Community Development Teams to Scale-Up MTFC in California

描述（由申请人提供）：虽然在开发和测试干预措施方面取得了巨大进展，这些干预措施对儿童和青少年随机试验的结果显示出一致的积极影响，但超过90%的公共资助的儿童服务系统不提供有证据支持的治疗或服务。如PA-04-019所述，需要研究如何将有效的干预措施落实到真实的世界社会环境中。在这个应用程序中，我们建议测试社区发展团队（CDT）的有效性，理论驱动的模型，以促进采用，实施和可持续性的一个这样的干预（多维治疗寄养; MTFC）在加州县尚未使用MTFC。为了检查CDT干预措施的有效性，各县将被随机分配到CDT + 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，县将支付所有对儿童和家庭的直接服务。CDT干预模式是由加州心理健康研究所（CIMH）开发的，旨在参与和支持全州的循证规划。在拟议的研究中，我们将测试一组固定的上下文因素（即，作为CMHS系统的护理站点，贫困程度，城市/农村，消费者宣传的存在，合作历史）缓和了假设的干预效果。此外，我们将研究一组动态上下文因素（即，心理和组织气候，以及对循证实践的态度）介导随机分配和干预效果之间的关联。将采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、从业者、养父母以及青少年及其家人。分析将检查干预结果（MTFC的采用率、实施率和可持续性）的组间差异，以及固定因素的假设调节效应和动态因素的中介效应。这项研究的设计将提供信息，增加对“需要什么”的理解，以参与和支持社区循证方案的吸收、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.