Mental Health Agency Officials' Perceived Priorities for Youth Mental Health and Factors That Influence Priorities.

OBJECTIVE: This study aimed to characterize the perceived priorities of state and county policy makers for youth mental health services and the factors that influence those priorities. METHODS: Mental health agency officials (N=338; N=221 state officials, N=117 county officials) representing 49 states completed a Web-based survey in 2019-2020. On 5-point scales, respondents rated the extent to which 15 issues were priorities for their agency in providing youth mental health services and the extent to which nine factors influenced those priorities. RESULTS: Suicide was identified as the highest priority (mean±SD rating=4.38±0.94), followed by adverse childhood experiences and childhood trauma and then increasing access to evidence-based treatments. Budget issues (mean=4.27±0.92) and state legislative priorities (mean=4.01±0.99) were perceived as having the greatest influence on setting priorities. CONCLUSIONS: These findings provide insights into youth mental health policy priorities and can be used to guide implementation and dissemination strategies for research and program development within state and county systems.

Adapting the Parent Connector program for caregivers of adults with SMI: the Family Connector experience.

Caregivers play an essential role in the recovery of their adult loved ones with serious mental illness (SMI). Promoting caregiver empowerment and well-being is critical but has often been overlooked. Family peer interventions are well-suited to fill this need; however, research is limited supporting their use with caregivers of adults with SMI. Our team is currently engaged in a study evaluating an adapted version of the evidenced-based Parent Connectors program1,2, renamed Family Connectors (FC), for caregivers of young adults recently discharged from the First Episode Psychosis program in New York (OnTrackNY). This paper, written collaboratively with family peer professionals, describes the adaptation process we followed to systematically document the family peer professional experience one year into delivering the FC program to this novel population. Modifications made to improve intervention fit included tailoring the content of the intervention, incorporating an outside approach into the program, lengthening the service in some cases, and adding a weekly peer supervision meeting. We hope that these insights are used to inform future efforts to advance support for families of loved ones with SMI, and more broadly, that our approach serves as a model for effective collaboration to improve the application of peer support services for unique groups.

Community-based family peer navigator programme to facilitate linkage to coordinated specialty care for early psychosis among Black families in the USA: A protocol for a hybrid type I feasibility study.

BACKGROUND: Approximately 70% of Black/African American family members report no contact with mental health providers prior to initial diagnosis and the receipt of services for early psychosis. Black families often encounter barriers and experience delays on the pathway to coordinated specialty care programmes for early psychosis. METHODS AND ANALYSIS: This mixed-methods study will (1) develop and refine a family peer navigator (FPN) for Black families designed to increase access and engagement in coordinated specialty care and (2) pilot-test FPN for Black families with 40 family members with loved ones at risk for psychosis in a randomised trial to assess the acceptability and feasibility. Families will be randomised to FPN (n=20) or a low-intensive care coordination (n=20). Other outcomes include proposed treatment targets (eg, knowledge, social connectedness), preliminary impact outcomes (time to coordinated specialty care programmes, initial family engagement), and implementation outcomes (acceptability, feasibility, appropriateness). ETHICS AND DISSEMINATION: Ethics approval has been obtained from Washington State University Institutional Review Board and informed consent will be obtained from all participants. This study will establish an innovative culturally responsive FPN programme and implementation strategy, and generate preliminary data to support a larger hybrid effectiveness-implementation trial. Study findings will be presented at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05284721.

Mental health service availability for autistic youth in New York City: An examination of the developmental disability and mental health service systems.

LAY ABSTRACT: Autistic children and adolescents experience high rates of co-occurring mental health conditions, including depression and suicidality, which are frequently identified by stakeholders as treatment priorities. Unfortunately, accessing community-based mental health care is often difficult for autistic youth and their families. The first obstacle families confront is finding a provider that offers mental health treatment to autistic youth within the many service systems involved in supporting the autism community. The mental health and developmental disability systems are two of the most commonly accessed, and previous work has shown there is often confusion over which of these systems is responsible for providing mental health care to autistic individuals. In this study, we conducted a telephone survey to determine the availability of outpatient mental health services for autistic youth with depressive symptoms or suicidal thoughts or behaviors in New York City across the state's mental health and developmental disability systems. Results showed that while a greater percentage of clinics in the mental health system compared with in the developmental disability system offered outpatient mental health services to autistic youth (47.1% vs 25.0%), many more did not offer care to autistic youth and there were very few options overall. Therefore, it is important that changes to policy are made to increase the availability of services and that mental health care providers' knowledge and confidence in working with autistic youth are improved.

Inter-agency collaboration is associated with increased frequency of research use in children's mental health policy making.

OBJECTIVE: To determine whether the self-report frequency of inter-agency collaboration about children's mental health issues is associated with the self-report frequency of using research evidence in children's mental health policy and program decision making in mental health agencies (MHAs). DATA SOURCES: Primary data were collected through web-based surveys of state (N = 221) and county (N = 117) MHA officials. DESIGN: The primary independent variable was a composite score quantifying the frequency of collaboration about children's mental health issues between officials in MHAs and six other state agencies. The dependent variables were composite scores quantifying the frequency of research use in children's mental health policy and program decision making in general and for specific purposes (i.e., conceptual, instrumental, tactical, imposed). Covariates were composite scores quantifying well-established determinants of research use (e.g., agency leadership, research use skills) in agency policy and program decision making. DATA METHODS: Separate multiple linear regression models estimated associations between frequency of inter-agency collaboration and research use scores, adjusting for other determinants of research use, respondent state, and other covariates. Data from state and county officials were analyzed separately. PRINCIPAL FINDINGS: The frequency of inter-agency collaboration was positively and independently associated with the frequency of research use in children's mental health policy making among state (ß = 0.22, p = 0.004) and county (ß = 0.39, p < 0.0001) MHA officials. Inter-agency collaboration was also the only variable significantly associated with the frequency of research use for all four specific purposes among state MHA officials, and similar findings we observed among county MHA officials. The magnitudes of associations between inter-agency collaboration and frequency of research use were generally stronger than for more well-established determinants of research use in policy making. CONCLUSIONS: Strategies that promote collaboration between MHA officials and external agencies could increase the use of research evidence in children's mental health policy and program decision making in MHAs.

Policy Makers' Priorities for Addressing Youth Substance Use and Factors That Influence Priorities.

OBJECTIVE: Understanding public policy makers' priorities for addressing youth substance use and the factors that influence these priorities can inform the dissemination and implementation of strategies that promote evidence-based decision making. This study characterized the priorities of policy makers in substance use agencies of U.S. states and counties for addressing youth substance use, the factors that influenced these priorities, and the differences in priorities and influences between state and county policy makers. METHODS: In 2020, a total of 122 substance use agency policy makers from 35 states completed a Web-based survey (response rate=22%). Respondents rated the priority of 14 issues related to youth substance use and the extent to which nine factors influenced these priorities. Data were analyzed as dichotomous and continuous variables and for state and county policy makers together and separately. RESULTS: The highest priorities for youth substance use were social determinants of substance use (87%), adverse childhood experiences and childhood trauma (85%), and increasing access to school-based substance use programs (82%). The lowest priorities were increasing access to naloxone for youths (49%), increasing access to medications for opioid use disorder among youths (49%), and deimplementing non-evidence-based youth substance use programs (41%). The factors that most influenced priorities were budget issues (80%) and state legislature (69%), federal (67%), and governor priorities (65%). Issues related to program implementation and deimplementation were significantly higher priorities for state than for county policy makers. CONCLUSIONS: These findings can inform the tailoring of dissemination and implementation strategies to account for the inner- and outer-setting contexts of substance use agencies.

Impacts of COVID-19 on Mental Health Safety Net Services for Youths: A National Survey of Agency Officials.

OBJECTIVE: Mental health agencies provide critical safety net services for youths. No research has assessed impacts of the COVID-19 pandemic on services these agencies provide or youths they serve. This study sought to characterize agency officials' perceptions of the pandemic's impacts on youths and challenges to providing youth services during the pandemic and to examine associations between these challenges and impacts. METHODS: Surveys were completed in September-October 2020 by 159 state or county mental health agency officials from 46 states. Respondents used 7-point scales (higher rating indicated more severe impact or challenge) to rate the pandemic's impact on youth mental health issues, general service challenges, and telepsychiatry service challenges across patient, provider, and financing domains. Multiple linear regression models estimated associations between service challenges (independent variables) and pandemic impacts (dependent variables). RESULTS: Most agency officials perceived the pandemic as having disproportionately negative mental health impacts on socially disadvantaged youths (serious impact, 72%; mean rating=5.85). Only 15% (mean=4.29) perceived the pandemic as having a seriously negative impact on receipt of needed youth services. Serious service challenges were related to youths' lack of reliable equipment or Internet access for telepsychiatry services (serious challenge, 59%; mean=5.47) and the inability to provide some services remotely (serious challenge, 42%, mean=4.72). In regression models, the inability to provide some services remotely was significantly (p≤0.01) associated with three of five pandemic impacts. CONCLUSIONS: Officials perceived the COVID-19 pandemic as exacerbating youth mental health disparities but as not having a dramatic impact on receipt of needed services.

Evaluation of a Modified Bit Device to Obtain Saliva Samples from Horses.

(1) Background: Accounting for the well-being of equine partners is a responsibility of those engaged in Equine-Assisted Services (EAS). Researchers took heed of this call to action by developing an innovative way to collect data to assess the physiological indicators of stress in equine participants. The collection of saliva is considered to be a minimally invasive method of data collection and is typically performed using a cotton swab; however, in equines, the introduction of a foreign object may induce stress; (2) Methods: Researchers used a modified bit to collect pooled saliva in an effort to further reduce stress during the saliva collection process. Additionally, the collection of pooled saliva, via the bit, increases the opportunity to consider additional analyses, such as oxytocin, which is more reliable in pooled saliva than site-specific saliva captured with a swab; (3) Results: A data analysis demonstrated that ample saliva was captured using the modified bit. Observational data supported that the horses demonstrated fewer physical stress signals to the bit than to the swab. Thus, the modified bit is a feasible and valid method for equine salivary sample collection; (4) Conclusions: The results suggest that the modified bit provides a viable method to collect equine saliva and supports national calls to prioritize animal welfare analysis, specifically for horses used within EAS. Future research should enhance methodological rigor, including in the process and timing, thereby contributing to the bit's validation.

Impact of the COVID-19 Pandemic on Child and Adolescent Mental Health Policy and Practice Implementation.

BACKGROUND: The impact of the 2019 coronavirus pandemic on the mental health of millions worldwide has been well documented, but its impact on prevention and treatment of mental and behavioral health conditions is less clear. The COVID-19 pandemic also created numerous challenges and opportunities to implement health care policies and programs under conditions that are fundamentally different from what has been considered to be usual care. Methods: We conducted a qualitative study to determine the impact of the COVID-19 pandemic on implementation of evidence-based policy and practice by State Mental Health Authorities (SMHA) for prevention and treatment of mental health problems in children and adolescents. Semi-structured interviews were conducted with 29 SMHA representatives of 21 randomly selected states stratified by coronavirus positivity rate and rate of unmet services need. Data analysis with SMHA stakeholders used procedures embedded in the Rapid Assessment Procedure-Informed Community Ethnography methodology. Results: The need for services increased during the pandemic due primarily to family stress and separation from peers. States reporting an increase in demand had high coronavirus positivity and high unmet services need. The greatest impacts were reduced out-of-home services and increased use of telehealth. Barriers to telehealth services included limited access to internet and technology, family preference for face-to-face services, lack of privacy, difficulty using with young children and youth in need of substance use treatment, finding a Health Insurance Portability and Accountability Act (HIPAA)-compliant platform, training providers and clients, and reimbursement challenges. Policy changes to enable reimbursement, internet access, training, and provider licensing resulted in substantially fewer appointment cancellations or no-shows, greater family engagement, reduction in travel time, increased access for people living in remote locations, and increased provider communication and collaboration. States with high rates of coronavirus positivity and high rates of unmet need were most likely to continue use of telehealth post-pandemic. Despite these challenges, states reported successful implementation of policies designed to facilitate virtual services delivery with likely long-term changes in practice. Conclusions: Policy implementation during the pandemic provided important lessons for planning and preparedness for future public health emergencies. Successful policy implementation requires ongoing collaboration among policy makers and with providers.

Revisiting caregiver satisfaction with children's mental health services in the United States.

Nearly four decades ago, Unclaimed Children documented the gaps in the United States between mental health programs and caregivers' perspectives about those services for their children. This absence of attention to parent or caregiver perspectives, including their satisfaction with these services, was a key finding of the report, which detailed system failure in caring for youth with mental health needs. Since then, the focus on caregiver satisfaction with children's mental health services has been largely overlooked in research, and when examined has been mostly included as an indicator of the feasibility of program implementation. In striking contrast, overall healthcare system reforms have highlighted the importance of improving consumer's direct experience of care. However, caregiver satisfaction remains largely disconnected to these overall health system reforms, even as reforms focus increasingly on value-based, coordinated and integrated care. In this paper, we review literature from 2010 to 2020, revisit the measurement of caregiver satisfaction, identify how and when it is being measured, and delineate a research agenda to both realign it with health system improvements, refine its focus on expectancies and appropriateness, and root it more firmly in the principles of user experience (UX) and human-centered design (HCD).

Determinants of using children's mental health research in policymaking: variation by type of research use and phase of policy process.

BACKGROUND: Research use in policymaking is multi-faceted and has been the focus of extensive study. However, virtually no quantitative studies have examined whether the determinants of research use vary according to the type of research use or phase of policy process. Understanding such variation is important for selecting the targets of implementation strategies that aim to increase the frequency of research use in policymaking. METHODS: A web-based survey of US state agency officials involved with children's mental health policymaking was conducted between December 2019 and February 2020 (n = 224, response rate = 33.7%, 49 states responding (98%), median respondents per state = 4). The dependent variables were composite scores of the frequency of using children's mental health research in general, specific types of research use (i.e., conceptual, instrumental, tactical, imposed), and during different phases of the policy process (i.e., agenda setting, policy development, policy implementation). The independent variables were four composite scores of determinants of research use: agency leadership for research use, agency barriers to research use, research use skills, and dissemination barriers (e.g., lack of actionable messages/recommendations in research summaries, lack of interaction/collaboration with researchers). Separate multiple linear regression models estimated associations between determinant and frequency of research use scores. RESULTS: Determinants of research use varied significantly by type of research use and phase of policy process. For example, agency leadership for research use was the only determinant significantly associated with imposed research use (ß = 0.31, p < 0.001). Skills for research use were the only determinant associated with tactical research use (ß = 0.17, p = 0.03) and were only associated with research use in the agenda-setting phase (ß = 0.16, p = 0.04). Dissemination barriers were the most universal determinants of research use, as they were significantly and inversely associated with frequency of conceptual (ß = -0.21, p = 0.01) and instrumental (ß = -0.22, p = 0.01) research use and during all three phases of policy process. CONCLUSIONS: Decisions about the determinants to target with policy-focused implementation strategies-and the strategies that are selected to affect these targets-should reflect the specific types of research use that these strategies aim to influence.

Dissemination Strategies to Accelerate the Policy Impact of Children's Mental Health Services Research.

The United States is in the midst of a children's mental health crisis, with rates of depression, anxiety, and suicide increasing precipitously. Evidence produced by children's mental health services research can help address this crisis by informing public policy decisions about service delivery, system design, and investments in the social determinants of mental health. Unfortunately, the policy impact of children's mental health services research is limited because evidence often fails to reach policy makers, be responsive to their needs, resonate with their worldview, or reflect the contexts in which they make decisions. Dissemination strategies-defined as the development and targeted distribution of messages and materials about research evidence pertaining to a specific issue or intervention-can help address these challenges. Yet, limited integrated guidance exists to inform the design of such strategies. This article addresses this need by synthesizing the results of empirical studies to provide guidance about how to enhance the dissemination of children's mental health services research to policy makers. The article provides four recommendations about the content of policy maker-focused dissemination materials, discusses how strategic framing and message tailoring can increase the chances that evidence is persuasive to policy makers, and highlights strategies to ensure that evidence reaches policy makers.

Acquisition of Information About Innovative Practices in Outpatient Mental Health Clinics.

This study uses qualitative interviews with leaders of 34 mental health clinics in the context of a statewide rollout of clinical and business innovations to explore how clinics first learn about innovations and which external sources of information they access. Clinic leaders reported accessing information about innovations mainly from government agencies, professional associations, peer organizations, and research literature. Leaders mentioned an average of two external sources of information. There was evidence of variation in how leaders accessed information and how information about innovations was communicated within clinics. Findings have implications for improving dissemination of information about innovations in mental health systems.

The role of the outer setting in implementation: associations between state demographic, fiscal, and policy factors and use of evidence-based treatments in mental healthcare.

BACKGROUND: Despite consistent recognition of their influence, empirical study of how outer setting factors (e.g., policies, financing, stakeholder relationships) influence public systems' investment in and adoption of evidence-based treatment (EBT) is limited. This study examined associations among unmodifiable (e.g., demographic, economic, political, structural factors) and modifiable (e.g., allocation of resources, social processes, policies, and regulations) outer setting factors and adoption of behavioral health EBT by US states. METHODS: Multilevel models examined relationships between state characteristics, an array of funding and policy variables, and state adoption of behavioral health EBTs for adults and children across years 2002-2012, using data from the National Association for State Mental Health Program Directors Research Institute and other sources. RESULTS: Several unmodifiable state factors, including per capita income, controlling political party, and Medicaid expansion, predicted level of state fiscal investments in EBT. By contrast, modifiable factors, such as interagency collaboration and investment in research centers, were more predictive of state policies supportive of EBT. Interestingly, level of adult EBT adoption was associated with state fiscal supports for EBT, while child EBT adoption was predicted more by supportive policies. State per capita debt and direct state operation of services (versus contracting for services) predicted both child and adult EBT adoption. CONCLUSIONS: State-level EBT adoption and associated implementation support is associated with an interpretable array of policy, financing, and oversight factors. Such information expands our knowledge base of the role of the outer setting in implementation and may provide insight into how best to focus efforts to promote EBT for behavioral health disorders.

Are There Missed Opportunities to Maximize Organ Donation Registrations? An Examination of Driver's License Applications Across the United States.

INTRODUCTION: With 116 000 people waiting for transplants and 8000 patients dying annually on waiting lists, the United States has a considerable organ shortage. An insufficient number of Americans have registered to become organ donors when obtaining driver's licenses or ID cards. Across states, there is considerable variability in organ donor registration rates as well as driver's license applications. METHODS: The purpose of this project was to describe the variability in the phrasing of the organ donor registration question by state bureaus of motor vehicles as well as other application questions that might influence this decision. In particular, the frequency of states employing empirically supported messages to increase donor registrations was ascertained. The content and phrasing of 46 different driver's license applications was coded in regard to seeking organ donor registrations. FINDINGS: No states used the empirically supported strategies of reciprocity, descriptive norms, or loss/gain framing from the interdisciplinary field of behavioral economics. Twelve states used injunctive norms to signify social approval for organ donation. Many state applications had lengthy organ donation sections and health questions that could discourage donor registrations. DISCUSSION: There is an extremely low use of empirically supported messages to increase organ donation registrations in driver's license applications in the United States. Opportunities exist for thoughtful consideration of the wording of driver's license applications. States interested in exploring ways to increase donations could undertake controlled variation of applications to test the effects of message framing on registration rates.

Do Subspecialists Ask About and Refer Families with Psychosocial Concerns? A Comparison with General Pediatricians.

Objectives Calls for pediatricians to tend to children's psychosocial concerns have existed for decades because they are known to negatively impact child health. Children with chronic illnesses frequently have child- and family-level psychosocial concerns that complicate the care provided by their pediatric subspecialists. This study compares pediatricians who exclusively practice general pediatrics with subspecialists regarding their inquiring/screening and referring for psychosocial concerns. Physician and practice characteristics associated with these behaviors were examined. Methods We conducted a cross-sectional study using the 2013 American Academy of Pediatrics Periodic Survey of Fellows. Respondents included 304 pediatricians who exclusively practice general pediatrics and 147 subspecialists. The primary analysis compared the current practices of generalists vs. subspecialists with regard to inquiring/screening and referring children with 10 different psychosocial concerns. Covariates included socio-demographics, practice characteristics, and training experiences. Weighted univariate, bivariate and multivariable analyses were performed. Results Less than half of all pediatricians in the sample reported routinely inquiring/screening for most psychosocial concerns, and 2/3 of subspecialists failed to routinely inquire/screen for most of these conditions. Pediatricians who practice general pediatrics exclusively were more likely to inquire/screen (incident rate ratio (IRR) 1.41, p < .05) and refer (IRR 1.59, p < .001) for a greater number of psychosocial concerns than subspecialists, after adjusting for provider and practice characteristics. Having attended a child or adolescent mental health (MH) lecture/conference in the past 2 years was also related to inquiring/screening (IRR 1.24, p < .05). Conclusions Pediatricians infrequently inquire/screen and refer psychosocial concerns, with subspecialists addressing these concerns even less frequently.

Use of a Web-Based Shared Decision-Making Program: Impact on Ongoing Treatment Engagement and Antipsychotic Adherence.

OBJECTIVE: The authors examined the impact of a Web-based shared decision-making application, MyCHOIS-CommonGround, on ongoing outpatient mental health treatment engagement (all users) and antipsychotic medication adherence (users with schizophrenia). METHODS: An intervention study was conducted by comparing Medicaid-enrolled MyCHOIS-CommonGround users in 12 participating mental health clinics (N=472) with propensity score-matched adults receiving services in nonparticipating clinics (N=944). Medicaid claims were used to assess ongoing treatment engagement and antipsychotic adherence (among individuals with schizophrenia) one year prior to and after entry into the cohort. Multilevel linear models were conducted to estimate the effects of the MyCHOIS-CommonGround program over time. RESULTS: No differences during the baseline year were found between the MyCHOIS-CommonGround group and the matched control group on demographic, diagnostic, or service use characteristics. At one-year follow-up, engagement in outpatient mental health services was significantly higher for MyCHOIS-CommonGround users than for the control group (months with a service, 8.54±.22 versus 6.95±.15; ß=1.40, p<.001). Among individuals with schizophrenia, antipsychotic medication adherence was also higher during the follow-up year among MyCHOIS-CommonGround users compared with the control group (proportion of days covered by medication, .78±.04 versus .69±.03; ß=.06, p<.01). CONCLUSIONS: These findings provide new evidence that shared decision-making tools may promote ongoing mental health treatment engagement for individuals with serious mental illness and improved antipsychotic medication adherence for those with schizophrenia.

Screening for and preventing perinatal depression.

New York City (NYC) public hospitals recently mandated that all pregnant women be screened for depression, but no funds were allocated for screening or care coordination/treatment, and research suggests that unfunded mandates are not likely to be successful. To address this, we implemented an on-site depression prevention intervention (NYC ROSE) for positive depression screens among pregnant, mostly Black and Hispanic, lower-income women in one public hospital. In this paper, we used Aarons' implementation model to describe the successes and challenges of screening and intervention. Patient tracking sheets and electronic medical records were abstracted. Key informant interviews and an informal focus group were conducted, and staff observations were reviewed; common implementation themes were identified and fit into Aarons' model. We found that a lack of funding and staff training, which led to minimal psychoeducation for patients, were outer context factors that may have made depression screening difficult, screening results unreliable, and NYC ROSE enrollment challenging. Although leadership agreed to implement NYC ROSE, early involvement of all levels of staff and patients would have better informed important inner context factors, like workflow and logistical/practical challenges. There was also a mismatch between the treatment model and the population being served; patients often lived too far away to receive additional services on site, and economic issues were often a higher priority than mental health services. Screening and interventions for perinatal depression are essential for optimal family health, and a detailed, thoughtful and funded approach can help ensure effectiveness of such efforts.

Beyond Screening: A Stepped Care Pathway for Managing Postpartum Depression in Pediatric Settings.

The negative consequences of untreated postpartum depression (PD) for both the woman and her infant are well established. The impact of maternal depression has led to recommendations on systematic perinatal depression screening. Unfortunately, large-scale initiatives on PD screening have found no benefit unless systems are in place to facilitate appropriate interventions for women who screen positive. Pediatric primary care has been a focus of efforts to support screening and management of PD because pediatric providers, unlike adult healthcare providers, have the most frequent contact with postpartum women through well-child visits. Well-child visits thus present an unparalleled opportunity to detect and intervene with PD. Literature reviews suggest that specific strategies are feasible within pediatric settings and could benefit both the woman and her child. In this article, we present a stepped care approach for screening and managing PD, integrating common elements found in existing pediatric-based models. A stepped care approach is ideal because PD is a heterogeneous condition, with a range of presentations and hence responsiveness to various interventions. This care pathway begins with systematic screening for depression symptoms, followed by a systematic risk assessment for women who screen positive and care management based on risk profiles and responsiveness. This approach allows pediatric providers to be optimally flexible and responsive in addressing the majority of women with PD within the context of the family-centered medical home to improve child well-being. Challenges to managing PD within pediatrics are discussed, including strategies for addressing them. Implications for research, policy, and practice are discussed.

Adoption of innovative and evidence-based practices for children and adolescents in state-supported mental health clinics: a qualitative study.

BACKGROUND: This study examined how mental health clinic administrators decided whether or not to adopt evidence-based and other innovative practices by exploring their views of implementation barriers and facilitators and operation of these views in assessment of implementation costs and benefits. METHODS: Semi-structured interviews were conducted with 75 agency chief executive officers and program directors of 34 New York State-licensed mental health clinics serving children and adolescents. RESULTS: Three interconnected themes relating to barriers and facilitators were identified, namely costs and benefits associated with adoption, capacity for adoption, and acceptability of new practices. The highest percentage of participants (86.7%) mentioned costs as a barrier, followed by limited capacity (55.9%) and lack of acceptability (52.9%). The highest percentage (82.3%) of participants identified available capacity as a facilitator, followed by acceptability (41.2%) and benefits or limited costs (24.0%). Assessment of costs and benefits exhibited several principles of behavioural economics, including loss aversion, temporal discounting use of heuristics, sensitivity to monetary incentives, decision fatigue, framing, and environmental influences. CONCLUSIONS: The results point to opportunities for using agency leader models to develop strategies to facilitate implementation of evidence-based and innovative practices for children and adolescents.