Evidence-Based Treatments in Community Mental Health Settings: Use and Congruence With Children's Primary Diagnosis and Comorbidity.

Many evidence-based treatments (EBTs) have been identified for specific child mental health disorders, but there is limited research on the use of EBTs in community-based settings. This study used administrative data from a statewide system of care to examine 1) the extent to which EBTs were provided congruent with the child's primary diagnosis, 2) whether there were differences in effectiveness of EBTs that were congruent or incongruent with the child's primary diagnosis, and 3) whether comorbidity moderated the effectiveness of EBTs for children based on congruence with their primary diagnosis. The sample consisted of 23,895 children ages 3-17 with at least one of the most common diagnoses (attention-deficit/hyperactivity disorder, conduct problems, depressive disorders, anxiety disorders, and post-traumatic stress disorder) who received outpatient psychotherapy. Data were collected as part of routine care, including child demographic characteristics, diagnosis, treatment type, and problem severity. Forty-two percent of children received an EBT congruent with their diagnosis, and these children showed greater improvement than the 35% of children who received no EBT (ES = 0.14-0.16) or the 23% who received an EBT incongruent with their diagnosis (ES = 0.06-0.15). For children with comorbid diagnoses, the use of EBTs congruent with the primary diagnosis was also associated with the greatest improvement, especially when compared to no EBT (ES = 0.22-0.24). Results of the current study support the use of EBTs in community-based settings, and suggest that clinicians should select EBTs that match the child's primary diagnosis to optimize treatment outcomes, especially for children with comorbidity.

Clinician training, then what? Randomized clinical trial of child STEPs psychotherapy using lower-cost implementation supports with versus without expert consultation.

OBJECTIVE: Implementation of evidence-based treatments in funded trials is often supported by expert case consultation for clinicians; this may be financially and logistically difficult in clinical practice. Might less costly implementation support produce acceptable treatment fidelity and clinical outcomes? METHOD: To find out, we trained 42 community clinicians from four community clinics in Modular Approach to Therapy for Children (MATCH), then randomly assigned them to receive multiple lower-cost implementation supports (LC) or expert MATCH consultation plus lower-cost supports (CLC). Clinically referred youths (N = 200; ages 7-15 years, M = 10.73; 53.5% male; 32.5% White, 27.5% Black, 24.0% Latinx, 1.0% Asian, 13.5% multiracial, 1.5% other) were randomly assigned to LC (n = 101) or CLC (n = 99) clinicians, and groups were compared on MATCH adherence and competence, as well as on multiple clinical outcomes using standardized measures (e.g., Child Behavior Checklist, Youth Self-Report) and idiographic problem ratings (Top Problems Assessment). RESULTS: Coding of therapy sessions revealed substantial therapist adherence to MATCH in both conditions, with significantly stronger adherence in CLC; however, LC and CLC did not differ significantly in MATCH competence. Trajectories of change on all outcome measures were steep, positive, and highly similar for LC and CLC youths, with no significant differences; a supplemental analysis of posttreatment outcomes also showed similar LC and CLC posttreatment scores, with most LC-CLC differences nonsignificant. CONCLUSIONS: The findings suggest that effective implementation of a complex intervention in clinical practice may be supported by procedures that are less costly and logistically challenging than expert consultation. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Psychiatric Community Crisis Services for Youth.

Each year, increasing numbers of children and families seek care for psychiatric crises; unfortunately, most communities offer limited services to meet these needs. Youth in crisis often present to emergency departments, but may not need or benefit from that level of care. Instead, data reflect improved clinical and financial outcomes when communities offer a continuum of crisis services. In this article, the authors present care models from two communities - Ventura County, California, and the state of Connecticut - and review program development, implementation, and monitoring. The authors also highlight principles for leaders to consider in developing these services.

Family-Based Recovery: An Innovative In-Home Substance Abuse Treatment Model for Families with Young Children.

Family-based in-home treatment can effectively meet the needs of mothers and fathers struggling with the dual challenges of substance abuse recovery and parenting infants and toddlers. This article describes one such program, Family-Based Recovery (FBR), which integrates substance abuse treatment for parents and infant mental health intervention with the goal of preventing child maltreatment and family disruption. Program design, implementation, and results are provided. Outcome data suggest that FBR is a promising model.

Risk and protective factors associated with patterns of antisocial behavior among nonmetropolitan adolescents.

This study used latent class analysis (LCA) to identify patterns of antisocial behavior (ASB) in a sample of 1,820 adolescents in a nonmetropolitan region of the Northeast. Self-reported ASBs including stealing, fighting, damaging property, and police contact were assessed. LCA identified four classes of ASB including a non-ASB class, a mild, a moderate, and a serious ASB class. Multinomial logistic regression indicated that parent-child relationships served as a protective factor against engaging in ASB and peer, school, and community risk and protective factors differentiated mild patterns of ASB from more intense patterns of involvment. These findings suggest utility in using the LCA to better understand predictors of adolescent ASB to inform more effective prevention and intervention efforts targeting youth who exhibit different patterns of behavior.

Parental Knowledge and Substance Use among African American Adolescents: Influence of Gender and Grade Level.

Parental knowledge is defined as parental awareness and information about a child's activities, whereabouts, and associations that is obtained through parental monitoring, parental solicitation, or self-disclosure. Increased parental knowledge is generally associated with lower adolescent substance use; however, the influence of various contextual factors, such as adolescent gender and grade level is not well understood, particularly for different racial or ethnic groups. In the present study, we used Hierarchical Generalized Linear Modeling (HGLM) analyses to examine the longitudinal relationship of parental knowledge to adolescent substance use in the context of adolescent gender and grade level among 207 urban African American adolescents in grades 6-11. Results indicated that increased parental knowledge is associated with a concurrent lower likelihood of substance use across all types of substances examined (alcohol, tobacco, marijuana, other drug use, and any drug use), but it did not predict changes in substance use one year later for the entire sample. However, analyses by gender and grade level showed that for boys and middle school youth, parental knowledge was a protective factor for increases in substance use across one year. Findings are discussed in terms of their implications for prevention and health promotion interventions for adolescent substance use among African American youth.

Extended Day Treatment: A Comprehensive Model of After School Behavioral Health Services for Youth.

This paper describes Extended Day Treatment (EDT), an innovative intermediate-level service for children and adolescents with serious emotional and behavioral disorders, delivered in the after school hours. The current paper describes the core components of the EDT model of care within the context of statewide systems of care, including its theoretical foundations, core service components, relation to evidence-based practices, workforce composition and staff training, and data collection and reporting mechanisms. Recommendations are provided for statewide implementation, followed by discussion of model development as an approach to systems reform for the treatment of children and youth with emotional and behavioral disorders.

Maltreatment following reunification: predictors of subsequent Child Protective Services contact after children return home.

OBJECTIVES: This study examined risk of maltreatment among children exiting foster care using a statewide sample of children reunified between 2001 and 2004 in Rhode Island. The objectives were: (1) to compare rates of maltreatment following parental reunification for youth in care as a result of maltreatment with those in care for other reasons; and (2) to assess the effects of child, family, and case characteristics on rates of re-maltreatment among children placed in foster care due to maltreatment. METHOD: A longitudinal dataset of all reunified cases was matched with state records of substantiated Child Protective Service (CPS) investigations. Two Cox proportional hazards models were tested. The first model compared rates of subsequent maltreatment for two groups: children in foster care as a result of maltreatment, and those in care for other reasons. The second model investigated the effects of child, family, and case characteristics on re-maltreatment rates for those in care as a result of maltreatment. RESULTS: Children in foster care due to maltreatment were significantly more likely to be maltreated following reunification. Among children in foster care due to maltreatment, factors that raised risk for re-maltreatment included a previous foster care placement, exiting care from a non-relative foster home, and removal due to neglect. Older adolescents had lower rates of re-maltreatment than infants. Child neglect was the primary type of recurrent maltreatment that occurred following reunification. CONCLUSIONS: Supports are needed for families about to be reunified, particularly when the removal was prompted by incidents of abuse or neglect. Incidents of neglect are particularly likely and appropriate services should specifically target factors contributing to neglect. Cases involving youth with a history of repeated foster care placement or in which non-relative placements are utilized may need additional supports. PRACTICE IMPLICATIONS: This study suggests that services should be developed to minimize the risk for recurrent maltreatment following reunification. Services would be most useful for high-risk cases prior to reunification and during the first year following reunification. Understanding the risks associated with maltreatment will help guide development of appropriate interventions.

Impact of a positive youth development program in urban after-school settings on the prevention of adolescent substance use.

PURPOSE: Positive youth development (PYD) emphasizes a strengths-based approach to the promotion of positive outcomes for adolescents. After-school programs provide a unique opportunity to implement PYD approaches and to address adolescent risk factors for negative outcomes, such as unsupervised out-of-school time. This study examines the effectiveness of an after-school program delivered in urban settings on the prevention of adolescent substance use. METHODS: A total of 304 adolescents participated in the study: 149 in the intervention group and 155 in a control group. A comprehensive PYD intervention that included delivery of an 18-session curriculum previously found to be effective in preventing substance use in school settings was adapted for use in urban after-school settings. The intervention emphasizes adolescents' use of effective decision-making skills to prevent drug use. Assessments of substance use attitudes and behaviors were conducted at program entry, program completion, and at the 1-year follow-up to program entry. Propensity scores were computed and entered in the analyses to control for any pretest differences between intervention and control groups. Hierarchical linear modeling (HLM) analyses were conducted to assess program effectiveness. RESULTS: The results demonstrate that adolescents receiving the intervention were significantly more likely to view drugs as harmful at program exit, and exhibited significantly lower increases in alcohol, marijuana, other drug use, and any drug use 1 year after beginning the program. CONCLUSIONS: A PYD intervention developed for use in an urban after-school setting is effective in preventing adolescent substance use.

The impact of parental alcohol or drug removals on foster care placement experiences: a matched comparison group study.

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.

Changes in Placement among Children in Foster Care: A Longitudinal Study of Child and Case Influences.

Using Cox regression modeling, this longitudinal study examines child and case characteristics associated with changes in placement among 5,909 Rhode Island children in foster care. Results suggest that half of all children experience at least one placement change while in care. Infants change placements least, and risk increases with child age. Emergency shelter settings have the highest risk of placement change, followed by nonrelative settings, group home settings, and relative foster care. The reasons for removal from the home and the history of previous placements also predict placement changes, as do the interactions between foster care setting and some child characteristics.