Improving Family-to-Family Services in Childrens Mental Health

描述(由申请者提供)：家庭同伴倡导者在精神健康劳动力中是一个不断增长的部门。在纽约，家庭同伴倡导者(FPA)在大约400个家庭对家庭支持计划(F2F)中工作，为有心理健康问题的青少年的父母/照顾者提供一系列服务(例如，信息和教育、宣传等)。纽约州计划在未来两年内将FPA的数量翻一番，建立一个认证程序，使FPA的作用专业化，并使F2F成为州法规下的一项收费服务。一个由关键利益相关者组成的协作委员会开发了一个质量改进干预措施，以支持FPA的培训(称为家长授权和参与计划，或PEP)。PEP在NIMH资助的一项研究(R34MH071745)中进行了试点测试。结果表明，它导致了FPA在有效的MH实践、自我效能、专业技能发展和与父母的工作联盟方面的知识的改善。然而，工作环境中的机构级背景因素降低了FPA的有效性。对儿童保健机构结构和气候的实证研究表明，工作环境中的社会背景因素预测服务效率和儿童结果。针对机构社会背景的组织干预具有较强的实证支持，能够提高卫生保健机构的服务质量。因此，拟议的研究将：(1)概述20个提供F2F的机构的基础设施和社会-组织背景；(2)使用创新的标准化父母“演练”方法检查这些服务的过程和内容；(3)基于(1)和(2)的数据确定质量实践的相关性，并使用这些数据来指导对这一新劳动力实施机构层面的组织干预；以及(4)在20个机构中进行一项实验研究，以检查机构水平干预对机构背景、FPA行为、父母和青年结果的可行性和影响。这项分两个阶段进行的研究建立在哥伦比亚大学、卫生部和以社区为基础的家庭倡导组织之间的长期合作基础上。它将两种基于理论的方法(行为和社会-组织)联系在一起，这两种方法共同表明，(通过FPA的工作)增加父母参与和赋权的家庭/消费者战略和改变机构社会背景的战略是互补的。如果将这些战略整合到卫生保健服务机构中，这些战略很可能会改善将FPA纳入精神卫生机构、提供者和父母之间的工作联盟以及父母和青少年成果的情况。

DESCRIPTION (provided by applicant): Family Peer Advocates are a growing sector in the mental health workforce. In New York, Family Peer Advocates (FPA) work in approximately 400 Family-to-Family Support Programs (F2FS), providing a range of services (e.g., information and education, advocacy, etc) to parents/caregivers of youth with mental health issues. New York State has plans to double the number of FPA over the next two years, establish a credentialing process to professionalize the role of the FPA, and enable F2FS to become a billable service under state regulations. A quality improvement intervention to support the training of FPA (known as the Parent Empowerment and Engagement Program, or PEP) was developed by a collaborative board of key stakeholders. PEP was pilot-tested in an NIMH-funded study (R34MH071745). Results suggested that it led to improvements in FPA knowledge about effective MH practices, self-efficacy, professional skill development, and working alliances with parents. However, agency-level contextual factors within the work environment mitigated FPA effectiveness. Empirical studies of children's MH agency structure and climate suggest social contextual factors within work environments predict service effectiveness and child outcomes. Organizational interventions targeting agency social context have strong empirical support and can improve the quality of services in MH agencies. Therefore, the proposed study will: (1) Profile the infrastructure and social-organizational context of 20 agencies providing F2FS; (2) Examine the process and content of those services using an innovative Standardized Parent "Walkthrough" methodology; (3) Identify correlates of quality practices based on data from (1) and (2) and use these to guide the implementation of an agency-level organizational intervention for this new workforce; and (4) Conduct an experimental study among 20 agencies to examine the feasibility and impact of the agency-level intervention on agency context; FPA behavior, parent and youth outcomes. This two-phase study builds on the long-term collaborative work among Columbia University, OMH and community-based family advocacy organizations. It links two theory-based approaches (behavioral and social-organizational), which together suggest that family/consumer strategies to increase parental engagement and empowerment (via the work of FPA's) and strategies to change agency social contexts are complementary. If integrated within MH service agencies, these strategies are likely to improve integration of FPAs into mental health agencies, working alliances between providers and parents, and parent and youth outcomes.