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Boyd MR, Becker KD, Park AL, Pham K, Chorpita BF. Managers' Micro-Communities Matter: The Impact of Clinical Supervision Team on Therapist Perception of the Organization. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01376-0. [PMID: 38676872 DOI: 10.1007/s10488-024-01376-0] [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] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
Positive organizational climate - employee perceptions of their work environment and the impact of this environment on well-being and functioning - is associated with desirable organizational and client-level outcomes in mental health organizations. Clinical supervisors are well-positioned to impact organizational climate, as they serve as intermediaries between higher-level administrators who drive the policies and procedures and the therapists impacted by such decisions. This cross-sectional study examined the role of clinical supervisors as drivers of therapist perceptions of organizational climate within supervisory teams. Specifically, the present study investigated: (1) shared perceptions of organizational climate among therapists on the same supervisory team; (2) predictors of therapist climate perceptions. Eighty-six therapists were supervised by 22 supervisors. Indices of interrater agreement and interrater reliability of therapists on the same supervisory team were examined to determine shared or distinct perceptions of organizational climate. Multi-level models were used to examine whether supervisor attitudes towards evidence-based practices and therapist perceptions of supervisor communication predicted perceived organizational climate. Results showed perceptions of organizational cohesion and autonomy were shared among therapists on the same supervisory team and distinct from therapists on different supervisory teams. Therapist perceptions of their supervisor's communication was positively associated with perceptions of organizational cohesion and autonomy. These findings align with emerging evidence that middle managers shape their employees' experience of their work environment through communication strategies. These findings also point to the potential for intervening at lower organizational levels to improve overall organizational climate.
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Affiliation(s)
- Meredith R Boyd
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Kimberly D Becker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Alayna L Park
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Kaitlyn Pham
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
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2
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Williams NJ, Russo J, Vredevoogd M, Grover T, Green P, Proctor E, Bhat A, Unützer J, Bennett IM. Association of organizational culture and climate with variation in the clinical outcomes of collaborative care for maternal depression in community health centers. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231205891. [PMID: 37936965 PMCID: PMC10576428 DOI: 10.1177/26334895231205891] [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: 11/09/2023] Open
Abstract
Background Organizational factors may help explain variation in the effectiveness of evidence-based clinical innovations through implementation and sustainment. This study tested the relationship between organizational culture and climate and variation in clinical outcomes of the Collaborative Care Model (CoCM) for treatment of maternal depression implemented in community health centers. Method Organizational cultures and climates of 10 community health centers providing CoCM for depression among low-income women pregnant or parenting were assessed using the organizational social context (OSC) measure. Three-level hierarchical linear models tested whether variation in culture and climate predicted variation in improvement in depression symptoms from baseline to 6.5-month post-baseline for N = 468 women with care ±1 year of OSC assessment. Depression symptomology was measured using the Patient Health Questionnaire (PHQ-9). Results After controlling for patient characteristics, case mix, center size, and implementation support, patients served by centers with more proficient cultures improved significantly more from baseline to 6.5-month post-baseline than patients in centers with less proficient cultures (mean improvement = 5.08 vs. 0.14, respectively, p = .020), resulting in a large adjusted effect size of dadj = 0.78. A similar effect was observed for patients served by centers with more functional climates (mean improvement = 5.25 vs. 1.12, p < .044, dadj = 0.65). Growth models indicated that patients from all centers recovered on average after 4 months of care. However, those with more proficient cultures remained stabilized whereas patients served by centers with less proficient cultures deteriorated by 6.5-month post-baseline. A similar pattern was observed for functional climate. Conclusions Variation in clinical outcomes for women from historically underserved populations receiving Collaborative Care for maternal depression was associated with the organizational cultures and climates of community health centers. Implementation strategies targeting culture and climate may improve the implementation and effectiveness of integrated behavioral health care for depression.
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Affiliation(s)
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Melinda Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Tess Grover
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Phillip Green
- Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, USA
| | - Enola Proctor
- Brown School of Social Work, Washington University, Saint Louis, MO, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ian M. Bennett
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Maxwell CA, Ehrhart MG, Williams NJ, Moore TM, Kendall PC, Beidas RS. The Organizational Financial Context of Publicly-Funded Mental Health Clinics: Development and Preliminary Psychometric Evaluation of the Agency Financial Status Scales. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:780-792. [PMID: 33740163 DOI: 10.1007/s10488-021-01128-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 01/08/2023]
Abstract
Funding is a major barrier to implementation of evidence-based practices (EBPs) in publicly-funded community mental health clinics (CMHCs). Understanding how best to deploy implementation strategies that address this barrier requires greater clarity on the financial context within agencies. We developed the Agency Financial Status Scales (AFSS) to assess employee perceptions of the level of three hypothesized and theoretical funding related constructs in organizations: (a) perceptions of financial health, (b) financial attitudes toward EBPs, and (c) strategic financial climate. This investigation serves as a preliminary evaluation of this measure. Participants were 239 therapists and 40 supervisors from 25 publicly-funded CMHCs providing outpatient mental health services for young people. Confirmatory factor analysis was used to investigate the latent trait structure of the items. Internal consistency, interrater agreement, concordance between therapists and supervisors, and convergent validity were also examined. A two-factor model measuring perceptions of financial health and strategic financial climate best fit the data. For both of these scales, alpha reliability was acceptable and agreement statistics provided moderate support for aggregation at the organizational level. Analyses supported the convergent validity of the scales. The development and preliminary evaluation of the AFSS is an important first step in understanding the financial context of publicly-funded CMHCs. Though findings from this investigation are promising, additional development and testing are needed to develop a more thorough understanding of the constructs and to improve the validity and reliability of this measure.
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Affiliation(s)
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, USA
| | | | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA
| | | | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA.
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Penn Implementation Science Center At the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
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Williams NJ, Frederick L, Ching A, Mandell D, Kang-Yi C, Locke J. Embedding school cultures and climates that promote evidence-based practice implementation for youth with autism: A qualitative study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 25:982-994. [PMID: 33307761 PMCID: PMC8089033 DOI: 10.1177/1362361320974509] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Schools play a major role in providing services to youth with autism; however, not all schools use evidence-based practices, defined as interventions that are proven to improve youth well-being through rigorous research. School culture and climate are strong predictors of whether or not a school uses evidence-based practices; however, little is known about how principals can create school cultures and climates that support the use of these practices. This study interviewed 32 teachers in elementary schools that implemented three closely related evidence-based practices for youth with autism to better understand how principals create school cultures and climates that support effective services. Analysis of the teachers' responses identified seven strategies principals can use to create school cultures and climates that support the implementation of effective practices for youth with autism. The strategies include the following: (a) support teachers to obtain professional development focused on autism, (b) align performance expectations and evaluations with the needs of students with autism and evidence-based practice delivery, (c) allocate resources to ensure adequate staff, materials, and training are available to implement evidence-based practices, (d) be open and flexible to allow teachers to use the building and resources as needed to meet students' needs, (e) provide direct assistance, feedback, and coaching to troubleshoot challenges or involve outside experts to do so, (f) openly value the work of special education teachers and provide recognition to those who develop expertise in evidence-based practices, and (g) look for opportunities to integrate special and general education teachers and students to foster a truly inclusive climate.
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A Qualitative Examination of a School-Based Implementation of Computer-Assisted Cognitive-Behavioral Therapy for Child Anxiety. SCHOOL MENTAL HEALTH 2021; 13:347-361. [PMID: 34178162 DOI: 10.1007/s12310-021-09424-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mental health treatment in schools has the potential to improve youth treatment access. However, school-specific barriers can make implementing evidence-based interventions difficult. Task-shifting (i.e., training lay staff to implement interventions) and computer-assisted interventions may mitigate these barriers. This paper reports on a qualitative examination of facilitators and barriers of a school-based implementation of a computer-assisted intervention for anxious youth (Camp Cope-A-Lot; CCAL). Participants (N = 45) included school staff in first through fourth grades. Providers attended a training in CCAL and received weekly, hour-long group consultation calls for three months. In the second year, the sustainability of CCAL use was assessed. Qualitative interviews were conducted after the first year (initial implementation) and second year (sustainability). Interviews were analyzed using the Consolidated Framework for Implementation Research domains to classify themes. Although participants reported that CCAL included useful skills, they expressed concerns about recommended session length (45 minutes) and frequency (weekly). Time burden of consultation calls was also a barrier. School staff facilitated implementation by enabling flexible scheduling for youth to be able to participate in the CCAL program. However, the sustainability of the program was limited due to competing school/time demands. Results suggest that even with computer assisted programs, there is a need to tailor interventions and implementation efforts to account for the time restrictions experienced by school-based service providers. Optimal fit between the intervention and specific school is important to maintain the potential benefits of computer-assisted treatments delivered by lay service providers in schools.
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Ouellette RR, Goodman AC, Martinez-Pedraza F, Moses JO, Cromer K, Zhao X, Pierre J, Frazier SL. A Systematic Review of Organizational and Workforce Interventions to Improve the Culture and Climate of Youth-Service Settings. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:764-778. [PMID: 32303926 PMCID: PMC9872793 DOI: 10.1007/s10488-020-01037-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Both organizational culture and climate are associated with service quality and outcomes across youth-service settings. Increasing evidence indicates capacity of organizational interventions to promote a positive and effective culture and climate. Less is known about common intervention components across studies and service settings. The current systematic review reviewed 9223 citations and identified 31 studies, across six youth-service settings, measuring changes over time in organizational culture and climate following implementation of an organizational or workforce support intervention. Results highlight the promise of organizational interventions, a need for more comparison and randomized designs, and future directions for maximizing capacity of organizations to promote health for frontline providers and the children they serve.
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Williams NJ, Wolk CB, Becker-Haimes EM, Beidas RS. Testing a theory of strategic implementation leadership, implementation climate, and clinicians' use of evidence-based practice: a 5-year panel analysis. Implement Sci 2020; 15:10. [PMID: 32033575 PMCID: PMC7006179 DOI: 10.1186/s13012-020-0970-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/31/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Implementation theory suggests that first-level leaders, sometimes referred to as middle managers, can increase clinicians' use of evidence-based practice (EBP) in healthcare settings by enacting specific leadership behaviors (i.e., proactive, knowledgeable, supportive, perseverant with regard to implementation) that develop an EBP implementation climate within the organization; however, longitudinal and quasi-experimental studies are needed to test this hypothesis. METHODS Using data collected at three waves over a 5-year period from a panel of 30 outpatient children's mental health clinics employing 496 clinicians, we conducted a quasi-experimental difference-in-differences study to test whether within-organization change in implementation leadership predicted within-organization change in EBP implementation climate, and whether change in EBP implementation climate predicted within-organization change in clinicians' use of EBP. At each wave, clinicians reported on their first-level leaders' implementation leadership, their organization's EBP implementation climate, and their use of both EBP and non-EBP psychotherapy techniques for childhood psychiatric disorders. Hypotheses were tested using econometric two-way fixed effects regression models at the organization level which controlled for all stable organizational characteristics, population trends in the outcomes over time, and time-varying covariates. RESULTS Organizations that improved from low to high levels of implementation leadership experienced significantly greater increases in their level of EBP implementation climate (d = .92, p = .017) and within-organization increases in implementation leadership accounted for 11% of the variance in improvement in EBP implementation climate beyond all other covariates. In turn, organizations that improved from low to high levels of EBP implementation climate experienced significantly greater increases in their clinicians' average EBP use (d = .55, p = .007) and within-organization improvement in EBP implementation climate accounted for 14% of the variance in increased clinician EBP use. Mediation analyses indicated that improvement in implementation leadership had a significant indirect effect on clinicians' EBP use via improvement in EBP implementation climate (d = .26, 95% CI [.02 to .59]). CONCLUSIONS When first-level leaders increase their frequency of implementation leadership behaviors, organizational EBP implementation climate improves, which in turn contributes to increased EBP use by clinicians. Trials are needed to test strategies that target this implementation leadership-EBP implementation climate mechanism.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, Boise, ID, USA. .,Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA. .,School of Social Work, Boise State University, Room 711, 1910 University Drive, Boise, ID, 83725, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Hall Mercer Community Mental Health Center, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
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Bain K, Landman M, Frost K, Raphael-Leff J, Baradon T. Lay counselors: Thoughts on the crossing of ecological frameworks and the use of lay counselors in the scale up of early infant mental health interventions. Infant Ment Health J 2019; 40:889-905. [PMID: 31425644 DOI: 10.1002/imhj.21814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The recent call for the scale-up of evidence-based early childhood development interventions, in lower and middle-income countries and for minority groups in high-income countries, has seen numerous suggestions to train greater numbers of lay mental health workers to fulfill these functions. While studies have found that concepts from developed country settings, such as attachment, parental sensitivity, and containment, find purchase and relevance within developing settings, the management of contextual and cultural factors and the tensions of cultural interfacing in the rollout of these programs in developing country settings require consideration. Drawing on the experiences of two successful South African mother-infant home-visiting programs as examples, this article discusses some of the challenges in provision of attachment-based infant mental health programs and highlights the need for careful consideration of a number of factors pertaining to the recruitment, supervision, and management of lay mental health workers before large-scale rollout is conducted.
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Affiliation(s)
- Katherine Bain
- School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Katherine Frost
- Ububele Educational and Psychotherapy Trust, Johannesburg, South Africa
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Becker-Haimes EM, Williams NJ, Okamura KH, Beidas RS. Interactions Between Clinician and Organizational Characteristics to Predict Cognitive-Behavioral and Psychodynamic Therapy Use. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:701-712. [DOI: 10.1007/s10488-019-00959-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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10
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Barnett M, Miranda J, Kia-Keating M, Saldana L, Landsverk J, Lau AS. Developing and evaluating a lay health worker delivered implementation intervention to decrease engagement disparities in behavioural parent training: a mixed methods study protocol. BMJ Open 2019; 9:e028988. [PMID: 31324682 PMCID: PMC6661633 DOI: 10.1136/bmjopen-2019-028988] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Behavioural parent training (BPT) programmes are effective in preventing and treating early-onset conduct problems and child maltreatment. Unfortunately, pervasive mental health service disparities continue to limit access to and engagement in these interventions. Furthermore, challenges with parental engagement can impede the successful implementation of evidence-based practices (EBPs) in community settings that serve low-income, ethnic minority families. Lay health workers (LHWs)-individuals without formal mental health training-represent an important workforce to increase engagement, as they are members of the communities they serve. However, the mobilisation of LHWs has not been well studied as an implementation strategy to extend the reach or effectiveness of EBPs in the USA. LHW-delivered implementation interventions that specifically support the engagement of Latinx parents in evidence-based BPT programmes have the potential to improve clinical and implementation outcomes. METHODS AND ANALYSIS A community-partnered approach will use the Quality Implementation Framework (QIF) to tailor and implement an LHW-delivered implementation intervention that aims to promote Latinx parent engagement in BPT programmes. Steps from the QIF will guide study activities to (1) conduct a mixed methods needs assessment to fit the implementation intervention to the local context, (2) adapt LHW-delivered implementation strategies to promote parent access to and engagement in Parent-Child Interaction Therapy and (3) conduct a hybrid effectiveness-implementation pilot trial to examine the feasibility, acceptability and preliminary effectiveness of the LHW implementation intervention at increasing engagement. ETHICS AND DISSEMINATION Study procedures have been approved by the Institutional Review Board at the University of California, Santa Barbara. Results will be shared with the community-advisory group, at community-based meetings for other stakeholders involved in the pilot project, and submitted for publication in peer-reviewed journals.
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Affiliation(s)
- Miya Barnett
- Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Jeanne Miranda
- Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California, USA
- Center for Health Services and Society, University of California Los Angeles, Los Angeles, California, USA
| | - Maryam Kia-Keating
- Counseling, Clinical, and School Psychology, University of California Santa Barbara, Santa Barbara, California, USA
| | - Lisa Saldana
- Oregon Social Learning Center, Eugene, Oregon, USA
| | | | - Anna S Lau
- Psychology, University of California Los Angeles, Los Angeles, California, USA
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Beidas RS, Williams NJ, Becker-Haimes EM, Aarons GA, Barg FK, Evans AC, Jackson K, Jones D, Hadley T, Hoagwood K, Marcus SC, Neimark G, Rubin RM, Schoenwald SK, Adams DR, Walsh LM, Zentgraf K, Mandell DS. A repeated cross-sectional study of clinicians' use of psychotherapy techniques during 5 years of a system-wide effort to implement evidence-based practices in Philadelphia. Implement Sci 2019; 14:67. [PMID: 31226992 PMCID: PMC6588873 DOI: 10.1186/s13012-019-0912-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/03/2019] [Indexed: 02/06/2023] Open
Abstract
Background Little work investigates the effect of behavioral health system efforts to increase use of evidence-based practices or how organizational characteristics moderate the effect of these efforts. The objective of this study was to investigate clinician practice change in a system encouraging implementation of evidence-based practices over 5 years and how organizational characteristics moderate this effect. We hypothesized that evidence-based techniques would increase over time, whereas use of non-evidence-based techniques would remain static. Method Using a repeated cross-sectional design, data were collected three times from 2013 to 2017 in Philadelphia’s public behavioral health system. Clinicians from 20 behavioral health outpatient clinics serving youth were surveyed three times over 5 years (n = 340; overall response rate = 60%). All organizations and clinicians were exposed to system-level support provided by the Evidence-based Practice Innovation Center from 2013 to 2017. Additionally, approximately half of the clinicians participated in city-funded evidence-based practice training initiatives. The main outcome included clinician self-reported use of cognitive-behavioral and psychodynamic techniques measured by the Therapy Procedures Checklist-Family Revised. Results Clinicians were 80% female and averaged 37.52 years of age (SD = 11.40); there were no significant differences in clinician characteristics across waves (all ps > .05). Controlling for organizational and clinician covariates, average use of CBT techniques increased by 6% from wave 1 (M = 3.18) to wave 3 (M = 3.37, p = .021, d = .29), compared to no change in psychodynamic techniques (p = .570). Each evidence-based practice training initiative in which clinicians participated predicted a 3% increase in CBT use (p = .019) but no change in psychodynamic technique use (p = .709). In organizations with more proficient cultures at baseline, clinicians exhibited greater increases in CBT use compared to organizations with less proficient cultures (8% increase vs. 2% decrease, p = .048). Conclusions System implementation of evidence-based practices is associated with modest changes in clinician practice; these effects are moderated by organizational characteristics. Findings identify preliminary targets to improve implementation.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Hall- Mercer Community Mental Health Center, Philadelphia, PA, USA.
| | | | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Hall- Mercer Community Mental Health Center, Philadelphia, FL, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Frances K Barg
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Kamilah Jackson
- Community Behavioral Health, Impact Reach, LLC, Philadelphia, PA, USA
| | - David Jones
- Department of Behavioral Health, Philadelphia, PA, USA
| | - Trevor Hadley
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, NY, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Geoffrey Neimark
- Community Behavioral Health, Impact Reach, LLC, Philadelphia, PA, USA
| | - Ronnie M Rubin
- Community Behavioral Health, Impact Reach, LLC, Philadelphia, PA, USA.,Impact Reach, LLC, Philadelphia, PA, USA
| | | | - Danielle R Adams
- School of Social Service Administration, University of Chicago, Chicago, IL, USA
| | - Lucia M Walsh
- Department of Psychology, University of Miami, Miami, FL, USA
| | - Kelly Zentgraf
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Hall- Mercer Community Mental Health Center, Philadelphia, PA, USA
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Stadnick NA, Lau AS, Barnett M, Regan J, Aarons GA, Brookman-Frazee L. Comparing Agency Leader and Therapist Perspectives on Evidence-Based Practices: Associations with Individual and Organizational Factors in a Mental Health System-Driven Implementation Effort. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:447-461. [PMID: 29101604 DOI: 10.1007/s10488-017-0835-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Agency leaders and therapists are essential stakeholders in implementation of evidence-based practices (EBPs) within publicly-funded mental health services. Little is known about how these stakeholders differ in their perceptions of specific EBPs and which individual and organizational factors differentially influence these perceptions. Within the context of a system-driven implementation of multiple EBPs, survey data from 160 leaders and 720 therapists were examined to assess differences in perceptions of six EBPs. Findings indicated that leaders and therapists have unique perspectives and preferences regarding EBPs that are shaped by distinct sociodemographic and professional characteristics and aspects of organizational functioning.
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Affiliation(s)
- Nicole A Stadnick
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA.
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Miya Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, USA
| | - Jennifer Regan
- Hathaway-Sycamores Child and Family Services, Pasadena, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, 3665 Kearny Villa Road, San Diego, CA, 92123, USA
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Beidas RS, Williams NJ, Green PD, Aarons GA, Becker-Haimes EM, Evans AC, Rubin R, Adams DR, Marcus SC. Concordance Between Administrator and Clinician Ratings of Organizational Culture and Climate. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 45:142-151. [PMID: 27817044 DOI: 10.1007/s10488-016-0776-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Organizational culture and climate are important determinants of behavioral health service delivery for youth. The Organizational Social Context measure is a well validated assessment of organizational culture and climate that has been developed and extensively used in public sector behavioral health service settings. The degree of concordance between administrators and clinicians in their reports of organizational culture and climate may have implications for research design, inferences, and organizational intervention. However, the extent to which administrators' and clinicians' reports demonstrate concordance is just beginning to garner attention in public behavioral health settings in the United States. We investigated the concordance between 73 administrators (i.e., supervisors, clinical directors, and executive directors) and 247 clinicians in 28 child-serving programs in a public behavioral health system. Findings suggest that administrators, compared to clinicians, reported more positive cultures and climates. Organizational size moderated this relationship such that administrators in small programs (<466 youth clients served annually) provided more congruent reports of culture and climate in contrast to administrators in large programs (≥466 youth clients served annually) who reported more positive cultures and climates than clinicians. We propose a research agenda that examines the effect of concordance between administrators and clinicians on organizational outcomes in public behavioral health service settings.
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Affiliation(s)
- Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA.
| | | | - Philip D Green
- Center for Behavioral Health Research, College of Social Work, University of Tennessee, Knoxville, TN, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Arthur C Evans
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA.,Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Ronnie Rubin
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA.,Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Danielle R Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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Williams NJ, Frank HE, Frederick L, Beidas RS, Mandell DS, Aarons GA, Green P, Locke J. Organizational culture and climate profiles: relationships with fidelity to three evidence-based practices for autism in elementary schools. Implement Sci 2019; 14:15. [PMID: 30755220 PMCID: PMC6373074 DOI: 10.1186/s13012-019-0863-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit implementation theory and strategy development to the extent that individual dimensions of culture and climate interact, mutually reinforce or counteract one another, or exhibit non-linear relationships. This study tests whether empirically identifiable culture and climate profiles emerge in a sample of organizations and examines how these profiles relate to EBP fidelity and work attitudes that support EBP sustainment, focusing on three EBPs for youth with autism delivered in schools as an example. METHODS The study included 65 elementary schools in the U.S. that implemented three EBPs-discrete trial training, pivotal response training, and visual schedules-for youth with autism. Organizational culture and climate and work attitudes were assessed using the Organizational Social Context measure at the beginning of the school year. Observations of EBP fidelity occurred mid school-year. We used bias-adjusted stepwise latent profile modeling to (1) identify subpopulations of schools that share similar culture and climate profiles, and (2) test for mean differences across profiles in observed EBP fidelity and teacher and staff work attitudes. RESULTS Controlling for region, four profiles best characterized the organizational cultures and climates of schools. Teachers and staff in schools with a comprehensive profile (high proficiency culture, positive climate) exhibited higher fidelity to two of three EBPs (d's = .95 to 1.64) and reported superior work attitudes (d's = .71 to 1.93) than teachers and staff in all other schools. Teachers and staff in supportive schools (low rigidity culture, positive climate) had better work attitudes, but not better fidelity, than those in schools with indifferent (low culture/climate, elevated stress) and constrained (high rigidity and resistance, high stress) profiles. CONCLUSIONS Organizational culture and climate profiles are a strong predictor of EBP fidelity and work attitudes that support EBP sustainment, highlighting the importance of an organization's overarching social context when developing implementation theory and strategies. Strategies that foster a comprehensive profile may improve EBP implementation.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Drive, Boise, ID, 83625, USA.
| | - Hannah E Frank
- Department of Psychology, Temple University, 1701 N 13th St., Philadelphia, PA, 19122, USA
| | - Lindsay Frederick
- Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St, Seattle, WA, 98105, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Philip Green
- Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, USA
| | - Jill Locke
- Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St, Seattle, WA, 98105, USA
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Williams NJ, Beidas RS. Navigating the storm: How proficient organizational culture promotes clinician retention in the shift to evidence-based practice. PLoS One 2018; 13:e0209745. [PMID: 30576374 PMCID: PMC6303097 DOI: 10.1371/journal.pone.0209745] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 12/11/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Clinician turnover is a major concern as mental health systems and organizations invest substantial resources in the implementation of evidence-based practice (EBP). In this study, we identify malleable factors associated with reduced clinician turnover during a system-wide EBP implementation initiative. Specifically, we examine how proficient organizational culture (i.e., norms and behavioral expectations that clinicians prioritize improvement in client well-being and exhibit competence in up-to-date treatment practices), EBP implementation climate (i.e., perceptions that the organization’s policies, procedures, and practices support EBP use), and change in these organizational characteristics relate to clinician turnover during a system-wide EBP transformation. Method Data were collected from 236 clinicians in 19 mental health clinics across 3 years of a system-wide EBP implementation initiative in the City of Philadelphia. Clinicians reported on proficient organizational culture and EBP implementation climate at baseline (T1) and two-year follow-up (T2). Administrators reported on clinician turnover at three-year follow-up (T3). Hypotheses were tested via multilevel mediation analyses incorporating mixed effects logistic regression models. Results Controlling for organization size, clinician job satisfaction, attitudes towards EBP, job tenure, and age, higher levels of proficient organizational culture and improvement in proficient culture from baseline to two-year follow-up predicted reduced clinician turnover in the year following; these effects were mediated by EBP implementation climate and by improvement in EBP implementation climate, respectively. Conclusions Organizations with more proficient cultures have more supportive EBP implementation climates that predict reduced clinician turnover during system-wide EBP implementation initiatives. Strategies that target these antecedents in mental health service organizations may contribute to reduced clinician turnover.
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Affiliation(s)
- Nathaniel J. Williams
- School of Social Work, Boise State University, Boise, Idaho, United States of America
- * E-mail:
| | - Rinad S. Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
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16
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Williams NJ, Ehrhart MG, Aarons GA, Marcus SC, Beidas RS. Linking molar organizational climate and strategic implementation climate to clinicians' use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study. Implement Sci 2018; 13:85. [PMID: 29940989 PMCID: PMC6019309 DOI: 10.1186/s13012-018-0781-2] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 06/18/2018] [Indexed: 11/23/2022] Open
Abstract
Background Behavioral health organizations are characterized by multiple organizational climates, including molar climate, which encompasses clinicians’ shared perceptions of how the work environment impacts their personal well-being, and strategic implementation climate, which includes clinicians’ shared perceptions of the extent to which evidence-based practice implementation is expected, supported, and rewarded by the organization. Theory suggests these climates have joint, cross-level effects on clinicians’ implementation of evidence-based practice and that these effects may be long term (i.e., up to 2 years); however, no empirical studies have tested these relationships. We hypothesize that molar climate moderates implementation climate’s concurrent and long-term relationships with clinicians’ use of evidence-based practice such that strategic implementation climate will have its most positive effects when it is accompanied by a positive molar climate. Methods Hypotheses were tested using data collected from 235 clinicians in 20 behavioral health organizations. At baseline, clinicians reported on molar climate and implementation climate. At baseline and at a 2-year follow-up, all clinicians who were present in the organizations reported on their use of cognitive-behavioral psychotherapy techniques, an evidence-based practice for youth psychiatric disorders. Two-level mixed-effects regression models tested whether baseline molar climate and implementation climate interacted in predicting clinicians’ evidence-based practice use at baseline and at 2-year follow-up. Results In organizations with more positive molar climates at baseline, higher levels of implementation climate predicted increased evidence-based practice use among clinicians who were present at baseline and among clinicians who were present in the organizations at 2-year follow-up; however, in organizations with less positive molar climates, implementation climate was not related to clinicians’ use of evidence-based practice at either time point. Conclusions Optimizing clinicians’ implementation of evidence-based practice in behavioral health requires attention to both molar climate and strategic implementation climate. Strategies that focus exclusively on implementation climate may not be effective levers for behavior change if the organization does not also engender a positive molar climate. These findings have implications for the development of implementation theory and effective implementation strategies.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Drive, Boise, ID, 83725, USA.
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Steven C Marcus
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
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Barnett ML, Lau AS, Miranda J. Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care. Annu Rev Clin Psychol 2018. [PMID: 29401043 DOI: 10.1146/annurev-clinpsy-050817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, California 93106, USA;
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, California 90095, USA;
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90095, USA;
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18
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Williams NJ, Glisson C, Hemmelgarn A, Green P. Mechanisms of Change in the ARC Organizational Strategy: Increasing Mental Health Clinicians' EBP Adoption Through Improved Organizational Culture and Capacity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:269-283. [PMID: 27236457 DOI: 10.1007/s10488-016-0742-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The development of efficient and scalable implementation strategies in mental health is restricted by poor understanding of the change mechanisms that increase clinicians' evidence-based practice (EBP) adoption. This study tests the cross-level change mechanisms that link an empirically-supported organizational strategy for supporting implementation (labeled ARC for Availability, Responsiveness, and Continuity) to mental health clinicians' EBP adoption and use. Four hundred seventy-five mental health clinicians in 14 children's mental health agencies were randomly assigned to the ARC intervention or a control condition. Measures of organizational culture, clinicians' intentions to adopt EBPs, and job-related EBP barriers were collected before, during, and upon completion of the three-year ARC intervention. EBP adoption and use were assessed at 12-month follow-up. Multilevel mediation analyses tested changes in organizational culture, clinicians' intentions to adopt EBPs, and job-related EBP barriers as linking mechanisms explaining the effects of ARC on clinicians' EBP adoption and use. ARC increased clinicians' EBP adoption (OR = 3.19, p = .003) and use (81 vs. 56 %, d = .79, p = .003) at 12-month follow-up. These effects were mediated by improvement in organizational proficiency culture leading to increased clinician intentions to adopt EBPs and by reduced job-related EBP barriers. A combined mediation analysis indicated the organizational culture-EBP intentions mechanism was the primary carrier of ARC's effects on clinicians' EBP adoption and use. ARC increases clinicians' EBP adoption and use by creating proficient organizational cultures that increase clinicians' intentions to adopt EBPs.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Dr., Boise, ID, 83725-1940, USA.
| | - Charles Glisson
- Children's Mental Health Services Research Center, University of Tennessee, Knoxville, TN, USA
| | - Anthony Hemmelgarn
- Children's Mental Health Services Research Center, University of Tennessee, Knoxville, TN, USA
| | - Philip Green
- Children's Mental Health Services Research Center, University of Tennessee, Knoxville, TN, USA
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Barnett ML, Lau AS, Miranda J. Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care. Annu Rev Clin Psychol 2018; 14:185-208. [PMID: 29401043 DOI: 10.1146/annurev-clinpsy-050817-084825] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, California 93106, USA;
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, California 90095, USA;
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California 90095, USA;
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20
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Hoagwood KE, Olin SS, Storfer-Isser A, Kuppinger A, Shorter P, Wang NM, Pollock M, Peth-Pierce R, Horwitz S. Evaluation of a Train-The-Trainers Model for Family Peer Advocates in Children's Mental Health. JOURNAL OF CHILD AND FAMILY STUDIES 2017; 27:1130-1136. [PMID: 29576726 PMCID: PMC5854741 DOI: 10.1007/s10826-017-0961-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Standardized training and credentialing is increasingly important to states and healthcare systems. Workforce shortages in children's mental health can be addressed through training and credentialing of professional peer parents (called family peer advocates or FPAs), who deliver a range of services to caregivers. A theory-based training program for FPAs targeting skills and knowledge about childhood mental health services (Parent Empowerment Program, or PEP) was developed through a partnership among a statewide family-run organization, state policy leaders, and academic researchers. Prior studies by this team using highly-experienced family peer advocates (who were also co-developers of the training program) as trainers found improvements in knowledge about mental health services and self-efficacy. In 2010, to meet demands and scale the model, a training of trainers (TOT) model was developed to build a cohort of locally-trained FPAs to deliver PEP training. A pre/post design was used to evaluate the impact of TOT model on knowledge and self-efficacy among 318 FPAs across the state. Participants showed significant pre-post (6 month) changes in knowledge about mental health services and self-efficacy. There were no significant associations between any FPA demographic characteristics and their knowledge or self-efficacy scores. A theory-based training model for professional peer parents working in the children's mental health system can be taught to local FPAs, and it improves knowledge about the mental health system and self-efficacy. Studies that evaluate the effectiveness of different training modalities are critical to ensure that high-quality trainings are maintained.
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Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - S. Serene Olin
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Amy Storfer-Isser
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Anne Kuppinger
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Priscilla Shorter
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Nicole M. Wang
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | - Michele Pollock
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
| | | | - Sarah Horwitz
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, New York, NY USA
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Gleacher AA, Olin SS, Nadeem E, Pollock M, Ringle V, Bickman L, Douglas S, Hoagwood K. Implementing a Measurement Feedback System in Community Mental Health Clinics: A Case Study of Multilevel Barriers and Facilitators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2017; 43:426-40. [PMID: 25735619 DOI: 10.1007/s10488-015-0642-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Measurement feedback systems (MFSs) have been proposed as a means of improving practice. The present study examined the implementation of a MFS, the Contextualized Feedback System (CFS), in two community-based clinic sites. Significant implementation differences across sites provided a basis for examining factors that influenced clinician uptake of CFS. Following the theoretical implementation framework of Aarons et al. (Adm Policy Mental Health Mental Health Serv Res 38(1):4-23, 2011), we coded qualitative data collected from eighteen clinicians (13 from Clinic U and 5 from Clinic R) who participated in semi-structured interviews about their experience with CFS implementation. Results suggest that clinicians at both clinics perceived more barriers than facilitators to CFS implementation. Interestingly, clinicians at the higher implementing clinic reported a higher proportion of barriers to facilitators (3:1 vs. 2:1); however, these clinicians also reported a significantly higher level of organizational and leadership supports for CFS implementation. Implications of these findings are discussed.
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Affiliation(s)
| | - Serene S Olin
- New York University Langone Medical Center, New York, USA
| | - Erum Nadeem
- New York University Langone Medical Center, New York, USA
| | | | - Vanesa Ringle
- New York University Langone Medical Center, New York, USA
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Glisson C, Williams NJ, Hemmelgarn A, Proctor E, Green P. Aligning organizational priorities with ARC to improve youth mental health service outcomes. J Consult Clin Psychol 2016; 84:713-25. [PMID: 27253202 DOI: 10.1037/ccp0000107] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The Availability, Responsiveness, and Continuity (ARC) organizational intervention is designed to improve community-based youth mental health services by aligning organizational priorities with 5 principles of effective service organizations (i.e., mission driven, results oriented, improvement directed, relationship centered, participation based). This study assessed the effect of the ARC intervention on youth outcomes and the mediating role of organizational priorities as a mechanism linking the ARC intervention to outcomes. METHOD Fourteen community-based mental health agencies in a midwestern metropolis along with 475 clinicians and 605 youth (ages 5-18) served by those agencies were randomly assigned to the 3-year ARC intervention or control condition. The agencies' priorities were measured with the ARC Principles Questionnaire (APQ) completed by clinicians at the end of the intervention. Youth outcomes were measured as total problems in psychosocial functioning described by their caregivers using the Shortform Assessment for Children (SAC) at 6 monthly intervals. RESULTS The rate of improvement in youths' psychosocial functioning in agencies assigned to the ARC condition was 1.6 times the rate of improvement in agencies assigned to the control condition, creating a standardized difference in functioning of d = .23 between the 2 groups at the 6-month follow-up. The effect on youth outcomes was fully mediated by the alignment of organizational priorities described in the 5 ARC principles (d = .21). CONCLUSION The ARC organizational intervention improves youth outcomes by aligning organizational priorities with the 5 ARC principles. The findings suggest that organizational priorities explain why some community mental health agencies are more effective than others. (PsycINFO Database Record
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Affiliation(s)
- Charles Glisson
- Center for Behavioral Health Research, University of Tennessee
| | | | | | - Enola Proctor
- Brown School of Social Work, Washington University in St. Louis
| | - Philip Green
- Center for Behavioral Health Research, University of Tennessee
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Henderson RJ, Johnson AM, Moodie ST. Revised Conceptual Framework of Parent-to-Parent Support for Parents of Children Who Are Deaf or Hard of Hearing: A Modified Delphi Study. Am J Audiol 2016; 25:110-26. [PMID: 27249168 DOI: 10.1044/2016_aja-15-0059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/28/2015] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND A scoping review of the literature was conducted, resulting in the development of a conceptual framework of parent-to-parent support for parents with children who are Deaf or hard of hearing. This is the 2nd stage of a dual-stage scoping review. PURPOSE This study sought stakeholder opinion and feedback with an aim to achieve consensus on the constructs, components, and design of the initial conceptual framework. RESEARCH DESIGN A modified electronic Delphi study was completed with 21 handpicked experts from 7 countries who have experience in provision, research, or experience in the area of parent-to-parent support. Participants completed an online questionnaire using an 11-point Likert scale (strongly disagree to strongly agree) and open-ended questions to answer various questions related to the descriptor terms, definitions, constructs, components, and overall design of the framework. RESULTS Participant responses led to the revision of the original conceptual framework. CONCLUSION The findings from this dual-stage scoping review and electronic Delphi study provide a conceptual framework that defines the vital contribution of parents in Early Hearing Detection and Intervention programs that will be a useful addition to these programs.
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Affiliation(s)
- Rebecca J. Henderson
- Health & Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Andrew M. Johnson
- Health & Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Sheila T. Moodie
- Health & Rehabilitation Sciences Program, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
- National Centre for Audiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
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Williams NJ. Assessing mental health clinicians' intentions to adopt evidence-based treatments: reliability and validity testing of the evidence-based treatment intentions scale. Implement Sci 2016; 11:60. [PMID: 27150798 PMCID: PMC4857292 DOI: 10.1186/s13012-016-0417-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/05/2016] [Indexed: 12/02/2022] Open
Abstract
Background Intentions play a central role in numerous empirically supported theories of behavior and behavior change and have been identified as a potentially important antecedent to successful evidence-based treatment (EBT) implementation. Despite this, few measures of mental health clinicians’ EBT intentions exist and available measures have not been subject to thorough psychometric evaluation or testing. This paper evaluates the psychometric properties of the evidence-based treatment intentions (EBTI) scale, a new measure of mental health clinicians’ intentions to adopt EBTs. Methods The study evaluates the reliability and validity of inferences made with the EBTI using multi-method, multi-informant criterion variables collected over 12 months from a sample of 197 mental health clinicians delivering services in 13 mental health agencies. Structural, predictive, and discriminant validity evidence is assessed. Results Findings support the EBTI’s factor structure (χ2 = 3.96, df = 5, p = .556) and internal consistency reliability (α = .80). Predictive validity evidence was provided by robust and significant associations between EBTI scores and clinicians’ observer-reported attendance at a voluntary EBT workshop at a 1-month follow-up (OR = 1.92, p < .05), self-reported EBT adoption at a 12-month follow-up (R2 = .17, p < .001), and self-reported use of EBTs with clients at a 12-month follow-up (R2 = .25, p < .001). Discriminant validity evidence was provided by small associations with clinicians’ concurrently measured psychological work climate perceptions of functionality (R2 = .06, p < .05), engagement (R2 = .06, p < .05), and stress (R2 = .00, ns). Conclusions The EBTI is a practical and theoretically grounded measure of mental health clinicians’ EBT intentions. Scores on the EBTI provide a basis for valid inferences regarding mental health clinicians’ intentions to adopt EBTs. Discussion focuses on research and practice applications. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0417-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Dr., Boise, ID, 83725-1940, USA.
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Glisson C, Williams NJ. Assessing and changing organizational social contexts for effective mental health services. Annu Rev Public Health 2016; 36:507-23. [PMID: 25785894 DOI: 10.1146/annurev-publhealth-031914-122435] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Culture and climate are critical dimensions of a mental health service organization's social context that affect the quality and outcomes of the services it provides and the implementation of innovations such as evidence-based treatments (EBTs). We describe a measure of culture and climate labeled Organizational Social Context (OSC), which has been associated with innovation, service quality, and outcomes in national samples and randomized controlled trials (RCTs) of mental health and social service organizations. The article also describes an empirically supported organizational intervention model labeled Availability, Responsiveness, and Continuity (ARC), which has improved organizational social context, innovation, and effectiveness in five RCTs. Finally, the article outlines a research agenda for developing more efficient and scalable organizational strategies to improve mental health services by identifying the mechanisms that link organizational interventions and social context to individual-level service provider intentions and behaviors associated with innovation and effectiveness.
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Affiliation(s)
- Charles Glisson
- Children's Mental Health Services Research Center, University of Tennessee, Knoxville, Tennessee 37996; ,
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Glisson C, Williams NJ, Hemmelgarn A, Proctor E, Green P. Increasing clinicians' EBT exploration and preparation behavior in youth mental health services by changing organizational culture with ARC. Behav Res Ther 2016; 76:40-6. [PMID: 26649464 PMCID: PMC4706472 DOI: 10.1016/j.brat.2015.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Clinician EBT exploration and preparation behavior is essential to the ongoing implementation of new EBTs. This study examined the effect of the ARC organizational intervention on clinician EBT exploration and preparation behavior and assessed the mediating role of organizational culture as a linking mechanism. METHOD Fourteen community mental health agencies that serve youth in a major Midwestern metropolis along with 475 clinicians who worked in those agencies, were randomly assigned to either the three-year ARC intervention or control condition. Organizational culture was assessed with the Organizational Social Context (OSC) measure at baseline and follow-up. EBT exploration and preparation behavior was measured as clinician participation in nine separate community EBT workshops held over a three-year period. RESULTS There was 69 percent greater odds (OR = 1.69, p < .003) of clinicians in the ARC condition (versus control) attending each subsequent workshop. Workshop attendance in the control group remained under two percent and declined over three years while attendance in the ARC condition grew from 3.6 percent in the first workshop to 12 percent in the ninth and final workshop. Improvement in proficient organizational culture mediated the positive effect of the ARC intervention on clinicians' workshop attendance (a × b = .21; 95% CI:LL = .05, UL = .40). CONCLUSIONS Organizational interventions that create proficient mental health agency cultures can increase clinician EBT exploration and preparation behavior that is essential to the ongoing implementation of new EBTs in community youth mental health settings.
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Olin SCS, Hemmelgarn AL, Madenwald K, Hoagwood KE. An ARC-Informed Family Centered Care Intervention for Children's Community Based Mental Health Programs. JOURNAL OF CHILD AND FAMILY STUDIES 2016; 25:275-289. [PMID: 28781510 PMCID: PMC5542620 DOI: 10.1007/s10826-015-0220-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The experience of parents in helping their children access and use mental health services is linked to service outcomes. Parent peer support service, based on the principles of family-centered care, is one model to improve parent experience and engagement in services. Yet, little is known about how best to integrate this service into the existing array of mental health services. Integration is challenged by philosophical differences between family-centered services and traditional children's treatment services, and is influenced by the organizational social contexts in which these services are embedded. We describe an organizational and frontline team intervention that draws on research in behavior change, technology transfer, and organizational social context for youth with serious emotional disturbance. The two-pronged intervention, called FAMILY (FCC and ARC Model to Improve the Lives of Youth) is guided by the evidence-based Availability, Responsiveness, and Continuity (ARC) organizational intervention, targeted primarily at program and upper management leadership and includes a family-centered care (FCC) intervention, targeted at frontline providers. The approach employs multilevel implementation strategies to promote the uptake, implementation and sustainability of new practices. We include examples of exercises and tools, and highlight implementation challenges and lessons learned in facilitating program and staff level changes in family-centered service delivery.
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Affiliation(s)
- Su-Chin Serene Olin
- Department of Child and Adolescent Psychiatry, Center for Mental Health Implementation and Dissemination Science in States (IDEAS), New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Anthony L Hemmelgarn
- Children's Mental Health Services Research Center, University of Tennessee, 128 Henson Hall, Knoxville, TN 37996-3332, USA
| | - Kappy Madenwald
- Madenwald Consulting, LLC, Behavioral Healthcare Training and Consultation, Columbus, OH, USA
| | - Kimberly E Hoagwood
- Department of Child and Adolescent Psychiatry, Center for Mental Health Implementation and Dissemination Science in States (IDEAS), New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
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The Family Value of Information, Community Support, and Experience Study: Rationale, Design, and Methods of a "Family-Centered" Research Study. J Nerv Ment Dis 2015; 203:896-900. [PMID: 26524515 DOI: 10.1097/nmd.0000000000000393] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Patient Protection and Affordable Care Act focuses on improving consumer engagement and patient-centered care. This article describes the design and rationale of a study targeting family engagement in pediatric mental health services. The study is a 90-day randomized trial of a telephone-delivered Family Navigator services versus usual care for parents of Medicaid-insured youth younger than 13 years with serious mental illness. Youth are identified through a pediatric antipsychotic medication preauthorization program. Family Navigators offer peer support to empower and engage parents in their child's recovery. Outcomes include parent report of empowerment, social support, satisfaction with child mental health services, and child functioning as well as claims-based measures of psychotherapy service utilization and antipsychotic medication dosage. The focus on "family-centered" care in this study is strongly supported by the active role of consumers in study design and implementation.
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Atkins MS, Rusch D, Mehta TG, Lakind D. Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2015; 45:215-26. [PMID: 26155972 PMCID: PMC4706825 DOI: 10.1080/15374416.2015.1050724] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dissemination and implementation science (DI) has evolved as a major research model for children's mental health in response to a long-standing call to integrate science and practice and bridge the elusive research to practice gap. However, to address the complex and urgent needs of the most vulnerable children and families, future directions for DI require a new alignment of ecological theory and public health to provide effective, sustainable, and accessible mental health services. We present core principles of ecological theory to emphasize how contextual factors impact behavior and allow for the reciprocal impact individuals have on the settings they occupy, and an alignment of these principles with a public health model to ensure that services span the prevention to intervention continuum. We provide exemplars from our ongoing work in urban schools and a new direction for research to address the mental health needs of immigrant Latino families. Through these examples we illustrate how DI can expand its reach by embedding within natural settings to build on local capacity and indigenous resources, incorporating the local knowledge necessary to more substantively address long-standing mental health disparities. This paradigm shift for DI, away from an overemphasis on promoting program adoption, calls for fitting interventions within settings that matter most to children's healthy development and for utilizing and strengthening available community resources. In this way, we can meet the challenge of addressing our nation's mental health burden by supporting the needs and values of families and communities within their own unique social ecologies.
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Affiliation(s)
- Marc S. Atkins
- University of Illinois at Chicago, Institute for Juvenile Research (MC 747), 1747 W. Roosevelt Rd., Rm 155, Chicago, IL 60608, (312) 413-1048
| | - Dana Rusch
- University of Illinois at Chicago, Institute for Juvenile Research (MC 747), 1747 W. Roosevelt Rd, Rm. 155, Chicago, IL 60608, (312) 413-1708,
| | - Tara G. Mehta
- University of Illinois at Chicago, Institute for Juvenile Research (MC 747), 1747 W. Roosevelt Rd., Rm 155, Chicago, IL 60608, (312) 996-3910,
| | - Davielle Lakind
- University of Illinois at Chicago, Department of Psychology (MC 285), 1007 W. Harrison St., Chicago, IL 60607, (312) 413-1039,
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Gopalan G, Acri M, Lalayants M, Hooley C, Einbinder E. Child Welfare Involved Caregiver Perceptions of Family Support in Child Mental Health Treatment. JOURNAL OF FAMILY STRENGTHS 2014; 14:1-25. [PMID: 25755936 PMCID: PMC4351812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
| | - Mary Acri
- New York University School of Medicine,
| | | | - Cole Hooley
- McSilver Institute for Poverty Policy and Research at New York University,
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Henderson RJ, Johnson A, Moodie S. Parent-to-parent support for parents with children who are deaf or hard of hearing: a conceptual framework. Am J Audiol 2014; 23:437-48. [PMID: 25281845 DOI: 10.1044/2014_aja-14-0029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 08/31/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Parent-to-parent support for parents with children who are deaf or hard of hearing (D/HH) is identified as an important component of Early Hearing Detection and Intervention (EHDI) programs for children with hearing loss. PURPOSE The specific aim of this review was to identify the constructs and components of parent-to-parent support for parents of children who are D/HH. RESEARCH DESIGN An extensive scoping literature review identified 39 peer-reviewed articles published from 2000 to 2014. Studies were selected and reviewed based on standardized procedures. RESULTS Data were identified, extracted, and organized into libraries of thematic and descriptive content. A conceptual framework of parent-to-parent support for parents of children who are D/HH was developed and presented in a comprehensive, bidirectional informational graphic. The constructs and components of the conceptual framework are (a) well-being: parent, family, and child; (b) knowledge: advocacy, system navigation, and education; and (c) empowerment: confidence and competence. CONCLUSION The findings from this scoping review led to the development of a structured conceptual framework of parent-to-parent support for parents of children who are D/HH. The conceptual framework provides an important opportunity to explore and clearly define the vital contribution of parents in EHDI programs.
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Affiliation(s)
- Rebecca J. Henderson
- Health & Rehabilitation Sciences Program, Western University, London, ON, Canada
| | - Andrew Johnson
- Health & Rehabilitation Sciences Program, Western University, London, ON, Canada
| | - Sheila Moodie
- Health & Rehabilitation Sciences Program, Western University, London, ON, Canada
- National Centre for Audiology, Western University, London, ON, Canada
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Becker KD, Chorpita BF, Daleiden EL. Coordinating people and knowledge: Efficiency in the context of the Patient Protection and Affordable Care Act. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2014. [DOI: 10.1111/cpsp.12062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Hoagwood KE, Olin SS, Horwitz S, McKay M, Cleek A, Gleacher A, Lewandowski E, Nadeem E, Acri M, Chor KHB, Kuppinger A, Burton G, Weiss D, Frank S, Finnerty M, Bradbury DM, Woodlock KM, Hogan M. Scaling up evidence-based practices for children and families in New York State: toward evidence-based policies on implementation for state mental health systems. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2014; 43:145-57. [PMID: 24460518 PMCID: PMC3954943 DOI: 10.1080/15374416.2013.869749] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policymakers, providers, and family support specialists have worked in partnership since 2002 to redesign and evaluate the children's mental health system. Five system strategies driven by empirically based practices and organized within a state-supported infrastructure have been used in the child and family service system with more than 2,000 providers: (a) business practices, (b) use of health information technologies in quality improvement, (c) specific clinical interventions targeted at common childhood disorders, (d) parent activation, and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems.
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Serene Olin S, Kutash K, Pollock M, Burns BJ, Kuppinger A, Craig N, Purdy F, Armusewicz K, Wisdom J, Hoagwood KE. Developing quality indicators for family support services in community team-based mental health care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:7-20. [PMID: 23709287 PMCID: PMC3858539 DOI: 10.1007/s10488-013-0501-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Quality indicators for programs integrating parent-delivered family support services for children's mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.
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Affiliation(s)
- S Serene Olin
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, One Park Avenue, 7th Floor, New York, NY, 10016, USA,
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Hoagwood KE, Burns BJ. Vectoring for true north: building a research base on family support. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:1-6. [PMID: 24005247 PMCID: PMC3880611 DOI: 10.1007/s10488-013-0516-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Child Study Center, New York University School of Medicine, One Park Avenue at East 33rd, 8th Floor, New York, NY, 10016, USA,
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Kutash K, Acri M, Pollock M, Armusewicz K, Olin SCS, Hoagwood KE. Quality indicators for multidisciplinary team functioning in community-based children's mental health services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 41:55-68. [PMID: 23873037 PMCID: PMC3953037 DOI: 10.1007/s10488-013-0508-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The current study examined the organizational social context in 21 community-based programs serving youth at-risk for out-of-home care due to emotional or behavioral disorders and their families and program performance on five quality indicators of team functioning in teams that included a family support specialist. Results indicate that programs with higher performance on structures to facilitate teamwork, informal communication mechanisms among team members, and the ability to integrate family support specialists as equal members of the team showed more positive organizational functioning. Implications for the role of quality indicators in health care reform efforts are discussed.
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Affiliation(s)
- Krista Kutash
- Department of Child and Family Studies, Florida Mental Health Institute, University of South Florida, Tampa, FL, USA
| | - Mary Acri
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Michele Pollock
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Kelsey Armusewicz
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Su-chin Serene Olin
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University School of Medicine, New York, NY, USA. New York State Office of Mental Health, Albany, NY, USA
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Williams NJ, Glisson C. Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare. CHILDREN AND YOUTH SERVICES REVIEW 2013; 35:10.1016/j.childyouth.2013.09.002. [PMID: 24273363 PMCID: PMC3834965 DOI: 10.1016/j.childyouth.2013.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE High caseworker turnover has been identified as a factor in the poor outcomes of child welfare services. However, almost no empirical research has examined the relationship between caseworker turnover and youth outcomes in child welfare systems and there is an important knowledge gap regarding whether, and how, caseworker turnover relates to outcomes for youth. We hypothesized that the effects of caseworker turnover are moderated by organizational culture such that reduced caseworker turnover is only associated with improved youth outcomes in organizations with proficient cultures. METHODS The study applied hierarchical linear models (HLM) analysis to the second National Survey of Child and Adolescent Well-being (NSCAW II) with a U.S. nationwide sample of 2,346 youth aged 1.5- to 18-years-old and 1,544 caseworkers in 73 child welfare agencies. Proficient organizational culture was measured by caseworkers' responses to the Organizational Social Context (OSC) measure; staff turnover was reported by the agencies' directors; and youth outcomes were measured as total problems in psychosocial functioning with the Child Behavior Checklist (CBCL) completed by the youths' caregivers at intake and at 18 month follow-up. RESULTS The association between caseworker turnover and youth outcomes was moderated by organizational culture. Youth outcomes were improved with lower staff turnover in proficient organizational cultures and the best outcomes occurred in organizations with low turnover and high proficiency. CONCLUSIONS To be successful, efforts to improve child welfare services by lowering staff turnover must also create proficient cultures that expect caseworkers to be competent and responsive to the needs of the youth and families they serve.
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Affiliation(s)
- Nathaniel J. Williams
- Children’s Mental Health Services Research Center, University of Tennessee, Knoxville, USA; 128 Henson Hall, University of Tennessee, Knoxville, TN, 37996, USA; ; Phone: 1-(865) -974-9216
| | - Charles Glisson
- Children’s Mental Health Services Research Center, University of Tennessee, Knoxville, USA; 128 Henson Hall, University of Tennessee, Knoxville, TN, 37996, USA;
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