Long-Term Effects of Pre-Placement Risk Factors on Children's Psychological Symptoms and Parenting Stress Among Families Adopting Children From Foster Care.

This exploratory longitudinal study examined behavioral outcomes and parenting stress among families with children adopted from foster care, taking into account environmental and biological risk factors. Child internalizing and externalizing problems and parenting stress were assessed in 82 adopted children and their families at 2 months post-placement, 12 months post-placement, and then yearly until 5 years post-placement. A history of abuse/neglect predicted significantly higher externalizing and internalizing problems at a borderline level of statistical significance. In the initial stages after placement, externalizing problems were significantly higher among children who were 4 years or older at placement versus those who were younger than 4, although differences were no longer significant 5 years post-placement. Statistical trends in parenting stress reflected reduced stress in the first 12 months followed by a plateau for parents who adopted older children and greater stress for parents who adopted younger children. Familiar limitations for observational cohort data apply. Nonetheless, the availability of longitudinal follow-up on a sizable sample of children adopted from foster care adds insight to the psychological dynamics for adoptive families and suggests that families of children adopted from the foster care system may have unique needs for ongoing support around behavioral issues.

Development and Piloting of a Classroom-Focused Measurement Feedback System.

The present study used a community partnered research method to develop and pilot a classroom-focused measurement feedback system (MFS) for school mental health providers to support teachers' use of effective universal and target classroom practices related to student emotional and behavioral issues. School personnel from seven urban elementary and middle school classrooms participated. Phase I involved development and refinement of the system through a baseline needs assessment and rapid-cycle feedback. Phase II involved detailed case study analysis of pre-to-post quantitative and implementation process data. Results suggest that teachers who used the dashboard along with consultation showed improvement in observed classroom organization and emotional support. Results also suggest that MFS use was tied closely to consultation dose, and that broader support at the school level was critical. Classroom-focused MFSs are a promising tool to support classroom improvement, and warrant future research focused on their effectiveness and broad applicability.

Using a Theory-Guided Learning Collaborative Model to Improve Implementation of EBPs in a State Children's Mental Health System: A Pilot Study.

Learning collaboratives (LCs) are used widely to promote implementation of evidence-based practices. However, there has been limited research on the effectiveness of LCs and models vary widely in their structure, focus and components. The goal of the present study was to develop and field test a theory-based LC model to augment a state-led, evidence-based training program for clinicians providing mental health services to children. Analysis of implementation outcomes contrasted LC sites to matched comparison sites that participated in the clinical training program alone. Results suggested that clinicians from sites participating in the LC were more highly engaged in the state-led clinical training program and were more likely to complete program requirements.

What Predicts Clinician Dropout from State-Sponsored Managing and Adapting Practice Training.

Dropouts from system-wide evidence-based practice trainings are high; yet there are few studies on what predicts dropouts. This study examined multilevel predictors of clinician dropout from a statewide training on the Managing and Adapting Practice program. Extra-organizational structural variables, intra-organizational variables and clinician variables were examined. Using multivariable logistic regression analysis, state administrative data and prospectively collected clinician participation data were used to predict dropout. Two characteristics were predictive: younger clinicians and those practicing in upstate-rural areas compared to downstate-urban areas were less likely to drop out from training. Implications for research and policy are described.

Implementing a Measurement Feedback System in Community Mental Health Clinics: A Case Study of Multilevel Barriers and Facilitators.

Measurement feedback systems (MFSs) have been proposed as a means of improving practice. The present study examined the implementation of a MFS, the Contextualized Feedback System (CFS), in two community-based clinic sites. Significant implementation differences across sites provided a basis for examining factors that influenced clinician uptake of CFS. Following the theoretical implementation framework of Aarons et al. (Adm Policy Mental Health Mental Health Serv Res 38(1):4-23, 2011), we coded qualitative data collected from eighteen clinicians (13 from Clinic U and 5 from Clinic R) who participated in semi-structured interviews about their experience with CFS implementation. Results suggest that clinicians at both clinics perceived more barriers than facilitators to CFS implementation. Interestingly, clinicians at the higher implementing clinic reported a higher proportion of barriers to facilitators (3:1 vs. 2:1); however, these clinicians also reported a significantly higher level of organizational and leadership supports for CFS implementation. Implications of these findings are discussed.

Scaling up evidence-based practices for children and families in New York State: toward evidence-based policies on implementation for state mental health systems.

Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policymakers, providers, and family support specialists have worked in partnership since 2002 to redesign and evaluate the children's mental health system. Five system strategies driven by empirically based practices and organized within a state-supported infrastructure have been used in the child and family service system with more than 2,000 providers: (a) business practices, (b) use of health information technologies in quality improvement, (c) specific clinical interventions targeted at common childhood disorders, (d) parent activation, and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems.

Understanding the components of quality improvement collaboratives: a systematic literature review.

CONTEXT: In response to national efforts to improve quality of care, policymakers and health care leaders have increasingly turned to quality improvement collaboratives (QICs) as an efficient approach to improving provider practices and patient outcomes through the dissemination of evidence-based practices. This article presents findings from a systematic review of the literature on QICs, focusing on the identification of common components of QICs in health care and exploring, when possible, relations between QIC components and outcomes at the patient or provider level. METHODS: A systematic search of five major health care databases generated 294 unique articles, twenty-four of which met our criteria for inclusion in our final analysis. These articles pertained to either randomized controlled trials or quasi-experimental studies with comparison groups, and they reported the findings from twenty different studies of QICs in health care. We coded the articles to identify the components reported for each collaborative. FINDINGS: We found fourteen crosscutting components as common ingredients in health care QICs (e.g., in-person learning sessions, phone meetings, data reporting, leadership involvement, and training in QI methods). The collaboratives reported included, on average, six to seven of these components. The most common were in-person learning sessions, plan-do-study-act (PDSA) cycles, multidisciplinary QI teams, and data collection for QI. The outcomes data from these studies indicate the greatest impact of QICs at the provider level; patient-level findings were less robust. CONCLUSIONS: Reporting on specific components of the collaborative was imprecise across articles, rendering it impossible to identify active QIC ingredients linked to improved care. Although QICs appear to have some promise in improving the process of care, there is great need for further controlled research examining the core components of these collaboratives related to patient- and provider-level outcomes.

Consultation as an implementation strategy for evidence-based practices across multiple contexts: unpacking the black box.

There is great interest in the dissemination and implementation of evidence-based treatments and practices for children across schools and community mental health settings. A growing body of literature suggests that the use of one-time workshops as a training tool is ineffective in influencing therapist behavior and patient outcomes and that ongoing expert consultation and coaching is critical to actual uptake and quality implementation. Yet, we have very limited understanding of how expert consultation fits into the larger implementation support system, or the most effective consultation strategies. This commentary reviews the literature on consultation in child mental health, and proposes a set of core consultation functions, processes, and outcomes that should be further studied in the implementation of evidence-based practices for children.

The role of consultation calls for clinic supervisors in supporting large-scale dissemination of evidence-based treatments for children.

This study explores the content of consultation provided to clinic supervisors within the context of a statewide training program in an evidence-based practice. Minute-to-minute live coding of consultation calls with clinic supervisors was conducted in order to identify the content and distribution of call topics. Results indicated that approximately half of the total speaking time was spent on a range of clinically relevant topics (e.g., cognitive-behavioral therapy techniques, fidelity to the treatment protocols). The remaining time was spent on program administration and CBT-related supervisory issues. This pilot study has broad implications for structuring the content of consultation process in large-scale dissemination efforts involving multiple portions of the clinical workforce.

Pre-placement risk and longitudinal cognitive development for children adopted from foster care.

This study examined the trajectory of cognitive development over the first five years of adoptive placement among children adopted from foster care and how pre-adoption risk factors relate to this development. Overall, children's cognitive scores increased significantly, with the most rapid improvement occurring in the first year post-placement. By five years post-placement, children's mean cognitive and achievement scores were in the average range. Adoption is a positive intervention for children's cognitive development.

The Impact of the COVID-19 Pandemic on Adolescents: An Opportunity to Build Resilient Systems.

The impact of the COVID-19 pandemic on adolescents is significant. Educational progress and mental health, in particular, have been negatively affected. Among youth from vulnerable communities, pre-existing academic and health disparities have been exacerbated. Youth outcomes are often attributed to individual resilience - or lack thereof; in this paper, we describe how failure to adapt and effectively cope at the system level (ie, lack of system resilience) is implicated in the current dual educational and mental crisis. We describe opportunities to make our systems more nimble and better-equipped to support youth moving forward.

Trauma-informed care in school-based health centers: A mixed methods study of behavioral health screening and services.

An explanatory, parallel mixed method design was used to examine trauma screening and behavioral health service rates in urban school-based health centers (SBHCs) and SBHC personnel's experiences providing culturally responsive, trauma-informed care. Logistic regressions were performed with electronic medical records from N = 4,794 patients ages 12-22 receiving care in a SBHC using trauma screening rates and service use as dependent variables. Quantitative analyses were supplemented with semistructured interviews with medical providers and behavioral health clinicians (N = 9) from eight SBHCs. The overall trauma screening rate across the SBHCs was 69.2%. Screening rates were higher for older and Spanish-speaking youth. The rate of behavioral health use was 32.9%, with higher rates among students screened for trauma at a prior medical visit, recent immigrant, and female youth. This suggests that trauma screening is feasible and facilitates access. Additionally, English-speaking youth were more likely to use behavioral health services than Spanish-speakers. Qualitative analyses suggested a strong sense of mission, collaboration, and beliefs that trauma screening facilitated access to care all facilitated trauma-focused screening. Barriers included staffing shortages and language translation challenges. Analysis also highlighted the importance of culturally responsive practices (e.g., interpreters, culture-specific assessment tools, knowledge of population needs). Mixed methods integrative analysis highlighted the ways in which barriers and facilitators aligned with the overall rates of access to screening and behavioral health care, and factors that helped the SBHCs tailor care to diverse youth. Limitations and implications for practice are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reinforcement sensitivity and risk for psychopathology following exposure to violence: a vulnerability-specificity model in Latino youth.

Urban Latino youth are exposed to high rates of violence, which increases risk for diverse forms of psychopathology. The current study aims to increase specificity in predicting responses by testing the hypothesis that youths' reinforcement sensitivity-behavioral inhibition (BIS) and behavioral approach (BAS)-is associated with specific clinical outcomes and increases risk for the development of such problems following exposure to violence. Utilizing a short-term longitudinal design, Latino youth (N = 168) provided reports of BIS/BAS and emotional/behavioral problems at Time 1, exposure to violence between Time 1 and Time 2, and clinical symptoms at Time 2. Results suggested that reinforcement sensitivity moderated the relation between violence exposure and psychopathology, such that increasing levels of BIS were associated with elevated risk for internalizing and posttraumatic stress symptoms following exposure to violence whereas BAS increased risk for externalizing problems. The importance of building on existing knowledge to understand minority youth psychopathology is discussed.

Supporting teachers during the COVID-19 pandemic: A community-partnered rapid needs assessment.

Using a community-partnered research framework, the goal of this study was to rapidly assess coronavirus disease (COVID-19) impact on teachers, students, and families and guidance received to navigate distance learning. Participants were teachers (N = 430) working in elementary schools (n = 301), middle schools (n = 56), high schools (n = 60), and other schools (n = 13) in two large urban school districts heavily impacted by COVID-19. Results indicated teacher concerns regarding student instructional loss and exposure to direct and indirect COVID-related trauma. There were mean differences in teacher concern by school level (p = .001, η² = .033) with elementary teachers reporting the greatest concerns regarding instructional loss. Over 40% of teachers reported that more than 20% of their students had a family member infected with COVID-19 or employed as a frontline healthcare worker. Approximately 99% of teachers reported a significant gap in student access to the internet and distance learning devices. Teachers reported receiving more school than district guidance regarding distance learning, student engagement, and using social emotional learning (SEL) programs. Results informed professional development priorities for educators and immediate supports needed for students and families. Study limitations and future directions for research and practice are discussed. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The Psychological, Academic, and Economic Impact of COVID-19 on College Students in the Epicenter of the Pandemic.

Initial research has indicated that college students have experienced numerous stressors as a result of the pandemic. The current investigation enrolled the largest and most diverse sample of college students to date (N = 4714) from universities in New York (NY) and New Jersey (NJ), the epicenter of the North American pandemic in Spring 2020. We described the impact on the psychological, academic, and financial health of college students who were initially most affected and examined racial/ethnic group differences. Results indicated that students' mental health was severely affected and that students of color were disproportionately affected by academic, financial, and COVID-related stressors. Worry about COVID-19 infection, stressful living conditions, lower grades, and loneliness emerged as correlates of deteriorating mental health. COVID-19's mental health impact on college students is alarming and highlights the need for public health interventions at the university level.

Effects on school outcomes in low-income minority youth: preliminary findings from a community-partnered study of a school-based trauma intervention.

OBJECTIVE: To examine academic outcomes of a community-partnered school mental health intervention for students exposed to community violence. DESIGN: Randomized controlled trial. SETTING AND PARTICIPANTS: Sixth-grade students (N = 123) from 2 middle schools in Los Angeles during the 2001-2002 academic year who had exposure to violence and posttraumatic stress symptoms in the clinical range. INTERVENTION: Students were randomized to either receive a 10-session standardized school trauma intervention (Cognitive Behavioral Intervention for Trauma in Schools) soon after screening (early intervention) or after a delay following screening (delayed intervention), but within the same school year. MAIN OUTCOME MEASURES: 59 students in the early intervention group vs. 64 students in the delayed intervention group (screened in September or December) were compared on spring semester grades in math and language arts, controlling for the students' standardized state test scores from the previous academic year and other covariates. RESULTS: Students in the early intervention group had a significantly higher spring semester mean grade in math (2.0 vs 1.6) but not language arts (2.2 vs 1.9). Students in the early intervention group were more likely than students in the delayed intervention group to have a passing grade (C or higher) in language arts (80% vs 61%; P < .033) by spring semester; we also found a substantial difference in the number of students receiving a passing math grade (70% vs 55%; P = .053). CONCLUSION: Through a collaborative partnership between school staff and researchers, preliminary evidence suggests that receiving a school trauma intervention soon after screening compared to delaying treatment can result in better school grades.

Statewide CBT Training for Clinicians and Supervisors Treating Youth: The New York State Evidence Based Treatment Dissemination Center.

In recent years, several states have undertaken efforts to disseminate evidence-based treatments to agencies and clinicians in their children's service system. In New York, the Evidence Based Treatment Dissemination Center adopted a unique translation-based training and consultation model in which an initial 3-day training was combined with a year of clinical consultation with specific clinician and supervisor elements. This model has been used by the New York State Office of Mental Health for the past 3 years to train 1,210 clinicians and supervisors statewide. This article describes the early adoption and initial implementation of a statewide training program in cognitive-behavioral therapy for youth. The training and consultation model and descriptive findings are presented; lessons learned are described. Future plans include a focus on sustainability and measurement feedback of youth outcomes to enhance the continuity of this program and the quality of the clinical services.

Going to Scale: Experiences Implementing a School-Based Trauma Intervention.

This article describes implementation experiences "scaling up" the Cognitive Behavioral Intervention for Trauma in Schools (CBITS)-an intervention developed using a community partnered research framework. Case studies from two sites that have successfully implemented CBITS are used to examine macro- and school-level implementation processes and strategies used to address implementation issues and create a successful implementation support system. Key elements of the implementation support system include pre-implementation work, ongoing clinical and logistical implementation supports, promotion of fidelity to the intervention's core components, tailored implementation to fit the service context, and a value on monitoring child outcomes.

Trauma in Schools: An Examination of Trauma Screening and Linkage to Behavioral Health Care in School-Based Health Centers.

BACKGROUND: This study examined trauma screening and behavioral health linkage rates in school-based health centers (SBHCs). METHODS: Participants included 4161 English- and Spanish-speaking patients between the ages of 12 and 22 across 8 urban SBHCs 2 years. Screening rates at medical visits and linkage to additional behavioral health screening and services were assessed via electronic medical records and a chart audit. RESULTS: Medical providers administered the Primary Care-PTSD screen to 66.3% of patients in year 1 and 46.7% of patients in year 2. Rates of positive trauma screens were 27.5% and 32.1%, respectively, with more girls screening positive than boys. Few (year 1; 8.1%; year 2: 9.6%) adolescents received additional trauma screening by a behavioral health clinician. However, the majority were linked to services (year 1: 66%; year 2: 74%). Lack of documentation (year 1: 24%; year 2: 33%) was a common gap in the charts of patients who did not receive a second stage trauma screening. Demographic differences in screening rates were minimal. CONCLUSION: The current study supports the feasibility of traumatic stress screening and linkage within an integrated care setting. Process improvement efforts should, however, address communication gaps around trauma assessment and its integration into ongoing care.

Aligning Research and Policy on Social-Emotional and Academic Competence for Young Children.

RESEARCH FINDINGS: The purpose of this article is to describe current education policies as they relate to the promotion of social, emotional, and academic (SEA) development and competence for young children. Academic and social-emotional competencies are described and conceptualized as developmentally linked, reciprocal processes that should be supported by education in an integrated, holistic manner. PRACTICE OR POLICY: The article reviews major public policies and national initiatives that have implications for the education of young children (e.g., Head Start, No Child Left Behind, IDEA) and highlights opportunities within these policies to promote programs that can support SEA competencies, as well as the limitations of these policies. The article also includes a review of the limitations of existing resources available to educators to identify evidence-based programs that support SEA competencies and concludes with recommendations for better alignment between research and policy to support SEA competencies.