USA
| | - Mark Skidmore
- Department of Agricultural, Food, and Resource Economics and Department of Economics, Michigan State University, East Lansing, Michigan, USA
| | - Robert Shupp
- Department of Agricultural, Food, and Resource Economics, Michigan State University, East Lansing, Michigan, USA
| | - Paula K Miller
- Department of Sociology and Anthropology, Ohio University, Athens, Ohio, USA
| | - Courtney Cuthbertson
- Human Development and Family Studies, University of Illinois, Urbana-Champaign, Urbana, Illinois, USA
| | - Stephan Goetz
- Department of Agricultural Economics, Sociology, and Education, The Pennsylvania State University, State College, Philadelphia, Pennsylvania, USA
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Gopalan G, Lee KA, Pisciotta C, Hooley C, Stephens T, Acri M. Implementing a Child Mental Health Intervention in Child Welfare Services: Stakeholder Perspectives on Feasibility. JOURNAL OF EMOTIONAL AND BEHAVIORAL DISORDERS 2023; 31:204-218. [PMID: 37635804 PMCID: PMC10454527 DOI: 10.1177/10634266221120532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
This pilot study integrated quantitative and qualitative data to examine the feasibility of implementing a modified version of a multiple family group behavioral parent training intervention (The 4Rs and 2Ss for Strengthening Families Program [4Rs and 2Ss]) in child welfare (CW) placement prevention services, from the perspectives of participating caregivers (n = 12) and CW staff (n = 12; i.e., 6 caseworkers, 4 supervisors, and 2 administrators). Quantitative surveys were administered to caregivers and CW staff followed by semi-structured interviews to examine the feasibility of implementing the modified 4Rs and 2Ss program, as well as factors impacting feasibility. Results indicated that quantitative benchmarks for high feasibility were met in all assessed areas (e.g., family recruitment, caseworker fidelity ratings, CW staff feasibility ratings) except for family attendance, which was markedly lower than desired. Factors facilitating feasibility included agency and research support, intervention ease-of-use, perceived benefits to existing CW practice, as well as logistical support (e.g., food, transportation, childcare) promoting attendance. Factors hindering feasibility included conflicts between research-based eligibility criteria and existing client population demographics, research-related processes resulting in delays, CW staff role conflicts, added workload burden, complex family issues, and power differentials inherent to CW services which complicated families' voluntary participation.
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Affiliation(s)
- Geetha Gopalan
- Hunter College – Silberman School of Social Work, 2180 Third Ave., New York, NY 10035
| | - Kerry A Lee
- Graduate School of Social Work and Social Research of Bryn Mawr College, Bryn Mawr, PA 19010
| | - Caterina Pisciotta
- The Graduate Center, City University of New York, 365 Fifth Ave., New York, NY 10016
| | - Cole Hooley
- School of Social Work, College of Family, Home and Social Sciences, Brigham Young University, Provo, UT 84602
| | - Tricia Stephens
- Hunter College – Silberman School of Social Work, 2180 Third Ave., New York, NY 10035
| | - Mary Acri
- McSilver Institute for Poverty Policy and Research, New York University Silver School of Social Work, 41 East 11 St., New York, NY 10001
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Hynes DM, Thomas KC. Realigning theory with evidence to understand the role of care coordination in mental health services research. INTERNATIONAL JOURNAL OF CARE COORDINATION 2023; 26:55-61. [PMID: 37333504 PMCID: PMC10273861 DOI: 10.1177/20534345231153801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
Current theoretical models intended to guide health services research and evaluation lack care coordination-its features and impacts. These aspects are critical for understanding the role of care coordination in healthcare use, quality, and outcomes. In this Focus article, we briefly review the well-known Andersen individual behavioral model (IBM) of healthcare use and the Donabedian health system and quality model (HSQM) together with recent practice-based evidence. We propose a new integrated theoretical model of healthcare and care coordination. The model can serve as a guide for future research to better understand the variation in care coordination services and delivery and its added value to improving mental health in different real-world settings.
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Affiliation(s)
- Denise M Hynes
- Center to Improve Veteran Involvement in Care, VA Portland Healthcare System, Portland, OR, USA
- Health Management and Policy Program, School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, and Center for Quantitative Life Sciences, Oregon State University, Corvallis, OR, USA
| | - Kathleen C Thomas
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy; Cecil G. Sheps Center for Health Services Research and Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Bunger AC, Yoon S, Maguire-Jack K, Phillips R, West KY, Clark-Hammond G, Kranich C. Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children's Mental Health Systems: A Case Study of the Gateway CALL Demonstration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:327-341. [PMID: 36449108 PMCID: PMC9931844 DOI: 10.1007/s10488-022-01238-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/05/2022]
Abstract
The mental health needs of children and youth involved in the child welfare system remain largely unmet. Service cascades are an emerging approach to systematizing mental health screening, assessment, and treatment referral processes. However, evidence is minimal and inconsistent regarding the effectiveness of such approaches for improving mental health service access and outcomes. In an effort to address this gap, this study presents a case-study of the implementation fidelity and treatment outcomes of the Gateway CALL service cascade. Study analyses involved longitudinal data collected as part of a larger evaluation of Gateway CALL. Specifically, descriptive and linear mixed model analyses were conducted to assess the implementation of service cascade components, and changes in mental health outcomes (behavior problems) among 175 children placed out-of-home during the study. Study analyses found that although fidelity was strong early in the service cascade, implementation began to break down once components involved more than one service system (child welfare, mental health). However, results also indicated that parent-reported child behavior problems decreased significantly over time, despite later cascade components being implemented with poor fidelity to the Gateway CALL service model. For children and youth involved in child welfare systems, service cascades like Gateway CALL have the potential to significantly improve both mental health service receipt and outcomes. To maximize the effectiveness of such approaches, later phases of implementation may require increased attention and support, particularly regarding processes and outcomes that cross child welfare and mental health service systems.
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Affiliation(s)
- Alicia C. Bunger
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | - Susan Yoon
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | | | - Rebecca Phillips
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | | | | | - Christiana Kranich
- Government Resource Center, Ohio Colleges of Medicine, Columbus, OH 43210 USA
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Flourishing mental health among adults with child welfare contact during childhood: Findings from a nationally representative Canadian survey. Psychiatry Res 2022; 316:114660. [PMID: 35715251 DOI: 10.1016/j.psychres.2022.114660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 05/14/2022] [Accepted: 05/31/2022] [Indexed: 11/22/2022]
Abstract
This study investigated the prevalence of and factors associated with complete mental health (CMH) among a nationally representative sample of Canadians who had contact with child welfare services before age 16. CMH was defined as (1) the absence of suicidality, mental illness, and substance abuse or dependence in the preceding year; (2) happiness or life satisfaction almost every day in the preceding month, and; (3) social and psychological well-being almost every day in the preceding month. Data came from the 2012 Canadian Community Health Survey - Mental Health. A subsample of 732 adults with child welfare contact during childhood was analyzed using bivariate chi-square analyses and multivariate logistic regression models. Overall, 63.5% of adults with child welfare contact during childhood were in CMH. Those with a post-secondary degree, who were married, who had a confidant, and who used religion or spirituality to cope with daily challenges were more likely to be in CMH. The odds of CMH were higher among those without chronic pain, functional limitations, and a history of depression, anxiety, or substance abuse or dependence. The results of this study indicate significant resiliency among adults following contact with child welfare services during childhood. Implications for appropriate interventions are discussed.
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Mieloo CL, van der Ende J, van Zijl AL, Schuring M, Steijn B, Jansen W. Changes in youth care use after the implementation of community-based support teams: repeated measurement study using registry data and data on team characteristics. BMJ Open 2022; 12:e048933. [PMID: 35172992 PMCID: PMC8852673 DOI: 10.1136/bmjopen-2021-048933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES New legislation on youth care in the Netherlands led to the implementation of community-based support teams, providing integrated primary youth care. Important aims of the new Youth Act were more integrated, timely care and less use of intensive forms of care. Our aim was to study changes in youth care use in time and the role of newly introduced community-based support teams herein. SETTING Register data (2015-2018) on youth of a large city were linked and combined with administrative and aggregated data on team characteristics. PARTICIPANTS Data on 126 095 youth (0-18 years) were available for analyses. PRIMARY AND SECONDARY OUTCOME MEASURES Primary, specialised and residential youth care use were the primary outcomes. RESULTS Generalised estimating equations analyses adjusted for individual characteristics demonstrated that over 4 years, use of primary youth care increased from 2.2% to 8.5% (OR 1.70; 99% CI 1.67 to 1.73), specialised youth care decreased from 7.2% to 6.4% (OR 0.98; 99% CI 0.97 to 1.00) and residential youth care increased slightly (OR 1.04; 99% CI 1.01 to 1.06). Gender, age, family status, migrant background and educational level were all associated with the types of youth care use and also with some trends in time. Likelihood to receive care increased in time for preschool and younger children but did not improve for migrant children.Case load, team size, team turnover, team performance and transformational leadership showed significant associations with different types of youth care use but hardly with trends in time. CONCLUSION Patterns of youth care use changed towards more locally provided primary youth care, slightly less specialised and slightly more residential youth care. Furthermore, youth care use among younger children increased in time. These trends are partly in line with the trends intended by the Youth Act. Little evidence was found for the role of specific team characteristics on changes in youth care use in time.
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Affiliation(s)
- Cathelijne L Mieloo
- Governance of Urban Transitions - Research Group Transforming Youth Care, Haagsche Hogeschool, Den Haag, Zuid-Holland, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry, Erasmus MC Sophia Children Hospital, Rotterdam, Zuid-Holland, The Netherlands
| | - Alissa Lysanne van Zijl
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Merel Schuring
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Bram Steijn
- Department of Public Administration and Sociology, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
- Department of Social Development, Gemeente Rotterdam, Rotterdam, The Netherlands
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Taylor EK, Dopp AR, Lounsbury K, Thompson Y, Miller M, Jorgensen A, Silovsky JF. Enhancing Early Engagement (E3) in mental health services training for children's advocacy center's victim advocates: feasibility protocol for a randomized controlled trial. Pilot Feasibility Stud 2021; 7:212. [PMID: 34872619 PMCID: PMC8645678 DOI: 10.1186/s40814-021-00949-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022] Open
Abstract
Background Child maltreatment is a major public issue in the United States, yet most children affected by abuse or neglect never engage in evidence-based practices (EBP) for child mental health. Children’s Advocacy Centers (CACs’) are uniquely situated to serve as Family Navigators who connect children impacted by maltreatment to appropriate EBPs. In fact, the CAC position of Victim Advocate mirrors the Mental Health Family Navigator national initiative. Methods The feasibility study protocol is to develop, implement, and evaluate web-based and consultative training for Victim Advocates to enhance early engagement in services (E3 training). The interactive web-based training embeds key targets of knowledge and skills related to family engagement, trauma, and EBP services. Participating CACs were randomized to E3 webinar-based training, E3 webinar plus consultation, or delayed training. The project will test the E3 training’s impact on key mechanisms of change (e.g., knowledge, skills) to improve rates of screening, referral, and access to EBP services. The feasibility of implementing the training program and differential impact and costs by level of training will be examined. Discussion The overarching goal of this project is to test the feasibility of training that is readily implemented through CACs and examine the mechanisms for improving early engagement and, ultimately, child, and adolescent mental health outcomes. Results and cost findings will be used to plan a large-scale comprehensive, mixed-methods hybrid type II effectiveness-implementation and cost-effectiveness trial of family navigator E3 training. If outcomes are positive, considerable infrastructure exists to support the scale-up and sustainability of E3 training nationwide, by embedding the training in national CAC training protocols. Trial registration NCT04221633 Date and version identifier March 25, 2021; Vers. 1.0 (original); September 11, 2021; Vers 2.0 (revision); October 29, 2021; Vers. 3.0 (revision)
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Affiliation(s)
- Erin K Taylor
- Center on Child Abuse and Neglect, Department of Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th St #4900, Oklahoma City, OK, 73104, USA.
| | - Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Kaitlin Lounsbury
- National Children's Alliance, 516 C St NE #100, Washington, DC, 20002, USA
| | - Yutian Thompson
- Center on Child Abuse and Neglect, Department of Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th St #4900, Oklahoma City, OK, 73104, USA
| | - Michelle Miller
- National Children's Alliance, 516 C St NE #100, Washington, DC, 20002, USA
| | - Ashley Jorgensen
- HumRRO, 700 North Hurstbourne Parkway, Suite 100, Louisville, KY, 40222, USA
| | - Jane F Silovsky
- Center on Child Abuse and Neglect, Department of Pediatrics, University of Oklahoma Health Sciences Center, 940 NE 13th St #4900, Oklahoma City, OK, 73104, USA
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14
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Bunger AC, Maguire-Jack K, Yoon S, Mooney D, West KY, Hammond GC, Kranich C. Does mental health screening and assessment in child welfare improve mental health service receipt, child safety, and permanence for children in out-of-home care? An evaluation of the Gateway CALL demonstration. CHILD ABUSE & NEGLECT 2021; 122:105351. [PMID: 34628151 DOI: 10.1016/j.chiabu.2021.105351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Unmet mental health service needs among children in out-of-home care are sometimes attributed to poor assessments and referrals in child welfare. The Gateway CALL project implemented mental health screening, diagnostic assessment, and referral to treatment practices. OBJECTIVE We examined the effectiveness of Gateway CALL for improving children's mental health service receipt, safety, and permanency outcomes. PARTICIPANTS AND SETTING Participants included 538 children (birth to 18 years) in out-of-home placements through a county-based child welfare agency over a 17-month period. METHODS We compared the mental health service receipt, safety, and permanency outcomes for 175 children who received Gateway CALL with 175 children who received "services as usual" identified through propensity score matching. Participant demographics, safety, and permanency outcomes were drawn from child welfare administrative records, and mental health service visits and diagnoses were drawn from Medicaid billing records. RESULTS Gateway CALL appeared to increase the number of mental health service visits children received (z = 2.14, p = 0.032), although not the likelihood of receiving services. In terms of child safety, children in Gateway CALL had a greater number of screened-in calls after the intervention than those in the comparison group [t(348) = -1.92, p = 0.03]; there were no differences in substantiations. There were also no observed effects on permanency. CONCLUSIONS Despite systematic efforts to identify, assess, and refer children to mental health services through the Gateway CALL intervention, substantial unmet mental health service needs among children persisted. Results have implications for designing interventions that promote cross-system service access.
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Affiliation(s)
- Alicia C Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA.
| | - Kathryn Maguire-Jack
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI 48109, USA
| | - Susan Yoon
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA
| | | | - Kristopher Y West
- Nationwide Children's Hospital, 495 East Main Street, Columbus, OH 43215, USA
| | | | - Christiana Kranich
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA
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Simmel C, Bowden CF, Neese-Todd S, Hyde J, Crystal S. Antipsychotic treatment for youth in foster care: Perspectives on improving youths' experiences in providing informed consent. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2021; 91:258-270. [PMID: 33983774 DOI: 10.1037/ort0000532] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The disproportionate prescribing of high-risk antipsychotic medication for youth in foster care is a significant social problem across the U.S. This qualitative study examined stakeholder perceptions of prescribing, being prescribed, or overseeing prescriptions for youth in foster care. Interviews and focus groups were conducted with clinicians, child welfare caseworkers, foster caregivers, and foster care alumni. The overall aim was to systematically explore their understanding of and experiences with the Informed Consent to treatment and shared decision-making processes related to prescribing and monitoring of antipsychotic medications for youth in foster care. Participants were recruited from around the country; data collection using structured interview or focus group guides occurred via telephone and web-based formats. This study is rooted in the lived experiences of stakeholders in addressing recent federal legislative mandates and guidelines for the oversight and co-ordination of mental health service delivery to youth in foster care. Numerous themes emerged that provide context in employing a team-based approach for youth engaged with multiple child-serving systems. Eight themes emerged that illustrate the necessary components of successfully implementing Informed Consent and shared decision-making as well as the barriers and concerns germane to this process. The findings address the nuanced complexity of and tensions with the trade-offs inherent in delivering mental health care to youth involved in foster care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Justeen Hyde
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System and Section General Internal Medicine, Boston University School of Medicine
| | - Stephen Crystal
- Institute for Health, Health Care Policy and Aging Research and School of Social Work, Rutgers University
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16
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Jörns-Presentati A, Groen G, Ødegård A. Psychometric Properties of the German Version of the Perception of Interprofessional Collaboration Model-Questionnaire (PINCOM-Q). Int J Integr Care 2021; 21:3. [PMID: 34754279 PMCID: PMC8555481 DOI: 10.5334/ijic.5660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 10/15/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The Perception of Interprofessional Collaboration-Model Questionnaire (PINCOM-Q) measures professionals' perceptions of interprofessional collaboration in the field of child and youth mental health. The aim of this study was to validate the PINCOM-Q in a sample of German child welfare and child and youth mental health professionals. METHODS The PINCOM-Q was translated into German and its underlying factor structure was examined using exploratory and confirmatory factor analysis. RESULTS AND DISCUSSION Findings from this study suggest four factors (Interprofessional Climate, Conflict, Role Expectancy and Shared Goals, and Motivation) capture the concept of perceptions of interprofessional collaboration between child welfare and child and adolescent psychiatry. CONCLUSION The use of PINCOM-Q (German) can be recommended as a research tool, investigating professional groups working with children and young people with multiple and complex needs.
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Affiliation(s)
| | - Gunter Groen
- Faculty of Business and Social Sciences, University of Applied Sciences, Hamburg, Germany
| | - Atle Ødegård
- Faculty of Health Sciences and Social Care, Molde University College, Specialized University of Logistics, Norway
- Nordland Research Institute, Norway
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17
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Racial/Ethnic Disparities in Depression Treatment for Caregivers Investigated by the US Child Welfare System. Acad Pediatr 2021; 21:1037-1045. [PMID: 33582310 DOI: 10.1016/j.acap.2021.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/06/2020] [Accepted: 02/06/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine whether there are racial/ethnic differences in depression treatment for caregivers investigated by the US child welfare system. METHODS This cross-sectional study used baseline data from the Second National Survey of Child and Adolescent Well-being, a nationally representative sample of children and caregivers investigated by US child welfare agencies (February 2008-April 2009). We included permanent caregivers who met criteria for major depression and had available covariate data (n = 908). In multivariable logistic regression models, we estimated the associations between caregiver race/ethnicity and past-year receipt of: any depression treatment, minimally adequate depression treatment, and depression treatment from 4 sectors (general medical, psychiatry, nonpsychiatry mental health, and human services). We controlled for clinical need and access variables according to the Institute of Medicine's definition of health care disparities. RESULTS Black caregivers had the lowest rates of treatment receipt of any racial/ethnic group, with 42.2% receiving any depression treatment and 17.2% receiving minimally adequate depression treatment in the past year. In multivariable analyses controlling for clinical need and access variables, Black caregivers were less likely than White caregivers to receive any depression treatment (odds ratio [OR] = 0.49 [95% CI: 0.24-0.97]), minimally adequate depression treatment (OR = 0.37 [95% CI: 0.16-0.85]), and depression treatment from the general medical sector (OR = 0.40 [95% CI: 0.18-0.89]) in the past year (all P< .05). CONCLUSIONS Future research should examine the underlying mechanisms of Black-White disparities in depression treatment for caregivers involved with the US child welfare system and develop targeted interventions to promote equitable mental health care for this highly vulnerable population.
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18
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Sustainment of Trauma-Focused and Evidence-Based Practices Following Learning Collaborative Implementation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:569-580. [PMID: 32090298 DOI: 10.1007/s10488-020-01024-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Given the need to develop and validate effective implementation models that lead to sustainable improvements, we prospectively examined changes in attitudes, behaviors, and perceived organizational support during and after statewide Community-Based Learning Collaboratives (CBLCs) promoting trauma-focused evidence-based practices (EBPs). Participants (N = 857; i.e., 492 clinicians, 218 brokers, and 139 senior leaders) from 10 CBLCs completed surveys pre- and post-CBLC; a subsample (n = 146) completed a follow-up survey approximately two years post-CBLC. Results indicated (a) medium, sustained increases in clinician-reported use of trauma-focused EBPs, (b) medium to large, sustained increases in perceived organizational support for trauma-focused EBPs, and (c) trivial to small, sustained increases in perceived organizational support for EBPs broadly. In contrast, clinician-reported overall attitudes towards EBPs decreased to a trivial degree pre- to post-CBLC, but then increased to a small, statistically significant degree from post-CBLC to follow-up. Notably, the degree of perceived improvements in organizational support for general and trauma-focused EBPs varied by professional role. Findings suggest the CBLC implementation strategies may both increase and sustain provider practices and organizational support towards EBPs, particularly those EBPs a CBLC explicitly targets.
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19
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Gopalan G, Kerns SEU, Horen MJ, Lowe J. Partnering for Success: Factors Impacting Implementation of a Cross-Systems Collaborative model Between Behavioral Health and Child Welfare. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:839-856. [PMID: 33861385 DOI: 10.1007/s10488-021-01135-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Cross-system implementation efforts can support needed mental health (MH) service utilization among children involved in the child welfare (CW) system. The Partnering for Success (PfS) initiative is one such effort that promotes greater collaboration between the CW and MH providers by building capacity within and across each system. Frontline CW providers learn to accurately identify child MH treatment targets, link families to locally-provided evidence-based treatments (EBTs), and monitor treatment progress. Concurrently, local MH providers are trained along with CW workers to utilize Cognitive Behavioral Therapy plus Trauma-Focused CBT (CBT +), a common elements training and consultation approach focusing on typical MH issues for CW-involved children: Anxiety, Depression, Behavioral Problems, and Traumatic Stress. Finally, agency leadership receive support around promoting implementation and sustainment. This paper examines factors identified by participating CW and MH staff which impacted PfS implementation. Twenty-nine frontline, supervisory, and executive CW and MH providers were interviewed via audio-recorded web-based calls in six focus groups and 10 individual interviews. Factors facilitating implementation success included training/consultation, support from supervisors and agency leadership, improved referral processes, high quality relationships and communication between CW and MH frontline staff, PfS tools and resources, opportunities to use PfS, as well as buy-in from providers and families. Implementation barriers included poor communication between CW and MH providers, conflicts over role expectations, workload and turnover challenges, lack of buy-in, as well as provider (e.g., not aligned with CBT +) and client characteristics (e.g., frequent crises).
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Affiliation(s)
- Geetha Gopalan
- Silberman School of Social Work, Hunter College, City University of NewYork, 2180 3rd Avenue, New York, NY, 10035, USA.
| | | | | | - Jennie Lowe
- Mid-Atlantic Behavioral Health, Wilmington, DE, USA
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20
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Gopalan G, Bunger AC, Powell BJ. Skills for Developing and Maintaining Community-Partnerships for Dissemination and Implementation Research in Children's Behavioral Health: Implications for Research Infrastructure and Training of Early Career Investigators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:227-243. [PMID: 30863918 DOI: 10.1007/s10488-019-00930-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
By engaging with community partners, dissemination and implementation scholars can enhance research relevance and translation. We illustrate the skills needed for developing and maintaining community partnerships by presenting two case studies of partnerships between early-career investigators and child welfare systems to implement mental health interventions. The cases represent two models of partnership (investigator-led and agency-led), highlighting the value and difficulty of conducting community-engaged implementation research. The experiences described feature strategies for building and managing relationships, navigating rules and regulations, adaptation, and securing resources. We offer suggestions for improving training and research infrastructures to support community-engaged implementation scholars.
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Affiliation(s)
- Geetha Gopalan
- Silberman School of Social Work, Hunter College, City University of New York, 2180 3rd Avenue, New York, NY, 10035, USA.
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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21
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Herbert JL, Bromfield LM. A quasi-experimental study of the Multi-Agency Investigation & Support Team (MIST): A collaborative response to child sexual abuse. CHILD ABUSE & NEGLECT 2021; 111:104827. [PMID: 33250277 DOI: 10.1016/j.chiabu.2020.104827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/15/2020] [Accepted: 11/19/2020] [Indexed: 06/12/2023]
Abstract
To improve the holistic response to child sexual abuse in Perth, Western Australia, a group consisting of government and community support agencies developed a new co-located approach that combined support services with investigations, called the Multi-agency Investigation & Support Team (MIST). The model was comparable to the prominent Children's Advocacy Centre approach, with adaptations for Australian conditions. This study evaluated the fidelity with which this new program was delivered and examined whether it resulted in improved criminal justice, child protection, and service outcomes compared to existing practice. Drawing on service data linked across participating agencies the study found MIST was delivered with reasonable fidelity to its planned procedure, but with some challenges for delivery of the program due to the relative workload for staff in the MIST condition. The service demonstrated high levels of caregiver satisfaction with the response and high rates of children's engagement with therapy. A quasi-experimental comparison between MIST (n = 126) and Practice as Usual (n = 276) found MIST was significantly faster throughout the criminal justice and child protection processes, but the conditions did not differ in the rate of arrest or child protection actions. While embedding support services within the investigation process may not have a dramatic influence on criminal justice and child protection outcomes, the high rates of uptake of therapeutic services and parental satisfaction suggest other benefits that require future exploration.
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Affiliation(s)
- James Leslie Herbert
- Australian Centre for Child Protection, University of South Australia, Australia.
| | - Leah Marie Bromfield
- Australian Centre for Child Protection, University of South Australia, Australia
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22
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Usacheva M, Timmer S, Choe D, Liu S, Thurston H, Urquiza A. Long-term mental health services use in children referred to a clinical intervention. CHILD ABUSE & NEGLECT 2021; 111:104763. [PMID: 33160648 DOI: 10.1016/j.chiabu.2020.104763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 08/22/2020] [Accepted: 09/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Recent advancements in pediatric mental health (MH) increased accessibility of evidence-based interventions. Yet, accessibility alone does not explain the rise in MH services use (MHSU). Maltreatment-related adversity, symptom severity, and access to early interventions have been linked to ongoing need for services, yet their joint contributions to continuities in MHSU remain unclear. OBJECTIVE The study examines the role of maltreatment, externalizing symptom severity, and referral for early intervention in pediatric MHSU across five years. To evaluate engagement in treatment, we accounted for treatment progress and referral type, comparing MHSU in court-mandated and voluntary participants. PARTICIPANTS AND SETTING Participants were 321 children (M = 4.3 years; 58.9 % boys) referred to parent-child interaction therapy (PCIT), an evidence-based intervention for families struggling with child disruptive behaviors and maltreating families involved with child welfare. Services were provided at a university-affiliated clinic in a metropolitan county. METHOD Symptom severity was assessed with standardized questionnaires; maltreatment history and referral type were obtained from casefile reviews. MHSU was tracked through county behavioral health diagnostic reports. The data were analyzed using structural equation modeling. RESULTS Results indicated that for the 44.9 % of children with onward referrals, the frequency of service use, but not progress in treatment, predicted ongoing services. Maltreatment emerged as a universal predictor, while externalizing predicted MHSU only in court-mandated participants, suggesting referral type contributes to quantifiable differences in MH needs. CONCLUSIONS Findings emphasize importance of ongoing funding for pediatric MH services, and the need to explore mechanisms underlying continuous MHSU in vulnerable children.
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Affiliation(s)
- Maria Usacheva
- Department of Pediatrics, CAARE Diagnostic and Treatment Center, UC Davis Children's Hospital, University of California, Davis, 3671 Business Drive, Sacramento, CA, 95820, United States; Department of Human Ecology, Human Development Graduate Group, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States.
| | - Susan Timmer
- Department of Pediatrics, CAARE Diagnostic and Treatment Center, UC Davis Children's Hospital, University of California, Davis, 3671 Business Drive, Sacramento, CA, 95820, United States; Department of Human Ecology, Human Development Graduate Group, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States
| | - Daniel Choe
- Department of Human Ecology, Human Development Graduate Group, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States
| | - Siwei Liu
- Department of Human Ecology, Human Development Graduate Group, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States
| | - Holly Thurston
- The Ohio State University, College of Social Work, 1947 College Road N, Columbus, OH, 43210, United States
| | - Anthony Urquiza
- Department of Pediatrics, CAARE Diagnostic and Treatment Center, UC Davis Children's Hospital, University of California, Davis, 3671 Business Drive, Sacramento, CA, 95820, United States; Department of Human Ecology, Human Development Graduate Group, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States
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23
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Flores MW, Lê Cook B, Mullin B, Halperin-Goldstein G, Nathan A, Tenso K, Schuman-Olivier Z. Associations between neighborhood-level factors and opioid-related mortality: A multi-level analysis using death certificate data. Addiction 2020; 115:1878-1889. [PMID: 32061139 PMCID: PMC7734613 DOI: 10.1111/add.15009] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 08/02/2019] [Accepted: 02/11/2020] [Indexed: 01/08/2023]
Abstract
AIM To identify associations between opioid-related mortality and neighborhood-level risk factors. DESIGN Cross-sectional study. SETTING Massachusetts, USA. PARTICIPANTS Using 2011-14 Massachusetts death certificate data, we identified opioid-related (n = 3089) and non-opioid-related premature deaths (n = 8729). MEASUREMENTS The independent variables consisted of four sets of neighborhood-level factors: (1) psychosocial, (2) economic, (3) built environment and (4) health-related. At the individual level we included the following compositional factors: age at death, sex, race/ethnicity, marital status, education, veteran status and nativity. The primary outcome of interest was opioid-related mortality. FINDINGS Multi-level models identified number of social associations per 10 000 [odds ratio (OR) = 0.84, P = 0.002, 95% confidence interval (CI) = 0.75-0.94] and number of hospital beds per 10 000 (OR = 0.78, P < 0.001, 95% CI = 0.68-0.88) to be inversely associated with opioid-related mortality, whereas the percentage living in poverty (OR = 1.01, P = 0.008, 95% CI = 1.00-1.01), food insecurity rate (OR = 1.21, P = 0.002, 95% CI = 1.07-1.37), number of federally qualified health centers (OR = 1.02, P = 0.028, 95% CI = 1.02-1.08) and per-capita morphine milligram equivalents of hydromorphone (OR = 1.05, P = 0.003, 95% CI = 1.01-1.08) were positively associated with opioid-related mortality. CONCLUSIONS Opioid-related deaths between 2011 and 2014 in the state of Massachusetts appear to be positively associated with the percentage living in poverty, food insecurity rate, number of federally qualified health centers and per-capita morphine milligram equivalents of hydromorphone, but inversely associated with number of social associations per 10 000 and number of hospital beds per 10 000.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Benjamin Lê Cook
- Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Brian Mullin
- Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, MA, USA
| | | | - Aparna Nathan
- Department of Bioinformatics, Harvard Medical School, Boston, MA, USA
| | - Kertu Tenso
- Health Equity Research Laboratory, Cambridge Health Alliance, Cambridge, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | - Zev Schuman-Olivier
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Addiction Services, Cambridge Health Alliance, Cambridge, MA, USA
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Abraczinskas M, Bory C, Plant R. Predictors of Behavioral Health Service Utilization in a Medicaid Enrolled Sample of Emerging Adults. CHILDREN AND YOUTH SERVICES REVIEW 2020; 108:104611. [PMID: 32863498 PMCID: PMC7451063 DOI: 10.1016/j.childyouth.2019.104611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Emerging adults (EA), individuals between the ages of 15-26, face many challenges in their transition to a new developmental stage, especially those with behavioral health concerns who do not receive the supports they need. Many EA drop out of services at 18, which is likely due in part to the need to transition to the adult service system and the lack of available transition support services in child/adolescent service systems. Though this is a clear disparity, research on EA service utilization, especially those enrolled in Medicaid and with co-occurring conditions, is rare. This paper begins to address this gap by examining variables at age 17 that predict the service utilization of continuously Medicaid enrolled EA at age 18. Data came from an administrative dataset. The sample had 4,548 EA and 53% were female, 50% identified with a minority group, and 19% were child-welfare involved. Exploratory logistic regression analyses were used. Minority EA had lower odds of utilizing services at age 18. EA involved with child welfare had greater odds of utilizing services at age 18. EA with at least one Substance Use Disorder (SUD) and at least one mental health disorder at 17 had a higher likelihood of service utilization at 18, the opposite was true for EA with only SUDs. These findings identified predictors of service utilization for an understudied sample-EA enrolled in Medicaid. Results provided preliminary evidence that EA with SUD diagnoses access behavioral health services differently than those without a SUD diagnosis, and that it is fruitful to examine subgroups of EA when seeking to understand their service utilization patterns. Identifying predictors of service utilization during the transition period from the child to the adult system can help inform systems interventions to retain EA in services.
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Karatekin C, Almy B, Mason SM, Borowsky I, Barnes A. Health-Care Utilization Patterns of Maltreated Youth. J Pediatr Psychol 2019; 43:654-665. [PMID: 29409026 DOI: 10.1093/jpepsy/jsy004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 01/18/2017] [Indexed: 11/14/2022] Open
Abstract
To examine in detail the health-care utilization patterns of maltreated children, we studied electronic health records (EHRs) of children assigned maltreatment-related codes in a large medical system. We compared youth with maltreatment-related diagnoses (N = 406) with those of well-matched youth (N = 406). Data were based on EHRs during a 4-year period from the University of Minnesota's Clinical Data Repository, which covers eight hospitals and over 40 clinics across Minnesota. A primary care provider (PCP) was assigned to over 80% of youth in both groups. As expected, however, the odds of not having a PCP were twice as high in the maltreated as in the comparison group. Also as expected, maltreated youth had higher rates of emergency department visits. We ruled out differences in age, gender, race, public insurance, duration in the medical system, type of specialty department, and clinic location as potential explanations for these differences. On the other hand, there were no significant differences between maltreated and comparison youth in hospitalizations, preventive visits, or office visits. Contrary to expectations, maltreated youth were not in the medical system for just a brief period of time and were not more likely to cancel or miss appointments. The current study adds to the research literature by providing more detailed information about the nature of health-care services used by children with maltreatment-related diagnoses.
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Affiliation(s)
| | - Brandon Almy
- Institute of Child Development, University of Minnesota
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26
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Wright B, Lau AS, Brookman-Frazee L. Factors Associated With Caregiver Attendance in Implementation of Multiple Evidence-Based Practices in Youth Mental Health Services. Psychiatr Serv 2019; 70:808-815. [PMID: 31159663 PMCID: PMC6718317 DOI: 10.1176/appi.ps.201800443] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The implementation of evidence-based practices (EBPs) in community mental health settings for youths has consistently yielded weakened effects compared with controlled trials. There is a need to feasibly measure the quality of large-scale implementation efforts to inform improvement targets. This study used therapist-reported caregiver attendance in treatment sessions as a quality indicator in the community implementation of EBPs. METHODS Data were collected from therapists practicing in agencies contracted to provide publicly funded children's mental health services following a system-driven implementation of multiple EBPs. Community therapists (N=101) provided information about youth clients (N=267) and psychotherapy sessions (N=685). Multivariable binomial logistic regressions were conducted to examine associations between caregiver attendance and therapist factors (e.g., licensure status, education), youth factors (e.g., gender, age), and the type of EBP delivered. RESULTS Caregiver attendance occurred in 42% of sessions. The following factors were associated with increased odds of caregiver attendance: younger client age, male sex of client, externalizing presenting problem, and delivery of an EBP that prescribes caregiver attendance at all sessions. Caregiver attendance at sessions targeting trauma or externalizing disorders appeared to explain the differences between boys and girls in levels of caregiver engagement. CONCLUSIONS Overall, the patterns of actual caregiver attendance appeared consistent with empirically informed practice parameters for involvement of caregivers in treatment. Still, the rates of caregiver attendance in externalizing-focused sessions were suboptimal, and the gender difference in these rates-which clearly disfavored girls-suggests targeted areas for quality improvement. Potential reasons for these quality gaps are discussed.
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Affiliation(s)
- Blanche Wright
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
| | - Lauren Brookman-Frazee
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
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Medicaid Spending Differences for Child/Youth Community-Based Care in California's Decentralized Public Mental Health System. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:15-27. [PMID: 27449116 DOI: 10.1007/s10488-016-0753-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study evaluated spending differences across counties during the decade after California decentralized its public mental health system. Medicaid data for 0-25 year olds using mental health services were collapsed to the county-year level (n = 627). Multivariate models with county fixed effects were used to predict per capita spending for community-based mental health care. While counties increased their spending over time, those with relatively low initial expenditures per user continued to spend less than counties with historically higher spending levels. Spending differences per user were most noticeable in counties with larger racial/ethnic minority populations that also had historically lower spending levels.
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28
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The Child and Adolescent Services Assessment: Interrater Reliability and Predictors of Rater Disagreement. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:944-957. [PMID: 29797150 DOI: 10.1007/s10488-018-0876-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The current study evaluated the interrater reliability of the Child and Adolescent Services Assessment (CASA), a widely used structured interview measuring pediatric mental health service use. Interviews (N = 72) were randomly selected from a pediatric effectiveness trial, and audio was coded by an independent rater. Regressions were employed to identify predictors of rater disagreement. Interrater reliability was high for items (> 94%) and summary metrics (ICC > .79) across service sectors. Predictors of disagreement varied by domain; significant predictors indexed higher clinical severity or social disadvantage. Results support the CASA as a reliable and robust assessment of pediatric service use, but administrators should be alert when assessing vulnerable populations.
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29
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Prior Authorization Policies and Preferred Drug Lists in Medicaid Plans: Stakeholder Perspectives on the Implications for Youth with ADHD. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:580-595. [PMID: 30993569 DOI: 10.1007/s10488-019-00937-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This qualitative study describes how Medicaid policies create challenges for the delivery and receipt of mental health treatment for low-income youth in Georgia. We conducted focus groups with caregivers of Medicaid-enrolled children with ADHD and semi-structured interviews with providers and administrators at four safety net clinics that provided mental health care to these youth. Stakeholders reported that prior authorization policies for psychosocial services, restrictiveness of preferred drug lists, and changes in preferred drug lists in Medicaid plans created barriers to treatment continuity and quality for youth with ADHD and led to more administrative burden for safety-net clinics serving these youth.
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30
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Fitts JJ, Aber MS, Allen NE. Individual, Family, and Site Predictors of Youth Receipt of Therapy in Systems of Care. CHILD & YOUTH CARE FORUM 2019. [DOI: 10.1007/s10566-019-09504-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Herbert JL, Bromfield L. Better Together? A Review of Evidence for Multi-Disciplinary Teams Responding to Physical and Sexual Child Abuse. TRAUMA, VIOLENCE & ABUSE 2019; 20:214-228. [PMID: 29334012 DOI: 10.1177/1524838017697268] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Multi-Disciplinary teams (MDTs) have often been presented as the key to dealing with a number of intractable problems associated with responding to allegations of physical and sexual child abuse. While these approaches have proliferated internationally, researchers have complained of the lack of a specific evidence base identifying the processes and structures supporting multi-disciplinary work and how these contribute to high-level outcomes. This systematic search of the literature aims to synthesize the existing state of knowledge on the effectiveness of MDTs. This review found that overall there is reasonable evidence to support the idea that MDTs are effective in improving criminal justice and mental health responses compared to standard agency practices. The next step toward developing a viable evidence base to inform these types of approaches seems to be to more clearly identify the mechanisms associated with effective MDTs in order to better inform how they are planned and implemented.
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Affiliation(s)
- James Leslie Herbert
- 1 Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
| | - Leah Bromfield
- 1 Australian Centre for Child Protection, University of South Australia, Adelaide, South Australia, Australia
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32
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Colvin ML, Thompson HM. Exploring the Experiences of Child Welfare-Focused Therapeutic Service Providers. J Behav Health Serv Res 2019; 47:86-101. [PMID: 30887414 PMCID: PMC7224150 DOI: 10.1007/s11414-019-09654-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The importance of mental and behavioral health for child welfare clients is well-documented; yet, little is known about the challenges therapeutic service providers (TSPs) experience working in child welfare practice. To explore this topic, five focus groups were conducted with 40 TSPs in a contracted mental and behavioral health agency and data were analyzed following an inductive thematic process. Eleven primary challenges were identified, including the difficulty of navigating numerous involved parties, an overwhelmed work environment, legal intersections common to child welfare cases, unrealistic agency expectations, and heighten case complexity when working with child welfare populations. Findings are organized across system, agency, and client levels and add to the understanding of TSP perspectives working with child welfare. Targeted interventions are discussed, such as efforts to promote realistic expectations and training strategies, as well as directions for future research to improve the intersection between child welfare and mental and behavioral health.
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Affiliation(s)
- Marianna L Colvin
- School of Social Work, SO303, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA.
| | - Heather M Thompson
- School of Social Work, SO303, Florida Atlantic University, 777 Glades Rd, Boca Raton, FL, 33431, USA
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33
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Baldwin H, Biehal N, Cusworth L, Wade J, Allgar V, Vostanis P. Disentangling the effect of out-of-home care on child mental health. CHILD ABUSE & NEGLECT 2019; 88:189-200. [PMID: 30537620 DOI: 10.1016/j.chiabu.2018.11.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 11/17/2018] [Accepted: 11/20/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Children in out-of-home care are consistently found to have poor mental health compared to children in the general population. However, UK research has so far failed to disentangle the impact of the care system on children's mental health outcomes from the effects of the adverse circumstances that led to their admission to care. OBJECTIVE This research investigated the association between care placement and the presence of child mental health problems after controlling for children's pre-care experiences. It also identified factors associated with mental health problems among children in care. PARTICIPANTS AND SETTING The sample comprised three groups of children involved with child welfare services due to maltreatment, including children in out-of-home care (n = 122), reunified children (n = 82) and those who had never been in care (n = 159). METHODS The mental health of the children in the three groups was compared, using information collected from their parents/foster carers and social workers. RESULTS The odds of a child in out-of-home care having a mental health problem were not significantly higher than those of a child who had never been in care (AOR = 1.24; p = 0.462). However, the odds of a child in out-of-home care having reactive attachment disorder (RAD) were significantly higher than those of a child who had never been in care (AOR=1.92; p = 0.032). CONCLUSIONS These findings make an important contribution to international debates about whether placing children in care is beneficial or detrimental to their wellbeing, and highlight a range of inter-linking factors associated with the mental health of children in out-of-home care.
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Affiliation(s)
- Helen Baldwin
- Department of Social Policy and Social Work, University of York, York, YO10 5DD, England, United Kingdom.
| | - Nina Biehal
- Department of Social Policy and Social Work, University of York, York, YO10 5DD, England, United Kingdom.
| | - Linda Cusworth
- Department of Social Policy and Social Work, University of York, York, YO10 5DD, England, United Kingdom.
| | - Jim Wade
- Department of Social Policy and Social Work, University of York, York, YO10 5DD, England, United Kingdom.
| | - Victoria Allgar
- Department of Health Sciences, University of York, YO10 5DD, York, England, United Kingdom.
| | - Panos Vostanis
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, LE1 7RH, England, United Kingdom.
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34
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Parker EM, Jacobson J, Pullmann MD, Kerns SEU. Identifying Psychosocial Problems Among Children and Youth in the Child Welfare System Using the PSC-17: Exploring Convergent and Discriminant Validity with Multiple Informants. Child Psychiatry Hum Dev 2019; 50:108-120. [PMID: 29961167 DOI: 10.1007/s10578-018-0824-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Youth who enter foster care are at risk of mental health need, but questions arise as to the validity of their self-reported symptomatology. This study examines the screening validity of the youth-report version of the Pediatric Symptom Checklist-17 (PSC-17) in a child welfare population. Data come from 2389 youth who completed a version of the PSC-17 adapted for youth report, and their biological and foster parents who completed the parent-report version. Youth also completed a shortened version of the Screen for Child Anxiety Related Disorders (SCARED). Convergent and discriminant validity of the PSC-17 was assessed using multi-trait multi-method matrices. The PSC-17's internalizing subscale was strongly correlated, attention subscale was moderately correlated, and externalizing subscale was weakly correlated with the SCARED's anxiety and PTSD subscales. Comparing youth and foster parent scores, the PSC-17 had moderate convergent validity and weak/fair discriminant validity. Comparing youth, foster parent, and biological parent scores, the PSC-17 had moderate convergent validity and weak/fair discriminant validity. The current study provides some support for the validity of the PSC-17 for the population of youth in foster care.
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Affiliation(s)
- Elizabeth M Parker
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA.
| | - Jedediah Jacobson
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA
| | - Suzanne E U Kerns
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 2815 Eastlake Ave E, Ste 200, Seattle, WA, 98102, USA.,University of Denver Graduate School of Social Work, 2148 S High St, Denver, CO, 80208, USA
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35
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Jung S, Lee D, Park S, Hong HJ. Subtypes of suicidal ideation in Korean adolescents: A multilevel latent profile analysis. Aust N Z J Psychiatry 2019; 53:158-167. [PMID: 29544350 DOI: 10.1177/0004867418763530] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE This study intended to classify subtypes of Korean adolescents with suicidal ideation based on mental health problems and to explore the relationship between such subtypes and individual-, school- and community-level factors. METHOD Data from high school freshmen who participated in the 2013 school-based mental health screening test and data about school and community variables obtained from public sources were combined and analyzed. A multilevel latent profile analysis using mental health issues as class indicators that included several predictors was conducted. RESULTS Three latent profiles were identified: Group 1 (6.5%) had high scores for both the internalizing and externalizing problems; Group 2 (40.2%) had high scores for internalizing problems, such as depression and mood related symptoms; and Group 3 (53.3%) had lower scores for all mental health problems compared to Groups 1 and 2. Gender, peer conflict, family conflict and academic problems were significant predictors at the individual level; school dropout rate was a significant school-level variable; and percent of youth in the total population, availability of mental health services, number of social welfare facilities and percentage of the total budget devoted to education/welfare were significant community-level variables. CONCLUSION The present findings suggest that adolescents with suicidal ideation can be classified into several distinct subtypes based on mental health problems. These profiles and their associated covariates will aid in the establishment of youth suicide prevention policies.
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Affiliation(s)
- Song Jung
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Dayoung Lee
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea.,2 Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Seongjun Park
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Hyun Ju Hong
- 1 Hallym University Suicide and School Mental Health Institute, Hallym University Sacred Heart Hospital, Anyang, South Korea.,2 Department of Psychiatry, Hallym University Sacred Heart Hospital, Anyang, South Korea
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36
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Hanson RF, Saunders BE, Ralston E, Moreland AD, Peer SO, Fitzgerald MM. Statewide implementation of child trauma-focused practices using the community-based learning collaborative model. Psychol Serv 2018; 16:170-181. [PMID: 30550316 DOI: 10.1037/ser0000319] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
A significant number of youth in the United States experience traumatic events that substantially increase the risk of physical and behavioral health problems across the life span. This public health concern warrants concerted efforts to promote trauma-informed, evidence-based practices that facilitate recovery. Although youth-focused trauma-specific treatments exist, determining effective ways to disseminate and implement these services-so that they are available, accessible, and sustainable-poses an ongoing challenge. This paper describes a comprehensive model for such implementation, the community-based learning collaborative (CBLC), developed as part of Project BEST, a four-phase statewide initiative to promote trauma-focused practices. The CBLC augments the learning collaborative model by including clinical and nonclinical (i.e., broker) professionals from multiple service organizations within a targeted community. CBLCs aim to build capacity for sustained implementation of trauma-focused practices by promoting interprofessional collaboration among those involved in the coordination and provision of these services. This paper describes the iterative development of the CBLC by examining participant completion data across the three completed phases of Project BEST (N = 13 CBLCs; 1,190 participants). Additionally, data from Project BEST's third phase (N = 6 CBLCs; 639 participants) were used to evaluate changes in the frequency of specific practices, pre- to post-CBLC, and post-CBLC perceived utility of CBLC components. High participant completion rates, significant increases in reported trauma-focused practices, and positive ratings of the CBLC's utility provisionally support the feasibility and efficacy of the model's final iteration. Implications for implementation and CBLC improvements are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Van den Steene H, van West D, Peeraer G, Glazemakers I. Professionals' views on the development process of a structural collaboration between child and adolescent psychiatry and child welfare: an exploration through the lens of the life cycle model. Eur Child Adolesc Psychiatry 2018; 27:1539-1549. [PMID: 29569022 DOI: 10.1007/s00787-018-1147-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 03/19/2018] [Indexed: 11/30/2022]
Abstract
This study, as a part of a participatory action research project, reports the development process of an innovative collaboration between child and adolescent psychiatry and child welfare, for adolescent girls with multiple and complex needs. The findings emerge from a qualitative descriptive analysis of four focus groups with 30 professionals closely involved in this project, and describe the evolution of the collaborative efforts and outcomes through time. Participants describe large investments and negative consequences of rapid organizational change in the beginning of the collaboration project, while benefits of the intensive collaboration only appeared later. A shared person-centred vision and enhanced professionals' confidence were pointed out as important contributors in the evolution of the collaboration. Findings were compared to the literature and showed significant analogy with the life cycle model for shared service centres that describe the maturation of collaborations from a management perspective. These findings enrich the knowledge about the development process of collaboration in health and social care. In increasingly collaborative services, child and adolescent psychiatrists and policy makers should be aware that gains from a collaboration will possibly only be achieved in the longer term, and benefit from knowing which factors have an influence on the evolution of a collaboration project.
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Affiliation(s)
- Helena Van den Steene
- Collaborative Antwerp Psychiatric Research Institute-Youth (CAPRI), University of Antwerp, Campus Drie Eiken-Gebouw R, Universiteitsplein 1, 2610, Antwerp, Belgium. .,University Centre of Child and Adolescent Psychiatry (ZNA-UKJA), University of Antwerp, Lindendreef 1, 2020, Antwerp, Belgium.
| | - Dirk van West
- Collaborative Antwerp Psychiatric Research Institute-Youth (CAPRI), University of Antwerp, Campus Drie Eiken-Gebouw R, Universiteitsplein 1, 2610, Antwerp, Belgium.,University Centre of Child and Adolescent Psychiatry (ZNA-UKJA), University of Antwerp, Lindendreef 1, 2020, Antwerp, Belgium.,Department of Clinical and Lifespan Psychology (KLEP), Faculty of Psychology and Educational Sciences, Free University Brussels (VUB), Pleinlaan 1, 1060, Brussels, Belgium
| | - Griet Peeraer
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Antwerp, Belgium
| | - Inge Glazemakers
- Collaborative Antwerp Psychiatric Research Institute-Youth (CAPRI), University of Antwerp, Campus Drie Eiken-Gebouw R, Universiteitsplein 1, 2610, Antwerp, Belgium.,University Centre of Child and Adolescent Psychiatry (ZNA-UKJA), University of Antwerp, Lindendreef 1, 2020, Antwerp, Belgium
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38
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McGihon R, Hawke LD, Chaim G, Henderson J. Cross-sectoral integration in youth-focused health and social services in Canada: a social network analysis. BMC Health Serv Res 2018; 18:901. [PMID: 30486805 PMCID: PMC6264042 DOI: 10.1186/s12913-018-3742-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/20/2018] [Indexed: 11/22/2022] Open
Abstract
Background Youth with concurrent substance use and mental health concerns have diverse psychosocial needs and may present to a multitude of clinical and social service sectors. By integrating service sectors at a system level, the diversity of needs of youth with concurrent disorders can be addressed in a more holistic way. The objective of the present study was to quantify the level of cross-sectoral integration in youth-focused services in Canada. Methods Social network analysis (SNA) was used to examine the relationships between eight sectors: addictions, child welfare, education, physical health, housing, mental health, youth justice, and other social services. A total of 597 participants representing twelve networks of youth-serving agencies across Canada provided information on their cross-sectoral contacts and referrals. Results Overall, results suggested a moderate level of integration between sectors. The mental health and the addictions sectors demonstrated only moderate integration, while the addictions sector was strongly connected with the youth justice sector. Conclusions Despite evidence of moderate integration, increased integration is called for to better meet the needs of youth with concurrent mental health and substance use concerns across youth-serving sectors. Ongoing efforts to enhance the integration between youth-serving sectors should be a primary focus in organizing networks serving youth with concurrent mental health and substance use needs.
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Affiliation(s)
- Rachel McGihon
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Lisa D Hawke
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Gloria Chaim
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Joanna Henderson
- Centre for Addiction and Mental Health, 80 Workman Way, Toronto, Ontario, M6J 1H4, Canada. .,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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39
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Hanson RF, Saunders BE, Peer SO, Ralston E, Moreland AD, Schoenwald S, Chapman J. Community-Based Learning Collaboratives and Participant Reports of Interprofessional Collaboration, Barriers to, and Utilization of Child Trauma Services. CHILDREN AND YOUTH SERVICES REVIEW 2018; 94:306-314. [PMID: 31105370 PMCID: PMC6516766 DOI: 10.1016/j.childyouth.2018.09.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Given the high prevalence and severe consequences of child trauma, effective implementation strategies are needed to increase the availability and utilization of evidence-based child trauma services. One promising strategy, the Community-Based Learning Collaborative (CBLC), augments traditional Learning Collaborative activities with a novel set of community-focused strategies. This prospective, observational study examined pre-to post-changes in CBLC participant reports of interprofessional collaboration (IPC), barriers to, and utilization of evidence-based child trauma treatment in their communities. Participants of five CBLCs from a statewide dissemination initiative, comprising 572 child abuse professionals (296 clinicians, 168 brokers, and 108 senior leaders), were surveyed pre-and post-CBLC participation. Results suggested that CBLCs significantly decreased barriers to child trauma treatment and significantly increased IPC and perceived utilization of evidence-based child trauma treatment. Further, changes in barriers partially mediated this relationship. Finally, small to medium differences in participants' reports were detected, such that senior leaders perceived significantly greater IPC than clinicians and brokers did, while brokers perceived significantly greater barriers to child trauma treatment than clinicians and senior leaders did. Collectively, these preliminary findings suggest the CBLC implementation model-which augments traditional Learning Collaborative models with a focus on fostering IPC-can reduce barriers and increase the utilization of evidence-based mental health treatment services.
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Affiliation(s)
- Rochelle F Hanson
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Benjamin E Saunders
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | | | | | - Angela D Moreland
- National Crime Victims Research & Treatment Center, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, U.S.A
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Kim M, Garcia AR, Yang S, Jung N. Area-socioeconomic disparities in mental health service use among children involved in the child welfare system. CHILD ABUSE & NEGLECT 2018; 82:59-71. [PMID: 29864610 DOI: 10.1016/j.chiabu.2018.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 05/08/2018] [Accepted: 05/16/2018] [Indexed: 06/08/2023]
Abstract
Relying on data from a nationally representative sample of youth involved in the child welfare system (CWS) in 1999-2000 (the National Survey of Child and Adolescent Well-Being, Cohort 1) and 2008-2009 (Cohort 2), this study implemented a diverse set of disparity indicators to estimate area-socioeconomic disparities in mental health (MH) services use and changes in area-socioeconomic disparities between the two cohorts. Our study found that there are area-socioeconomic disparities in MH service use, indicating that the rates of MH service use among youth referred to the CWS differ by area-socioeconomic positions defined by county-level poverty rates. We also found that area-socioeconomic disparities increased over time. However, the magnitude of the increase varied widely across disparity measures, suggesting that there are different conclusions about the trend and magnitude of area-socioeconomic disparities, depending upon which disparity measures are implemented. A greater understanding of the methodological differences among disparity measures is warranted, which will in turn impact how interventions are designed to reduce socioeconomic disparities among children in the CWS.
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Affiliation(s)
- Minseop Kim
- Department of Social Work, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
| | - Antonio R Garcia
- School of Social Policy and Practice, University of Pennsylvania, 3815 Walnut Street, Philadelphia, PA, 19104, USA
| | - Shuyan Yang
- Department of Social Work, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Nahri Jung
- Department of Social Work, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong
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Stahlschmidt MJ, Jonson-Reid M, Pons L, Constantino J, Kohl PL, Drake B, Auslander W. Trying to bridge the worlds of home visitation and child welfare: Lessons learned from a formative evaluation. EVALUATION AND PROGRAM PLANNING 2018; 66:133-140. [PMID: 29091788 PMCID: PMC5705411 DOI: 10.1016/j.evalprogplan.2017.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 09/11/2017] [Accepted: 10/02/2017] [Indexed: 05/22/2023]
Abstract
Young children in families contacting the child welfare system are at high risk of recurrent maltreatment and poor developmental outcomes. Home visitation programs to support parenting may offer hope as a preventive resource but these programs are rarely linked with child welfare. This article describes findings from a formative evaluation of a program designed to connect child welfare-involved families to an existing evidence-supported home visitation program. The program, Early Childhood Connections (ECC), was developed by a field-university partnership including leaders from a public state child welfare system, regional early childhood education systems, and several local agencies providing family support services. Despite extensive and rigorous planning by the workgroup and collaborative refining of the intervention approach as agency needs changed, the continued structural and policy changes within both the home visitation agency and the child welfare agencies created significant ongoing barriers to implementation. On the other hand, child welfare-involved families were receptive to engaging with home visitation. Implications of lessons learned for ongoing program development in this area are discussed.
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Affiliation(s)
- Mary Jo Stahlschmidt
- George Warren Brown School of Social Work, Washington University in St. Louis, United States
| | - Melissa Jonson-Reid
- George Warren Brown School of Social Work, Washington University in St. Louis, United States.
| | - Laura Pons
- Washington University in St. Louis School of Medicine, United States
| | - John Constantino
- Washington University in St. Louis School of Medicine, United States
| | - Patricia L Kohl
- George Warren Brown School of Social Work, Washington University in St. Louis, United States
| | - Brett Drake
- George Warren Brown School of Social Work, Washington University in St. Louis, United States
| | - Wendy Auslander
- George Warren Brown School of Social Work, Washington University in St. Louis, United States
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Garcia AR, Kim M, Palinkas LA, Snowden L, Landsverk J. Socio-contextual Determinants of Research Evidence Use in Public-Youth Systems of Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:569-78. [PMID: 25702145 DOI: 10.1007/s10488-015-0640-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recent efforts have been devoted to understanding the conditions by which research evidence use (REU) is facilitated from the perspective of system leaders in the context of implementing evidence-based child mental health interventions. However, we have limited understanding of the extent to which outer contextual factors influence REU. Outer contextual factors for 37 counties in California were gathered from public records in 2008; and child welfare, juvenile justice, and mental health system leaders' perceptions of their REU were measured via a web-based survey from 2010 to 2012. Results showed that leaders with higher educational attainment and in counties with lower expenditures on inpatient mental health services were significantly associated with higher REU. Positive relationships between gathering research evidence and racial minority concentration and poverty at the county level were also detected. Results underscore the need to identify the organizational and socio-political factors by which mental health services and resources meet client demands that influence REU, and to recruit and retain providers with a graduate degree to negotiate work demands and interpret research evidence.
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Affiliation(s)
- Antonio R Garcia
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104-6214, USA.
| | - Minseop Kim
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104-6214, USA
| | - Lawrence A Palinkas
- School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, USA
| | - Lonnie Snowden
- School of Public Health, University of California-Berkeley, 235 University Hall, 1090 Warfield Avenue, Oakland, CA, 94610, USA
| | - John Landsverk
- Child & Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200, San Diego, CA, 92123, USA
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Stewart SL, Falah Hassani K, Poss J, Hirdes J. The determinants of service complexity in children with intellectual disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2017; 61:1055-1068. [PMID: 29024219 DOI: 10.1111/jir.12423] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 08/15/2017] [Accepted: 08/28/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND To date, little is known about the predictors of healthcare service utilisation in children with intellectual disability (ID). The aim of this study was to identify the factors associated with service complexity in children with ID in Ontario, Canada. METHODS The population of this cross-sectional study consisted of 330 children with ID ages 4 to 18 years who accessed mental health services from November of 2012 to June of 2016 in four agencies. All participants completed the interRAI Child and Youth Mental Health and Developmental Disability Assessment Instrument, which is a semi-structured clinician-rated assessment that covers a range of common issues in children with ID. The outcome of this study was a service complexity variable based on (1) mental health service utilisation including any services provided to the child and (2) the management involved in providing that care. Eight individual items were summed, resulting in a scale that ranged from 0 to 8. Scores were then dichotomised into two groups: a score of 0-2 identified children with a low service complexity and a score of 3 or higher identified children with a high service complexity. RESULTS After adjustment for other covariates, gender was not associated with service complexity. Children aged 11-14 years and children with autism spectrum disorder used over twofold higher levels of service complexity than children aged equal to or less than 10 years or children with other causes of ID. Moreover, victims of bullying, high scores on the family functioning scale or learning or communication disorder were associated with greater service complexity. CONCLUSIONS The findings of this study indicate that a variety of factors are related to service complexity ranged from children's nonclinical (age and experiences of bullying) to clinical (e.g. aggression, learning/communication problems and autism spectrum disorder) characteristics.
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Affiliation(s)
- S L Stewart
- Faculty of Education, Western University, London, Ontario, Canada
| | - K Falah Hassani
- Faculty of Education, Western University, London, Ontario, Canada
| | - J Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - J Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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McDonald T, Bhattarai J, Akin B. Predictors of Consent in a Randomized Field Study in Child Welfare. ACTA ACUST UNITED AC 2017; 14:243-265. [PMID: 28486033 DOI: 10.1080/23761407.2017.1319774] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Randomized controlled trials (RCTs) are often viewed as the "gold standard" for proving the efficacy and effectiveness of new interventions. However, some are skeptical of the generalizability of the findings that RCTs produce. The characteristics of those willing to participate in research studies have the potential to affect the generalizability of its findings. This study examined factors that could influence consent among families recruited to participate in a randomized field trial in a real-world child welfare setting. METHODS This study tested the Parent Management Training Oregon Model for children in foster care with serious emotional disturbance. It employed a post-randomization consent design, whereby the entire sample of eligible participants, not just those who are willing to consent to randomization, are included in the sample. Initial eligibility assessment data and data from the federally mandated reporting system for public child welfare agencies provided the pool of potential predictors of consent. Bivariate and multivariate analyses were conducted to identify statistically significant predictors of consent. RESULTS Being a dual reunification family was the most significant factor in predicting consent. Unmarried individuals, younger, female parents, cases where parental incarceration was the reason for removal and cases where the removal reason was not due to their children's behavioral problem(s) were also more likely to participate. DISCUSSION As one of the first research studies to examine predictors of consent to a randomized field study in child welfare settings, results presented here can act as a preliminary guide for conducting RCTs in child welfare settings.
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Affiliation(s)
- Tom McDonald
- a School of Social Welfare, University of Kansas , Lawrence , Kansas , USA
| | - Jackie Bhattarai
- a School of Social Welfare, University of Kansas , Lawrence , Kansas , USA
| | - Becci Akin
- a School of Social Welfare, University of Kansas , Lawrence , Kansas , USA
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Ganser HG, Münzer A, Witt A, Plener PL, Muche R, Rosner R, Hagl M, Goldbeck L. Effectiveness of manualized case management on utilization of evidence-based treatments for children and adolescents after maltreatment: A randomized controlled trial. CHILD ABUSE & NEGLECT 2017; 67:371-382. [PMID: 28365428 DOI: 10.1016/j.chiabu.2017.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 03/12/2017] [Accepted: 03/14/2017] [Indexed: 05/03/2023]
Abstract
UNLABELLED The objective of this study was to compare structured case management (CM) to usual care (UC) for helping victims of child abuse and neglect (CAN) with mental disorders access evidence-based treatment (EBT). N=121 children and adolescents aged 4-17 with a history of CAN and a current mental disorder were recruited in three German states in a multi-center parallel group trial. They were randomly assigned, stratified by study site and level of psychosocial functioning, to receive CM additionally to UC or only UC. CM was delivered by trained professionals and volunteers, most of them affiliated to local child welfare agencies or NGOs. UC comprised child welfare services typically delivered in Germany. The primary outcome was EBT utilization after 6 months. Secondary outcome was the time until commencement of EBT. Outcomes were determined by semi-structured clinical interviews with assessors blinded to group allocation. Predictors of access to EBT and barriers to utilization of treatment were analyzed. The intent to treat analysis showed that after 6 months 23 of 60 participants recruited to CM (38%) and 19 of 61 participants recruited to UC (31%) were using EBT, χ2 (1, N=121)=0.689, p=.261. Female gender, out-of-home placement, and home state were significant predictors of access to EBT. Less than 40% of participants across both groups were successfully referred to EBT. Access to EBT seems to be in part due to system-level barriers, namely lack of implementation of EBT in community settings. TRIAL REGISTRATION DRKS00003979 German Clinical Trials Register.
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Affiliation(s)
- Helene Gertrud Ganser
- University of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Germany.
| | - Annika Münzer
- University of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Germany
| | - Andreas Witt
- University of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Germany
| | - Paul Lukas Plener
- University of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Germany
| | - Rainer Muche
- University of Ulm, Institute of Epidemiology and Medical Biometry, Germany
| | - Rita Rosner
- Catholic University of Eichstätt-Ingolstadt, Germany
| | - Maria Hagl
- Catholic University of Eichstätt-Ingolstadt, Germany
| | - Lutz Goldbeck
- University of Ulm, Department of Child and Adolescent Psychiatry/Psychotherapy, Germany
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Jolles MP, Wells R. Does caregiver participation in decision making within child welfare agencies influence children's primary and mental health care service use? Child Care Health Dev 2017; 43:192-201. [PMID: 27470153 PMCID: PMC5274592 DOI: 10.1111/cch.12384] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 04/05/2016] [Accepted: 06/27/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Many children in contact with child welfare agencies do not receive needed health services. These agencies have used participatory decision making (PDM) practices as a way to increase families' use of recommended services. However, we lack evidence of whether caregiver participation in PDM increases children's use of health services. This study uses a national sample of children involved with child welfare to compare their health service use between those children serve through a PDM practice and those who did not experience it. METHODS Cross-sectional analyses using the 2009-2010 National Survey of Child and Adolescent Well-Being. Propensity score analysis accounted for observed selection bias. PDM practice was measured as whether the caregiver was included in decision-making during service planning meetings. Health service use was measured as child's receipt of any primary or mental health care services in the past year. Primary health care need was measured using standardized measures and caseworker report. The sample was comprised of children ages 2-17 with primary or mental health needs in contact with a child welfare agency. RESULTS In the unmatched sample of 1,358 children, 14% were served through a PDM service practice, and 12% had a primary health care and 37% a mental health need. Families served through PDM were also reported by caseworkers as more cooperative during the child welfare investigation, and with fewer reports of domestic violence and agency re-referrals (P < 0.05). Analyses using matched samples showed that for primary health care, 59% of PDM children received services compared with 40% for non-PDM children (P = 0.004). Group differences were not significant for mental health services. CONCLUSIONS Lower-risk families were more likely to be served through PDM which was positively associated with child use of primary health services. Inclusion of caregivers in decision making may not be sufficient to overcome barriers to children's mental health service use.
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Affiliation(s)
- Mónica Pérez Jolles
- Assistant Professor, School of Social Work, University of Southern California, 669 W 34th St, Los Angeles, CA 90089,Research Affiliate, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr. Blvd, Chapel Hill, NC, 27599-7590, USA. Phone: 919-537-3706
| | - Rebecca Wells
- Professor, School of Public Health, Management, Policy and Community Health, University of Texas, P.O. Box 20186, Houston, TX 77025, Phone: 713-500-9184
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Schlüter-Cruse M, Schnepp W, Sayn-Wittgenstein FZ. Interprofessional cooperation by midwives in the field of out-of-hospital obstetrical care: an integrative review / Interprofessionelle Kooperation von Hebammen im Handlungsfeld der ambulanten geburtshilflichen Versorgung: ein integratives Review. INTERNATIONAL JOURNAL OF HEALTH PROFESSIONS 2016. [DOI: 10.1515/ijhp-2016-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The central objective of early prevention in Germany is an improved cooperation between professional groups of the health services and child and youth welfare in interprofessional networks. This objective derives from the realisation that proper care for families with infants can only be achieved if the various groups act in close integration. The ‘Federal Initiative early prevention’ explicitly calls for freelance midwives to be integrated in this context. However, only a few scientific findings on midwives’ cooperation in networks of early prevention have been published to date. This integrative review aims to identify the central themes of interprofessional cooperation of midwives in out-of-hospital obstetrical care from national and international research literature.
A systematic search of five research databases for publications between 2005 and 2015 was performed, complemented by a manual search.
25 studies were identified describing various contexts where midwives in out-of-hospital obstetrical care cooperate with other professional groups. Four key themes were analysed: contexts of cooperation, benefits of cooperation, facilitating and restrictive factors of cooperation, and competencies of cooperation. The studies show that there is only limited research coverage of the midwives’ perspective regarding interprofessional cooperation. The existing studies examine the cooperation of midwives primarily with health care professionals, and secondarily with professionals in the social services.
In order to expand knowledge on the cooperation of freelance midwives in the networks of early prevention, future research should focus on the perspective of midwives regarding cooperation with other professional groups, both in the health care sector and in the field of social services.
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Affiliation(s)
- Martina Schlüter-Cruse
- Osnabrück University of Applied Sciences, Faculty of Business Management and Social Sciences , Barbarastr. 24, 49076 Osnabrück , Germany
- Witten/Herdecke University, Faculty of Health, Department of Nursing Science , Stockumer Straße 12, 58453 Witten , Germany
| | - Wilfried Schnepp
- Witten/Herdecke University, Faculty of Health, Department of Nursing Science , Stockumer Straße 12, 58453 Witten , Germany
- Osnabrück University of Applied Sciences, Faculty of Business Management and Social Sciences , Barbarastr. 24, 49076 Osnabrück , Germany
| | - Friederike zu Sayn-Wittgenstein
- Osnabrück University of Applied Sciences, Faculty of Business Management and Social Sciences , Barbarastr. 24, 49076 Osnabrück , Germany
- Witten/Herdecke University, Faculty of Health, Department of Nursing Science , Stockumer Straße 12, 58453 Witten , Germany
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Hanson RF, Schoenwald S, Saunders BE, Chapman J, Palinkas LA, Moreland AD, Dopp A. Testing the Community-Based Learning Collaborative (CBLC) implementation model: a study protocol. Int J Ment Health Syst 2016; 10:52. [PMID: 27547240 PMCID: PMC4991101 DOI: 10.1186/s13033-016-0084-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 08/01/2016] [Indexed: 11/30/2022] Open
Abstract
Background High rates of youth exposure to violence, either through direct victimization or witnessing, result in significant health/mental health consequences and high associated lifetime costs. Evidence-based treatments (EBTs), such as Trauma-Focused Cognitive Behavioral Therapy (TF-CBT), can prevent and/or reduce these negative effects, yet these treatments are not standard practice for therapists working with children identified by child welfare or mental health systems as needing services. While research indicates that collaboration among child welfare and mental health services sectors improves availability and sustainment of EBTs for children, few implementation strategies designed specifically to promote and sustain inter-professional collaboration (IC) and inter-organizational relationships (IOR) have undergone empirical investigation. A potential candidate for evaluation is the Community-Based Learning Collaborative (CBLC) implementation model, an adaptation of the Learning Collaborative which includes strategies designed to develop and strengthen inter-professional relationships between brokers and providers of mental health services to promote IC and IOR and achieve sustained implementation of EBTs for children within a community. Methods/design This non-experimental, mixed methods study involves two phases: (1) analysis of existing prospective quantitative and qualitative quality improvement and project evaluation data collected pre and post, weekly, and monthly from 998 participants in one of seven CBLCs conducted as part of a statewide initiative; and (2) Phase 2 collection of new quantitative and qualitative (key informant interviews) data during the funded study period to evaluate changes in relations among IC, IOR, social networks and the penetration and sustainment of TF-CBT in targeted communities. Recruitment for Phase 2 is from the pool of 998 CBLC participants to achieve a targeted enrollment of n = 150. Study aims include: (1) Use existing quality improvement (weekly/monthly online surveys; pre-post surveys; interviews) and newly collected quantitative (monthly surveys) and qualitative (key informant interviews) data and social network analysis to test whether CBLC strategies are associated with penetration and sustainment of TF-CBT; and (2) Use existing quantitative quality improvement (weekly/monthly on-line surveys; pre/post surveys) and newly collected qualitative (key informant interviews) data and social network analysis to test whether CBLC strategies are associated with increased IOR and IC intensity. Discussion The proposed research leverages an on-going, statewide implementation initiative to generate evidence about implementation strategies needed to make trauma-focused EBTs more accessible to children. This study also provides feasibility data to inform an effectiveness trial that will utilize a time-series design to rigorously evaluate the CBLC model as a mechanism to improve access and sustained use of EBTs for children.
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Affiliation(s)
- Rochelle F Hanson
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC USA
| | - Sonja Schoenwald
- Division of Global and Community Health, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC USA
| | - Benjamin E Saunders
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC USA
| | - Jason Chapman
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR 97401 USA
| | - Lawrence A Palinkas
- School of Social Work, University of Southern California, 669W. 34th Street, MC0411, Los Angeles, CA 90089-0411 USA
| | - Angela D Moreland
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC USA
| | - Alex Dopp
- Department of Psychiatry and Behavioral Sciences, National Crime Victims Research and Treatment Center, Medical University of South Carolina, 67 President Street, MSC 861, Charleston, SC USA
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Kim M, Garcia AR. Measuring Racial/Ethnic Disparities in Mental Health Service Use Among Children Referred to the Child Welfare System. CHILD MALTREATMENT 2016; 21:218-227. [PMID: 27402724 DOI: 10.1177/1077559516656397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study aims to compare different approaches to measuring racial/ethnic disparities in mental health (MH) service use among a nationwide representative sample of children referred to the child welfare system and compare the magnitude and direction of potential disparities in MH service use over time. Using data from the National Survey of Child and Adolescent Well-Being, six summary measures of disparity were implemented to quantify racial/ethnic disparities in MH service use. This study found that youth of color were less likely than their White counterparts to receive MH services. This racial/ethnic disparity was found to increase over time; however, the magnitude of the increase varied considerably across disparity measures. In addition, the estimated increases in disparity were even greater when the sample was limited to youth in need of MH services. This study shows that the same data may produce different magnitudes of disparity, depending on which metric is implemented and whether MH need is accounted for. A greater understanding of and justification for selection of methods to examine MH disparities among child welfare researchers and policy makers is warranted.
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Affiliation(s)
- Minseop Kim
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong
| | - Antonio R Garcia
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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Goemans A, van Geel M, van Beem M, Vedder P. Developmental Outcomes of Foster Children: A Meta-Analytic Comparison With Children From the General Population and Children at Risk Who Remained at Home. CHILD MALTREATMENT 2016; 21:198-217. [PMID: 27481915 DOI: 10.1177/1077559516657637] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Foster care is often preferred to other placement options for children in the child welfare system. However, it is not clear how the developmental outcomes of foster children relate to children in other living arrangements. In this study, a series of meta-analyses are performed to compare the cognitive, adaptive, and behavioral functioning of children placed in foster care (n = 2,305) with children at risk who remained with their biological parents (n = 4,335) and children from the general population (n = 4,971). A systematic literature search in PsycINFO, Medline, ERIC, and ProQuest identified 31 studies suitable for inclusion (N = 11,611). Results showed that foster children had generally lower levels of functioning than children from the general population. No clear differences were found between foster children and children at risk who remained at home, but both groups experienced developmental problems. Improving the quality of foster care and future research to identify which children are best served by either foster care or in-home services are recommended.
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Affiliation(s)
- Anouk Goemans
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
| | - Mitch van Geel
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
| | - Merel van Beem
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
| | - Paul Vedder
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
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