Geetha Gopalan

Multiple Family Group Service Model for Children With Disruptive Behavior Disorders Child Outcomes at Post-Treatment

The purpose of this study was to determine the benefits of a multiple family group (MFG) service delivery model compared with services as usual (SAU) in improving the functioning of youth with oppositional defiant/conduct disorder in families residing in socioeconomically disadvantaged communities. Participants included 320 youth aged 7 to 11 and their families who were referred to participating outpatient clinics. Participants were assigned to the MFG or the SAU condition, with parent report of child oppositional behavior, social competence, and level of youth impairment as primary outcomes at post-treatment. Family engagement to MFG was measured by attendance to each group session. Caregivers of youth in the MFG service delivery model condition reported significant improvement in youth oppositional behavior and social competence compared with youth in the SAU condition. Impairment improved over time for both groups with no difference between treatment conditions. The MFG led to greater percentage of youth with clinically significant improvements in oppositional behavior. Attendance to the MFG was high, given the high-risk nature of the study population. The MFG service delivery model offers an efficient and engaging format to implement evidence-based approaches to improving functioning of youth with oppositional defiant and/or conduct disorder in families from socioeconomically disadvantaged communities.

It Takes a Village to Deliver and Test Child and Family-Focused Services:

Objectives: The purpose of this article is to highlight the benefits of collaboration in child focused mental health services research. Method: Three unique research projects are described. These projects address the mental health needs of vulnerable, urban, minority children and their families. In each one, service delivery was codesigned, interventions were co-delivered and a team of stakeholders collaboratively tested the impact of each one. Results: The results indicate that the three interventions designed, delivered, and tested are associated with reductions in youth mental health symptoms. Conclusion: These interventions are feasible alternatives to traditional individualized outpatient treatment.

Caregiver Depression and Youth Disruptive Behavior Difficulties

This study examines the rates of depressive symptoms and service use among caregivers whose children receive treatment for disruptive behavior disorders. Descriptive analyses examined preliminary baseline data from the Family Groups for Urban Youth with Disruptive Behaviors study for 212 caregivers to determine rates of caregiver depressive symptoms and lifetime mental health service use. Findings indicate that caregivers manifest substantially higher rates of depressive symptoms compared to national norms. Of those caregivers with clinically significant depressive symptoms, less than half reported ever receiving mental health services. Findings suggest that greater attention should be paid to identifying and treating caregiver depression among children receiving treatment for disruptive behavior disorders.

Statewide implementation of the 4 Rs and 2 Ss for strengthening families.

Embedding evidence-informed practices for children with mental health needs into “real-world” community settings has proven challenging. In this article, we discuss how the Practical, Robust, Implementation, and Sustainability Model (PRISM) guided statewide (New York) implementation of an evidence-informed intervention targeting families and youth with oppositional defiant and conduct disorders, collectively referred to as disruptive behavior disorders. Additionally, we present qualitative findings based on provider reports of integrating a novel, evidence-informed intervention within their respective community mental health settings. Finally, we discuss a process of modifying the intervention to address agency-level factors, as well as inform more widespread implementation efforts.

Multiple Family Groups for Child Behavior Difficulties Retention Among Child Welfare-Involved Caregivers.

Purpose: The Multiple Family Group (MFG) service delivery model to reduce childhood disruptive behavior disorders has shown promise in engaging child welfare–involved families. This qualitative study examines caregivers’ perceptions of factors that influence retention in MFGs among child welfare–involved families. Methods: Twenty-five predominantly Black and Hispanic adult (aged 26–57) female caregivers with child welfare services involvement participated in individual, in-depth interviews. Transcribed interview data were thematically coded, guided by grounded theory methodology. Emergent themes were subsequently organized into a conceptual framework. Results: Factors promoting retention included the quality of interaction among group members, group facilitators’ attentive approach with caregivers, supports designed to overcome logistical barriers, and perceptions of MFG activities as fun and helpful. Caregivers’ mental health and personal characteristics as well as children’s behavior also impacted retention. Conclusions: Findings suggest MFGs are acceptable for child welfare–involved caregivers. Modifications are suggested to tailor to setting and client characteristics.

Multiple Family Groups to reduce child disruptive behavior difficulties: Moderating effects of child welfare status on child outcomes

Children who remain at home with their permanent caregivers following a child welfare (CW) involvement (e.g., investigation, out-of-home placement) manifest high rates of behavioral difficulties, which is a risk factor for further maltreatment and out-of-home placement if not treated effectively. A recently tested Multiple Family Group (MFG) service delivery model to treat youth Disruptive Behavior Disorders (DBDs) has demonstrated effectiveness in improving child behavior difficulties among hard-to-engage, socioeconomically disadvantaged families by addressing parenting skills, parent-child relationships, family communication and organization, social support, and stress. This exploratory study examines whether child behavioral outcomes for MFG differ for families with self-reported lifetime involvement in CW services compared to other families, as families with CW involvement struggle with additional stressors that can diminish treatment success. Youth (aged 7-11) and their families were assigned to MFG or services as usual (SAU) using a block comparison design. Caregivers reported on child behavior, social skills, and functional impairment. Mixed effects regression modeled multilevel outcomes across 4 assessment points (i.e., baseline, mid-test, post-test, 6-month follow-up). Among CW-involved families, MFG participants reported significantly reduced child oppositional defiant disorder symptoms at 6-month follow-up compared with SAU participants. No other differences were found in the effect of MFG treatment between CW and non-CW involved families. Findings suggest that MFG may be as effective in reducing child behavior difficulties for both CW and non-CW involved families. As a short-term, engaging, and efficient intervention, MFG may be a particularly salient service offering for families involved in the CW system.

Project Step-Up Feasibility of a Comprehensive School-Based Prevention Program

Inner-city, low-income Black and Latino youth are at high risk for developing severe behavioral difficulties and dropping out of high school. After-school programs are excellent resources for targeting these issues, yet most focus on middle school populations, address either academic or socioemotional issues rather than a combination of efforts, and struggle to engage at-risk youth. This article presents feasibility data regarding mental health needs and participation in Project Step-Up, a secondary prevention high school program targeting socioemotional and academic domains with linkages provided to mental health resources for hard-to-engage youth. Results indicate that participants exhibit preservice mental health needs at greater rates than manifested in the general population, yet demonstrate attendance and retention rates exceeding those typically reported by after-school programs. Participation differences by race/ethnicity indicate Project Step-Up’s success at engaging Black and Latino youth. Study limitations, curriculum revisions, and planned future evaluations are further discussed.

Best Practices: Wellness Self-Management: An Adaptation of the Illness Management and Recovery Program in New York State

Wellness Self-Management (WSM) is a recovery-oriented, curriculum-based practice designed to help adults with serious mental health problems make informed decisions and take action to manage symptoms and improve their quality of life. WSM is an adaptation of the illness management and recovery program, a nationally recognized best practice. WSM uses comprehensive personal workbooks for group facilitators and consumers and employs a structured and easy-to-implement group facilitation framework. Currently, more than 100 adult mental health agencies are implementing WSM in New York State. The authors describe the development and key features of WSM and an initiative to promote widespread adoption and sustainability.

Feasibility of improving child behavioral health using task-shifting to implement the 4Rs and 2Ss program for strengthening families in child welfare

BackgroundChildren whose families are involved with child welfare services manifest disproportionately high levels of behavioral difficulties, which could be addressed in community-based organizations providing services to prevent out-of-home placement. Unfortunately, few evidence-based practices have been successfully implemented in child welfare settings, especially those originally delivered by mental health providers. Given that such settings typically employ caseworkers who lack prior mental health training, this is a significant barrier to implementation. Consequently, the overall aim of the current study is to test the feasibility of shifting a mental health intervention from specialized services to community-based organizations. It uses task-shifting and the Practical, Robust, Implementation, and Sustainability model (PRISM) to implement an evidence-based intervention to reduce child behavior difficulties, originally provided by mental health practitioners, so that it can be delivered by caseworkers providing placement prevention services to child welfare-involved families. Task-shifting involves (1) modifying the intervention for provision by non-mental health providers, (2) training non-mental health providers in the modified intervention, and (3) establishing regular supervision and monitoring by mental health specialists.Methods/designThis study uses the 4Rs and 2Ss Program for Strengthening Families, a multiple family group service delivery model to reduce child behavior difficulties, as the example intervention. This intervention has had prior success with child welfare-involved families. The proposed study objectives are (1) to tailor the content, training, and supervision of the intervention for delivery by caseworkers serving child welfare-involved families and (2) to assess the feasibility and acceptability of the modified intervention. Mixed quantitative and qualitative methods will assess feasibility and acceptability from key stakeholders (caseworkers, supervisors, administrators, caregivers). In phase I, a collaborative advisory board will be convened (1) to modify the intervention to be delivered by caseworkers in placement prevention service settings and (2) to develop training and supervision protocols for caseworkers. In phase 2, the modified intervention will be pilot-tested for delivery by n = 4 caseworkers to n = 20 families receiving placement preventive services (where children manifest behavior problems). Mixed quantitative/qualitative methods will be used to assess feasibility and acceptability.DiscussionThis protocol will be of particular interest to agency administrators, program managers, and researchers interested in developing and testing cross-setting implementation guidelines for similar evidence-based practices.

Depression and Service Use Among Caregivers Dually Involved in the Child Welfare and Mental Health Systems.

The purpose of this study was to investigate the prevalence of depression, use of mental health services, and correlates of service use among caregivers who are dually involved in the child welfare and child mental health systems. This study analyzed baseline data from 129 caregivers who reported child welfare system involvement and were participating in a Multiple Family Group service delivery model to reduce childhood disruptive behavior disorders. Seventy-eight (60.5%) of caregivers met or exceed the clinical cut-off for depression; of them 50 (64.1%) reported utilizing mental health services for their emotional health. Race, employment status, and Center for Epidemiologic Studies Depression Scale score were significantly associated with lifetime mental heath services use. Depression rates exceeded those found among caregivers involved in either the child welfare or child mental health systems. Rates of service use were higher than found in existing research. As expected, racial differences and depression were associated with service use; contrary to expectations, full-time employment was not associated with service use. Discrepancies between this study and existing research are discussed, as are practice, policy, and research implications.