Interagency Collaboration between Child Welfare Agencies, Schools, and Mental Health Providers and Children's Mental Health Service Receipt

Interagency Coordination to Manage Co-Occurring Intellectual and Developmental Disabilities and Mental Health Conditions

OBJECTIVE

The authors aimed to identify barriers to and strategies for supporting coordination between state agencies for intellectual and developmental disability (IDD) or mental health to meet the mental health needs of people with co-occurring IDD and mental health conditions.

METHODS

Forty-nine employees of state agencies as well as advocacy and service delivery organizations across 11 U.S. states with separate IDD and mental health agencies were interviewed between April 2022 and April 2023. Data were analyzed with a thematic analysis approach.

RESULTS

Interviewees reported that relationships between the IDD and mental health agencies have elements of both competition and coordination and that coordination primarily takes place in response to crisis events. Barriers to interagency coordination included a narrow focus on the populations targeted by each agency, within-state variation in agency structures, and a lack of knowledge about co-occurring IDD and mental health conditions. Interviewees also described both administrative (e.g., memorandums of understanding) and agency culture (e.g., focusing on whole-person care) strategies that are or could be used to improve coordination to provide mental health services for people with both IDD and a mental health condition.

CONCLUSIONS

Strategies that support state agencies in moving away from crisis response toward a focus on whole-person care should be prioritized to support coordination of mental health services for individuals with co-occurring IDD and mental health conditions.

Providers' experiences collaborating with child welfare workers: The good, the bad, and the impacts

BACKGROUND

Successful interprofessional collaborations have been identified as a potential solution to mitigate problems associated with negative outcomes for clients involved with the child welfare system. The barriers to collaborative relationships need to be better understood and effectively addressed.

OBJECTIVE

To understand the characteristics, barriers, and facilitators of collaborations between different types of providers and child welfare workers, as well as their impacts.

PARTICIPANTS AND SETTING

Mental health professionals, foster and kinship parents, legal professionals, and other providers responded to an online survey distributed in a Northeastern State of the United States of America.

METHOD

Participants (n = 208) completed the Quality of Collaboration with Child Welfare survey. Qualitative responses were analyzed by three coders using three levels of axial coding with constant comparison.

RESULTS

Participants identified different aspects of communication, relationships, and follow-through as key elements of successful collaborations, as well as the items most likely to interfere with their formation. Providers differed somewhat in how concerned they were with various aspects of collaborations in accordance with their professional roles. Barriers to successful collaborations included both individual and systemic factors which often resulted in negative outcomes. Overall, more negative experiences were offered than positive ones.

CONCLUSIONS

Strategies are needed to improve communication, promote positive relationships, and address systemic barriers to enhance collaboration and, in turn, improve outcomes for child welfare-involved clients.

Discrepancies between Foster Care Entry and Mental Health Service Use for Black and Latinx Youth

Black and Latinx youth are more likely to be placed into foster care compared to non-Latinx white youth. Foster care placement can facilitate mental health service use, yet youth from marginalized and oppressed racial and ethnic groups in foster care are still less likely to receive mental health services compared to non-Latinx white youth. This study aims to examine this discrepancy Black and Latinx youth face by testing (a) whether mental health need moderates the relationship between race or ethnicity and foster care placement and (b) whether race or ethnicity moderates the relationship between foster care placement and mental health service use. Data come from the National Survey of Child and Adolescent Well-Being (NSCAW II), a longitudinal national probability study of youth in contact with the child welfare system. Internalizing need was associated with a decreased likelihood of foster care placement for non-Latinx white youth compared to those with no need; findings showed the opposite for Latinx youth. Race and ethnicity did not significantly moderate the relationship between foster care placement and mental health service use, although predicted probabilities suggest that differences in mental health service use were more pronounced for Black and Latinx youth in in-home and kinship care compared to non-kinship foster care. Results suggest that despite main effects of race and ethnicity on foster care placement and mental health service use, discrepancies across these outcomes are not explained by race and ethnicity alone. Findings highlight the need to comprehensively examine predictors together, rather than separately, when assessing foster care care placement and mental health service use. A multi-pronged approach is outlined for child welfare reform.

Interagency Collaboration for Pediatric Autism Spectrum Disorder: Perspectives of Community-Based Providers

Background

Interagency collaboration between community and school settings is one mechanism to serve the complex needs of pediatric patients with autism spectrum disorder (ASD).

Purpose

We surveyed a national sample of community-based providers to examine their perspectives on interagency collaboration with school-based providers when serving pediatric patients with ASD.

Method

Medical and behavioral/mental health professionals practicing in community settings were recruited. Participants (N = 116) completed an online survey about their interagency collaboration experiences with schools.

Results

The majority of the sample reported engaging in interagency collaboration with school-based providers; however, the frequency was limited and was associated with the number of years working in the field. Community-based providers wanted more didactic and hands-on experiences in collaboration. Barriers and facilitators were related to schools' administration, school personnels' training in ASD, information exchange, and delineating between identification systems.

Discussion and Conclusion

Our findings highlight the importance of leadership support and the need for innovative training experiences to support school-community interagency collaboration.

Critical Factors Influencing Interorganizational Relationships Between Juvenile Probation and Behavioral Health Agencies

Although interorganizational relationships (IORs) are essential to the effective delivery of human services, very little research has examined relationships between juvenile justice agencies and behavioral health providers, and few studies have identified the most critical organizational and individual-level characteristics influencing IORs. Across 36 sites, juvenile probation officials (n = 458) and community behavioral health providers (n = 91) were surveyed about characteristics of their agencies, themselves, and IORs with each other. Generalized Linear Mixed Models were used to analyze the data. The strongest predictors included Perceived Organizational Support and individual Adaptability. Implications for research, theory and practice are discussed.

Better Together? A Review of Evidence for Multi-Disciplinary Teams Responding to Physical and Sexual Child Abuse

Multi-Disciplinary teams (MDTs) have often been presented as the key to dealing with a number of intractable problems associated with responding to allegations of physical and sexual child abuse. While these approaches have proliferated internationally, researchers have complained of the lack of a specific evidence base identifying the processes and structures supporting multi-disciplinary work and how these contribute to high-level outcomes. This systematic search of the literature aims to synthesize the existing state of knowledge on the effectiveness of MDTs. This review found that overall there is reasonable evidence to support the idea that MDTs are effective in improving criminal justice and mental health responses compared to standard agency practices. The next step toward developing a viable evidence base to inform these types of approaches seems to be to more clearly identify the mechanisms associated with effective MDTs in order to better inform how they are planned and implemented.

Community-Based Learning Collaboratives and Participant Reports of Interprofessional Collaboration, Barriers to, and Utilization of Child Trauma Services

Given the high prevalence and severe consequences of child trauma, effective implementation strategies are needed to increase the availability and utilization of evidence-based child trauma services. One promising strategy, the Community-Based Learning Collaborative (CBLC), augments traditional Learning Collaborative activities with a novel set of community-focused strategies. This prospective, observational study examined pre-to post-changes in CBLC participant reports of interprofessional collaboration (IPC), barriers to, and utilization of evidence-based child trauma treatment in their communities. Participants of five CBLCs from a statewide dissemination initiative, comprising 572 child abuse professionals (296 clinicians, 168 brokers, and 108 senior leaders), were surveyed pre-and post-CBLC participation. Results suggested that CBLCs significantly decreased barriers to child trauma treatment and significantly increased IPC and perceived utilization of evidence-based child trauma treatment. Further, changes in barriers partially mediated this relationship. Finally, small to medium differences in participants' reports were detected, such that senior leaders perceived significantly greater IPC than clinicians and brokers did, while brokers perceived significantly greater barriers to child trauma treatment than clinicians and senior leaders did. Collectively, these preliminary findings suggest the CBLC implementation model-which augments traditional Learning Collaborative models with a focus on fostering IPC-can reduce barriers and increase the utilization of evidence-based mental health treatment services.

Educational neglect: Understanding 20 years of child welfare trends

Educational neglect is an understudied phenomenon that is difficult to define and also to address. While it is clear that attending to children's academic needs is important to child development, few studies focus on educational neglect and therefore little is known about its associated risk factors and the outcomes following this form of maltreatment. The purpose of this research was to (a) determine the rate at which child welfare service providers investigate educational neglect in Canada and identify any trends in rates over time, (b) better understand educational neglect and its distinction from other types of neglect and truancy, and (c) understand how child welfare services respond to allegations of educational neglect. Data from five cycles of the Ontario Incidence Studies of Reported Child Abuse and Neglect were examined. A trend analysis was conducted followed by a mixed-method examination of educational neglect investigations. Results indicate that rates of investigated educational neglect in Ontario have been consistently low over time. However, these investigations are significantly more likely to be substantiated and to be transferred to ongoing child welfare services compared to investigations of other subtypes of neglect. Educational neglect investigations involving younger children are more likely to note risk factors for caregivers whereas those involving adolescents are more likely to note functioning issues for youth. The findings are discussed in relation to international trends in educational neglect and policy and practice implications are explored.

Interagency collaboration in children and young people's mental health: a systematic review of outcomes, facilitating factors and inhibiting factors

BACKGROUND

In the UK and internationally, there have been increasing calls for interagency collaboration across mental health services for children and young people. However, it is not clear whether such practices do, indeed, have a positive impact and, if so, what factors facilitate and inhibit collaboration across agencies.

METHODS

Electronic searches were carried out on seven key computerized bibliographic databases. For inclusion in the review, studies needed to report on close working by two or more services that provided mental health support for children and/or young people and that had some systematic collection of qualitative and/or quantitative data. Outcomes were analysed narratively, and facilitating and inhibiting factors were examined using thematic analysis.

RESULTS

A final sample of 33 studies was identified from 4136 initial records. Outcomes were mixed, with some findings indicating that interagency collaboration was associated with greater service use and equity of service provision, but other suggesting negative outcomes on service use and quality. However, interagency collaboration was perceived as helpful and important by both service users and professionals, and collaborative initiatives were evaluated positively. The factors most commonly identified as facilitating interagency collaboration were good interagency communication, joint trainings, good understandings across agencies, mutual valuing across agencies, senior management support, protocols on interagency collaboration and a named link person. The most commonly perceived barriers to interagency collaboration were inadequate resourcing, poor interagency communication, lack of valuing across agencies, differing perspectives, poor understandings across agencies and confidentiality issues.

CONCLUSIONS

The results are consistent with findings from previous reviews of interagency collaboration across adult and child services: there were some indications of benefit; and facilitating and inhibiting factors involved working relationships and multi-agency processes, resources and management. The identification of these factors has implications for practitioners, service managers, trainers, commissioners and researchers.

System-level intersectoral linkages between the mental health and non-clinical support sectors: a qualitative systematic review

OBJECTIVES

Concerns about fragmented mental health service delivery persist, particularly for people with severe and persistent mental illness. The objective was to review evidence regarding outcomes attributed to system-level intersectoral linkages involving mental health services and non-clinical support services, and to identify barriers and facilitators to the intersectoral linkage process.

METHODS

A systematic, qualitative review of studies describing attempts to coordinate the activities of multiple service agencies at the policy, program or organisational level was conducted. Electronic databases Medline, PsycINFO and EMBASE were searched via OVID from inception to July 2012.

RESULTS

Of 1593 studies identified, 40 were included in the review - 26 in adult and 14 in vulnerable youth populations. Identified mechanisms to promote positive system-level outcomes included: interagency coordinating committees or intersectoral/interface workers engaged in joint service planning; formalised interagency collaborative agreements; a single care plan in which the responsibilities of all agencies are described; cross-training of staff to ensure staff culture, attitudes, knowledge and skills are complementary; service co-location; and blended funding initiatives to ensure funding aligns with program integration. Identified barriers included: adequacy of funding and technology; ensuring realistic workloads; overcoming 'turf issues' between service providers and disagreements regarding areas of responsibility; ensuring integration strategies are implemented as planned; and maintaining stakeholder enthusiasm.

CONCLUSIONS

System-level intersectoral linkages can be achieved in various ways and are associated with positive clinical and non-clinical outcomes for services and clients. Some linkage mechanisms present greater implementation challenges than others (e.g. major technology upgrades or co-location in geographically remote areas). In some instances (e.g. co-location) alternative options may achieve equivalent benefits. Publication bias could not be discounted, and studies using high-quality research designs are scarce. The limited information base applicable to system-level integration argues strongly for the evaluation of the models that evolve in the rollout of the national Partners in Recovery initiative.

Enhancing cross-system collaboration for caregivers at risk for depression

In the United States, many health care systems function independently from one another. Increasing coordination across systems has the potential to vastly improve services and patient outcomes, yet implementing these changes can be challenging, requiring increased communication, interaction, and coordination across systems that typically function independently. Parental depression is one health issue that could benefit greatly from a comprehensive systems approach. The Helping Families Raise Healthy Children initiative is a cross-system quality improvement initiative aimed at improving identification and treatment of families faced with the dual challenge of caregiver depression and early childhood developmental delays. Four main techniques were used to foster and sustain cross-system collaboration and communication: cross-system trainings, regular meetings of collaborative partners, a cross-system learning collaborative for service providers, and two cross-system facilitators. The initiative achieved successful cross-system collaboration, suggesting that these methods may be used in other initiatives to foster similar types of collaboration across systems.

Mental health and the school environment: secondary schools, promotion and pathways to care

PURPOSE OF REVIEW

Addressing youth mental health in secondary schools has received greater attention globally in the past decade. It is essential that educators, mental health experts, researchers, and other related service providers understand the most current research findings to inform policy making, and identify priority areas for the development of future interventions and research strategies. This review describes literature during the past year on school-based mental health programs addressing mental health promotion, prevention, early identification and intervention/treatment.

RECENT FINDINGS

In contrast to the abundance of school-based mental health programs, the evidence of program effectiveness, safety and cost-effectiveness in this area is somewhat insufficient, mostly due to the lack of rigorous research designs, the heterogeneity of school environments, and the complexities of interventions that require multisector collaboration.

SUMMARY

Although the opportunity in school mental health is substantial, much yet needs to be done to develop and evaluate interventions that can be proven to be effective, safe and cost-effective. Mental health literacy may be an appropriate start that will help to set the foundation for mental health promotion, prevention and intervention.