An Examination of the 4 Rs 2 Ss for Problem Behaviors: A Preventive Approach.

Early treatment of behavioral problems can prevent their progression into intractable disorders. This study examined the impact of a multiple family group (MFG) intervention for children with behavior symptoms and their families. Fifty-four (n = 54) caregiver/child dyads with sub-clinical levels of oppositional defiant disorder (ODD) participated in a 16-week MFG. Child, caregiver, and family outcomes were assessed at baseline, post-treatment, and at 6 months follow-up. Significant decreases in impairment with parents, family members, and peers, and improvements in child self-esteem were found from baseline to follow-up. Caregiver stress increased; no significant changes in depression or perceived social support were found over time. The effectiveness of MFG as a preventive approach and areas of future research are discussed.

Examining Organizational Factors Supporting the Adoption and Use of Evidence-Based Interventions.

The purpose of this study was to develop a greater understanding of the factors influencing the adoption of evidence-based interventions in outpatient mental health clinics serving youth. An improved understanding of these factors can potentially improve efforts to ensure effective adoption, implementation, and sustainment of evidence-based interventions, and thus improve treatment for youth in mental health settings. This explanatory cross-sectional study involves secondary data analysis of a longitudinal randomized control intervention trial. The SEM- based model that was tested supported the primary hypothesis that a more supportive organizational climate with greater readiness for change is more likely to improve the chances for the adoption of evidence-based interventions in outpatient mental health clinics serving youths.

Providers' Perspectives on Implementing a Multiple Family Group for Children with Disruptive Behavior.

OBJECTIVES: The adoption of research-supported treatments is contingent upon multiple interactional levels, including provider level factors. Provider-level factors have been shown to be critical to uptake. The purpose of this study is to examine the relationship between sociodemographic factors, attitudes, and perceived barriers/facilitators to implementation through a comparative approach involving practitioners trained to facilitate a multiple family group intervention for children with disruptive behavior. METHODS: Participants included 91 practitioners who participated in an intervention study regarding barriers to adopting an evidence-based practice. Demographic characteristics were collected via a socio-demographic questionnaire. Barriers and facilitators were assessed via open-ended questions as well as a scale, developed by the authors and guided by the Consolidated Framework for Implementation Research that explored provider views regarding the intervention, the systemic and organizational context, experience facilitating groups and involving families in treatment, and feelings toward involving families in treatment. Between group analyses were conducted to examine demographic and characteristic differences of providers by implementation status. Independent samples t-tests for continuous characteristics and chi-square tests for categorical characteristics were used. Responses to open-ended questions were compiled, reviewed, and coded, and frequencies and percentages were calculated. RESULTS: Results demonstrated that providers who implemented the intervention were significantly more likely to have favorable attitudes toward the intervention compared to those who did not implement it. Prior experience facilitating groups was significantly associated with implementation. Common barriers to implementation included ineligible caseloads and feeling unqualified to deliver the intervention. CONCLUSIONS: Further attention on improving recruitment rates and promoting adequate training and supervision is needed.

Outcomes Associated With Adapting a Research-Supported Treatment for Children With Behavior Disorders.

PURPOSE: The aims of this study are to describe an adaptation process of a research-supported treatment (RST) for children with oppositional defiant disorder and to examine provider attitudes toward RSTs prior to and following this process. METHOD: Providers from 14 agencies in New York State delivered the adapted RST, following training. Attitudes toward RSTs were measured by the Evidence-Based Practice Attitude Scale at baseline and posttest. RESULTS: Openness toward RSTs decreased from baseline to posttest. The majority of providers reported modifications to the structure and process of the intervention. DISCUSSION: To improve the uptake and usability of RSTs in practice, future research must further address adaptation processes and their relationships to attitudes toward RSTs.

Getting to the table: Agency characteristics and evidence-based intervention adoption in children's mental health care.

Scaling evidence-based interventions (EBI) for children and families across healthcare systems can expand public health impact. Research has identified EBI adoption determinants. However, less understood are characteristics of agencies that opt in across the stages of adoption. This study examined the relationship between agency (N=69) characteristics (e.g., revenue) and four adoption stages during a large-scale trial of an EBI for children with significant behavioral difficulties and their families. 48 (70%) of agencies demonstrated interest, 28 (41%) scheduled an informational meeting, 20 (29%) received training, and 16 (22%) demonstrated EBI uptake. Analyses indicated no differences in characteristics and initial interest. However, agencies with small-sized revenue had significantly reduced odds at other adoption stages. Implications for strategies to bring EBI access to scale are discussed.

Perceived Benefits of a Multiple Family Group for Children with Behavior Problems and their Families.

Multiple family groups (MFG) have shown to have promising results for children with behavioral difficulties. The 4Rs and 2Ss is a curriculum-based multiple family group model for families of children with disruptive behavior disorders, who live in poverty-impacted communities. This study aimed to explore group processes and caregiver perceptions of the benefits of participating in the 4Rs and 2Ss MFG. Caregivers participating in the MFG were asked to complete a 29- item questionnaire which collected information about the perceived benefits of the MFG upon Yalom's therapeutic factors, including group cohesion, universality, interpersonal learning, guidance, catharsis- and self-understanding. Data were analyzed using SPSS 25, and descriptive statistics were performed for each sub-scale. Responses of open-ended questions were reviewed and coded by two of the authors. Thirty-two caregivers completed the survey. Results indicated that the MFG offered multiple benefits that alignwith Yalom's therapeutic factors, such as creating a sense of universality, catharsis, group cohesion, and interpersonal learning. Future research is needed to determine whether such therapeutic factors are associated with changes in child outcomes and family functioning.

Enacting lived experiences: Peer specialists with criminal justice histories.

OBJECTIVE: Peer specialists are frequently employed in mental health settings, with growing evidence for positive impact on subjective aspects of recovery. As more individuals within the mental health system have criminal justice involvement, peer specialists with incarceration histories are increasingly important, yet little is known about how their experiences with the criminal justice system factor into their work. This study sought to understand the experiences of peer specialists with criminal justice histories and how they incorporate these experiences into their work. METHODS: Purposive and snowball sampling was employed to recruit graduates from a peer training program. Three in-depth interviews were conducted each with 15 peer specialists who had incarceration experiences. RESULTS: Thematic analysis revealed that Having and Sharing Lived Experiences formed the basis of their work as peer specialists. On this foundation, participants expounded on their specialized contributions in their work as peer specialists: Engagement, Priority of Relationship, Instilling Hope, and Providing an Alternative Service. Participants' criminal justice histories influenced how they approached their work, especially around using disclosure, developing relationships, and instilling hope. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Peer specialists with incarceration histories may be a critical component toward recovery for consumers with criminal justice involvement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Examining Provider Factors Supporting the Adoption and Use of Research-Supported Interventions.

Purpose: The purpose of this study was to examine the factors associated with the adoption of research-supported interventions (RSIs) in outpatient mental health clinics serving youth in order to inform implementation efforts and ultimately improve treatment outcomes. Method: This explanatory cross-sectional study includes secondary data from a clinical trial of an innovative group-based RSI in public mental health clinics for youth in New York City. Structural Equation Modeling examined the relationships between attitudes toward and beliefs of RSIs and uptake/use of RSIs in practice among providers in mental health settings. Results: As providers attitudes toward and beliefs about RSIs became more favorable, on average, RSIs were used more in practice in mental health settings serving youth. Conclusion: These findings indicate attitudes toward, and beliefs about innovation can be a precursor to the decision whether or not to use an innovative RSI in clinical practice in these settings. Implications and future directions are discussed.

An Examination of the Relationship between Maternal Depression and Barriers to Child Mental Health Services.

OBJECTIVE: Maternal depression is a common, chronic set of disorders associated with significant burden to caregivers, children and families. Some evidence suggests that depression is associated with perceptions of barriers to child mental health treatment and premature termination from services. However, this relationship has not yet been examined among a predominantly low-income sample, which is at disproportionately high risk of depression, child mental health problems, and treatment drop out. Accordingly, the purpose of this study is to examine the relationships between caregiver depression and perceived barriers to treatment. METHODS: Three hundred twenty (n=320) children between the ages of 7 to 11 and their caregivers were assigned to either the 4 Rs and 2Ss for Strengthening Families, which is a multiple family group intervention, or services as usual (SAU) consisting of typical outpatient mental health services. Caregiver depression was measured by the Center for Epidemiologic Depression Scale; perceived barriers to treatment were assessed via the Kazdin Barriers to Treatment Scale. RESULTS: Clinically significant levels of depressive symptoms at baseline were significantly associated with greater scores in all four barriers to treatment subscales (stressors and obstacles competing with treatment, treatment demands and issues, perceived relevance, relationship with therapist) at post-test. CONCLUSIONS: Addressing maternal mental health, and attending to stressors that impede poverty-impacted families from child services is critical for the health and functioning of caregivers, and to ensure that children with mental health problems receive treatment.

Person-Centered Care and the Therapeutic Alliance.

Person-centered care has been gaining prominence in behavioral health care, and service planning has shifted towards "person-centered care planning" (PCCP), where individuals, in partnership with providers, identify life goals and interventions. A strong therapeutic alliance has been identified as key to a person-centered approach, but little is known about how the therapeutic relationship influences person-centered processes and outcomes. Using an explanatory sequential mixed methods design, this study investigated: (1) the association between the therapeutic alliance and PCCP, and (2) how the therapeutic relationship influences the process and outcomes of PCCP. Quantitative analyses found that a strong working alliance predicted greater personcenteredness. Qualitative analyses revealed two central themes: (1) the importance of connection, continuity, and calibration of the relationship to set the right conditions for PCCP, and (2) PCCP as a vehicle for engagement. Findings demonstrated that the therapeutic alliance is inextricably linked to the PCCP process, each influencing the other.

Who is accessing family mental health programs? Demographic differences before and after system reform.

Childhood mental health disorders are on the rise in the United States. To ensure equitable access to care, it is important to examine the characteristics of children and families who access services. This study compares the demographic characteristics of two samples of families who participated in National Institute of Mental Health-funded studies of a Multiple Family Group model, entitled the 4Rs and 2Ss Multiple Family Group (4Rs and 2Ss) in New York City. One sample is currently receiving services, and the other received services a decade ago. Significant differences in demographic characteristics were found between the two samples pertaining to child race, child nativity, caregiver age, primary caregiver, caregiver marital status, caregiver race, caregiver education, caregiver employment, and family income. Families currently engaging in the public mental health service system are primarily White, and are less disadvantaged than families a decade ago. These differences are examined in light of changing policy and epidemiological trends, and potential unintended consequences are discussed.

Testing the 4Rs and 2Ss Multiple Family Group intervention: study protocol for a randomized controlled trial.

BACKGROUND: Oppositional defiant disorder (ODD) is a major mental health concern and highly prevalent among children living in poverty-impacted communities. Despite that treatments for ODD are among the most effective, few children living in poverty receive these services due to substantial barriers to access, as well as difficulties in the uptake and sustained adoption of evidence-based practices (EBPs) in community settings. The purpose of this study is to examine implementation processes that impact uptake of an evidence-based practice for childhood ODD, and the impact of a Clinic Implementation Team (CIT)-driven structured adaptation to enhance its fit within the public mental health clinic setting. METHODS/DESIGN: This study, a Hybrid Type II effectiveness-implementation research trial, blends clinical effectiveness and implementation research methods to examine the impact of the 4Rs and 2Ss Multiple Family Group (MFG) intervention, family level mediators of child outcomes, clinic/provider-level mediators of implementation, and the impact of CITs on uptake and long-term utilization of this model. All New York City public outpatient mental health clinics have been invited to participate. A sampling procedure that included randomization at the agency level and a sub-study to examine the impact of clinic choice upon outcomes yielded a distribution of clinics across three study conditions. Quantitative data measuring child outcomes, organizational factors and implementation fidelity will be collected from caregivers and providers at baseline, 8, and 16 weeks from baseline, and 6 months from treatment completion. The expected participation is 134 clinics, 268 providers, and 2688 caregiver/child dyads. We will use mediation analysis with a multi-level Structural Equation Modeling (SEM) (MSEM including family level variables, provider variables, and clinic variables), as well as mediation tests to examine study hypotheses. DISCUSSION: The aim of the study is to generate knowledge about effectiveness and mediating factors in the treatment of ODDs in children in the context of family functioning, and to propose an innovative approach to the adaptation and implementation of new treatment interventions within clinic settings. The proposed CIT adaptation and implementation model has the potential to enhance implementation and sustainability, and ultimately increase the extent to which effective interventions are available and can impact children and families in need of services for serious behavior problems. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02715414 . Registered on 3 March 2016.

I have my own lease-So why the service plan again? Perspectives on service planning in supportive housing.

OBJECTIVE: This study aimed to understand multiple stakeholder perspectives implementing a recovery-oriented approach to service planning in supportive housing programs serving people with lived experience of mental illnesses. METHOD: Multiple stakeholders (N = 57) were recruited to participate in focus groups (N = 8), including 4 with tenants, 2 with service coordinators, 1 with supervisors, and 1 with leadership. Supportive housing programs were purposively sampled from a recovery-oriented organization serving 1,500 people annually. Stakeholders' experiences with service planning and implementing a recovery-oriented approach to service planning were explored. The authors conducted inductive thematic analyses combined with a conceptual matrix, which yielded themes across and within multiple stakeholder focus groups. RESULTS: Three themes emerged: (a) an institutional reminder-service planning experiences elicited negative emotions and served to remind people of experiences in institutional settings, (b) one-size-fits-all service planning-stakeholders perceived the use of quality assurance tools within the planning process as rigid to others' interests beyond their own, and (c) rules and regulations-reconciling funder requirements (e.g., completion dates) while also tailoring services to tenants' particular situations challenged providers. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Even in a recovery-oriented organization, findings suggest that service planning in supportive housing has limitations in responding to each tenant's iterative recovery process. Further, in this context where people can make their home, stakeholders questioned whether the very presence of ongoing service planning activities is problematic. However, tenant-service coordinator relationships predicated on mutual respect and esteem overcame some service planning limitations. (PsycINFO Database Record

Motivational Interviewing: Creating a Leadership Role for Social Work in the Era of Healthcare Reform.

To better address the needs of individuals with a range of complex health conditions, the Affordable Care Act has shifted the focus from acute care to prevention through behavior change and promoted the integration of physical and behavioral healthcare systems. Central to healthcare reform is delivering person-centered care, which means actively engaging people in their treatment decisions and managing their wellness. Motivational Interviewing (MI) is perhaps the most widely used intervention to promote behavior change. Although MI is utilized across most health disciplines, social workers are uniquely positioned to lead dissemination and on-going training efforts in this area.