Michael A. Lindsey

Evidence-based practice at a crossroads: The timely emergence of common elements and common factors

Social work is increasingly embracing evidence-based practice (EBP) as a decision-making process that incorporates the best available evidence about effective treatments given client values and preferences, in addition to social worker expertise. Yet, social work practitioners have typically encountered challenges with the application of manualized evidence-supported treatments. For social work, the path to implementing the delivery of science-informed practice remains at a crossroads. This article describes two emergent strategies that offer a plausible means by which many social workers can integrate an EBP model into their service delivery—common factors and common elements. Each strategy will be presented, and related evidence provided. Tools to implement a common elements approach and to incorporate client feedback consistent with a common factors perspective will also be described. These strategies will be placed in the broader context of the EBP framework to suggest possible advances in social work practice and research.

Family Matters: The Role of Mental Health Stigma and Social Support on Depressive Symptoms and Subsequent Help Seeking Among African American Boys

African American adolescent boys underutilize mental health service due to stigma associated with depression. Gaining an increased understanding of how depressed, African American adolescent boys perceive their mental health needs and engage in help-seeking behaviors might play an essential role in efforts to improve their symptoms and access to care. Using a mixed-methods design, this study examined the influence of mental health stigma and social support on depressive symptoms among African American adolescent boys. Findings indicated the protective effects of social support in decreasing depressive symptoms, especially when participants experienced mental health stigma. Results also revealed the pivotal role of family social support over both professional and peer support for participants who struggled with depressive symptoms. The primacy of family support among the sample, combined with the frequent distrust of professionals and peer networks, would indicate that working with families may improve initial identification of depression among African American adolescent boys and decrease their barriers to care.

Translating the Common Elements Approach: Social Work's Experiences in Education, Practice, and Research

The expansion of the use of evidence-based practices (EBPs) in mental health services is well under way and social work seeks to further its appropriate implementation in both specialty and nonspecialty mental health settings. The common elements approach is now recognized as demonstrating promise for use in a range of settings. This article discusses the attractiveness of the common elements approach and describes several efforts to integrate its content into social work education and to disseminate this approach into the field. Then the article presents research initiatives regarding two areas of nonspecialty mental health practice with children and families: (a) engaging clients in mental health services and (b) preventing the need for out-of-home placement for youth. Finally, we consider the challenges of the common elements framework for social work education and practice and future directions for research.

Evidence-Based Practice at a Crossroads: The Emergence of Common Elements and Factors

Social work is increasingly embracing evidence-based practice (EBP) as a decision-making process that incorporates the best available evidence about effective treatments given client values and preferences, in addition to social worker expertise. Yet, social work practitioners have typically encountered challenges with the application of manualized evidence-supported treatments. For social work, the path to implementing the delivery of science-informed practice remains at a crossroads. This article describes two emergent strategies that offer a plausible means by which many social workers can integrate an EBP model into their service delivery—common factors and common elements. Each strategy will be presented, and related evidence provided. Tools to implement a common elements approach and to incorporate client feedback consistent with a common factors perspective will also be described. These strategies will be placed in the broader context of the EBP framework to suggest possible advances in social work practice and research.

Program and Practice Elements for Placement Prevention: A Review of Interventions and Their Effectiveness in Promoting Home-Based Care

Preventing unnecessary out-of-home placement for youth with behavioral and emotional needs is a goal of several public child-serving services, including child welfare, juvenile justice, and child mental health. Although a small number of manualized interventions have been created to promote family driven and community-based services and have empirical support, other less established programs have been initiated by local jurisdictions to prevent out-of-home placement. To synthesize what is known about efforts to prevent placement, this article describes the common program and practice elements of interventions described in 37 studies (published in 51 articles) that measured placement prevention outcomes for youth at risk for out-of-home care because of behavioral or mental health needs. The most common program elements across published interventions were program monitoring, case management, and accessibility promotion. The most common clinical practice elements for working with youth were assessment and individual therapy; for caregivers, problem solving skills were most frequently included; and family therapy was most common for the family unit. Effect size estimates for placement-related outcomes (decreased out-of-home placement, decreased hospitalization, decreased incarceration, and decreased costs) were calculated to estimate the treatment effectiveness of the interventions in which the program components and clinical practices are embedded.

“We’re Going Through a Lot of Struggles That People Don’t Even Know About”: The Need to Understand African American Males’ Help-Seeking for Mental Health on Multiple Levels

Young adult Black males face challenges related to addressing their mental health needs, yet there is much more to know about their help-seeking experiences. Twenty-seven Black males, recruited from four community-based organizations, participated in four focus groups to explore perceptions of help-seeking for mental health. Identified themes, which function at individual, social network, community, and health care system levels, may facilitate or hinder Black males’ mental health help-seeking. Themes included (a) “taking care of it oneself” as opposed to seeking help from someone; (b) issues engaging sources of help, including the ability to trust providers or the relationship closeness with social network members; and (c) “tipping points” that activate help-seeking to avert crises. Study findings provide initial evidence about the importance of addressing mental health interventions for Black males on multiple levels beyond the individual including engaging men’s social supports, community, and the health care system.

Personal Resources and Homelessness in Early Life: Predictors of Depression in Consumers of Homeless MultiService Centers

This study explored the relationship between personal resources and previous adverse life events such as homelessness and depression. Participants were recruited from two church sponsored multisite social service centers in Anne Arundel County, Maryland. The interview included demographics and several standardized scales to assess history of homelessness, medical history, personal resources, and depressive symptoms. A hierarchical multiple regression analysis revealed that participants with higher levels of depressive symptoms were older, had a history of homelessness, had more health problems, had a history of mental illness, and had lower self-esteem, mastery, and mattering. A subanalysis indicated that individuals who had experienced homelessness at or before age 21 had higher levels of depressive symptoms than those who were first homeless as an adult. Previous history of homelessness, especially before age 21, and lack of personal resources may place individuals at risk for psychological distress, including higher levels of depressive symptoms.

Race-Related Differences in the Experiences of Family Members of Persons with Mental Illness Participating in the NAMI Family to Family Education Program

Families play an important role in the lives of individuals with mental illness. Coping with the strain of shifting roles and multiple challenges of caregiving can have a huge impact. Limited information exists regarding race-related differences in families’ caregiving experiences, their abilities to cope with the mental illness of a loved one, or their interactions with mental health service systems. This study examined race-related differences in the experiences of adults seeking to participate in the National Alliance on Mental Illness Family-to-Family Education Program due to mental illness of a loved one. Participants were 293 White and 107 African American family members who completed measures of problem- and emotion-focused coping, knowledge about mental illness, subjective illness burden, psychological distress, and family functioning. Multiple regression analyses were used to determine race-related differences. African American caregivers reported higher levels of negative caregiving experiences, less knowledge of mental illness, and higher levels of both problem-solving coping and emotion-focused coping, than White caregivers. Mental health programs serving African American families should consider targeting specific strategies to address caregiving challenges, support their use of existing coping mechanisms and support networks, and increase their knowledge of mental illness.

Predictors of Engagement in a School-Based Family Preventive Intervention for Youth Experiencing Behavioral Difficulties

The researchers longitudinally assessed parent and child levels of engagement in an evidence-based preventive intervention for children. The sample included 114 fifth graders with aggressive, disruptive behaviors and their parents who participated in the Coping Power Program. Findings indicate that levels of engagement differentially fluctuated for children and parents throughout the course of the intervention. Results also suggest that child levels of engagement early in the course of the program influenced parent mid-intervention levels of engagement. Further, these relationships persisted when the influence of family environment variables were included in analyses.

North Carolina Family Assessment Scale: Measurement Properties for Youth Mental Health Services

Objective: The purpose of this study is to assess the reliability and validity of the North Carolina Family Assessment Scale (NCFAS) among families involved with youth mental health services. Methods: Using NCFAS data collected by child mental health intake workers with 158 families, factor analysis was conducted to assess factor structure, and thematic analysis of intake notes was used to test content validity. Results: This study found only three NCFAS subscales. The case notes included themes specific to youth with mental health needs that were not captured by current NCFAS items. Conclusions: This study suggests variation in the fit for the NCFAS in child mental health services compared to the measurement properties established in child welfare samples.