Charlotte Lyn Bright

Toward a policy ecology of implementation of evidence-based practices in public mental health settings

BackgroundMental health policymaking to support the implementation of evidence-based practices (EBPs) largely has been directed toward clinicians. However, implementation is known to be dependent upon a broader ecology of service delivery. Hence, focusing exclusively on individual clinicians as targets of implementation is unlikely to result in sustainable and widespread implementation of EBPs.DiscussionPolicymaking that is informed by the implementation literature requires that policymakers deploy strategies across multiple levels of the ecology of implementation. At the organizational level, policies are needed to resource the added marginal costs of EBPs, and to assist organizational learning by re-engineering continuing education units. At the payor and regulatory levels, policies are needed to creatively utilize contractual mechanisms, develop disease management programs and similar comprehensive care management approaches, carefully utilize provider and organizational profiling, and develop outcomes assessment. At the political level, legislation is required to promote mental health parity, reduce discrimination, and support loan forgiveness programs. Regulations are also needed to enhance consumer and family engagement in an EBP agenda. And at the social level, approaches to combat stigma are needed to ensure that individuals with mental health need access services.SummaryThe implementation literature suggests that a single policy decision, such as mandating a specific EBP, is unlikely to result in sustainable implementation. Policymaking that addresses in an integrated way the ecology of implementation at the levels of provider organizations, governmental regulatory agencies, and their surrounding political and societal milieu is required to successfully and sustainably implement EBPs over the long term.

Acculturation, Familism and Mother-Daughter Relations Among Suicidal and Non-Suicidal Adolescent Latinas

We examined the role of acculturation, familism and Latina mother–daughter relations in suicide attempts by comparing 65 adolescents with recent suicide attempts and their mothers to 75 teens without any attempts and their mothers. Attempters and non-attempters were similar in acculturation and familistic attitudes but attempters report significantly less mutuality and communication with their mothers than non-attempters. Mothers of attempters reported lower mutuality and communication with their daughters than mothers of non-attempters. Small increments in mutuality decreased the probability of a suicide attempt by 57%. Acculturation and familism do not appear to play major roles in suicide attempts but relational factors may. Instituting school-based psychoeducational groups for young Latinas, particularly in middle school, and their parents, separately and jointly, and focusing on raising effective communication and mutuality between parents and adolescent daughters are important primary prevention strategies.

Outcomes of Group Care for Youth: A Review of Comparative Studies

Objective: The purpose of this study was to review empirical evidence of the effects of placement in group care compared to other interventions. Method: Two-group empirical studies were identified and effect sizes for all reported outcomes were calculated. Results: Nineteen two-group studies were found that compared group care with family foster care, treatment foster care, no placement, and different group care models. Most effects were small to moderate, with strongest effects for shorter lengths of stay for family-centered group care models and decreased delinquency for Multidimensional Treatment Foster Care (MTFC) compared to group care. Conclusion: Based on the limited number of two-group studies of varying quality, outcomes of group care are often worse than alternative interventions. However, some group care models seem more promising than others.

Child Maltreatment and Delinquency Onset Among African American Adolescent Males

Child welfare and criminology research have increasingly sought to better understand factors that increase the likelihood that abused and neglected children will become involved in the juvenile justice system. However, few studies have addressed this relationship among African American male adolescents. The current study examines the relationship between child maltreatment (i.e., neglect, physical abuse, sexual abuse, and other/mixed abuse) and the likelihood of a delinquency petition using a sample of African American males (N = 2,335) born before 1990. Multivariable logistic regression models compared those with a delinquency-based juvenile justice petition to those without. Results indicate that African American males with a history of neglect, physical abuse, or other/mixed abuse were more likely to be involved in the juvenile justice system than those without any child maltreatment. Additionally, multiple maltreatment reports, a prior history of mental health treatment, victimization, and having a parent who did not complete high school also increased the likelihood of a delinquency petition. Implications for intervention and prevention are discussed.

Assessing Interpersonal Trauma in Older Adult Women

Interpersonal traumatic experiences (childhood abuse, sexual assault, and intimate partner violence) are common in older adult women and associated with negative short-term and long-term outcomes. Thus, assessing trauma symptoms is essential to providing adequate services. This article explores challenges of measuring trauma in older women, describes the Posttraumatic Diagnostic Scale (Foa, 1995), and evaluates the appropriateness of this instrument using data from a current study of older adult women. Symptom severity scores did not consistently reflect the experiences of the sample. Eschewing a clinical interview to assess the impact of interpersonal trauma in older adult women may be a mistake.

Applying Implementation Drivers to Child Welfare Systems Change: Examples From the Field

Implementation science is a relatively young field of research that studies efforts to put improved policies or programs into routine practice. In recent years, the Childrens Bureau has placed increasing emphasis on implementation of child welfare system reforms to promote improved outcomes for children, youth, and families. Using an implementation framework from the National Implementation Research Network, this article reviews the relevance of core drivers to child welfare and describes selected examples to illustrate how public agencies can apply and adapt concepts from implementation science to drive and sustain their system reforms.

Females in the Juvenile Justice System Who Are They and How Do They Fare

Increasing numbers of female youth involved in the juvenile justice system highlight the need to examine this population. This study enumerates distinct profiles of risk and protection among juvenile court-involved females, examining young adult outcomes associated with these profiles. Administrative data on 700 participants were drawn from multiple service sectors in a Midwest metropolitan region. Latent class and Pearson chi-square analyses were used. Five unique classes were identified; these classes were associated with young adult outcomes. One class of impoverished African American females was most likely to experience problematic young adult outcomes but least likely to have received juvenile justice services. Findings highlight the heterogeneity in the female juvenile court population and discrepancies between service needs and service receipt.

The Chain Has to Be Broken: A Qualitative Investigation of the Experiences of Young Women Following Juvenile Court Involvement

Whereas the number of girls involved in the juvenile justice system is on the rise, little is known about female juvenile offenders after they reach adulthood. This study aims to explore the meaning that young adult women ascribe to their juvenile court experiences and assess their perceptions of facilitators and barriers to progress in their adult lives. Data on services and support are presented from nine semistructured interviews. Findings include the commonality of mental health issues, substance abuse, and problematic relationships with intimate partners. Implications for service provision and policy, as well as future research directions, are outlined.

Collaborative Implementation of a Sequenced Trauma-Focused Intervention for Youth in Residential Care

Few evidence-based interventions have been developed or tested with youth in residential care. Moreover, models for transferring implementation knowledge from clinical trials to service settings are sparse. This article addresses the lessons learned about addressing this technology transfer gap by presenting a case study of a collaborative effort to implement a trauma-informed pilot program with youth in residential care. Key considerations are the collaborative nature of implementation efforts, the requirement of organizational support, the need for interventions to be sensitive to the child and the milieu, and the lack of fit between Medicaid reimbursement and evidence-based intervention.

SBIRT Training in Social Work Education: Evaluating Change Using Standardized Patient Simulation

A grand challenge for social work is addressing widespread public health problems of alcohol misuse. MSW students (n = 83) received Screening, Brief Intervention, and Referral to Treatment (SBIRT) training through didactic sessions, role plays, and pre–post videotaped standardized patient (SP) interactions. SBIRT knowledge, self-reported practice behaviors, and confidence were assessed at pretest, 30 days, and 6 months posttest. Videos were coded to assess intervention-adherent behaviors. General linear mixed models analyzed changes. Participants demonstrated increased adherence to SBIRT behaviors, and knowledge, skills, and confidence increased posttraining. Findings suggest SBIRT training increases students’ capacity to implement evidence-based interventions designed to reduce alcohol misuse.