Community Development Teams to Scale-Up MTFC in California

说明(申请人提供)：尽管在对儿童和青少年进行的随机试验中，在干预措施的开发和测试方面取得了巨大进展，这些干预措施对结果产生了一致、积极的影响，但90%以上的公共资助的儿童服务系统没有提供有证据支持的治疗或服务。如PA-04-019所述，需要研究将有效干预措施转移到现实世界社区环境中。在这项应用中，我们建议测试社区发展团队(CDT)的有效性，这是一个理论驱动的模型，旨在促进一种此类干预措施(多维治疗寄养护理；MTFC)在加州尚未使用MTFC的县的采用、实施和可持续性。为了检查CDT干预的有效性，将县随机分配到CDT加MTFC标准实施(CDT)条件或仅MTFC标准实施(SI)条件。CDT和SI县都将获得实施MTFC所需的资源，县将支付所有直接为儿童和家庭提供的服务。CDT干预模式是由加州精神卫生研究所(CIMH)开发的，目的是在全州范围内参与和支持循证规划。在拟议的研究中，我们将测试一套固定的背景因素(即CMHS护理地点系统、贫困程度、城市/农村、消费者权益主张的存在、合作历史)是否会缓和假设的干预效果。此外，我们将检验一组动态背景因素(即，心理和组织气氛，以及对循证实践的态度)的变化是否在随机分配和干预效果之间起中介作用。将使用多层次的干预和评估方法，涉及系统决策者、消费者代表、机构管理人员、从业人员、养父母以及青年及其家庭。分析将检验干预结果的群体差异(MTFC的采用率、实施率和可持续性)，以及固定因素的假设调节作用和动态因素的调节作用。这项研究的设计将提供信息，以增加对“需要什么”的理解，以参与和支持社区中循证项目的接受、实施和可持续性。

DESCRIPTION (provided by applicant): Although there has been tremendous progress in the development and testing of interventions that have shown consistent, positive effects on outcomes in randomized trials with children and adolescents, over 90% of publicly-funded child service systems do not deliver treatments or services that have an evidence base to support them. As described in PA-04-019, research is needed on the movement of efficacious interventions into real world community settings. In this application, we propose to test the effectiveness of the Community Development Team (CDT), a theory-driven model to promote the adoption, implementation, and sustainability of one such intervention (Multidimensional Treatment Foster Care; MTFC) in California counties that are not already using MTFC. To examine the effectiveness of the CDT intervention, counties will be randomly assigned to the CDT plus Standard Implementation of MTFC (CDT) condition, or to the Standard Implementation of MTFC only (SI) condition. Both CDT and SI counties will receive the resources needed to implement MTFC, and counties will pay for all direct services to children and families. The CDT intervention model was developed by the California Institute for Mental Health (CIMH) in an effort to engage and support evidence-based programming throughout the state. In the proposed study, we will test whether a set of fixed contextual factors (i.e., being a CMHS System of Care site, level of poverty, urban/rural, presence of consumer advocacy, history of collaboration) moderate the hypothesized intervention effect. Additionally, we will examine whether changes in a set of dynamic contextual factors (i.e., psychological and organizational climate, and attitudes toward evidence-based practices) mediate the association between random assignment and the intervention effects. A multi-level intervention and assessment approach will be used that involves system decision makers, consumer representatives, agency administrators, practitioners, foster parents, and youth and their families. Analyses will examine group differences in the intervention outcomes (rates of adoption, implementation, and sustainability of MTFC), as well as the hypothesized moderating effects of fixed factors and the mediating effects of dynamic factors. The design of this study will provide information that increases the understanding of "what it takes" to engage and support uptake, implementation, and sustainability of evidence-based programs in communities.