Michael D. Pullmann

Juvenile Offenders With Mental Health Needs: Reducing Recidivism Using Wraparound:

The rate of youth with mental health needs is disproportionately high in juvenile justice. Wraparound planning involves families and providers in coordinating juvenile justice, mental health, and other services and supports. This study compares data from two groups of juvenile offenders with mental health problems: 106 youth in a juvenile justice wraparound program called Connections and a historical comparison group of 98 youth in traditional mental health services. Cox regression survival analyses revealed that youth in Connections were significantly less likely to recidivate at all, less likely to recidivate with a felony offense, and served less detention time.

Barriers to and Supports of Family Participation in a Rural System of Care for Children with Serious Emotional Problems

Researchers have not adequately addressed the unique characteristics of rural areas that influence the accessibility of services for families with children who have serious emotional problems. Understanding rurality is particularly important to “systems of care” grant sites because these grants are intended to restructure mental health service delivery by building upon the strengths of a community and addressing the community’s needs. This qualitative study examines the barriers to and supports for participation in services within a rural system of care site through the reported experiences of eight caregivers and nine staff. Findings indicate families face many challenges related to rurality, including stigma, transportation, isolation, poverty, and service availability. In addition to these challenges, however, participants reported many meaningful supports such as the religious community and the close-knit community of families and service providers. We present implications for planning, implementing, and evaluating systems of care in rural areas.

Improving practice in community-based settings: a randomized trial of supervision – study protocol

BackgroundEvidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision or consultation is required. Supervision is notably under-investigated, particularly as provided in public mental health. The degree to which supervision in this setting includes ‘gold standard’ supervision elements from efficacy trials (e.g., session review, model fidelity, outcome monitoring, skill-building) is unknown. The current federally-funded investigation leverages the Washington State Trauma-focused Cognitive Behavioral Therapy Initiative to describe usual supervision practices and test the impact of systematic implementation of gold standard supervision strategies on treatment fidelity and clinical outcomes.Evidence-based treatments for child mental health problems are not consistently available in public mental health settings. Expanding availability requires workforce training. However, research has demonstrated that training alone is not sufficient for changing provider behavior, suggesting that ongoing intervention-specific supervision o

Engaging foster parents in treatment: a randomized trial of supplementing trauma-focused cognitive behavioral therapy with evidence-based engagement strategies.

The goal of this study was to examine the impact of supplementing Trauma-focused Cognitive Behavioral Therapy (TF-CBT; Cohen et al., 2006) with evidence-based engagement strategies on foster parent and foster youth engagement in treatment, given challenges engaging foster parents in treatment. A randomized controlled trial of TF-CBT standard delivery compared to TF-CBT plus evidence-based engagement strategies was conducted with 47 children and adolescents in foster care and one of their foster parents. Attendance, engagement, and clinical outcomes were assessed 1 month into treatment, end of treatment, and 3 months post-treatment. Youth and foster parents who received TF-CBT plus evidence-based engagement strategies were more likely to be retained in treatment through four sessions and were less likely to drop out of treatment prematurely. The engagement strategies did not appear to have an effect on the number of canceled or no-show sessions or on treatment satisfaction. Clinical outcomes did not differ by study condition, but exploratory analyses suggest that youth had significant improvements with treatment. Strategies that specifically target engagement may hold promise for increasing access to evidence-based treatments and for increasing likelihood of treatment completion.

Family Voice With Informed Choice: Coordinating Wraparound With Research-Based Treatment for Children and Adolescents

The wraparound process is a type of individualized, team-based care coordination that has become central to many state and system efforts to reform childrens mental health service delivery for youths with the most complex needs and their families. Although the emerging wraparound research base is generally positive regarding placements and costs, effect sizes are smaller for clinical and functional outcomes. This article presents a review of literature on care coordination and wraparound models, with a focus on theory and research that indicates the need to better connect wraparound-enrolled children and adolescents to evidence-based treatment (EBT). The article goes on to describe how recently developed applications of EBT that are based on quality improvement and flexible application of “common elements” of research-based care may provide a more individualized approach that better aligns with the philosophy and procedures of the wraparound process. Finally, this article presents preliminary studies that show the feasibility and potential effectiveness of coordinating wraparound with the Managing and Adapting Practice system, and discusses intervention development and research options that are currently under way.

Adolescent Use of School-Based Health Centers and High School Dropout

OBJECTIVE To determine the association between use of school-based health centers (SBHCs) and school dropout. DESIGN Quasi-experimental longitudinal analysis of a retrospective student cohort, with SBHC use as the independent variable. We statistically controlled for dropout risk and used propensity score regression adjustment to control for several factors associated with SBHC use. SETTING Integrated database from an urban public school district (academic outcomes) and department of public health (SBHC use). PARTICIPANTS District-enrolled students in their first semester of ninth grade in 2005 (N = 3334), followed up through their anticipated on-time graduation semester of 12th grade in 2009. Students were divided into 4 groups: never used (47%); low use (23%); moderate use (20%); and high users (10%). OUTCOME MEASURE Time to nongraduation (described as dropout). RESULTS Low to moderate SBHC use (0.125-2.5 visits per semester) was associated with a 33% reduction in dropout compared with non-SBHC users. The high-use group (>2.5 visits per semester) did not have dropout rates that differed from nonusers. For SBHC users who did drop out, dropout occurred approximately 1 semester later than nonusers. Exploratory analyses revealed that the association between SBHC use and prevention of dropout was greatest for higher-risk students. CONCLUSIONS This study found an association between low to moderate SBHC use and reductions in dropout for high school students in an urban school district, especially for students at higher risk for dropout. This study supports the theory that benefits of SBHCs extend beyond managing physical and mental health needs to include academic outcomes.

Effects of a multidisciplinary family treatment drug court on child and family outcomes: results of a quasi-experimental study

Family treatment drug courts (FTDCs) are an increasingly common approach for serving families involved in child welfare due to parental substance abuse; however, the evidence base for FTDCs remains emergent. This quasi-experimental study replicates previous research on FTDCs by comparing parental substance abuse treatment and child welfare outcomes for 76 FTDC participants to outcomes for 76 parents in the same system who did not participate in the FTDC, using propensity score matching. Data were obtained from the Superior court, FTDC, child welfare, and public substance use treatment service administrative databases. The follow-up window for participants ranged from 1 to 3 years. Results showed FTDC parents had significantly more review and motion hearings, were significantly more likely to enter treatment, entered treatment faster, received more treatment, and were more likely to successfully complete treatment. FTDC children spent significantly less time placed out of home, ended child welfare system involvement sooner, were more likely to be permanently placed and discharged from child welfare, and were more likely to return to parental care. Results demonstrate that FTDCs promote positive treatment and child welfare outcomes without deepening participants’ involvement in justice systems.

Participatory Research in Systems of Care for Children’s Mental Health

The children’s system of care initiative in the United States requires the participation of caregivers of children with emotional or behavioral problems in conducting research and evaluation. This entails a restructuring of traditional power dynamics among families served by the community mental health system and other system stakeholders, including researchers. However, evidence indicates that system of care research may not currently embrace the different types of knowledge possessed by caregivers and may be frustrated by traditional power hierarchies, resulting in research findings that are not useful for the community. In this paper I examine a framework for power and knowledge and examine how, when viewed through this framework, participatory research in the system of care initiative thus far may be less than authentic. I conclude with improvements suggested by the framework that are expected to shift power to caregivers and result in more useful, actionable research findings for the community.

Development and implementation of a child welfare workforce strategy to build a trauma-informed system of support for foster care

Effective strategies that increase the extent to which child welfare professionals engage in trauma-informed case planning are needed. This study evaluated two approaches to increase trauma symptom identification and use of screening results to inform case planning. The first study evaluated the impact of training on trauma-informed screening tools for 44 child welfare professionals who screen all children upon placement into foster care. The second study evaluated a two-stage approach to training child welfare workers on case planning for children’s mental health. Participants included (a) 71 newly hired child welfare professionals who received a 3-hr training and (b) 55 child welfare professionals who participated in a full-day training. Results from the first study indicate that training effectively increased knowledge and skills in administering screening tools, though there was variability in comfort with screening. In the second study, participants self-reported significant gains in their competency in identifying mental health needs (including traumatic stress) and linking children with evidence-based services. These findings provide preliminary evidence for the viability of this approach to increase the extent to which child welfare professionals are trauma informed, aware of symptoms, and able to link children and youth with effective services designed to meet their specific needs.

Clinician Use of Standardized Assessments Following a Common Elements Psychotherapy Training and Consultation Program

Despite increasing emphasis on the implementation of evidence-based treatments in community service settings, little attention has been paid to supporting the use of evidence-based assessment (EBA) methods and processes, a parallel component of evidence-based practice. Standardized assessment (SA) tools represent a key aspect of EBA and are central to data-driven clinical decision making. The current study evaluated the impact of a statewide training and consultation program in a common elements approach to psychotherapy. Practitioner attitudes toward, skill applying, and use of SA tools across four time points (pre-training, post-training, post-consultation, and follow-up) were assessed. Results indicated early increases in positive SA attitudes, with more gradual increases in self-reported SA skill and use. Implications for supporting the sustained use of SA tools are discussed, including the use of measurement feedback systems, reminders, and SA-supportive supervision practices.