Issues and challenges related to reducing the gap between child mental health research and practice are not minor. As the field continues to mature, energized by the challenges to develop treatment in more innovative ways and to disseminate EBP, the potential for improving child mental health is strong.
"Each year, about 6% of U.S. children and adolescents receive some form of mental health care at an annual cost of more than $11 billion . Despite the increased availability and demand for evidence-based practices (EBPs) for the treatment of youth mental health and behavioral problems [2-5], 90% of publicly funded child welfare, mental health, and juvenile justice systems do not use EBPs . The reasons for this lack of use and the characteristics of systems that predict successful implementation of EBPs remain poorly understood. "
[Show abstract][Hide abstract] ABSTRACT: The present study examines the structure and operation of social networks of information and advice and their role in making decisions as to whether to adopt new evidence-based practices (EBPs) among agency directors and other program professionals in 12 California counties participating in a large randomized controlled trial.
Interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. Grounded-theory analytic methods were used to identify themes related to EBP adoption and network influences. A web-based survey collected additional quantitative information on members of information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) for examination of associations between advice seeking and network structure.
Systems leaders develop and maintain networks of information and advice based on roles, responsibility, geography, and friendship ties. Networks expose leaders to information about EBPs and opportunities to adopt EBPs; they also influence decisions to adopt EBPs. Individuals in counties at the same stage of implementation accounted for 83% of all network ties. Networks in counties that decided not to implement a specific EBP had no extra-county ties. Implementation of EBPs at the two-year follow-up was associated with the size of county, urban versus rural counties, and in-degree centrality. Collaboration was viewed as critical to implementing EBPs, especially in small, rural counties where agencies have limited resources on their own.
Successful implementation of EBPs requires consideration and utilization of existing social networks of high-status systems leaders that often cut across service organizations and their geographic jurisdictions.
"well. Despite an increasing number of evidence-based interventions with demonstrated efficacy in reducing behavioral problems among child welfare populations, many of these interventions have not been widely implemented in practice (Burns, 2003; Garland, Hawley, Brookman-Frazee, & Hurlburt, 2008; Hoagwood, Burns, Kiser, Ringeisen, & Schoenwald, 2001; Kazdin, 2004). Given the tremendous mental health need of foster children and the volume of services purchased by the child welfare agencies, current policy and practice efforts must focus on ensuring that child welfare involved youth have access to effective mental health interventions. "
[Show abstract][Hide abstract] ABSTRACT: Despite the tremendous mental health need evidenced by children in foster care and high rates of use of mental health services among children in foster care, little is known about the impact of outpatient mental health services on the behavioral health of this population. This study utilizes data from the National Survey of Child and Adolescent Well-being (NSCAW), the first nationally representative study of child welfare in the United States. A subsample of 439 children who have experienced long-term foster care were included in this study. These data were used to estimate the impact of outpatient mental health services on the externalizing and internalizing behavior problems of children in long-term foster care. A propensity score matching model was employed to produce a robust estimate of the treatment effect. Results indicate that children who have experienced long-term foster care do not benefit from the receipt of outpatient mental health services. Study results are discussed in the context of earlier research on the quality of mental health services for children in foster care.
"Evidence-based practice (EBP) dissemination and implementation processes and outcomes have received increased attention in recent years. For children and youth mental health and social services in particular, addressing the challenges of dissemination and implementation of EBPs has been emphasized as critical for improving the quality of treatment services received as well as for EBP sustainability (Barlow, Levitt, & Bufka, 1999; Burns, 2003; Hoagwood, Burns, Kiser, Ringeisen, & Schoenwald, 2001). With the recognition that implementation of EBPs in real-world settings often represents a complex and challenging process, a growing body of literature has developed that examines factors influencing EBP implementation. "
[Show abstract][Hide abstract] ABSTRACT: Understanding the implementation of evidence-based practice (EBP) in community service settings is critical for the successful translation of research to practice. However, we have limited research evidence about the impact of EBP implementation on the mental health and social service workforce. In a previous study we demonstrated reduced staff turnover where an EBP was implemented with fidelity monitoring in the form of supportive ongoing supervision and consultation. Other research has shown that staff burnout and emotional exhaustion in particular is associated with poor quality of care and increased staff turnover intentions and turnover. Current research, however, has focused less on the effects that EBP implementation may have on staff emotional exhaustion. The present study investigates the association of EBP implementation and fidelity monitoring with staff emotional exhaustion in a statewide EBP implementation study. The 21 case-management teams in this study were randomized in a 2 (EBP vs. services as usual [SAU]) by 2 (monitoring vs. no monitoring) design. The EBP in this study was SafeCare, a home-based intervention that aims to reduce child neglect in at-risk families. SafeCare was developed from a behavior analysis approach and is based in cognitive behavioral principles. In keeping with our previous research, we hypothesized that providers implementing SafeCare with monitoring would have the lowest levels of emotional exhaustion and those receiving additional monitoring not in the context of EBP implementation would have higher emotional exhaustion relative to the other groups. Results supported our hypotheses in that we found lower emotional exhaustion for staff implementing the EBP but higher emotional exhaustion for staff receiving only fidelity monitoring and providing SAU. Together, these results suggest a potential staff and organizational benefit to EBP implementation and we discuss implications of the findings relative to EBPs and to fidelity monitoring.
Behaviour Research and Therapy 09/2009; 47(11):954-60. DOI:10.1016/j.brat.2009.07.006 · 3.85 Impact Factor
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