Supporting Implementation Through Online Learning Communities: Lessons Learned From a National Training and Technical Assistance Network.

Recent implementation science frameworks highlight the role of training and technical assistance (TTA) in building workforce capacity to implement evidence-based practices (EBPs). However, evaluation of TTA is limited. We describe three case examples that highlight TTA by three regional centers in the national Mental Health Technology Transfer Center (MHTTC) network. Each MHTTC formed Learning Communities (LCs) to facilitate connections among behavioral health professionals with the goals of sharing implementation strategies, discussing best-practices, and developing problem solving techniques. Data on outcomes were collected through a combination of self-report surveys and qualitative interviews. LC participants reported strong connectedness, gains in knowledge and skills, improvements in implementation capacity, and intentions to advocate for organizational and systems-level change. Furthermore, across the case examples, we identified LC characteristics that are associated with participant perceptions of outcomes, including tailoring LC content to workforce needs, providing culturally relevant information, engaging leaders, forming connections among participants and trainers, and challenging participants' current workplace practices. These findings are interpreted through the lens of the Interactive Systems Framework, which focuses on how TTA, such as LCs, can facilitate connections between the theoretical and empirical foundations of interventions and the practices of implementing interventions in real-world settings to advance workforce capacity.

Evaluation of a systems-level technical assistance program to support youth with complex behavioral health needs.

The National Technical Assistance Network for Children's Behavioral Health (TA Network) supports the development and implementation of Systems of Care (SOC) for youth with serious emotional disorders and their families in states, tribes, territories, and communities throughout the United States. The purpose of the current research was to conduct an evaluation of the TA Network to assess: The degree to which it has deployed research-based elements of TA; levels of participant satisfaction; types and scope of TA services provided; and systems-level outcomes. Study participants were drawn from a stratified random sample of SOC grant recipients who received technical support from the TA Network between 2013 and 2017. Results suggest that the TA Network has encompassed research-based elements of effective TA. Participants rated their interactions with the network very highly, and they accessed a wide variety of resources from the network. Finally, participants reported a variety of systems-level outcomes associated with TA Network support. Together, these findings underscore the importance of structuring TA systems to tailor support to fit with recipients' needs, build positive, proactive relationships, and offer services of sufficient dosage. Given the lack of rigorous evaluations on provision of TA, future studies can confirm the degree to which such tailored approaches to TA result in increased satisfaction, more effective implementation of SOC principles, and ultimately improved outcomes for youth and families.

Applying implementation science in mental health services: Technical assistance cases from the Mental Health Technology Transfer Center (MHTTC) network.

OBJECTIVE: Critical gaps exist between implementation of effective interventions and the actual services delivered to people living with mental disorders. Many technical assistance (TA) efforts rely on one-time trainings of clinical staff and printed guidelines that alone are not effective in changing clinical practice. The Mental Health Technology Transfer Center (MHTTC) Network uses implementation science to accelerate the use of evidence-based practices (EBPs), improve performance, and bring about systems-level change. METHOD: Four case examples illustrate how MHTTCs employ the Exploration-Preparation-Implementation-Sustainment (EPIS) implementation framework and intensive implementation strategies to educate clinicians, manage change, and improve processes. These examples include implementing motivational interviewing, cognitive-behavioral therapy for people with psychosis, strategies to decrease the no show rate for virtual appointments, and school mental health systems development. RESULTS: From Preparation through Sustainment, MHTTCs successfully employed implementation strategies including learning communities, audit and feedback, and coaching to bring about change. Each project attended to inner and outer contexts to eliminate barriers. The examples also show the benefit of integrating process improvement alongside implementation. CONCLUSIONS: The MHTTCs are a model for using implementation science to design technical assistance that leads to more successful practical execution of EBPs; thus reducing the gap between research and practice.

Systematic Review and Meta-analysis: Effectiveness of Wraparound Care Coordination for Children and Adolescents.

OBJECTIVE: Wraparound is a common method for coordinating care for children and adolescents with serious emotional disorders (SED), with nearly 100,000 youths served annually in the United States. The current systematic review and meta-analysis estimated effects on youth outcomes (symptoms, functioning, school, juvenile justice, and residential placement) and costs. METHOD: A literature search identified 17 peer-reviewed and gray literature studies meeting criteria, which were coded on characteristics of sample, design, implementation, and outcomes. Random effects modeling was conducted using Comprehensive Meta-Analysis Version 3.0. Effect sizes were calculated using Hedges g. Homogeneity of effects were assessed using Q statistics. RESULTS: Medium-sized effects favored Wraparound-enrolled youths for costs (g = 0.391, CI = 0.282-0.500, p < .001), residential outcomes (g = 0.413, CI = 0.176-0.650, p = .001), and school functioning (g = 0.397, CI = 0.106-0.688, p = .007); small effects were found for mental health symptoms (g = 0.358, CI = 0.030-0.687, p = .033) and functioning (g = 0.315, CI = 0.086-0.545, p = .007). Larger effects were found for peer-reviewed studies, quasi-experimental designs, samples with a larger percentage of youths of color, and Wraparound conditions with higher fidelity. CONCLUSION: Results indicate positive effects for Wraparound, especially for maintaining youths with SED in the home and community. However, many studies showed methodological weaknesses, and fidelity measurement was largely absent, suggesting a need for additional research. Nonetheless, the results should aid decisions around resource allocation, referral practices, and system partnerships among child psychiatrists and other behavioral health professionals.

What Happens When Training Goes Virtual? Adapting Training and Technical Assistance for the School Mental Health Workforce in Response to COVID-19.

The Northwest Mental Health Technology Transfer Center (MHTTC) provides workforce training and technical assistance (TA) to support evidence-based school mental health practices. Historically, this support targeted school professionals through in-person and online trainings, workshops, and coaching. However, in response to COVID-19 restrictions, all support moved to online formats, and the Center introduced trainings for families and caregivers. The purpose of this article is to present preliminary process and outcome data that compare the reach and impact of support before and following COVID-19-related restrictions. Results suggest that transition to online support resulted in a wider reach and a more diverse audience, with no decrease in trainee satisfaction and perceived impact. Furthermore, families and caregivers reported positive gains in knowledge and behaviors following participation in a virtual youth suicide prevention training. Together, these findings suggest that online training and TA can provide tangible benefits to professionals and family members who support student mental health.

Developing an Evidence-Based Technical Assistance Model: a Process Evaluation of the National Training and Technical Assistance Center for Child, Youth, and Family Mental Health.

The National Training and Technical Assistance Center for Child, Youth, and Family Mental Health (NTTAC) supports the development and implementation of systems of care (SOC) for youth with serious emotional disorders (SED) and their families. This article presents results from a process evaluation of NTTAC, conducted to support the Center's quality improvement and contribute to the knowledge base around provision of technical assistance (TA). The evaluation used a mixed methods approach with data collection focused on a defined subset of NTTAC TA recipients-recipients of federal Comprehensive Community Mental Health Services for Children SOC grants. Data sources included coded administrative records from SOC grant sites, administrative data from NTTAC, standardized measures of SOC development, and stakeholder survey data. Results indicate that TA dosage matched needs and goals of TA recipients (SOC sites), overall levels of satisfaction with TA were high, and TA content was generally aligned with need. TA recipients reported significant progress on indicators of SOC development over time. Together, these findings suggest that it is possible to develop TA methods that reflect the level and type of TA recipients' goals and needs, and, in turn, positively impact SOC development and behavioral health service delivery.

The Women's Experience: A Look at Risk and Protective Factors for Deployed Female Air Force Personnel.

Objective: Over the past few decades, women's roles in the United States military have expanded significantly. Currently women encounter more wartime experiences during deployment than in the past. Previous research with male service members has linked exposure to wartime events to subsequent development of post-traumatic stress disorder (PTSD) symptoms. However, because of the unique experiences of military women, research is needed to better understand the link between wartime experiences and mental health in female personnel. Methods: We examined the wartime experiences of deployed, active-duty female Airmen and their relations to PTSD. A large representative sample of active-duty female Air Force personnel, who responded to the U.S. Air Force Community Assessment Survey (CAS), was used to determine the relationships between wartime experiences and symptoms of PTSD. Previous research suggests the possibility that factors, including unit cohesion and self-efficacy, may mediate these relations. Results: Descriptive analyses indicate that the percentage of personnel experiencing PTSD symptoms increased as the number of wartime experiences increased. Logistic regression analyses revealed that wartime experiences were positively related to subsequent PTSD-related symptoms. Both unit cohesion and self-efficacy were negatively related to PTSD symptoms, but neither variable was found to moderate the relationship between wartime experiences and PTSD. Conclusions: Women are experiencing greater numbers of wartime experiences. Like men, as the number of wartime experiences increases, PTSD symptoms increase as well. Self-efficacy and unit cohesion were found to lower these symptoms, indicating that these factors may help decrease the negative impact of wartime experiences.

A formative evaluation of a coach-based technical assistance model for youth- and family-focused programming.

BACKGROUND: The Children, Youth, and Families At-Risk (CYFAR) initiative provides funding and technical support for local community-based programs designed to promote positive outcomes among vulnerable populations. In 2013, CYFAR implemented significant changes in the way it provides technical assistance (TA) to grantees. These changes included introducing a new TA model in which trained coaches provide proactive support that is tailored to individual CYFAR projects. The purpose of this paper is to describe the evolution of this TA model and present preliminary findings from a formative evaluation. METHODS: CYFAR Principal Investigators (PIs) were invited to respond to online surveys in 2015 and 2016. The surveys were designed to assess PI attitudes towards the nature and quality of support that they receive from their coaches. RESULTS: CYFAR PIs reported that their coaches have incorporated a range of coaching skills and techniques into their work. PIs have generally positive attitudes towards their coaches, and these attitudes have become more positive over time. CONCLUSIONS: Results suggest that CYFAR PIs have been generally supportive of the new TA system. Factors that may have facilitated support include a strong emphasis on team-building and the provision of specific resources that support program design, implementation, and evaluation.

Thriving in School: The Role of Sixth-Grade Adolescent-Parent-School Relationships in Predicting Eighth-Grade Academic Outcomes.

The present study uses an ecological systems perspective to examine how parental involvement in school-related activities in sixth grade influences early adolescents' school bonding and academic achievement in eighth grade. Results of multilevel models of multiple data sources (i.e., adolescents, parents, and principals) suggested that parents' involvement in school, as reported by the adolescent in sixth grade, was a significant predictor of school bonding and academic grades in eighth grade. Furthermore, parent reports of guidance, support, and involvement in school and non-school activities were unrelated to their adolescents' grades and school bonding. Finally, schools' efforts to engage parents did not consistently predict an association between parental involvement and adolescent outcomes.

A multi-level examination of how the organizational context relates to readiness to implement prevention and evidence-based programming in community settings.

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown. Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.

Knowledge, Attitudes, and Commitment Concerning Evidence-Based Prevention Programs: Differences between Family and Consumer Sciences and 4-H Youth Development Educators.

In this article, we describe the results of a study designed to assess knowledge, perceptions, and attitudes towards evidence-based and other prevention programs among county Extension educators. We examined differences across educators from the Family and Consumer Sciences (FCS) and 4-H Youth Development program areas. Analyses based on a multi-state sample of educators revealed significant differences across program areas such that, compared to their 4-H counterparts, FCS educators were more knowledgeable of evidence-based programs and had more favorable perceptions and attitudes towards evidence-based and other pre-packaged prevention programs. These findings suggest that Cooperative Extension administrators should work to encourage the use of evidence-based and other prevention programs, particularly within the 4-H program area.