Melissa Kimber

Becoming an Evidence-Based Service Provider: Staff Perceptions and Experiences of Organizational Change

In 2006, Ontario’s Policy Framework for Child and Youth Mental Health identified a need to improve the dissemination of what works in mental health practice and put it into practice. While an encouraging policy direction, the operationalization of evidence-based practice (EBP) implementation in child and youth mental health systems requires further consideration and the provision of support at the organizational and workforce levels. Thus far, the field of implementation science has identified that the implementation of effective and efficient behavioral health treatment programs involves a number of factors beyond that of consulting the research evidence and committing to the adoption of a particular practice. The range of factors identified as important in EBP implementation is captured in several frameworks and has been synthesized in a Consolidated Framework for Implementation Research (CFIR). This framework provides an overarching typology or meta-theory of relevant implementation constructs: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. The CFIR identifies constructs for which evidence supports their influence (positively or negatively, as specified) on implementation but does not specify the interactions between these constructs. We know little of how the process of implementation unfolds in real-world settings, and thus stand to learn a great deal through practice-based implementation studies done in partnership with community-based providers. Here, we have selected to explore the process through an exploratory case study. Given the paucity of literature examining implementation processes within the pediatric behavioral healthcare field, the present study used an exploratory framework to follow a change initiative involving the implementation of multiple EBPs over a four-year period in a large pediatric behavioral health service provider organization. In this paper, we report on staffIn 2006, Ontario’s Policy Framework for Child and Youth Mental Health identified a need to improve the dissemination of what works in mental health practice and put it into practice. While an encouraging policy direction, the operationalization of evidence-based practice (EBP) implementation in child and youth mental health systems requires further consideration and the provision of support at the organizational and workforce levels. Thus far, the field of implementation science has identified that the implementation of effective and efficient behavioral health treatment programs involves a number of factors beyond that of consulting the research evidence and committing to the adoption of a particular practice. The range of factors identified as important in EBP implementation is captured in several frameworks and has been synthesized in a Consolidated Framework for Implementation Research (CFIR). This framework provides an overarching typology or meta-theory of relevant implementation constructs: intervention characteristics, outer setting, inner setting, characteristics of the individuals involved, and the process of implementation. The CFIR identifies constructs for which evidence supports their influence (positively or negatively, as specified) on implementation but does not specify the interactions between these constructs. We know little of how the process of implementation unfolds in real-world settings, and thus stand to learn a great deal through practice-based implementation studies done in partnership with community-based providers. Here, we have selected to explore the process through an exploratory case study. Given the paucity of literature examining implementation processes within the pediatric behavioral healthcare field, the present study used an exploratory framework to follow a change initiative involving the implementation of multiple EBPs over a four-year period in a large pediatric behavioral health service provider organization. In this paper, we report on staff

Using a knowledge transfer framework to identify factors facilitating implementation of family‐based treatment

OBJECTIVE To conduct a qualitative study to identify factors that would facilitate the transfer of the research evidence on Family-Based Treatment (FBT) into clinical practice. METHOD Fundamental qualitative description guided sampling, data collection, and analytic decisions for this study. Forty therapists who treat children and adolescents under the age of 18 with Anorexia Nervosa (AN) and belong to Ontarios provincial network of specialized eating disorder services completed an in-depth interview focusing on elements proposed by the Lavis knowledge transfer framework. An experienced coder conducted content analysis, with 20% of the interviews double-coded for reliability purposes. RESULTS Participants requested training in the FBT model, including the provision of research evidence (i.e., journal articles), as well as the specific tenets of the model according to the FBT manual. The suggested audience for implementation included not only therapists themselves, but administrators, physicians, and community members. The development of best practice guidelines was also supported. Local FBT experts were suggested as credible messengers. Infrastructure relating to financial support and time away from clinical duties were reported to be essential for training. Ongoing supervision and mentorship were reported to be important elements of implementation and evaluation processes. DISCUSSION Suggestions for moving FBT into practice were consistent with previous research, however, the importance of obtaining the evidence in the form of primary research articles and obtaining team buy-in were remarkable. Developing context-specific training programs and administrative processes for the implementation of FBT are warranted.

Measurement Invariance of the WHODAS 2.0 in a Population-Based Sample of Youth

The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a brief measure of global disability originally developed for adults, which has since been implemented among samples of children and youth. However, evidence of its validity for use among youth, particularly measurement invariance, is lacking. Investigations of measurement invariance assess the extent to which the psychometric properties of observed items in a measure are generalizable across samples. Satisfying the assumption of measurement invariance is critical for any inferences about between-group differences. The objective of this paper was to empirically assess the measurement invariance of the 12-item interview version of the WHODAS 2.0 measure in an epidemiological sample of youth (15 to 17 years) and adults (≥ 18 years) in Canada. Multiple-group confirmatory factor analysis using a categorical variable framework allowed for the sequential testing of increasingly restrictive models to evaluate measurement invariance of the WHODAS 2.0 between adults and youth. Findings provided evidence for full measurement invariance of the WHODAS 2.0 in youth aged 15 to 17 years. The final model fit the data well: χ2(159) = 769.04, p < .001; CFI = 0.950, TLI = 0.958, RMSEA (90% CI) = 0.055 [0.051, 0.059]. Results from this study build on previous work supporting the validity of the WHODAS 2.0. Findings indicate that the WHODAS 2.0 is valid for making substantive comparisons of disability among youth as young as 15 years of age.

Mandated reporters’ experiences with reporting child maltreatment: a meta-synthesis of qualitative studies

Objective To systematically search for research about the effectiveness of mandatory reporting of child maltreatment and to synthesise qualitative research that explores mandated reporters’ (MRs) experiences with reporting. Design As no studies assessing the effectiveness of mandatory reporting were retrieved from our systematic search, we conducted a meta-synthesis of retrieved qualitative research. Searches in Medline (Ovid), Embase, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Sociological Abstracts, Education Resources Information Center, Criminal Justice Abstracts and Cochrane Library yielded over 6000 citations, which were deduplicated and then screened by two independent reviewers. English-language, primary qualitative studies that investigated MRs’ experiences with reporting of child maltreatment were included. Critical appraisal involved a modified checklist from the Critical Appraisal Skills Programme and qualitative meta-synthesis was used to combine results from the primary studies. Setting All healthcare and social-service settings implicated by mandatory reporting laws were included. Included studies crossed nine high-income countries (USA, Australia, Sweden, Taiwan, Canada, Norway, Finland, Israel and Cyprus) and three middle-income countries (South Africa, Brazil and El Salvador). Participants: The studies represent the views of 1088 MRs. Outcomes Factors that influence MRs’ decision to report and MRs’ views towards and experiences with mandatory reporting of child maltreatment. Results Forty-four articles reporting 42 studies were included. Findings indicate that MRs struggle to identify and respond to less overt forms of child maltreatment. While some articles (14%) described positive experiences MRs had with the reporting process, negative experiences were reported in 73% of articles and included accounts of harm to therapeutic relationships and child death following removal from their family of origin. Conclusions The findings of this meta-synthesis suggest that there are many potentially harmful experiences associated with mandatory reporting and that research on the effectiveness of this process is urgently needed.

Dissemination and Implementation of Manualized Family-Based Treatment: A Systematic Review

The objective of this article was to systematically review the literature pertaining to the dissemination and implementation of manualized family-based treatment (FBT). Several studies were found looking at the dissemination of FBT to sites beyond those of the primary research, mainly focusing on patient outcomes. Alternatively, articles were found which focused primarily on implementation outcomes, such as the barriers and facilitating factors for FBT uptake, a knowledge transfer model that could be applied to improve uptake, and team decision-making processes. It remains important to study the implementation of FBT in clinical practice due to the barriers identified in the literature.

Body image dissatisfaction among immigrant children and adolescents in Canada and the United States: A scoping review

OBJECTIVE To systematically summarize the literature examining body image dissatisfaction (BID) among immigrant children and adolescents living in Canada and the United States (US). METHOD Sources were identified by entering search terms into six electronic databases and by completing an electronic hand search of research journals focusing on body image. Eligible sources were those published between 1946 and November 2012, conducted within Canada or the US, included immigrant children or adolescents (<18 years), and measured BID through self-report. Synthesis followed the principles of thematic and content analysis (Vaismoradi et al., Nurs Health Sci, 2013,15,398-405). RESULTS A total of 12 sources were included in our synthesis, spanning years 1991 to 2010. These studies indicate that immigrant children and adolescents experience BID. However, the literature is plagued by a disproportionate focus on females, Latino/Hispanic immigrants, and inadequate attention to issues of measurement. DISCUSSION There is no evidence about the BID experiences of immigrant children and adolescents in Canada and limited information has stemmed from the US. A more robust evidence-base should include the use of advanced methods to examine the influence of acculturation and acculturative stress on BID among immigrant male and female children and adolescents.

The associations between sex, immigrant status, immigrant concentration and intimate partner violence: Evidence from the Canadian General Social Survey

Intimate partner violence (IPV) is an important public health concern, yet little is known about the combined effects of individual- and neighbourhood-level characteristics on IPV among immigrants. The aim of this study is to examine: (1) the association between immigrant status and IPV victimisation and whether sex modifies this association, and (2) the association between the neighbourhood concentration of immigrants and IPV victimisation, and whether immigrant status modifies this association. Our sample of 10,964 males and females comes from the 2009 Canadian General Social Survey. After controlling for covariates, immigrant status was not associated with IPV, and sex significantly modified the association between immigrant status and financial and physical/sexual IPV. Compared to males, second-generation females were less likely to report financial IPV and first-generation females were more likely to report physical/sexual IPV. Immigrant status modified the association between the neighbourhood concentration of immigrants and emotional and physical/sexual IPV. Compared to third-generation males, first-generation males living in neighbourhoods with a higher concentration of immigrants were more likely to report emotional IPV, whereas second-generation males in these neighbourhoods were less likely to report physical/sexual IPV. Interventions to reduce IPV should pay equal attention to individual- and neighbourhood-level influences.

Consequences of child emotional abuse, emotional neglect and exposure to intimate partner violence for eating disorders: a systematic critical review

BackgroundChild maltreatment and eating disorders are significant public health problems. Yet, to date, research has focused on the role of child physical and sexual abuse in eating-related pathology. This is despite the fact that globally, exposure to emotional abuse, emotional neglect and intimate partner violence are the three of the most common forms of child maltreatment. The objective of the present study is to systematically identify and critically review the literature examining the association between child emotional abuse (EA), emotional neglect (EN), and exposure to intimate partner violence (IPV) and adult eating-disordered behavior and eating disorders.MethodsA systematic search was conducted of five electronic databases: Medline, Embase, PsycINFO, CINAHL, and ERIC up to October 2015 to identify original research studies that investigated the association between EA, EN and children’s exposure to IPV, with adult eating disorders or eating-disordered behavior using a quantitative research design. Database searches were complemented with forward and backward citation chaining. Studies were critically appraised using the Quality in Prognosis Studies (QUIPS) tool.ResultsA total of 5556 publications were screened for this review resulting in twenty-three articles included in the present synthesis. These studies focused predominantly on EA and EN, with a minority examining the role of child exposure to IPV in adult eating-related pathology. Prevalence of EA and EN ranged from 21.0% to 66.0%, respectively. No prevalence information was provided in relation to child exposure to IPV. Samples included predominantly White women. The methodological quality of the available literature is generally low. Currently, the available literature precludes the possibility of determining the extent to which EA, EN or child exposure to IPV have independent explanatory influence in adult eating-related pathology above what has been identified for physical and sexual abuse.ConclusionsWhile a large proportion of adults with eating disorders or eating-disordered behavior report EA, EN, or child exposure to IPV , there is a paucity of high-quality evidence about these relationships.

The association between child exposure to intimate partner violence (IPV) and perpetration of IPV in adulthood—A systematic review

Increasingly recognized as a distinct form of childhood maltreatment, childrens exposure to intimate partner violence (IPV) has been shown to be associated with an array of negative psychosocial outcomes, including elevated risk for additional violence over the life course. Although studies have identified child exposure to IPV as a predictor of IPV perpetration in adulthood, no review has critically evaluated the methodology of this quantitative work. The present study examines the association between childhood exposure to IPV and the perpetration of IPV in adulthood based on a systematic review of the literature from inception to January 4, 2016. Databases searched included Medline, Embase, PsycINFO, CINAHL, Cochrane Database of Systematic Reviews, Sociological Abstracts and ERIC. Database searches were complemented with backward and forward citation chaining. Studies were critically appraised using the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Of 5601 articles identified by the search, 19 studies were included for data extraction. Sixteen of these studies found that child exposure to IPV was significantly and positively associated with adult IPV perpetration; three studies reported null findings. The methodological quality of the studies was low. Work thus far has tended to focus on child exposure to physical IPV and the perpetration of physical IPV within heterosexual contexts. In addition, measures of child exposure to IPV vary in their classification of what exposure entails. We critically discuss the strengths and limitations of the existing evidence and the theoretical frameworks informing this work.

Suicidal Behaviour Among Adolescents and Young Adults with Self-Reported Chronic Illness

Objective: The aims of this study were to estimate the: (1) 12-mo prevalence of suicidal thoughts, plans, and attempts in a population sample of adolescents and young adults with and without chronic illness; (2) associations among chronic illness and suicidal thoughts and behaviour (STB); and, (3) moderating roles of mood and substance use disorder on this association. Method: Individuals were aged 15 to 30 y (n = 5,248) from the Canadian Community Health Survey-Mental Health. Twelve-month STB and psychiatric disorder were measured using the World Health Organization Composite International Diagnostic Interview 3.0. Multinomial logistic regression examined associations between chronic illness and STB, adjusting for relevant sociodemographic and health characteristics. Product term interactions among chronic illness, mood, and substance use disorders were included in the regression models to examine potential moderating effects. Results: Prevalence of suicidal thoughts, plans, and attempts was higher in individuals with chronic illness (P < 0.01 for all). After adjustment, chronic illness increased the odds for suicidal thoughts [OR = 1.28 (1.01 to 1.64)], plans [OR = 2.34 (1.22 to 4.39)], and attempts [OR = 4.63 (1.52 to 14.34)]. In the presence v. absence of a mood disorder, the odds for suicidal thoughts were higher among individuals with chronic illness [OR = 1.89 (1.06 to 5.28)]. Conclusions: Suicidal thoughts and behaviours are common among adolescents and young adults with chronic illness, particularly among those with comorbid mood disorders. Health professionals should routinely ask about STB during assessments of their adolescent and young adult patients.