State behavioral health agency website references to evidence-based program registers.

PURPOSE: Evidence-based program registers (EBPRs) are important tools for facilitating the use of evidence-based practices or programs (EBPs) by state statutory agencies responsible for behavioral healthcare, broadly defined as substance misuse, mental health, HIV/AIDS prevention, child welfare, and offender rehabilitation. There are currently no data on the purposes for which such state agencies reference EBPRs on their official websites. METHOD: A webscraping method was used to identify and classify relevant "hits", defined as a state behavioral health webpage with single or multiple references to a study EBPR. A total of 778 hits (unique combinations of webpage and register) were coded. Up to three codes were applied to each hit for the "reasons for the EBPR reference" (EBPR use) dimension, one code was applied to each hit for the "purpose of the EBPR reference" and "intended audience of the webpage containing the hit" dimensions, and up to two codes were applied to each hit for the "funding mentions" dimension. RESULTS: Three EBPRs out of 28 accounted for 73.6% of the hits. The most frequent reason for referencing EBPRs were as a resource for selecting EBPs or validating existing programs and practices. The references tended to appear in reports from the state, in training materials, or guidelines. The references tended to address broad groups of behavioral healthcare professionals. EBPRs were frequently referenced in the context of federal block grants or other federal funding. CONCLUSIONS: Increasing state agencies' awareness and use of the entire range of existing EBPRs may improve implementation of EBPs nationally.

Protocol for comparing two training approaches for primary care professionals implementing the Safe Environment for Every Kid (SEEK) model.

BACKGROUND: Child maltreatment (CM) is a major public health problem, affecting many lives, in the short and long term, and costing individuals, families, and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents; promote children's health, development, and safety; help prevent CM; and benefit the health of the US population. This study will examine intervention strategies for optimizing SEEK's adoption, implementation, and sustainment, and its effectiveness in preventing CM.Despite strong evidence from two federally funded randomized controlled trials, SEEK has not been widely adopted. The goal of this study is to examine technology-driven implementation strategies to scale-up SEEK-in pediatric and family medicine primary care settings. The aims are to (1) evaluate the effectiveness of training strategies on SEEK's implementation in primary care practices, (2) evaluate barriers and facilitators to successful implementation and sustainment of SEEK, and (3) examine the model's effectiveness in preventing CM and the economic costs of implementing SEEK. METHODS: This randomized type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK's adoption and implementation in pediatric and family medicine practices in different regions of the USA. These are independent online training and in-depth structured training via a quality improvement project, approved by the American Boards of Pediatrics and of Family Medicine. We will also evaluate SEEKonline, software that assists primary care practitioners implement the model, and a "Traditional" paper and pencil strategy for their impact on implementation. The study uses the EPIS framework and the Universal Stages of Implementation Completion, quantitative measures, qualitative interviews, and data abstracted from electronic health records. DISCUSSION: The knowledge gained should improve pediatric primary care to better address prevalent social determinants of health, benefiting many children and families. The outcomes should enhance the field of implementation science and guide future interventions in primary care. TRIAL REGISTRATION: NCT03642327, Clinical Trials, registered August 21, 2018.

Practitioner review: Children in foster care--vulnerabilities and evidence-based interventions that promote resilience processes.

BACKGROUND: An increasing number of children are placed in foster care (i.e., a kin or nonkin family home other than the biological parent) due to experiences of physical, sexual, emotional, or psychological abuse, and/or neglect. Children in foster care are at increased risk for a host of negative outcomes encompassing emotional, behavioral, neurobiological, and social realms. METHODS: Areas of risk and vulnerability among foster children are described, including emotional and behavioral deficits, impaired neurobiological development, and social relationship deficits. Evidence suggesting the significance of family placement changes and prenatal exposure to substances as contributing mechanisms is presented. Based on a systematic search of the PsycINFO database (to March 2012), eight efficacious evidence-based interventions for foster families are summarized. FINDINGS: Although the development of evidence-based interventions that improve outcomes for foster children has lagged behind the delivery of interventions in other service sectors (e.g., mental health and educational sectors), several interventions across childhood and adolescence offer promise. Service system constraints offer both challenges and opportunities for more routine implementation of evidence-based interventions. CONCLUSIONS: Given the increased likelihood of poor outcomes for foster children, increased efforts to understand the pathways to vulnerability and to implement interventions shown to be effective in remediating risks and improving outcomes for this population are indicated. Evaluation of efficacious interventions in countries outside of the United States is also needed.

A collaborative care telemedicine intervention to overcome treatment barriers for Latina women with depression during the perinatal period.

Maternal depression is highly prevalent (10-20%) during the perinatal period, with rates as high as 35% to 40% for Latinas. However, few Latinas are either identified or treated during the perinatal period. The Perinatal Mental Health (PMH) model was designed to ameliorate the barriers that prevent adequate diagnoses and intervention. The PMH is a culturally sensitive, short-term telemedicine, collaborative care intervention for addressing depression among Mexican American mothers. It attends to sociocultural and socioeconomic dimensions and is delivered by trained mental health advisors in obstetric care settings. This article describes the feasibility and acceptability of using the PMH. Participants (N = 79) were selected from a 1st-year ongoing randomized trial in community obstetric clinics. The intervention seems feasible and acceptable; low-income Latinas, identified as depressed during the perinatal period, reported having access to a range of appropriate community services and high satisfaction.

The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study.

UNLABELLED: ABSTBACKGROUND: Evidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States. METHODS: In-person, group-administered surveys were conducted with a sample of 1,112 mental health service providers in a nationwide sample of 100 mental health service institutions in 26 states in the United States. The study examines these associations with a two-level Hierarchical Linear Modeling (HLM) analysis of responses to the Evidence-Based Practice Attitude Scale (EBPAS) at the individual clinician level as a function of the Organizational Social Context (OSC) measure at the organizational level, controlling for other organization and clinician characteristics. RESULTS: We found that more proficient organizational cultures and more engaged and less stressful organizational climates were associated with positive clinician attitudes toward adopting evidence-based practice. CONCLUSIONS: The findings suggest that organizational intervention strategies for improving the organizational social context of mental health services may contribute to the success of evidence-based practice dissemination and implementation efforts by influencing clinician attitudes.

Trajectories of maternal harsh parenting in the first 3 years of life.

OBJECTIVE: Despite the high prevalence rates of harsh parenting, the nature of developmental change in this domain early in life and the factors that contribute to changes in harsh parenting over time are not well understood. The present study examined developmental patterns in maternal harsh parenting behavior from birth to age 3 years and their related longitudinal risk factors (contextual and intrapersonal). Partner aggression was also tested as a time-varying predictor to examine its time-specific influence on maternal harsh parenting. METHODS: Longitudinal data from 4 assessments of a community sample of 488 at-risk mothers were analyzed using latent growth curve modeling. Maternal risk factors and harsh parenting behaviors were assessed at birth and at ages 1, 2, and 3 years. RESULTS: There was a significant increase in maternal harsh parenting from birth to age 3, particularly between ages 1 and 2. There was a significant direct effect of maternal alcohol use and abuse history on maternal harsh parenting at age 3, and maternal age was positively associated with change in maternal harsh parenting over time. In addition, partner aggression was significantly and positively associated with maternal harsh parenting at each time point. CONCLUSIONS: The findings suggest possible developmental trends in the emergence of maternal harsh parenting during infancy and toddlerhood. Further investigation is needed to elucidate individual differences in the developmental patterns and to differentiate predictive factors that persist across time and factors that are unique to specific developmental stages. PRACTICE IMPLICATIONS: The overall high prevalence rates of harsh parenting behavior and growth of such behavior in infancy and toddlerhood support the need for developmentally sensitive early intervention programs.

Psychosocial interventions for children and adolescents in foster care: review of research literature.

Between one-half and three-fourths of children entering foster care exhibit behavioral or social-emotional problems warranting mental health care. This paper, condensed and updated from a technical report prepared for Casey Family Programs in 2005, reviews evidence-based and promising interventions for the most prevalent mental conditions found among children in foster care. This paper also makes several recommendations regarding increasing access to mental health care and effective psychosocial interventions for foster care children.

Child maltreatment profiles and adjustment problems in high-risk adolescents.

The purpose of this article is to identify profiles of maltreatment experiences in a sample of high-risk adolescents and to investigate the relationship between the derived profiles and psychological adjustment. Participants are 1,131 youth between the ages of 12 and 18 years involved with publicly funded mental health and social services. Information on physical, sexual, and emotional maltreatment and psychological symptoms are obtained in interviews with adolescents and their primary caregivers. Using latent profile analysis, three maltreatment profiles are identified: "sexual+physical+emotional maltreatment," "physical+emotional maltreatment," and "low maltreatment." Adolescents in the two maltreatment profiles generally have significantly higher scores on symptom scales compared with those in the "low maltreatment" profile, but scores in the two maltreatment profiles do not differ. Findings highlight the need for agencies to identify and provide appropriate intervention for youth who experience multiple types of maltreatment.

Intimate partner violence and psychological functioning in Latina women.

In this study, the researchers examined the associations among intimate partner violence and psychological functioning in 282 Latina women between 18 and 45 years. Participants were interviewed about demographic characteristics, experiences with physical, sexual, and psychological intimate partner violence, psychological symptoms, stressful life events, and childhood maltreatment. Physical violence was associated with symptoms of depression and hostility, and psychological abuse was related to depression, hostility, and somatization. Sexual violence was generally not associated with psychological functioning. The different types of intimate partner violence were not related to participants' self-esteem. Implications for interventions with Latina women are discussed.

Prevention of behavior problems for children in foster care: outcomes and mediation effects.

Parent training for foster parents is mandated by federal law and supported by state statues in nearly all states; however, little is known about the efficacy of that training, and recent reviews underscore that the most widely used curricula in the child welfare system (CWS) have virtually no empirical support (Grimm, Youth Law News, April-June:3-29, 2003). On the other hand, numerous theoretically based, developmentally sensitive parent training interventions have been found to be effective in experimental clinical and prevention intervention trials (e.g., Kazdin and Wassell, Journal of the American Academy of Child and Adolescent Psychiatry, 39:414-420, 2000; McMahon and Forehand, Helping the noncompliant child, Guilford Press, New York, USA, 2003; Patterson and Forgatch, Parents and adolescents: I. Living together, Castalia Publishing, Eugene, OR, USA, 1987; Webster-Stratton et al., Journal of Clinical Child Pyschology Psychiatry, 42:943-952, 2001). One of these, Multidimensional Treatment Foster Care (MTFC; Chamberlain, Treating chronic juvenile offenders: Advances made through the Oregon Multidimensional Treatment Foster Care model, American Psychological Association, Washington, DC, USA, 2003), has been used with foster parents of youth referred from juvenile justice. The effectiveness of a universal intervention, KEEP (Keeping Foster Parents Trained and Supported) based on MTFC (but less intensive) was tested in a universal randomized trial with 700 foster and kinship parents in the San Diego County CWS. The goal of the intervention was to reduce child problem behaviors through strengthening foster parents' skills. The trial was designed to examine effects on both child behavior and parenting practices, allowing for specific assessment of the extent to which improvements in child behavior were mediated by the parenting practices targeted in the intervention. Child behavior problems were reduced significantly more in the intervention condition than in the control condition, and specific parenting practices were found to mediate these reductions, especially for high-risk children in foster families reporting more than six behavior problems per day at baseline.

Substance involvement among youths in child welfare: the role of common and unique risk factors.

This study examines risk factors for substance involvement for youths involved with the child welfare (CW) system. In addition to common risk factors examined in general population studies; this research examines risk factors unique to youths in the CW system, including age at entry into CW and number of out-of-home placements. Participants included 214 youths ages 13 to 18, randomly sampled from youths active to CW in San Diego County, California. Severity of substance involvement was assessed through structured diagnostic interviews determining lifetime substance use, abuse, and dependence. Hierarchical regression analyses including demographics, psychosocial variables, maltreatment history, CW placement variables, and the interaction of age at entry into CW and number of out-of-home placements revealed that both common and CW-specific risk factors were associated with the severity of youth substance involvement. Multiple-placement changes, later entry into the CW system, and multiple-placement changes at an older age are associated with higher risk for more serious substance involvement for youths in CW.

Persistence of intimate partner violence among families referred to child welfare.

The purpose of this study is to examine the longitudinal course of intimate partner violence (IPV) among female caregivers of children receiving child welfare services. Data are derived from the National Survey of Child and Adolescent Well-Being, a national probability study of children investigated for child abuse and neglect in the United States. Caregivers (n = 861) are interviewed about demographic characteristics, mental health, substance use, and physical violence by a partner at the close of the investigation and at an 18-month follow-up. Polychotomous logistic regression examines the associations of severe and minor IPV controlling for caregiver and environmental characteristics. The results suggest that factors related to initial risk for IPV do not affect the continuation of IPV and that patterns of IPV differ for racial and ethnic groups.

Female caregivers' experiences with intimate partner violence and behavior problems in children investigated as victims of maltreatment.

OBJECTIVE: We examined the relationship between women's experiences with intimate partner violence and their reports of child behavior problems. METHODS: Data were from the National Survey of Child and Adolescent Well-Being, a national probability study of children who were the subjects of child abuse and neglect investigations. The sample consisted of 2020 female caregivers of children between the ages of 4 and 14 years who were interviewed about demographic characteristics, child behavior problems, female caregiver mental health, parenting behaviors, experiences with intimate partner violence, and community characteristics. Information on child abuse and neglect was obtained in interviews with child protective services workers. Multiple-regression analyses were used to investigate the association between caregiver victimization and child behavior problems while controlling for the effects of child, family, and environmental characteristics. The potential moderating effects of caregiver depression and parenting practices on the relation between intimate partner violence and child behavior problems were examined also. RESULTS: Severe intimate partner violence was associated with both externalizing and internalizing behavior problems when other risk factors were controlled. Use of corporal punishment and psychological aggression were significant moderators, but maternal depression did not moderate the relation between intimate partner violence and behavior problems. CONCLUSIONS: This study adds to the evidence that maternal caregivers' experiences with intimate partner violence are related to child functioning. The findings suggest that systematic efforts are needed to ensure that mental health needs are identified and addressed appropriately in children exposed to this violence.

Racial and ethnic differences in utilization of mental health services among high-risk youths.

OBJECTIVE: Racial and ethnic disparities in mental health service use have been identified as a major public health problem. However, the extent to which these disparities may be accounted for by other confounding sociodemographic or clinical predictors of service use (e.g., family income, functional impairment, caregiver strain) is relatively unexplored, especially for youth services. The goal of this study was to test for racial/ethnic disparities in use of a variety of outpatient, inpatient, and informal mental health services among high-risk youths, with the effects of other predictive factors controlled. METHOD: Participants were 1,256 youths ages 6-18 years who received services in a large, publicly funded system of care (including the child welfare, juvenile justice, special education, alcohol and drug abuse, and mental health service sectors). Youths and caregivers were interviewed with established measures of mental health service use, psychiatric diagnoses, functional impairment, caregiver strain, and parental depression. RESULTS: Significant racial/ethnic group differences in likelihood of receiving any mental health service and, specifically, formal outpatient services were found after the effects of potentially confounding variables were controlled. Race/ethnicity did not exert a significant effect on the use of informal or 24-hour-care services. CONCLUSIONS: Racial/ethnic disparities in service use remain a public health problem.

Models of research-operational collaboration for behavioral health in space.

Addressing the behavioral health needs of astronauts clearly requires collaborations involving researchers, clinicians and operational support personnel, program administrators, and the astronauts themselves. However, such collaborations are often compromised by a failure to understand the needs, priorities, constraints, and preferences of potential collaborators. This failure, in turn, can lead to research of poor quality, implementation of programs and procedures that are not evidence-based, and an increased risk of morbidity and mission failure. The experiences of social marketing strategies in health promotion and disease prevention, cultural exchange between developers of evidence-based treatments and consumers, and dissemination and implementation of evidence-based practices in mental health services offer three different models of research-operational collaboration with relevance to behavioral health in space. Central to each of these models are the patterns of interpersonal relations and the individual, social, and organizational characteristics that influence these patterns. Any program or countermeasure for behavioral health in space must be both needs-based and evidence-based. The successful development, dissemination, implementation, and sustainability of such a program require communication, collaboration, and consensus among all key stakeholders. To accomplish this, all stakeholders must participate in creating a culture of operational research.

Use of mental health services by youths in public sectors of care.

The present paper examined the lifetime rates of mental health service use in a representative sample of youths identified as receiving services in at least one sector of care in a publicly funded service system of a large, metropolitan area. Service use was examined in relation to age, gender, mental health diagnostic status, and service sector involvement. Participants were 1706 youths ages 6-17 years who were active in at least one of the following service sectors: alcohol and drug services, child welfare, juvenile justice, mental health, and special education services for serious emotional disturbance. Structured service use and diagnostic interviews were administered to youths and their caregivers. High lifetime rates of mental health service use were found. Eighty-seven percent of the sample used at least one outpatient service, 45% used at least one inpatient service, and 71% reported use of a school-based service. Youths involved with the mental health and special education sectors had the highest rates of service use. In contrast, youths enumerated from the juvenile justice system tended to have the lowest rates of use. Additional research is needed to refine our understanding of the factors associated with the observed patterns of service use.

The San Diego East County school shootings: a qualitative study of community-level post-traumatic stress.

INTRODUCTION: Within one month (March 2001), two separate incidents of school shootings occurred at two different high schools within the same school district in San Diego's East County. OBJECTIVE: To examine community-wide expressions of post-traumatic distress resulting from the shootings that may or may not fulfill DSM-IV criteria for post-traumatic stress disorder (PTSD), but which might interfere with treatment and the prevention of youth violence. METHODS: A qualitative study was undertaken using Rapid Assessment Procedures (RAP) in four East San Diego County communities over a six-month period following the two events. Semi-structured interviews were conducted with 85 community residents identified through a maximum variation sampling technique. Interview transcripts were analyzed by coding consensus, co-occurrence, and comparison, using text analysis software. RESULTS: Three community-wide patterns of response to the two events were identified: (1) 52.9% of respondents reported intrusive reminders of the trauma associated with intense media coverage and subsequent rumors, hoaxes, and threats of additional acts of school violence; (2) 44.7% reported efforts to avoid thoughts, feelings, conversations, or places (i.e., schools) associated with the events; negative assessment of media coverage; and belief that such events in general cannot be prevented; and (3) 30.6% reported anger, hyper-vigilance, and other forms of increased arousal. Twenty-three (27.1%) respondents reported symptoms of fear, anxiety, depression, drug use, and psychosomatic symptoms in themselves or others. CONCLUSIONS: School shootings can precipitate symptoms of post-traumatic stress disorder at the community level. Such symptoms hinder the treatment of individuals with PTSD and the implementation of effective prevention strategies and programs.