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）：本申请涉及广泛的挑战领域（15）转化科学和特定挑战主题15- mh -105，支持在临床和社区环境中采用干预措施的策略。本申请将研究在儿童福利机构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和改善学业成绩。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)需要基于经验的战略，以便在城市服务环境中成功实施基于证据的服务；(2)特别迫切需要为寄养儿童实施有效的心理健康服务，这些儿童的心理健康问题发生率是普通儿童的三到四倍（Burns等人，2004年；Leslie等人，2005年）。要传播的干预措施包括家长管理培训与在家和学校学习的结构化支持相结合。本应用中提出的增强实施模型采用了罗杰斯（2003）创新扩散理论的改编，该理论表明，通过使用结构化的实施过程，特别是在传播努力中使用具有高度影响力的干预早期采采者，可以提高干预的吸收（Atkins等人，2008；罗杰斯，2003）。160名有情绪和行为问题的寄养儿童的社会工作者和临床社会工作者（“提供者”）将被随机分配到实验和控制条件中。干预小组将包括主要的意见领袖、社会工作者和养父母倡导者，他们将针对两个层面的干预：儿童福利提供者和养父母。本研究的一个关键假设是，相对于“照常训练”的实施过程，通过实验实施过程有针对性地接受干预措施将提高干预措施的接受程度，并减少儿童行为和学校问题。所有假设将使用社会网络分析和随机效应回归模型进行检验。这一应用建立在先前的儿童福利机构干预研究的基础上，该研究发现，父母管理干预与寄养父母自愿参加团体在减少寄养儿童的儿童行为问题方面是有效的（例如，Price et al., 2008; Chamberlain, 2002）。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，主要用于市中心的非裔美国养父母，我们发现，与接受常规服务的对照组养父母相比，意向治疗干预组的养父母报告的儿童行为问题显著减少。在这个试点项目中，通过在社区环境和寄养家庭中提供服务，我们能够覆盖80%的选定样本。尽管干预的积极结果和强烈的养父母兴趣，然而，在我们的培训和体内指导阶段，现有的本科水平的提供者很少接受干预。寄养父母和机构提供者对干预措施的反应形成了鲜明的对比，这为在一个短时间、高强度的项目中研究创新的实施过程创造了绝佳的机会，该项目的目标是解决高需求服务系统中的一个关键实施问题。本应用程序通过比较接受强化实施策略的实验组与接受标准培训的对照组的干预使用、保真度和儿童结果，专门解决了干预的吸收和可持续性。实验实施过程将分三个阶段进行，并在5个时间点进行审查。在前三个月的研究阶段，项目聘用的MSWs和寄养父母倡导者（“变革推动者”）将融入现有的机构社会工作团队，共同提供小组和家访，由研究项目和机构主管共同培训和监督，并特别注重增加知识，曝光和与潜在的干预接受者的沟通。在第二阶段，将积极将干预措施转移给现有的提供者，特别注重培训关键意见领袖提供者有效传播干预措施。在第三阶段，机构工作人员将提供服务，只有在机构提供者提出要求时才提供咨询。在美国，超过50万的寄养儿童是我们社会中最脆弱的群体。他们有很大的心理健康问题风险，导致在成年早期被监禁（27%的男孩和10%的女孩）和无家可归（12%的青年）等后果的风险极高（Courtney等人，2001年）。鉴于这一人口的极端脆弱性和改变其生活机会的迫切需要，传播阻断这一轨迹的有效干预措施的战略意义重大。