Modeling the Decision of Mental Health Providers to Implement Evidence-Based Children's Mental Health Services: A Discrete Choice Conjoint Experiment.

Using an online, cross sectional discrete choice experiment, we modeled the influence of 14 implementation attributes on the intention of 563 providers to adopt hypothetical evidence-based children's mental health practices (EBPs). Latent class analysis identified two segments. Segment 1 (12%) would complete 100% of initial training online, devote more time to training, make greater changes to their practices, and introduce only minor modifications to EBPs. Segment 2 (88%) preferred fewer changes, more modifications, less training, but more follow-up. Simulations suggest that enhanced supervisor support would increase the percentage of participants choosing the intensive training required to implement EBPs. The dissemination of EBPs needs to consider the views of segments of service providers with differing preferences regarding EBPs and implementation process design.

Perceived reciprocal value of health professionals' participation in global child health-related work.

BACKGROUND: Leading children's hospitals in high-income settings have become heavily engaged in international child health research and educational activities. These programs aim to provide benefit to the institutions, children and families in the overseas locations where they are implemented. Few studies have measured the actual reciprocal value of this work for the home institutions and for individual staff who participate in these overseas activities. Our objective was to estimate the perceived reciprocal value of health professionals' participation in global child health-related work. Benefits were measured in the form of skills, knowledge and attitude strengthening as estimated by an adapted Global Health Competency Model. METHODS: A survey questionnaire was developed following a comprehensive review of literature and key competency models. It was distributed to all health professionals at the Hospital for Sick Children with prior international work experience (n = 478). RESULTS: One hundred fifty six health professionals completed the survey (34%). A score of 0 represented negligible value gained and a score of 100 indicated significant capacity improvement. The mean respondent improvement score was 57 (95% CI 53-62) suggesting improved overall competency resulting from their international experiences. Mean scores were >50% in 8 of 10 domains. Overall scores suggest that international work brought value to the hospital and over half responded that their international experience would influence their decision to stay on at the hospital. CONCLUSIONS: The findings offer tangible examples of how global child health work conducted outside of one's home institution impacts staff and health systems locally.

Behavioral and Electrophysiological Differences in Executive Control Between Monolingual and Bilingual Children.

This study examined executive control in sixty-two 5-year-old children who were monolingual or bilingual using behavioral and event-related potentials (ERPs) measures. All children performed equivalently on simple response inhibition (gift delay), but bilingual children outperformed monolinguals on interference suppression and complex response inhibition (go/no-go task). On the go/no-go task, ERPs showed larger P3 amplitudes and shorter N2 and P3 latencies for bilingual children than for monolinguals. These latency and amplitude data were associated with better behavioral performance and better discrimination between stimuli for bilingual children but not for monolingual children. These results clarify the conditions that lead to advantages for bilingual children in executive control and provide the first evidence linking those performance differences to electrophysiological brain differences in children.

Scoping review of toolkits as a knowledge translation strategy in health.

BACKGROUND: Significant resources are invested in the production of research knowledge with the ultimate objective of integrating research evidence into practice. Toolkits are becoming increasingly popular as a knowledge translation (KT) strategy for disseminating health information, to build awareness, inform, and change public and healthcare provider behavior. Toolkits communicate messages aimed at improving health and changing practice to diverse audiences, including healthcare practitioners, patients, community and health organizations, and policy makers. This scoping review explores the use of toolkits in health and healthcare. METHODS: Using Arksey and O'Malley's scoping review framework, health-based toolkits were identified through a search of electronic databases and grey literature for relevant articles and toolkits published between 2004 and 2011. Two reviewers independently extracted data on toolkit topic, format, target audience, content, evidence underlying toolkit content, and evaluation of the toolkit as a KT strategy. RESULTS: Among the 253 sources identified, 139 met initial inclusion criteria and 83 toolkits were included in the final sample. Fewer than half of the sources fully described the toolkit content and about 70% made some mention of the evidence underlying the content. Of 83 toolkits, only 31 (37%) had been evaluated at any level (27 toolkits were evaluated overall relative to their purpose or KT goal, and 4 toolkits evaluated the effectiveness of certain elements contained within them). CONCLUSIONS: Toolkits used to disseminate health knowledge or support practice change often do not specify the evidence base from which they draw, and their effectiveness as a knowledge translation strategy is rarely assessed. To truly inform health and healthcare, toolkits should include comprehensive descriptions of their content, be explicit regarding content that is evidence-based, and include an evaluation of the their effectiveness as a KT strategy, addressing both clinical and implementation outcomes.

The Cognitive Development of Young Dual Language Learners: A Critical Review.

Dual language exposure and bilingualism are relatively common experiences for children. The present review set out to synthesize the existing research on cognitive development in bilingual children and to identify the gaps and the methodological concerns present in the existing research. A search of major data bases for research conducted with typically-developing, preschool-age dual language learners between 2000-2013 yielded 102 peer-reviewed articles. The existing evidence points to areas of cognitive development in bilingual children where findings are robust or inconclusive, and reveals variables that influence performance. The present review also identifies areas for future research and methodological limitations.

Bilingual effects on cognitive and linguistic development: role of language, cultural background, and education.

A total of 104 six-year-old children belonging to 4 groups (English monolinguals, Chinese-English bilinguals, French-English bilinguals, Spanish-English bilinguals) were compared on 3 verbal tasks and 1 nonverbal executive control task to examine the generality of the bilingual effects on development. Bilingual groups differed in degree of similarity between languages, cultural background, and language of schooling. On the executive control task, all bilingual groups performed similarly and exceeded monolinguals; on the language tasks the best performance was achieved by bilingual children whose language of instruction was the same as the language of testing and whose languages had more overlap. Thus, executive control outcomes for bilingual children are general but performance on verbal tasks is specific to factors in the bilingual experience.

Short-term music training enhances verbal intelligence and executive function.

Researchers have designed training methods that can be used to improve mental health and to test the efficacy of education programs. However, few studies have demonstrated broad transfer from such training to performance on untrained cognitive activities. Here we report the effects of two interactive computerized training programs developed for preschool children: one for music and one for visual art. After only 20 days of training, only children in the music group exhibited enhanced performance on a measure of verbal intelligence, with 90% of the sample showing this improvement. These improvements in verbal intelligence were positively correlated with changes in functional brain plasticity during an executive-function task. Our findings demonstrate that transfer of a high-level cognitive skill is possible in early childhood.

Advancing implementation frameworks with a mixed methods case study in child behavioral health.

Despite a growing policy push for the provision of services based on evidence, evidence-based treatments for children and youth with mental health challenges have poor uptake, yielding limited benefit. With a view to improving implementation in child behavioral health, we investigated a complementary implementation approach informed by three implementation frameworks in the context of implementing motivational interviewing in four child and youth behavioral health agencies: the Active Implementation Frameworks (AIF) (process), the Consolidated Framework for Implementation Research (factors), and the Implementation Outcomes Framework (evaluation). The study design was mixed methods with embedded interrupted time series and motivational interviewing (MI) fidelity was the primary outcome. Focus groups and field notes informed perspectives on the implementation approach, and a questionnaire explored the salience of Consolidated Framework for Implementation Research (CFIR) factors. Findings validate the process guidance provided by the AIF and highlight CIFR factors related to implementation success. Novel CFIR factors, not elsewhere reported in the literature, are identified that could potentially extend the framework if validated in future research. Introducing fidelity measurement in practice proved challenging and was not sustained beyond the study. A complementary implementation approach was successful in implementing MI in child behavioral health agencies. In contrast with the typical train and hope approach to implementation, practice change did not occur immediately post-training but emerged over a 7 month period of consultation and practice following a discrete interactive training period. The saliency of CFIR constructs aligned with findings from studies conducted in other contexts, demonstrating external validity and highlighting common factors that can focus planning and measurement.

The effectiveness of consultation for clinicians learning to deliver motivational interviewing with fidelity.

Despite the emerging literature documenting gains in clinician competence following consultation, little empirical work has examined consultation as an implementation strategy. To this end, the present study examined consultation in the context of implementing motivational interviewing in four community child and youth mental health organizations. We used qualitative methods with a dual goal: to describe the consultation process and to explore trainees' perspectives on consultation. Participants included 22 clinicians and 9 supervisors who received monthly, group, phone-based consultation for seven months following training in motivational interviewing. Analyses showed that consultation was perceived as effective because it helped to "keep motivational interviewing alive," fulfilled a profound learning function through collaboration and connection with others, and served as protected time for reflection on practice change. Our findings contribute to a body of knowledge about consultation elements that appear to be effective when implementing research-supported interventions in child and youth mental health.

Developing a tool to measure the reciprocal benefits that accrue to health professionals involved in global health.

Research to date on global health collaborations has typically focused on documenting improvements in the health outcomes of low/middle-income countries. Recent discourse has characterised these collaborations with the notion of 'reciprocal value', namely, that the benefits go beyond strengthening local health systems and that both partners have something to learn and gain from the relationship. We explored a method for assessing this reciprocal value by developing a robust framework for measuring changes in individual competencies resulting from participation in global health work. The validated survey and evidence-based framework were developed from a comprehensive review of the literature on global health competencies and reciprocal value. Statistical analysis including factor analysis, evaluation of internal consistency of domains and measurement of floor and ceiling effects were conducted to explore global health competencies among diverse health professionals at a tertiary paediatric health facility in Toronto, Canada. Factor analysis identified eight unique domains of competencies for health professionals and their institutions resulting from participation in global health work. Seven domains related to individual-level competencies and one emphasised institutional capacity strengthening. The resulting Global Health Competency Model and validated survey represent useful approaches to measuring the reciprocal value of global health work among diverse health professionals and settings. Insights gained through application of the model and survey may challenge the dominant belief that capacity strengthening for this work primarily benefits the recipient individuals and institutions in low/middle-income settings.

Implementation of Interventions for the Control of Typhoid Fever in Low- and Middle-Income Countries.

Past research has focused on typhoid fever surveillance with little attention to implementation methods or effectiveness of control interventions. This study purposefully sampled key informants working in public health in Chile, India, Pakistan, Bangladesh, Thailand, Vietnam, South Africa, and Nigeria to 1) scope typhoid-relevant interventions implemented between 1990 and 2015 and 2) explore contextual factors perceived to be associated with their implementation, based on the Consolidated Framework for Implementation Research (CFIR). We used a mixed methods design and collected quantitative data (CFIR questionnaire) and qualitative data (interviews with 34 public health experts). Interview data were analyzed using a deductive qualitative content analysis and summary descriptive statistics are provided for the CFIR data. Despite relatively few typhoid-specific interventions reportedly implemented in these countries, interventions for diarrheal disease control and regulations for food safety and food handlers were common. Most countries implemented agricultural and sewage treatment practices, yet few addressed the control of antibiotic medication. Several contextual factors were perceived to have influenced the implementation of typhoid interventions, either as enablers (e.g., economic development) or barriers (e.g., limited resources and habitual behaviors). Consolidated Framework for Implementation Research factors rated as important in the implementation of typhoid interventions were remarkably consistent across countries. The findings provide a snapshot of typhoid-relevant interventions implemented over 25 years and highlight factors associated with implementation success from the perspective of a sample of key informants. These findings can inform systematic investigations of the implementation of typhoid control interventions and contribute to a better understanding of the direct effects of implementation efforts.

Emerging bilingualism: dissociating advantages for metalinguistic awareness and executive control.

The present studies revealed different factors associated with the reported advantages found in fully bilingual children for metalinguistic awareness and executive control. Participants were 100 children in Study 1 and 80 children in Study 2 in the process of becoming bilingual by attending immersion programs. In both studies, level of proficiency in the language of testing was related to performance on metalinguistic tasks and length of time in the immersion program was related to performance on executive control tasks. This dissociation is consistent with models of lifespan development that distinguish between representational structure and executive control.

Word Mapping and Executive Functioning in Young Monolingual and Bilingual Children.

The effect of bilingualism on the cognitive skills of young children was investigated by comparing performance of 162 children who belonged to one of two age groups (approximately 3- and 4½-year-olds) and one of three language groups on a series of tasks examining executive control and word mapping. The children were monolingual English speakers, monolingual French speakers, or bilinguals who spoke English and one of a large number of other languages. Monolinguals obtained higher scores than bilinguals on a receptive vocabulary test and were more likely to demonstrate the mutual exclusivity constraint, especially at the younger ages. However, bilinguals obtained higher scores than both groups of monolinguals on three tests of executive functioning: Luria's tapping task measuring response inhibition, the Opposite Worlds task requiring children to assign incongruent labels to a sequence of animal pictures, and reverse categorization in which children needed to reclassify a set of objects into incongruent categories after an initial classification. There were no differences between the groups in the ANT flanker task requiring executive control to ignore a misleading cue. This evidence for a bilingual advantage in aspects of executive functioning at an earlier age than previously reported is discussed in terms of the possibility that bilingual language production may not be the only source of these developmental effects.