Tara G. Mehta

Future Directions for Dissemination and Implementation Science: Aligning Ecological Theory and Public Health to Close the Research to Practice Gap

Dissemination and implementation science (DI) has evolved as a major research model for childrens mental health in response to a long-standing call to integrate science and practice and bridge the elusive research to practice gap. However, to address the complex and urgent needs of the most vulnerable children and families, future directions for DI require a new alignment of ecological theory and public health to provide effective, sustainable, and accessible mental health services. We present core principles of ecological theory to emphasize how contextual factors impact behavior and allow for the reciprocal impact individuals have on the settings they occupy, and an alignment of these principles with a public health model to ensure that services span the prevention to intervention continuum. We provide exemplars from our ongoing work in urban schools and a new direction for research to address the mental health needs of immigrant Latino families. Through these examples we illustrate how DI can expand its reach by embedding within natural settings to build on local capacity and indigenous resources, incorporating the local knowledge necessary to more substantively address long-standing mental health disparities. This paradigm shift for DI, away from an overemphasis on promoting program adoption, calls for fitting interventions within settings that matter most to childrens healthy development and for utilizing and strengthening available community resources. In this way, we can meet the challenge of addressing our nations mental health burden by supporting the needs and values of families and communities within their own unique social ecologies.

A Pilot Demonstration of Comprehensive Mental Health Services in Inner-City Public Schools.

BACKGROUND National policy statements increasingly espouse the delivery of comprehensive mental health services in schools. In response to the limited evidence supporting this recommendation, the purpose of this study was to assess the need for, and feasibility, desirability, and outcomes of a full model of comprehensive mental health services in 2 public elementary schools in inner-city neighborhoods. METHODS The program, based upon a national model for comprehensive school mental health services, comprised universal and indicated preventive as well as clinical interventions designed to target needs identified in a baseline screening survey. The program was implemented over 1 school year by mental health professionals in collaboration with school teachers. Mental health outcomes comparing baseline to follow-up data were assessed in multiple domains among students and teachers. RESULTS After 1 year of intervention, students had significantly fewer mental health difficulties, less functional impairment, and improved behavior, and reported improved mental health knowledge, attitudes, beliefs, and behavioral intentions. Teachers reported significantly greater proficiency in managing mental health problems in their classrooms. School staff overwhelmingly endorsed satisfaction with the program. CONCLUSION If the observed favorable findings from this pilot demonstration can be replicated in methodologically rigorous studies, additional support would be garnered for national policy recommendations about comprehensive school mental health services.

Moving Science Into State Child and Adolescent Mental Health Systems: Illinois' Evidence-Informed Practice Initiative

In 2005, the Illinois State Mental Health Authority embarked on an initiative to close the gap between research and practice in the childrens mental health system. A stakeholder advisory council developed a plan to advance evidence informed practice through policy and program initiatives. A multilevel approach was developed to achieve this objective, which included policy change, stakeholder education, and clinician training. This article focuses on the evidence-informed training process designed following review of implementation research. The training involved in-person didactic sessions and twice-monthly telephone supervision across 6 cohorts of community based clinicians, each receiving 12 months of training. Training content initially included cognitive behavioral therapy and behavioral parent training and was adapted over the years to a practice model based on common element concepts. Evaluation based on provider and parent report indicated children treated by training clinicians generally showed superior outcomes versus both a treatment-as-usual comparison group for Cohorts 1 to 4 and the statewide child population as a whole after 90 days of care for Cohorts 5 to 6. The results indicated primarily moderate to strong effects for the evidence-based training groups. Moving a large public statewide child mental health system toward more effective services is a complex and lengthy process. These results indicate training of community mental health providers in Illinois in evidence-informed practice was moderately successful in positively impacting child-level functional outcomes. These findings also influenced state policy in committing resources to continuing the initiative, even in difficult economic times.

Redesigning community mental health services for urban children: Supporting schooling to promote mental health

OBJECTIVE This study examined a school- and home-based mental health service model, Links to Learning, focused on empirical predictors of learning as primary goals for services in high-poverty urban communities. METHOD Teacher key opinion leaders were identified through sociometric surveys and trained, with mental health providers and parent advocates, on evidence-based practices to enhance childrens learning. Teacher key opinion leaders and mental health providers cofacilitated professional development sessions for classroom teachers to disseminate 2 universal (Good Behavior Game, peer-assisted learning) and 2 targeted (Good News Notes, Daily Report Card) interventions. Group-based and home-based family education and support were delivered by mental health providers and parent advocates for children in kindergarten through 4th grade diagnosed with 1 or more disruptive behavior disorders. Services were Medicaid-funded through 4 social service agencies (N = 17 providers) in 7 schools (N = 136 teachers, 171 children) in a 2 (Links to Learning vs. services as usual) × 6 (pre- and posttests for 3 years) longitudinal design with random assignment of schools to conditions. Services as usual consisted of supported referral to a nearby social service agency. RESULTS Mixed effects regression models indicated significant positive effects of Links to Learning on mental health service use, classroom observations of academic engagement, teacher report of academic competence and social skills, and parent report of social skills. Nonsignificant between-groups effects were found on teacher and parent report of problem behaviors, daily hassles, and curriculum-based measures. Effects were strongest for young children, girls, and children with fewer symptoms. CONCLUSION Community mental health services targeting empirical predictors of learning can improve school and home behavior for children living in high-poverty urban communities.

Schooling and Children's Mental Health: Realigning Resources to Reduce Disparities and Advance Public Health

Schools have long been the primary setting for childrens mental health services but have neither the resources nor the expertise to manage these services independently. The critical importance of school success for childrens adjustment provides a strong rationale for schooling as an essential component of childrens mental health services. In this article, we review evidence for how schooling and mental health coalesce, suggesting an alignment of school and community mental health resources that prioritizes successful schooling as a key mental health outcome. We describe collaborative principles and ecological practices that advance a public health focus on childrens mental health while also reducing the burden on schools to maintain mental health services. We close with a model of mental health services illustrating these principles and practices in high-poverty urban schools and propose future directions for research and practice to promote positive mental health for all children and youth.

The Social Context of Urban Classrooms Measuring Student Psychological Climate

Classrooms are unique and complex work settings in which teachers and students both participate in and contribute to classroom processes. This article describes the measurement phase of a study that examined the social ecology of urban classrooms. Informed by the dimensions and items of an established measure of organizational climate, we designed the Student Climate Survey (n = 53 items) to assess student psychological climate in third through eighth grades. We administered the survey to 621 students at three time points within one school year in 69 classrooms within eight urban schools. A multidimensional item response theory (IRT) analysis based on a full-information item bifactor model revealed 18 items that loaded on a primary factor and demonstrated good criterion and predictive validity. Opportunities for the Student Climate Survey to advance our contextual understanding of urban classrooms and inform intervention are discussed.

Supporting Mental Health Providers: the Feasibility and Promise of a Virtual Professional Learning Community

ABSTRACT In collaboration with a large state entity, two virtual professional learning communities (VPLCs) were developed to support community mental health providers following a 12-month evidence-based practices (EBP) training and consultation. In this paper, the development, implementation, and initial feasibility of the VPLCs were described. Social network analyses were conducted to explore whether structural elements of a social network that support implementation of innovative practices were present. Feedback from participants contributed to the content, structure, and process of VPLCs to increase acceptability and feasibility. Results indicated that 23 of 24 clinicians attended three of six sessions and 20 of 24 clinicians attended at least four of six sessions, indicating feasibility of the VPLC. Social network results need to be interpreted with caution due to small sample, but suggest that VPLC provider social networks may contain structures (density and boundary density) that support innovative practices. Consenting providers reported relatively high intent to contact VPLC peers, indicating they want to contact peers when needed, but reported lower levels of actual contact with VPLC peers, suggesting that barriers exist to actually reaching out to colleagues for advice. Recommendations to enhance sustainability of effective practices post training andconsultation are discussed.