Data-Informed Communication: How Measurement-Based Care Can Optimize Child Psychotherapy.

Measurement-based care (MBC) research and practice, including clinical workflows and systems to support MBC, are grounded in adult-serving mental health systems. MBC research evidence is building in child and adolescent services, but MBC practice is inherently more complex due to identified client age, the family system and the need to involve multiple reporters. This paper seeks to address a gap in the literature by providing practical guidance for youth-serving clinicians implementing MBC with children and their families. We focus on MBC as a data-informed, client-centered communication process, and present three key strategies to enhance usual care child and adolescent psychotherapy via developmentally-appropriate MBC. These strategies include (1) go beyond standardized measures; (2) lean into discrepancies; and (3) get curious together. Case-based examples drawn from various child-serving settings illustrate these key strategies of MBC in child psychotherapy.

Leveraging Measurement-Based Care to Reduce Mental Health Treatment Disparities for Populations of Color.

Disparities in mental health treatment have consistently been documented for clients of color as compared to White clients. Most mental health care disparities literature focuses on access to care at the point of initial engagement to treatment, resulting in a dearth of viable solutions being explored to retain clients in care once they begin. Measurement-based care (MBC) is a person-centered practice that has been shown to improve the therapeutic relationship, make treatment more personalized, and empower the client to have an active role in their care. Problems with therapeutic alliance and treatment relevance are associated with early termination for communities of color in mental health services. However, MBC has not been explored as a clinical practice to address therapeutic alliance and continual engagement for people of color seeking mental health care. This Point of View describes several MBC features that may be able to impact current sources of disparity in mental health treatment quality and provides a rationale for each. Our hope is that the field of MBC and progress feedback will more explicitly consider the potential of MBC practices to promote equity and parity in mental health services of color and will start to explore these associations empirically. We also discuss whether MBC should be culturally adapted to optimize its relevance and effectiveness for communities of color and other groups experiencing marginalization. We propose that MBC has promise to promote equitable mental health service quality and outcomes for communities of color.

Active bystandership by youth in the digital era: Microintervention strategies for responding to social media-based microaggressions and cyberbullying.

Microaggressions are intentional or unintentional slights, insults, invalidations, and offensive behaviors that communicate hostile or derogatory messages to minoritized populations. When microaggressions cross over to social media, they can be considered a form of cyberbullying, which occurs over digital devices and harms, threatens, undermines, or socially excludes others. Microaggressions and cyberbullying have adverse mental health outcomes for racial and cultural minority youth, and there is an urgent need for practical strategies youth can use online to interrupt and disarm negative and harmful social media content. We used a multimethod approach to critically appraise and adapt Sue et al.'s (2019) microinterventions framework for use on social media with youth bystanders. Our analysis found high compatibility between microinterventions and youth bystander research, supporting transferability to social media for use with youth. Relevant adaptations include incorporating strategies that promote cognitive appraisal, cognitive empathy, education via social media, and use of social media features for external support. Using a social media microaggression example for each of the four microinterventions, we provide concrete tactics and example social media posts that youth can use when they come across insulting or offensive commentary online. The resulting framework offers a promising set of theory and research-informed strategies ready for further testing and refinement. When validated and refined, these microinterventions could be used as stand-alone strategies and/or incorporated into existing cyberbullying prevention or media literacy programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis.

BACKGROUND: Prior studies indicate the effectiveness of measurement-based care (MBC), an evidence-based practice, in improving and accelerating positive outcomes for youth receiving behavioral health services. MBC is the routine collection and use of client-reported progress measures to inform shared decision-making and collaborative treatment adjustments and is a relatively feasible and scalable clinical practice, particularly well-suited for under-resourced community mental health settings. However, uptake of MBC remains low, so information on determinants related to MBC practice patterns is needed. METHODS: Quantitative and qualitative data from N = 80 clinicians who implemented MBC using a measurement feedback system (MFS) were merged to understand and describe determinants of practice over three study phases. Quantitative, latent class analysis identified clinician groups based on participants' ratings of MFS acceptability, appropriateness, and feasibility and describes similarities/differences between classes in clinician-level characteristics (e.g., age; perceptions of implementation climate; reported MFS use; phase I). Qualitative analyses of clinicians' responses to open-ended questions about their MFS use and feedback about the MFS and implementation supports were conducted separately to understand multi-level barriers and facilitators to MFS implementation (phase II). Mixing occurred during interpretation, examining clinician experiences and opinions across groups to understand the needs of different classes of clinicians, describe class differences, and inform selection of implementation strategies in future research (phase III). RESULTS: We identified two classes of clinicians: "Higher MFS" and "Lower MFS," and found similarities and differences in MFS use across groups. Compared to Lower MFS participants, clinicians in the Higher MFS group reported facilitators at a higher rate. Four determinants of practice were associated with the uptake of MBC and MFS in youth-serving community mental health settings for all clinicians: clarity, appropriateness, and feasibility of the MFS and its measures; clinician knowledge and skills; client preferences and behaviors; and incentives and resources (e.g., time; continuing educational support). Findings also highlighted the need for individual-level implementation strategies to target clinician needs, skills, and perceptions for future MBC and MFS implementation efforts. CONCLUSION: This study has implications for the adoption of evidence-based practices, such as MBC, in the context of community-based mental health services for youth.

Advancing Mental Health Screening in Schools: Innovative, Field-Tested Practices and Observed Trends During a 15-Month Learning Collaborative.

Schools are well positioned to facilitate early identification and intervention for youth with emerging mental health needs through universal mental health screening. Early identification of mental health concerns via screening can improve long-term student development and success, but schools face logistical challenges and lack of pragmatic guidance to develop local screening policies and practices. This study summarizes mental health screening practices tested by six school districts participating in a 15-month learning collaborative. Qualitative analysis of 42 Plan-Do-Study-Act cycles revealed that districts tested quality improvement changes across seven screening practice areas, with all teams conducting at least one test to: 1) build a foundation; and 2) identify resources, logistics and administration processes. Quantitative data indicated that the average percentage of total students screened increased from 0% to 22% (range = 270 - 4,850 students screened at follow-up). Together, these results demonstrate how school districts not currently engaged in mental health screening can apply small, specific tests of change to develop a locally-tailored, practical and scalable process to screen for student mental health concerns. Lessons learned are provided to inform future directions for school-based teams.

How low can you go? Examining the effects of brief online training and post-training consultation dose on implementation mechanisms and outcomes for measurement-based care.

BACKGROUND: Initial training and ongoing post-training consultation (i.e., ongoing support following training, provided by an expert) are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outcomes. Moreover, the degree to which training and consultation engage theoretical implementation mechanisms-such as provider knowledge, skills, and attitudes-is not well understood. This study examined the effects of a brief online training and varying dosages of post-training consultation (BOLT+PTC) on implementation mechanisms and outcomes for measurement-based care (MBC) practices delivered in the context of education sector mental health services. METHODS: A national sample of 75 clinicians who provide mental health interventions to children and adolescents in schools were randomly assigned to BOLT+PTC or control (services as usual). Those in BOLT+PTC were further randomized to 2-, 4-, or 8-week consultation conditions. Self-reported MBC knowledge, skills, attitudes, and use (including standardized assessment, individualized assessment, and assessment-informed treatment modification) were collected for 32 weeks. Multilevel models were used to examine main effects of BOLT+PTC versus control on MBC use at the end of consultation and over time, as well as comparisons among PTC dosage conditions and theorized mechanisms (skills, attitudes, knowledge). RESULTS: There was a significant linear effect of BOLT+PTC over time on standardized assessment use (b = .02, p < .01), and a significant quadratic effect of BOLT+PTC over time on individualized assessment use (b = .04, p < .001), but no significant effect on treatment modification. BOLT + any level of PTC resulted in higher MBC knowledge and larger growth in MBC skill over the intervention period as compared to control. PTC dosage levels were inconsistently predictive of outcomes, providing no clear evidence for added benefit of higher PTC dosage. CONCLUSIONS: Online training and consultation in MBC had effects on standardized and individualized assessment use among clinicians as compared to services as usual with no consistent benefit detected for increased consultation dosage. Continued research investigating optimal dosages and mechanisms of these established implementation strategies is needed to ensure training and consultation resources are deployed efficiently to impact clinician practices. TRIAL REGISTRATION: ClinicalTrials.gov NCT05041517 . Retrospectively registered on 10 September 2021.

Implementation strategies to promote measurement-based care in schools: evidence from mental health experts across the USA.

BACKGROUND: Despite an established taxonomy of implementation strategies, minimal guidance exists for how to select and tailor strategies to specific practices and contexts. We employed a replicable method to obtain stakeholder perceptions of the most feasible and important implementation strategies to increase mental health providers' use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments. METHODS: A national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on "go-zone" graphs and compared across providers and researchers to identify top-rated strategies. RESULTS: The initial 33 strategies were rated as "relevant" or "relevant with changes" to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; on a scale of 1 to 5, importance ratings (3.61-4.48) were higher than feasibility ratings (2.55-4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: (1) assess for readiness and identify barriers and facilitators; (2) identify and prepare champions; (3) develop a usable implementation plan; (4) offer a provider-informed menu of free, brief measures; (5) develop and provide access to training materials; and (6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, providers reported higher feasibility of train-the trainer approaches than researchers, and researchers reported higher importance of monitoring fidelity than providers. CONCLUSIONS: The education sector is the most common setting for child and adolescent mental health service delivery in the USA. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents, and their families. This empirically derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.

The Stress and Resilience Town Hall: A systems response to support the health workforce during COVID-19 and beyond.

OBJECTIVE: The COVID-19 pandemic is a traumatic stressor resulting in anxiety, depression, post-traumatic stress, and burnout among healthcare workers. We describe an intervention to support the health workforce and summarize results from its 40-week implementation in a large, tri-state health system during the COVID-19 pandemic. METHOD: We conducted 121 virtual and interactive Stress and Resilience Town Halls attended by 3555 healthcare workers. Town hall participants generated 1627 stressors and resilience strategies that we coded and analyzed using rigorous qualitative methods (Kappa = 0.85). RESULTS: We identify six types of stressors and eight types of resilience strategies reported by healthcare workers, how these changed over time, and how town halls were responsive to emerging health workforce needs. We show that town halls dedicated to groups working together yielded 84% higher mean attendance and more sharing of stressors and resilience strategies than those offered generally across the health system, and that specific stressors and strategies are reported consistently while others vary markedly over time. CONCLUSIONS: The virtual and interactive Stress and Resilience Town Hall is an accessible, scalable, and sustainable intervention to build mutual support, wellness, and resilience among healthcare workers and within hospitals and health systems responding to emerging crises, pandemics, and disasters.

A modified measurement-based care approach to improve mental health treatment engagement among racial and ethnic minoritized youth.

Despite high levels of need, racial and ethnic minoritized (REM) youth are much less likely than their White peers to engage in mental health treatment. Concerns about treatment relevance and acceptability and poor therapeutic alliance have been shown to impact treatment engagement, particularly retention, among REM youth and families. Measurement-based care (MBC) is a client-centered practice of collecting and using client-reported progress data throughout treatment to inform shared decision-making. MBC has been associated with increased client involvement in treatment, improved client-provider communication, and increased satisfaction with treatment services. Despite its promise as a treatment engagement strategy, MBC has not been studied in this capacity with REM youth or systematically modified to address the needs of culturally-diverse populations. In this article, we propose a culturally-modified version of MBC, Strategic Treatment Assessment with Youth (STAY), to improve treatment engagement among REM youth and families. Specifically, STAY is designed to target perceptual barriers to treatment to improve treatment retention and ultimately, client outcomes. The four STAY components (i.e., Introduce, Collect, Share, and Act) are based on an existing MBC practice framework and modified to address perceptual barriers to treatment among REM youth. The clinical application of this model is presented via a case example. Finally, future research directions to explore the use of MBC as a treatment retention strategy with REM client populations are provided. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Structural School Characteristics and Neighborhood Risk Factors: Associations with Student-Reported School Climate in a Large, Urban Public School District in the United States.

School climate consistently predicts youth academic success, social-emotional well-being, and substance use, and positive school climate can buffer the negative effects of community violence exposure on youth development. Various structural school and neighborhood factors have been associated with school climate, but prior research has not examined these relations comprehensively. We examined the relation between 18 school building and school neighborhood factors with student-reported school climate among 15,833 students in 124 public schools in a large, urban district in the United States. In this sample, attendance rate was most consistently associated with school climate (ß = 0.015; p < .001). Teacher years of experience, mobility rate, number of students in special education, adult arrests in the school neighborhood, and service calls for shootings and dirty streets and alleys in the school neighborhood were also significantly associated with various domains of school climate. These findings highlight the need for future longitudinal research on the influence of both school building and school neighborhood factors on school climate for public schools. Schools in our sample had a wide range of school climate scores despite consistently high crime rates and other structural risk factors such as low socioeconomic status throughout the city, so there are implications for researchers and education leaders to work together to identify opportunities for schools to foster positive school climate despite systemic school and/or neighborhood risk factors.

A Roadmap for Measurement-based Care Implementation in Intensive Outpatient Treatment Settings for Children and Adolescents.

Measurement-based care (MBC), the routine collection and use of patient-reported data to monitor progress and tailor treatment, has been predominantly studied in adult treatment settings. Although growing evidence supports MBC effectiveness with youth in outpatient settings and university training clinics, there is a substantial dearth of findings about successful implementation of MBC in "real world" youth treatment settings, particularly intensive settings offering group-based treatment. The current manuscript provides a foundational model of MBC implementation for "real world" intensive outpatient programs (IOP) for youth using the organizational framework of the Consolidated Framework for Implementation Research (CFIR). We also illustrate MBC implementation within a hospital-based adolescent psychiatric IOP, including enhancements to the foundational model and timely discussion of adjustments necessitated by the COVID-19 pandemic and transition to telehealth. Given the promising transdiagnostic and transtheoretical applicability of MBC, coupled with the MBC mandate for Joint Commission accredited health-care systems, IOP programs are well-positioned to adopt, implement and sustain MBC with careful attention to a phased, multilevel implementation approach.

What Gets Measured Gets Done: How Mental Health Agencies can Leverage Measurement-Based Care for Better Patient Care, Clinician Supports, and Organizational Goals.

Mental health clinicians and administrators are increasingly asked to collect and report treatment outcome data despite numerous challenges to select and use instruments in routine practice. Measurement-based care (MBC) is an evidence-based practice for improving patient care. We propose that data collected from MBC processes with patients can be strategically leveraged by agencies to also support clinicians and respond to accountability requirements. MBC data elements are outlined using the Precision Mental Health Framework (Bickman et al. in Adm Policy Mental Health Mental Health Serv Res 43:271-276, 2016), practical guidance is provided for agency administrators, and conceptual examples illustrate strategic applications of one or more instruments to meet various needs throughout the organization.

Can We Move the Needle on School Mental Health Quality Through Systematic Quality Improvement Collaboratives?

Learning collaboratives (LCs) have often been used to improve somatic health care quality in hospitals and other medical settings, and to some extent to improve social services and behavioral health care. This initiative is the first demonstration of a national, systematic LC to advance comprehensive school mental health system quality among school district teams. Twenty-four districts representing urban, rural, and suburban communities in 14 states participated in one of two 15-month LCs. Call attendance (M = 73%) and monthly data submission (M = 98% for PDSA cycles and M = 65% for progress measures) indicated active engagement in and feasibility of this approach. Participants reported that LC methods, particularly data submission, helped them identify, monitor and improve school mental health quality in their district. Qualitative feedback expands quantitative findings by detailing specific benefits and challenges reported by participants and informs recommendations for future research on school mental health LCs. Rapid-cycle tests of improvement allowed teams to pursue challenging and meaningful school mental health quality efforts, including mental health screening in schools, tracking the number of students receiving early intervention (Tier 2) and treatment (Tier 3) services, and monitoring psychosocial and academic improvement for students served.

Factors Associated with Community-Partnered School Behavioral Health Clinicians' Adoption and Implementation of Evidence-Based Practices.

Community-partnered school behavioral health (CP-SBH) is a model whereby schools partner with local community agencies to deliver services. This mixed-methods study examined 80 CP-SBH clinicians' adoption and implementation of evidence-based practice (EBP) approaches following mandated training. Forty-four clinicians were randomly assigned to one of two training conditions for a modular common elements approach to EBPs; 36 clinicians were preselected for training in a non-modular EBP. EBP knowledge improved for all training conditions at 8-month follow-up and practice element familiarity improved for modular approach training conditions, but the modular condition including ongoing consultation did not yield better results. Qualitative interviews (N = 17) highlighted multi-level influences of the CP-SBH service system and individual clinician characteristics on adoption and implementation.

When Behavioral Health Concerns Present in Pediatric Primary Care: Factors Influencing Provider Decision-Making.

Primary care providers (PCPs) frequently encounter behavioral health (BH) needs among their pediatric patients. However, PCPs report variable training in and comfort with BH, and questions remain about how and when PCPs address pediatric BH needs. Existing literature on PCP decisions to address pediatric BH in-office versus referring to subspecialty BH is limited and findings are mixed. Accordingly, this study sought to examine parameters and contextual factors influencing PCP decisions and practices related to BH care. Qualitative interview results with 21 PCPs in Maryland indicated that decisions about how and when to address pediatric BH concerns are influenced by the type BH service needed, patient characteristics, the availability of BH services in the community, and possibly PCPs' perceptions of BH care as a distinct subspecialty. Findings suggest that efforts to support individual PCPs' capacity to address BH within primary care must be balanced by efforts to expand the subspecialty BH workforce.

Pediatric Primary Care Providers' Use of Behavioral Health Consultation.

This column describes a qualitative study in which 32 primary care providers (PCPs) reported barriers to and facilitators of using a behavioral health (BH) consultation program. Barriers included program incompatibility with organizational culture, limited exposure to the program, existing access to referral sources, and negative beliefs about BH consultation. Reported facilitators included having personal relationships with BH program staff, exposure to program information, and positive beliefs about BH consultation. PCPs recommended outreach activities and optimal program features to increase use of BH consultation.

Dissemination and implementation science in program evaluation: A telemental health clinical consultation case example.

Increased attention has been placed on evaluating the extent to which clinical programs that support the behavioral health needs of youth have effective processes and result in improved patient outcomes. Several theoretical frameworks from dissemination and implementation (D&I) science have been put forth to guide the evaluation of behavioral health program implemented in the context of real-world settings. Although a strong rationale for the integration of D&I science in program evaluation exists, few examples exist available to guide the evaluator in integrating D&I science in the planning and execution of evaluation activities. This paper seeks to inform program evaluation efforts by outlining two D&I frameworks and describing their integration in program evaluation design. Specifically, this paper seeks to support evaluation efforts by illustrating the use of these frameworks via a case example of a telemental health consultation program in pediatric primary care designed to improve access to behavioral health care for children and adolescents in rural settings. Lessons learned from this effort, as well as recommendations regarding the future evaluation of programs using D&I science to support behavioral health care in community-based settings are discussed.

Advancing Evidence-Based Assessment in School Mental Health: Key Priorities for an Applied Research Agenda.

Evidence-based assessment (EBA) is a critically important aspect of delivering high-quality, school-based mental health care for youth. However, research in this area is limited and additional applied research on how best to support the implementation of EBA in school mental health (SMH) is needed. Accordingly, this manuscript seeks to facilitate the advancement of research on EBA in SMH by reviewing relevant literature on EBA implementation in schools and providing recommendations for key research priorities. Given the limited number of published studies available, findings from child and adolescent mental health and implementation science research are also included to inform a robust and comprehensive research agenda on this topic. Based on this literature review, five priorities for research on EBA in SMH are outlined: (1) effective identification of assessment targets, (2) appropriate selection of assessment measures, (3) investigation of organizational readiness for EBA, (4) study of implementation support for EBA, and (5) promotion of EBA data integration and use. Each priority area includes recommended directions for future research. A comprehensive and robust research agenda is warranted to build the science and practice of implementing EBA in SMH. Specific directions for this agenda are offered.

Youth, Caregiver, and Staff Perspectives on an Initiative to Promote Success of Emerging Adults with Emotional and Behavioral Disabilities.

Transitioning to adulthood is more challenging for youth with emotional and behavioral disorders (EBD) as compared to youth with other disability types and typically-developing peers. Outcomes for emerging adults with EBD as a group are particularly concerning in the domains of unemployment, educational dropout rates, and interactions with the judicial system including incarceration, early parenting, homelessness, substance abuse, mental health problems, and suicide. The current study presents qualitative program evaluation data for one of seven grantee states awarded 5-year cooperative agreements by the Substance Abuse Mental Health Services Administration (SAMHSA) to build developmentally-appropriate and effective youth-guided local systems of care for transition age youth, ages 16-25 years, to promote positive transition outcomes. Findings, obtained from focus groups of 25 participating transition age youth, caregivers, staff, and supervisors, include strategies for maintaining and expanding on the strengths of program, as well as for improving specific program areas. Also, consistent with the goals of the program, this process provided an opportunity for the youth and caregivers to voice their opinions and perspectives regarding their services. Implications for research and practice on effectively serving the unique needs of young adults experiencing EBD and their families in areas such as navigating special education, providing emotional and behavioral supports, and leveraging interagency collaboration are discussed.