Dissemination of Effective MH Services in Foster Care

在寄养中传播有效的 MH 服务

• 批准号: 7938872
• 负责人: SONYA J LEATHERS
• 金额: $ 44.29万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-25 至 2012-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7938872
• 关键词: Address; Advocate; African American; Area; Behavioral; Burn injury; Child; Child Behavior; Child Welfare; Clinical; Communication; Communities; Consultations; Control Groups; Diffusion of Innovation; Emotional; Employee Strikes; Evidence based intervention; General Population; Goals; Group Homes; Health Services Research; Home environment; Home visitation; Homelessness; House Call; Imprisonment; Influentials; Intervention; Intervention Studies; Knowledge; Lead; Learning; Life; Mental Health; Mental Health Services; Modeling; National Institute of Mental Health; Outcome; Parents; Pathway Analysis; Phase; Pilot Projects; Population; Price; Problem behavior; Process; Provider; Public Health; Randomized; Relative (related person); Reporting; Research; Research Project Grants; Risk; Sampling; Schools; Services; Social Network; Social Work; Social Workers; Societies; Structure; Supervision; System; Testing; Time; Training; Translational Research; Work; Youth; base; boys; child mental health service; community setting; effective intervention; evidence base; experience; foster care; foster child; foster home; foster parent; girls; group intervention; high risk; improved; in vivo; inner city; innovation; interest; member; response; theories; uptake; volunteer; young adult

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (15) Translational Science and Specific Challenge Topic 15-MH-105, Strategies to support uptake of interventions within clinical and community settings. This application will study an innovative approach to implementing mental health services in child welfare settings to reduce foster children's behavior problems and improve school outcomes. This work will address two critical needs in child mental health services research: (1) the need for empirically-based strategies to successfully implement evidence-based services in urban service settings and (2) the particularly urgent need to implement effective mental health services for foster children, who experience three to four times the rate of mental health problems than in the general population of children (Burns et al., 2004; Leslie et al., 2005). The intervention to be disseminated includes parent management training integrated with structured support of learning at home and in school. The enhanced implementation model proposed in this application uses an adaptation of Rogers' (2003) diffusion of innovation theory, which suggests that intervention uptake is improved by using a structured implementation process and, in particular, using highly influential early adopters of the intervention in efforts for dissemination (Atkins et al., 2008; Rogers, 2003). The caseworkers and clinical social workers ("providers") of 160 foster children with emotional and behavior problems will be randomized to experimental and control conditions. The intervention group will include key opinion leader social workers and foster parent advocates who will target uptake of the intervention at two levels: child welfare providers and foster parents. A key hypothesis of this study is that targeting uptake of interventions through an experimental implementation process will improve intervention uptake and lead to lessened child behavior and school problems relative to a "training as usual" implementation process. All hypotheses will be tested using social network analysis and random effects regression models. This application builds on previous intervention research in child welfare settings that has found that parent management interventions with foster parents volunteering to attend groups are effective in reducing foster children's child behavior problems (e.g., Price et al., 2008; Chamberlain, 2002). In addition, in our recently completed pilot study (NIMH K01 070580) in which we adapted Chamberlain's parent management training materials for use with primarily inner city, African American foster parents, we found that foster parents in an intent-to-treat intervention group reported significantly fewer child behavior problems over time relative to control group foster parents receiving services as usual. In this pilot project, we were able to reach 80% of our selected sample by providing services in both community-based settings and foster homes. Despite the positive outcomes of the intervention and strong foster parent interest, however, little uptake of the intervention occurred by existing bachelor's level providers following our training and in vivo coaching phase. This striking contrast in foster parents' and agency providers' responses to the intervention has created the perfect opportunity to study an innovative implementation process in a short, intense project with the goal of addressing a critical implementation problem in high-need service systems. This application specifically addresses intervention uptake and sustainability by comparing intervention use, fidelity, and child outcomes for an experimental receiving an enhanced implementation strategy vs. a control group receiving standard training. The experimental implementation process will occur in three phases and be examined across 5 time points. In the first 3-month phase of the research, project-hired MSWs and foster parent advocates ("change agents") will be infused into existing agency social work teams to conjointly provide groups and home visits, with shared training and supervision from the research project and agency supervisors and a particular focus on increasing knowledge, exposure, and communication with potential adopters of the intervention. In the second phase, active transfer of the intervention to existing providers will occur, with a particular focus on training key opinion leader providers (KOLs) in effective dissemination of the intervention. In the third phase, agency staff will provide services, with consultation provided only as requested by agency providers. The over 500,000 foster children in the U.S. are among the most vulnerable members of our society. They have significant risks for mental health problems that lead to an extraordinarily high risk for outcomes such as incarceration (27% of boys and 10% of girls) and homelessness (12% of all youth) in young adulthood (Courtney, et al., 2001). The significance of strategies to disseminate effective interventions that interrupt this trajectory is enormous, given the extreme vulnerability of this population and the critical need to change their life chances. PUBLIC HEALTH SIGNIFICANCE: The proposed research will study an innovative approach to implementing mental health services in child welfare settings to reduce foster children's behavior problems and improve school outcomes. This work will address two critical needs in child mental health services research: (1) the need for empirically-based strategies to successfully implement evidence-based services in urban service settings and (2) the particularly urgent need to implement effective mental health services for foster children, who experience three to four times the rate of mental health problems than in the general population of children. This application specifically addresses intervention uptake and sustainability by comparing intervention use, fidelity, and child outcomes for an experimental group receiving an enhanced implementation strategy vs. a control group receiving standard training. The experimental implementation process will occur in three phases and be examined across 5 time points (baseline and 3, 6, 9, and 18 months). The implementation model is based on Rogers' (2003) diffusion of innovation theory, which suggests that intervention uptake is improved by using a structured implementation process and, in particular, using highly influential early adopters of the intervention in dissemination efforts.

描述（由申请人提供）：本申请应解决广泛的挑战领域（15）转化科学和特定挑战主题15-MH-105，这是支持临床和社区环境内干预措施的策略。该应用程序将研究一种在儿童福利环境中实施心理健康服务的创新方法，以减少寄养儿童的行为问题并改善学校成果。这项工作将解决儿童心理健康服务研究中的两个关键需求：（1）需要基于经验的策略在城市服务环境中成功实施基于证据的服务，以及（2）尤其需要为养育儿童实施有效的心理健康服务，他们经历了精神健康问题的三到四倍，是儿童普通人群的三倍（Burns等，2004; Leslie; leslie; Leslie et et et and e e e e e ef Childer of Childer of Childers of Childers of Chircters''。要分发的干预措施包括与在家中和学校学习结构化支持集成的父母管理培训。在本应用程序中提出的增强实施模型使用了Rogers（2003）的适应创新理论的扩散，这表明通过使用结构化实施过程改善了干预措施的吸收，尤其是使用高度影响力的早期采用者来进行散布的努力（Atkins等，2008; Rogers; Rogers; Rogers; 2003; 2003年）。 160名患有情感和行为问题的儿童的案例工作者和临床社会工作者（“提供者”）将被随机分为实验和控制条件。干预小组将包括关键人物的领导者社会工作者和培养父母的拥护者，他们将以两个层面的措施将干预措施的吸收：儿童福利提供者和寄养父母。这项研究的一个关键假设是，通过实验实施过程靶向干预措施的靶向将改善干预措施的吸收，并导致相对于“照常培训”实施过程而减少儿童行为和学校问题。所有假设将使用社交网络分析和随机效应回归模型进行测试。该申请是基于以前在儿童福利环境中的干预研究的基础，发现父母管理与寄养父母自愿参加小组有效减少寄养儿童的儿童行为问题（例如Price等，2008; Chamberlain，2002年）有效。此外，在我们最近完成的试点研究（NIMH K01 070580）中，我们改编了张伯伦的父母管理培训材料，主要与内城，非裔美国人寄养父母一起使用，我们发现养育父母的养育父母在验证干预小组中报告说，相对于对照组的寄养父母的服务，相对于对照组的寄养者的服务，养育孩子行为问题明显减少了较少的儿童行为问题。在这个试点项目中，我们能够通过在社区设置和寄养家庭中提供服务来达到我们选定的样本的80％。尽管干预的积极成果和强烈的寄养父母的兴趣，但在我们的培训和体内教练阶段，现有单身汉的级别提供者的干预措施几乎没有采取干预措施。在寄养父母和代理提供者对干预措施的反应中，这种显着的对比为研究创新的实施过程创造了一个绝佳的机会，以解决一个简短而激烈的项目，目的是解决高需求服务系统中的关键实施问题。该应用程序专门解决了通过比较使用干预，忠诚度和儿童成果的实验，以接受增强的实施策略与接受标准培训的对照组，以解决干预措施的吸收和可持续性。实验实施过程将分为三个阶段，并在5个时间点进行检查。在研究的第一个3个月阶段中，项目雇用的MSW和寄养父母的拥护者（“变更代理”）将被注入现有的代理社会工作团队中，以共同提供团体和家庭访问，并从研究项目和机构主管那里进行共同的培训和监督，并特别关注与潜在的干预者的知识，知识，暴露，曝光，曝光，接触者的交流。在第二阶段，将进行干预措施向现有提供者进行主动转移，特别关注培训关键意见领导者提供者（KOLS），以有效地传播干预措施。在第三阶段，代理商工作人员将提供服务，并仅按照代理提供商的要求提供咨询。美国超过500,000名寄养儿童是我们社会中最脆弱的成员之一。他们面临精神健康问题的重大风险，导致诸如监禁（男孩的27％和10％的女孩）和无家可归者（占所有青少年的12％）等结果的风险极高的风险（Courtney等，2001年）。鉴于该人群的极端脆弱性以及改变其生活机会的迫切需要，打断这种轨迹的有效干预措施的策略的意义是巨大的。 公共卫生的意义：拟议的研究将研究一种在儿童福利环境中实施心理健康服务的创新方法，以减少儿童的行为问题并改善学校的成果。这项工作将满足儿童心理健康服务研究中的两个关键需求：（1）需要基于经验的策略在城市服务环境中成功实施基于证据的服务，以及（2）（2）尤其需要为寄养儿童实施有效的心理健康服务，他们经历了精神健康问题的三到四倍，是儿童的三到四倍。该应用程序专门解决了通过比较使用干预，忠诚度和儿童成果的实验组，以接受增强的实施策略与接受标准培训的对照组。实验实施过程将分为三个阶段，并在5个时间点（基线和3、6、9和18个月）进行检查。该实施模型基于Rogers（2003）的创新理论的扩散，该理论表明，通过使用结构化的实施过程，特别是使用对分发工作中干预的高度早期采用者来改善干预措施的吸收。