Edward Cohen

Assessing Model Fidelity in Two Family Group Decision-Making Programs: Is This Child Welfare Intervention Being Implemented as Intended?

Abstract As family group decision-making (FGDM) is a relatively new child welfare intervention, research has not adequately explored its implementation in multiple contexts or the degree to which implementation matches the previously defined goals, principles, and structures of the model. This article outlines the key components of FGDM and discusses the findings from a two county study of FGDM. Data collected from multiple sources participating in Californias Waiver Demonstration Project provide a multidimensional look at model fidelity. Using bivariate analysis and comparing results from multiple sources suggested that although basic FGDM elements were followed, certain philosophies, including community representation and mobilization of supports, were not consistently implemented. In addition, although everyone shared favorable impressions of the conferences themselves, conference participants were more positive than child welfare workers and caregivers about the conferences effectiveness for helping the child. Even if FGDM is implemented as intended, these findings suggest this intervention may not adequately engage family and community members to sustain long-term action which would impact the intended child welfare outcomes. Given the rise in the number of communities utilizing FGDM, measuring intervention fidelity and ultimately linking fidelity to outcomes are important for implementation on a larger scale.

School-based prevalence assessment of the need for mental health services: Survey development and pilot study.

Objective: The School Site Needs Assessment instrument was designed to provide a multidimensional environmental scan of potential need for mental health services in classrooms and schools. Method: Items of the instrument covering various academic, social, and mental health domains were developed based on analysis of previous case management contact data and input from stakeholders. The teacher-response instrument was piloted with a convenience sample of 85 classrooms in seven schools. Results: 43% of students were observed by teachers to have at least one problem that could likely result in referral to a case manager. Frequently counted problems included “disruptive in class” (14% of students), “failing” risk (13% of students), and “hyperactive”-related behaviors (10% of students). Conclusions: The School Site Needs Assessment can assist school social workers in assessing the environmental mental health context of students and classrooms from the important perspective of teachers, leading to classroom and school site interventions.

Managed care and service capacity development in a public mental health system.

Developing a continuum of care is considered to be one of the first steps in the process of implementing managed care strategies. This study summarizes the results of a final survey that focused on the ability of Colorado community mental health centers (CMHCs) to build service capacity and create new programs as a result of Medicaid capitation financing. Capitated agencies, compared to those that remained fee-for- service during the study period, reported a much greater ability to develop services as a result of capitation. Decreases in services were minimal for all agencies. Some differences in managed care organizational models were noted, as were differences in the speed of implementation. Gaps in some services still remain. These findings point to important program implementation issues for publicly funded managed care.

The Development of Social Work in Vietnam: The Role of International Collaboration

This paper explores the emergence of social work as a profession in Vietnam and the ways in which international collaboration can play a role in its development. The paper reviews the literature pertaining to the social issues that have accompanied recent rapid social and economic change in Vietnam. The authors then describe recent developments in social work and social work education in Vietnam in response to these emerging problems. The role of international collaboration is explored and examples of four recent collaborations are provided that illustrate exchanges of curriculum and related social work knowledge, capacity building, technical assistance, and teaching. Factors that influence successful international collaborations are delineated and conclusions about future opportunities for such collaborations in Vietnam are presented.

Exploring the Transferability of Competency-Based Education Model to Social Work Education in Vietnam

Abstract The Socialist Republic of Vietnam (hereafter Vietnam) has made extraordinary strides in terms of economic progress during the past two decades. Such rapid economic change has also created many social problems such as poverty, family abuse, substance abuse, HIV/AIDS, and mental health problems. Vietnam has taken steps to develop workforce capacity to ameliorate such challenges by investing in social work educational programs, including participation in an international collaborative initiative, the Social Work Education Enhancement Program (SWEEP). This article describes the procedures and process of the initial stage of the development of a competency-based social work curriculum in Vietnam through SWEEP. More specifically, this paper presents the following collaborative strategies between partners in Vietnam and the SWEEP team in the United States: conducting a needs assessment; providing trainings on competency-based education (CBE) to the partners in Vietnam; and receiving feedback from the partners to grasp the challenges at the early stage of development of CBE in Vietnam. While this article focuses on Vietnam, the SWEEP project can be a reference from which to develop social work education in other countries in regard to global collaboration for development of social work curriculum based on the CBE model.

Personal reflection and experience of a Fulbright Scholar: teaching a mental health course in Vietnam’s changing culture

Abstract This paper documents the experience of developing and teaching a course on mental health for undergraduate social worker students during a semester in Vietnam. Social work is a profession at the early stages of development in Vietnam, requiring much curriculum development. There are over 40 universities with undergraduate social work education programs, but few of the faculty have had training or experience in practicing social work. The paper will summarize the main reasons for developing such a course given the current state of mental health need and services in a changing culture, as well as the current state of professional social work education and the newly established profession of social work. The author describes the contexts underlying the course—the status of social work and social work education in Vietnam, the context of mental health and mental illness in Vietnam, and curriculum adaptation to the cultural context. From this experience, the lessons learned about the role of cross-cultural critical thinking, cultural knowledge, and other strategies will be discussed about teaching a subject like mental health internationally.

Book Review: Creswell, J. W., & Plano Clark, V. L. (2006). Designing and Conducting Mixed Methods Research. Thousand Oaks, CA: Sage:

wraparound services, has been an early pioneer and advocate of this model, whereas Patricia Chamberlain, author of the chapter on treatment foster care, is widely credited with developing and testing the Oregon treatment foster care model (now called multidimensional treatment foster care, a behaviorally based intervention providing family-based treatment to youth with conduct disorders). Sonja Schoenwald and Melissa Rowland, coauthors of the chapter on MST, have long been associated with the development and dissemination of this treatment model and currently serve on the board of directors of MST Services, Inc., the for-profit organization created to license the model to providers. Part III of Community Treatment for Youth focuses on evidencebased practices as opposed to the treatment models discussed in Part II. These practices such as cognitive-behavioral therapy and psychopharmacology can be used within a variety of therapeutic modalities and service models. Also contained in this section is a very useful review of the current research on treatment effectiveness for a variety of common disorders in children, such as attentiondeficit/hyperactivity disorder, major depressive disorder, disruptive disorders, and various anxiety disorders including PTSD. In the concluding section of the book, Michael English reviews the public policies that currently affect provision of evidence-based community mental health services for children. He notes the significant movement since the CASSP initiative toward a systemic approach to service delivery. Children are now understood to live within a systemic context of family, school, community, culture, and society and to affect and be affected by each. Services must be multidimensional, involving all of these systems to be successful. Families, in particular, are key in successful mental health care of children and youth, and their engagement as partners in the therapeutic process is essential. English also notes the policy trend toward early intervention and prevention in children’s mental health care. Neurobiological studies of early brain development have heightened awareness of the longterm impact on psychosocial development of trauma and attachment failure in early life. The field of infant mental health has developed significantly during the past decade in response. Another policy shift noted in this chapter is the recognition that children and youth with severe emotional and behavior disorders are found in significant numbers in all child-serving systems, including juvenile justice, child welfare, and public education. Siloed funding that ignores the mental health needs of children in foster care or youth in juvenile detention facilities is no longer feasible. These systems have often failed to work collaboratively in the past to address these needs because of funding constraints and territorial concerns. Increasingly, public policies encourage child-serving systems to seek ways to collaborate across system boundaries to provide mental health services to children and families in need. The final chapter in Community Treatment for Youth, written by the book’s authors, along with John Weisz, another prominent researcher and theoretician in children’s mental services, outlines a series of steps to bring evidence-based practices to community mental health providers in ways that reflect the wisdom and experiences of practitioners rather than imposing laboratory-created interventions in the field. The latter approach has frequently proven to meet with resistance and failure in real-world applications. The authors seek to develop a collaborative process among theoreticians, researchers, and practitioners committed to the provision of effective children’s mental health services that recognizes and draws on the knowledge and experience of each. Since this book was published in 2002, each of the models presented has been further developed and researched, sometimes raising questions about the model’s original conceptualization, application, or demonstrated effectiveness. A recent systematic review of MST outcomes research by Littell (2005), for instance, found that model was not more effective than usual treatment alternatives. Although these findings have themselves been questioned (Henggeler, Schoenwald, Swenson, & Bourdin, 2006), they serve to remind us that even the most widely implemented evidence-based model may be based on less-than-compelling evidence, particularly absent external evaluations by those not vested in the outcomes. At the same time, pressures from federal and state agency funders and third-party payers on mental health providers to adopt treatment models that appear to have an evidentiary base are intense, leading, at times, to the application of evidence-based models to populations and problems for which they are untested and potentially inappropriate if not harmful. For example, treatment models found to successfully treat externalizing disorders in older youth are being applied to young children who are victims of early life trauma in spite of growing evidence of the importance of treating these children for the psychophysiological impact of their experiences. According to Burns, in her introductory chapter to this book, its purpose is to reduce the critical gap between evidence and practice as a precursor to better mental health outcomes for children and families. However, as she notes, without supporting policy changes and improved clinical training, the likelihood of closing this gap remains small. Recent studies of technology transfer support this prediction. Simply exposing clinicians to new models of treatment, no matter how persuasive the evidence base, is insufficient to ensure integration of these models in practice. As Hoagwood, Burns, and Weisz point out in their concluding chapter, the crucial next step in implementing evidence-based models in community-based mental health services for children and youth is to engage in a process of collaboration with clinicians and families to design, develop, and test interventions that reflect real-life experiences and needs. This is as true today as it was when Community Treatment for Youth was published in 2002.