Angela M. Blizzard

Supporting the Transition from Inpatient Hospitalization to School

The School Transition Program (STP) is a 3-month intervention developed to address the unique needs of youth transitioning back to school from an inpatient psychiatric hospitalization. The STP focuses on promoting communication across school, home, and hospital. It includes psychoeducation, emotional support for caregivers, and the creation of transition plans in collaboration with school staff and families. Matching interventions to the academic, social, emotional/behavioral needs of these youth and increasing support to their caregivers has the potential to ease stress, reduce challenges and promote success during and after the transition period.

Behavioral Parent Training in Infancy: What About the Parent–Infant Relationship?

Behavioral parent training (BPT) and attachment interventions have demonstrated efficacy in improving outcomes for young children. Despite theoretical overlap in these approaches, the literature has evolved separately, particularly with respect to outcome measurement in BPT. We examined the impact of the Infant Behavior Program (IBP), a brief home-based adaptation of Parent–Child Interaction Therapy, on changes in attachment-based caregiving behaviors (sensitivity, warmth, and intrusiveness) at postintervention and 3- and 6-month follow-ups during a videotaped infant-led play. Sixty mother–infant dyads were randomly assigned to receive the IBP (n = 28) or standard care (n = 30). Infants were an average age of 13.52 months and predominately from ethnic or racial minority backgrounds (98%). We used bivariate correlations to examine the association between attachment-based caregiving behaviors and behaviorally based parenting do and don’t skills and structural equation modeling to examine the direct effect of the IBP on attachment-based caregiving behaviors and the indirect effect of behaviorally based parenting skills on the relation between intervention group and attachment-based caregiving behaviors. Behaviorally based parenting do and don’t skills were moderately correlated with attachment-based caregiving behaviors. Results demonstrated a direct effect of the IBP on warmth and sensitivity at postintervention and 3- and 6-month follow-ups. The direct effect of the IBP on warmth and sensitivity at the 3- and 6-month follow-ups was mediated by increases in parenting do skills at postintervention. Findings suggest that behaviorally based parenting skills targeted in BPT programs have a broader impact on important attachment-based caregiving behaviors during the critical developmental transition from infancy to toddlerhood.

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

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

Pediatric Primary Care Providers’ Use of Behavioral Health Consultation

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

Impacts of a Medicaid Wraparound Model Demonstration Program on Youth Specialty Mental Health Services Use.

Effective coordination of mental health care is critical in Medicaid wraparound model programs for youth. This study examined participation over time in mental health services for youth diverted or transitioned from residential care to a Medicaid wraparound demonstration program. Youth in wraparound had more sustained use of mental health outpatient clinic services than did propensity score matched youth who were not in wraparound. However, the rate of outpatient clinic follow-up after inpatient discharge was no greater in wraparound. Routine assessment of wraparound programs’ impacts on receipt of mental health care may inform the development of Medicaid wraparound program performance standards.

Increasing global knowledge exchange in school mental health

Since its inception, Advances in School Mental Health Promotion (ASMHP) has emphasized its international focus, both in terms of manuscript solicitation and readership. This focus reflects two overarching principles: (1) innovation and progress in school mental health is occurring across the globe, with unique pockets of excellence in specific topics occurring in individual communities, countries, and continents, and (2) as a field, we will increase our efficiency and promote more meaningful, impactful, and sustainable growth if we work collectively as an international force. Since our first issue was published in January of 2008, we have continued to receive and publish manuscripts from a diverse, international cadre of leading school mental health researchers and practitioners. Before introducing the multinational collection of papers for this special issue, I will review our history of international submissions and publications, as well as highlight some promising current international endeavors in the field of school mental health. To date, our submissions reflect 21 countries. Likewise, our published papers reflect an international authorship, with 16 countries represented. Notably, the majority of submission and publications are from authors in the USA, Canada, Australia, and the UK, respectively. This may reflect relative advancement of school mental health in these fields, but also likely reflects less systematic outreach by ASMHP to other countries. Thus, a goal in our strategic plan is to increase outreach to both authors and readers from a more diverse international audience, with support of our editorial board and publisher. We have been privileged to witness and participate in recent advancements in the area of global school mental health. First, our Annual Conference on Advancing School Mental Health, co-sponsored by our national Center for School Mental Health (CSMH, http:// csmh.umaryland.edu) at the University of Maryland (funded by the United States Department of Health and Human Services, Health Resources and Services Administration) and the IDEA Partnership (funded by the Office of Special Education Programs), has seen a sharp increase in international attendance in recent years. Our recent conferences have included participants from several countries, including Australia, Canada, China, Denmark, England, Germany, Hong Kong, Ireland, Japan, New Zealand, South Korea, and the USA. This, in part, reflects the work initiated by the International Alliance for Child and Adolescent Mental Health in Schools (INTERCAMHS), founded at the conference in 2003, and also just the growth in attention globally to the importance of mental health in schools. A second notable development occurred at the 2014 World Congress on Mental Health Promotion, during which the first meeting of the School

Parent Training and Skill Acquisition and Utilization Among Spanish- and English-Speaking Latino Families

In the U.S., there is a growing Latino population, in which parents primarily speak Spanish to their children. Despite the evidence that language preference is associated with level of acculturation and influences parenting practices in these families, no study has compared how Spanish- and English-speaking Latino families acquire and utilize the skills taught during parent-training programs such as Parent-Child Interaction Therapy (PCIT). Twenty-seven mother-infant Latino dyads received a home-based adaptation of the Child-Directed Interaction (CDI) phase of PCIT as part of a larger randomized control trial. Most infants were male (63%), and their average age was 13.7 months (SD = 1.43). Most families (52%) lived below the poverty line. The Dyadic Parent-Child Interaction Coding System-Third Edition (DPICS-III) was employed to evaluate PCIT skills at baseline and post-treatment, as well as at 3- and 6-month follow-up, assessments. We conducted multiple linear regression analyses among Spanish-speaking (55%) and English-speaking (45%) families to examine differences in acquisition and utilization of do and don’t skills at each assessment while controlling for mother’s education. Results yielded no group differences in the acquisition rate of do or don’t skills at any time point. However, Spanish-speaking mothers used significantly more don’t skills than English-speaking mothers at each assessment. Specifically, Spanish-speaking families used significantly more commands at baseline, post-treatment, and the 6-month follow-up assessments, as well as more questions at post-treatment and at the 6-month follow-up assessments. These findings highlight the importance of addressing cultural values such as respeto to ensure culturally robust parent-training programs for Latino families.

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

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

Improving quality in school mental health

School mental health (SMH) quality assessment and improvement has been a primary overarching theme of this journal since its inception. In recent decades, dimensions of SMH quality have moved beyond bureaucratic processes (e.g. credentialing, adherence to paperwork requirements) and/or liability protection (e.g. procedures for handling crises) toward better articulated and perhaps nuanced dimensions including: (a) quality of stakeholder involvement in program development, guidance, evaluation and continuous improvement; (b) quality of collaborative relations among families, school staff and community providers; (c) the range of preventive and treatment services provided; (d) productivity of staff; (e) quality of training and supervision of staff; (f) team building and service coordination; (g) emphasis on evidence-based prevention and intervention; (h) cultural responsiveness of interventions; (i) use of appropriate evaluation strategies; (j) use of evaluation findings to continuously improve programs and services and (k) connecting evaluation findings to advocacy and policy improvement agendas (Ambrose, Weist, Schaeffer, Nabors, & Hill, 2002; Evans, Sapia, Axelrod, & Glomb, 2002; Nabors, Lehmkuhl, & Weist, 2003; President’s New Freedom Commission on Mental Health, 2003). Simultaneously, systems for measuring SMH quality have evolved, with several measures being developed to help schools and their broader authorities (e.g. school districts) assess and monitor progress (e.g. School Mental Health Quality Assessment Questionnaire, Weist, Stephan, Lever, Moore, & Lewis, 2006; Mental Health Planning and Evaluation Template, National Assembly on School-based Health Care, 2010; School Mental Health Capacity Instrument, Feigenberg, Watts, & Buckner, 2010). Access to and quality of school-based health services vary greatly at all local and state levels across the United States, with many youth unable to access high-quality services. In 2014, two national leaders in school health, the national Center for School Mental Health (CSMH, http://csmh.umaryland.edu) and the School-Based Health Alliance (www. sbh4all.org), were charged by the federal Department of Health and Human Services, Health Resources and Services Administration with further advancing quality and sustainability efforts across the country. The

Caregiver Perspectives During the Post Inpatient Hospital Transition: A Mixed Methods Approach

2.8 million 4-year cooperative agreement will support the efforts of partnering organizations’ to improve the quality of care delivered by school-based health centres (SBHCs) and comprehensive school mental health systems (CSMHSs) nationwide. Specific project activities include: