Faculty Bibliography

Calls for expanded use of tested child mental health interventions in child welfare practice add new urgency to the longstanding question of how to enhance parent engagement in child welfare services, where low and uneven levels of engagement are pervasive, and services to parents and children tend to be separated, leaving important opportunities for parent-child interventions underutilized. Tackling these issues requires both expanded understandings of what engagement entails and the incorporation into child welfare practice of systematic, research-based strategies for supporting parental involvement. Drawing on a review of factors that shape (and often confound) efforts to engage parents in child welfare, and on relevant research, this paper lays the initial foundation for such an approach by identifying and describing six core dimensions of engagement and related intervention strategies.

Objective: The dynamics of interactions between evidence-based intervention (EBI) developers and trainers and organizations and providers that deliver the EBI was examined in two case studies, a statewide randomized effectiveness trial of an EBI to reduce child neglect and a randomized trial of EBIs for depression, anxiety, and conduct problems in children and adolescents. Methods: Data were collected using ethnographic methods of participant observation and semistructured interviews and analyzed using grounded theory analytic methods. Results: Formal and informal interactions between EBI propagators and end users provide access to resources and exchange of global and local knowledge of service delivery. Productive interactions require accessibility, mutual respect, a shared language, and a willingness to engage in negotiation and compromise to resolve differences in demands imposed by organizational culture, the need for EBI fidelity, and client characteristics. Conclusion: A cultural exchange characterized by information sharing and behavioral change through a process of negotiation and compromise is central to evidence-based practice in youth serving systems of care.

The purpose of this study was to test a three component framework for enhancing quality in school mental health (SMH), focusing on quality assessment and improvement (QAI), family engagement/empowerment, and modular evidence-based practice (EBP) implementation in three established SMH programs. The study involved a 2-year, multisite (Delaware, Maryland, Texas) formative evaluation with clinicians randomly assigned to participate in either the QAI (target) intervention or a Wellness Plus Information (WPI, comparison) intervention. As hypothesized, clinicians who participated in the QAI condition demonstrated significantly greater implementation of quality indicators and greater implementation of EBP as compared to clinicians in the WPI condition. However, contrary to original hypotheses, findings did not reveal differences between the conditions in knowledge or attitudes toward EBP, clinician self-efficacy, or student psychosocial outcomes. Implications for future research on quality improvement in SMH are discussed, with an emphasis on the need to examine the impact of increased implementation and resource support to SMH clinicians.

This study examined the factors that are important to successful implementation and sustainability of evidence-based interventions in school settings. Developers of interventions that have been designated as "evidence-based" in multiple vetted lists and registries available to schools participated in a structured interview. The interview focused on potential facilitators and barriers to implementation and sustainability of their intervention. The interviews were transcribed and coded to identify similarities and differences among the responses as well as themes that cut across participants. Results indicated that those concerned with effective implementation and sustainability need to address several areas: (a) development of principal and other administrator support; (b) development of teacher support; (c) development of financial resources to sustain practice; (d) provision of high-quality training and consultation to ensure fidelity; (e) alignment of the intervention with school philosophy, goals, policies, and programs; (f) ensuring that program outcomes and impact are visible to key stakeholders; and (g) development of methods for addressing turnover in school staff and administrators.

Evaluations of quality improvement efforts targeted at mental health services in primary care pediatrics are rare. We evaluated a short-targeted educational session, a Web-based system, the Child Health and Development Interactive System, and a local area mental health services resource guide. Most physicians believed the information in the educational session was at least somewhat likely to change their practice. However, only 9.2% of the families invited to complete the Web-based system did so. Physicians found access to the Web-based system time consuming and, because the billing code for the screening activity was carved out of most of Ohio's privately-insured contract, physicians received no reimbursement for the screenings. Physicians were unenthusiastic about the local resource guide because the resources were not rated for quality. This quality improvement effort demonstrates that there are not easy solutions to practice change and highlights the need for implementation support when introducing new technology.

Pediatric residency reforms have increased emphasis on psychosocial issues, but we do not know whether this has changed pediatricians' perceptions of barriers to addressing maternal depression. A survey of 1600 members of the American Academy of Pediatrics investigated whether training in adult mental health issues and perceived barriers to addressing maternal depression differed for current pediatric residents, pediatricians in practice <5 years, and those in practice >or=5 years. Training did not differ for respondents who were currently in training, in practice <5 years, or in practice >or=5 years. Those in practice >or=5 years reported more barriers to addressing maternal depression compared with current residents. Current residents with training in adult mental techniques reported fewer barriers to the care of maternal depression. However, in spite of residency reforms, 81% of current residents reported no training in adult mental health issues.

OBJECTIVE: The experiences of clinicians in regard to initial and long-term intention to use evidence-based treatments were examined in order to better understand factors involved in implementation of innovative treatments. METHODS: Ethnographic methods of participant observation and extended semistructured interviews with four trainers, six clinical supervisors, and 52 clinicians at five agencies in Honolulu and six in Boston were used to understand treatment implementation in the Clinic Treatment Project, a randomized effectiveness trial of evidence-based treatments for depression, anxiety, and conduct problems of children. Grounded-theory analytic methods were used to analyze field notes, interview transcripts, and meeting minutes. RESULTS: Three patterns in regard to long-term intention to implement the treatments were evident: application of the treatments with fidelity, abandonment of the treatments, and selective or partial application. These patterns were perceived to be associated with three preimplementation factors: lag time between initial training in the treatment protocol and treatment use in practice, clinician engagement with the project, and clinician-treatment fit. Four additional factors were proximal outcomes of the three determinants as well as first steps of implementation: clinicians' first impressions of the evidence-based treatments after initial use, competence in treatment use, clinician and researcher adaptability, and clinician-researcher interactions. CONCLUSIONS: Interactions between preimplementation factors and initial implementation experiences and between researchers and clinicians during the early implementation steps were related to intentions to sustain treatment.