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.

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.

Are children with anxiety disorders privately referred to a university clinic like those referred from the public mental health system?

Compared two groups of children with anxiety disorders served at a single mental health clinic whose referral source differed: private referrals (i.e., parent/legal guardian initiated) and public referrals (e.g., via state contracts--Departments of Health and Education, juvenile justice system). Comparisons were made across three domains of variables: (a) symptoms/diagnoses, (b) functioning, and (c) environments. Few symptom differences emerged. However, large differences were evident for contextual variables like family income and life stressors. Overall, the pattern of differences point to possible directions for adaptation of treatments for use with children with anxiety disorders served in public mental health systems.