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Expanding attention-deficit/hyperactivity disorder service provision in urban socioeconomically disadvantaged communities: A pilot study

Chacko, Anil; Hopkins, Karen; Acri, Mary; Mendelsohn, Alan; Dreyer, Benard
Objective: Access to evidence-based psychosocial interventions for the treatment of attention-deficit/hyperactivity disorder (ADHD) is a challenge in urban, socioeconomically disadvantaged communities. Approaches that leverage existing but underdeveloped workforces and connects these with well-established settings that treat ADHD offers an opportunity to address this barrier. This pilot study focused on a preliminary test of the potential utility of paraprofessional-delivered behavioral parent training (BPT) to parents of children with ADHD being treated in a developmental behavioral pediatric practice. Method: In an open clinical trial of 7 families, Family Peer Advocate paraprofessionals delivered BPT to parents of children with ADHD. Parent reports of their child's ADHD symptoms/ oppositional defiant behaviors and functional impairment were assessed before, weekly during BPT, and immediately after BPT. Parents report of their positive and negative parenting behaviors were assessed before and immediately after BPT. Results: Findings demonstrated that participation in BPT was associated with improvements in child-and parent-level outcomes, with moderate to large effects across outcomes. Conclusions: Integrating existing service systems with oversight through pediatric psychologists offers opportunities to efficiently utilize resources, thereby increasing access to evidence-based interventions for ADHD in urban, socioeconomically disadvantaged communities. This study advances the scope of paraprofessional involvement in formal pediatric settings. In addition, it highlights the potential effectiveness of peer-to-peer delivered services.
ISSN: 2169-4826
CID: 4509962

Pilot Study of an Online Parent-Training Course for Disruptive Behavior with Live Remote Coaching for Practitioners

Ortiz, Camilo; Vidair, Hilary; Acri, Mary; Chacko, Anil; Kobak, Kenneth
Objective/UNASSIGNED:Many clinicians find it challenging to obtain training in evidence-based interventions, including behavioral parent training, which is considered the front-line treatment for children with disruptive behaviors (Chacko et al., 2017). Workshops, ongoing consultation, and feedback provided in person are effective, yet are rarely feasible for clinicians in the field (Fixsen, Blase, Duda, Naoom, & Van Dyke, 2010). The purpose of the present study was to conduct a preliminary assessment of an online tutorial combined with live remote coaching for training mental health professionals in behavioral parent training. Method/UNASSIGNED:Participants in this pretest-posttest open trial were 22 clinicians and graduate students (73% female) from around the United States. Results/UNASSIGNED:The web platform operated successfully, and clinicians found the training to be highly satisfactory. Compared to pre-training, participants demonstrated large improvements in knowledge about disruptive behavior and behavioral parent training and performed significantly better on demonstrations of skill in administering behavioral parent-training components. Conclusions/UNASSIGNED:An online course combined with live remote coaching is a promising methodology for significantly increasing the number of clinicians trained in evidence-based interventions for disruptive behavior in children. Next steps for evaluation and expansion of this training model are discussed.
PMID: 34017154
ISSN: 0735-7028
CID: 5018292

Providers' Perspectives on Implementing a Multiple Family Group for Children with Disruptive Behavior

Hamovitch, Emily K; Acri, Mary; Bornheimer, Lindsay A; Falek, Idan; Lambert, Kate; Galler, Madeline
Objectives/UNASSIGNED:The adoption of research-supported treatments is contingent upon multiple interactional levels, including provider level factors. Provider-level factors have been shown to be critical to uptake. The purpose of this study is to examine the relationship between sociodemographic factors, attitudes, and perceived barriers/facilitators to implementation through a comparative approach involving practitioners trained to facilitate a multiple family group intervention for children with disruptive behavior. Methods/UNASSIGNED:Participants included 91 practitioners who participated in an intervention study regarding barriers to adopting an evidence-based practice. Demographic characteristics were collected via a socio-demographic questionnaire. Barriers and facilitators were assessed via open-ended questions as well as a scale, developed by the authors and guided by the Consolidated Framework for Implementation Research that explored provider views regarding the intervention, the systemic and organizational context, experience facilitating groups and involving families in treatment, and feelings toward involving families in treatment. Between group analyses were conducted to examine demographic and characteristic differences of providers by implementation status. Independent samples t-tests for continuous characteristics and chi-square tests for categorical characteristics were used. Responses to open-ended questions were compiled, reviewed, and coded, and frequencies and percentages were calculated. Results/UNASSIGNED:Results demonstrated that providers who implemented the intervention were significantly more likely to have favorable attitudes toward the intervention compared to those who did not implement it. Prior experience facilitating groups was significantly associated with implementation. Common barriers to implementation included ineligible caseloads and feeling unqualified to deliver the intervention. Conclusions/UNASSIGNED:Further attention on improving recruitment rates and promoting adequate training and supervision is needed.
PMID: 33343177
ISSN: 1062-1024
CID: 5069992

Getting to the table: Agency characteristics and evidence-based intervention adoption in children's mental health care

Choy-Brown, Mimi; Hamovitch, Emily K; Bornheimer, Lindsay A; Acri, Mary C; McKay, Mary M
Scaling evidence-based interventions (EBI) for children and families across healthcare systems can expand public health impact. Research has identified EBI adoption determinants. However, less understood are characteristics of agencies that opt in across the stages of adoption. This study examined the relationship between agency (N=69) characteristics (e.g., revenue) and four adoption stages during a large-scale trial of an EBI for children with significant behavioral difficulties and their families. 48 (70%) of agencies demonstrated interest, 28 (41%) scheduled an informational meeting, 20 (29%) received training, and 16 (22%) demonstrated EBI uptake. Analyses indicated no differences in characteristics and initial interest. However, agencies with small-sized revenue had significantly reduced odds at other adoption stages. Implications for strategies to bring EBI access to scale are discussed.
PMID: 32189819
ISSN: 0190-7409
CID: 4353642

Examining a peer-delivered program for child welfare-involved caregivers at risk for depression

Acri, Mary C.; Hamovitch, Emily; Gopalan, Geetha; Lalayants, Marina
Caregivers involved in the child welfare system are at heightened risk for depression, which has innumerable, deleterious effects upon the family. Screening and active outreach can facilitate identification and service use, yet there are considerable obstacles to detection and help-seeking. The purpose of this study was to examine the impact of a peer-delivered detection and active outreach program upon depression and engagement in mental health services. Twenty-four caregivers participated in this four-session intervention (Mage? = ?32.5?±?7.46 years). Caregivers evidenced significant reductions in depressive from baseline to posttest and from baseline to follow-up; scores moved from clinically significant levels of depressive symptoms (M = 26.33) to the subclinical range (M = 14.4 at follow-up). A notable increase in treatment engagement over time, as well as the stability of caregivers involved in treatment was detected. Finally, the number of perceived barriers to help seeking were similar among caregivers who were engaged versus not engaged in services. The findings suggest that the active components of the intervention, when delivered by a peer, can effectively reduce depressive symptoms among high-risk caregivers.
ISSN: 1554-8732
CID: 4464102

Outcomes Associated With Adapting a Research-Supported Treatment for Children With Behavior Disorders

Acri, Mary C; Bornheimer, Lindsay A; Hamovitch, Emily K; Lambert, Kate
Purpose/UNASSIGNED:The aims of this study are to describe an adaptation process of a research-supported treatment (RST) for children with oppositional defiant disorder and to examine provider attitudes toward RSTs prior to and following this process. Method/UNASSIGNED:Providers from 14 agencies in New York State delivered the adapted RST, following training. Attitudes toward RSTs were measured by the Evidence-Based Practice Attitude Scale at baseline and posttest. Results/UNASSIGNED:Openness toward RSTs decreased from baseline to posttest. The majority of providers reported modifications to the structure and process of the intervention. Discussion/UNASSIGNED:To improve the uptake and usability of RSTs in practice, future research must further address adaptation processes and their relationships to attitudes toward RSTs.
PMID: 32855587
ISSN: 1049-7315
CID: 5069972

Examining Provider Factors Supporting the Adoption and Use of Research-Supported Interventions

Flaherty, Hanni B; Bornheimer, Lindsay A; Hamovitch, Emily; Garay, Elene; Mini De Zitella, Maria L; Acri, Mary; Mckay, Mary
Purpose: The purpose of this study was to examine the factors associated with the adoption of research-supported interventions (RSIs) in outpatient mental health clinics serving youth in order to inform implementation efforts and ultimately improve treatment outcomes. Method: This explanatory cross-sectional study includes secondary data from a clinical trial of an innovative group-based RSI in public mental health clinics for youth in New York City. Structural Equation Modeling examined the relationships between attitudes toward and beliefs of RSIs and uptake/use of RSIs in practice among providers in mental health settings. Results: As providers attitudes toward and beliefs about RSIs became more favorable, on average, RSIs were used more in practice in mental health settings serving youth. Conclusion: These findings indicate attitudes toward, and beliefs about innovation can be a precursor to the decision whether or not to use an innovative RSI in clinical practice in these settings. Implications and future directions are discussed.
PMID: 32459158
ISSN: 2640-8074
CID: 4474482

Provider Attitudes, Organizational Readiness for Change, and Uptake of Research Supported Treatment

Bornheimer, Lindsay A; Acri, Mary; Parchment, Tyrone; McKay, Mary M
Purpose/UNASSIGNED:As implementation and evaluation of research supported treatment (RST) expands across diverse mental health settings, it is essential to understand the facilitators and inhibitors of uptake. The current study examined the relationships between organizational readiness for change, attitudes toward RST, and use of RST among a sample primarily of social workers. Methods/UNASSIGNED:Participants included 158 providers from public child mental health outpatient clinics in the New York metropolitan area. Data were analyzed using structural equation modeling. Results/UNASSIGNED:Use of RST was greater among providers who were younger and had fewer years of professional experience. Both organizational need for change and climate directly and indirectly related to use of RST through attitudes toward RST (partial mediator). Discussion/UNASSIGNED:The organizational context is an important factor that relates to attitudes toward and use of RST in practice. Future research is needed to continue examining factors of RST uptake and sustainability.
PMID: 32863681
ISSN: 1049-7315
CID: 4603522

An Assessment of The New York State Behavioral Health System's Readiness to Transition to Medicaid Managed Care

Acri, Mary; Fuss, Ashley Ann; Quintero, Patricia; Baier, Meaghan; Connolly, Claire; Dean-Assael, Kara; Ferris, Dan; Franco, Lydia; McGuire, Morgan; Vilgorin, Boris; Cleek, Andrew
New York State has one of the most richly funded Medicaid programs in the United States. In an effort to achieve the triple aim New York State is undergoing a significant redesign of its Medicaid program including transitioning nearly all Medicaid funded behavioral health services into Medicaid managed care. In preparation for this transition, a state funded technical assistance center assessed the behavioral health care system's readiness to undergo this reform across 11 domains. Between September and November, 2014, the TA center electronically distributed a readiness survey to 897 mental health and substance abuse agencies: 313 (n = 269, 33%) organizations completed the assessment. As a whole, the sample felt partially ready to transition; analysis by domain revealed agencies were most ready to interface with managed care providers, and least ready to collect and evaluate outcome data. Significant differences in readiness were found depending by organizational characteristics (number of programs, licensure, and region). In anticipation of large-scale reforms, states would benefit from an initial needs assessment to identify gaps in knowledge and skills, which in turn, can then guide preparatory efforts and provide needed supports to facilitate major changes in service delivery and billing.
PMID: 30701376
ISSN: 1573-2789
CID: 3687322

Disseminating clinical and fiscal practices across the New York State behavioral healthcare system

Acri, Mary; Fuss, Ashley Ann; Quintero, Patricia; Hoagwood, Kimberly; McKay, Mary M; Cleek, Andrew
In order to facilitate the adoption of innovative practices in the mental health service system, providers require access to both new information and methodologies, and ongoing training, supervision and consultation. Technical Assistance centers have been proposed as a way to disseminate effective interventions through the provision of resources including information, ongoing training and consultation. The purpose of this study is to describe the New York State Technical Assistance Center's reach across the child public mental health service system and variations in characteristics of training activities, including dosage, content and method of format. Between 2011 and 2015, 460 (92.6%) of all New York State mental health clinics attended a training. The most highly attended events focused on business practices, followed by evidence-based treatments and clinic practices, and trauma-informed care. All were delivered via a webinar format, and were less than one day in duration. The behavioral health service system must be equipped to adapt to changing clinical and business practices in order to provide quality care and remain fiscally viable. New York State's TA center reached the majority of child mental health service providers across the state. Next steps are to closely examine the impact of TA supports upon adoption and sustained use of practices. Implications of these findings and additional future directions are presented.
PMID: 30887913
ISSN: 1541-034x
CID: 3734962