Improving Family-to-Family Services in Childrens Mental Health

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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.