Improving Child Behavior Using Task Shifting to Implement MFGs in Child Welfare

由儿童福利（CW）参与家庭抚养的具有破坏性行为困难的儿童增加了 未来遭受虐待和被安置在家庭外的风险。然而，缺乏可用的提供者和困难 让家庭参与精神卫生机构往往限制了获得治疗的机会。社区组织 由CW当局签约以防止家庭外安置的社区组织可能是理想的分娩地点 心理健康循证实践（EBP）作为现有安置预防服务的辅助手段。作为 因此，在一个环境中可以全面满足涉及化学武器的家庭的需要。不幸的是， 在CW环境中成功实施，特别是那些最初设计由 高级心理健康提供者（即，硕士或博士）。鉴于国会预算办公室通常雇佣单身汉级别的 由于社会工作者缺乏先进的心理健康培训，这是实施的一个重大障碍。作为 作为一种潜在的解决方案，任务转移为促进EBP的实施提供了一种实用而有效的策略 在精神卫生专业人员短缺的情况下，涉及（1）调整EBP，由非 心理健康提供者;（2）在定制的EBP中培训非心理健康提供者;（3）建立 由心理健康专家对非心理健康提供者进行定期监督和监测。拟议 R21研究将改进任务转移策略，以实施EBP，减少儿童破坏性行为 困难，最初设计由先进的心理健康从业者（硕士或博士）提供，所以 它可以由社区组织中的学士级别的个案工作者提供， cw的家庭。我们将利用多家庭集团制造（MFG）服务提供模式， 儿童破坏性行为障碍的例子EBP，因为它有一个有益的影响， 在社区儿童心理健康环境中进行测试时， 为涉及CW的家庭提供服务。本研究的主要目的是：（1）利用任务转移的方法来调整教学内容， 培训和监督生产，由学士学位的个案工作者在为涉及化学武器的人服务的社区组织中提供 （2）评估在服务于CW的社区组织中任务转移的MFG的可行性和可接受性- 涉及家庭。本研究的设计和评价由实用，稳健， 执行和可持续性模式（PRISM），以支持长期执行工作。我们将使用 采用定量和定性相结合的方法评估可行性和关键利益攸关方的可接受性 （个案工作者、主管、照顾者）。通过使用CW系统作为非专业服务部门平台， 开展有针对性的心理健康服务，拟议的研究将提供有关使用 任务转移，以促进类似EBP的交叉设置实施。任务转移还可以提供 在转变儿童服务系统过程中，以创新方式增加EBP的使用并降低成本。

Children with disruptive behavior difficulties reared by child welfare (CW)-involved families have an increased risk of future maltreatment and out-of-home placement. However, the lack of available providers and difficulties engaging families in mental health agencies frequently limit treatment access. Community-based organizations (CBOs) contracted by CW authorities to prevent out-of-home placement may be ideal locations to deliver child mental health Evidence-Based Practices (EBPs) as an adjunct to existing placement prevention services. As a result, CW-involved families' needs can be met comprehensively in one setting. Unfortunately, few EBPs have been successfully implemented in CW settings, especially those originally designed to be delivered by advanced mental health providers (i.e., Masters or PhDs). Given that CBO's typically employ bachelors'-level caseworkers who lack advanced mental health training, this is a significant barrier to implementation. As a potential solution, task shifting provides a practical and efficient strategy for facilitating implementation of EBPs where there are shortages of mental health professionals, involving (1) tailoring the EBP for provision by non- mental health providers; (2) training non-mental health providers in the tailored EBP; and (3) establishing regular supervision and monitoring of non-mental health providers by mental health specialists. The proposed R21 study will refine task-shifting strategies to implement an EBP to reduce child disruptive behavior difficulties, originally designed to be provided by advanced mental health practitioners (Masters or PhD), so that it can be delivered by bachelor's-level caseworkers in CBOs providing placement prevention services to CW-involved families. We will utilize the Multiple Family Group MFG (MFG) service delivery model to reduce child disruptive behavior disorders as the example EBP, because it has a beneficial impact on engagement, child behavior, and family processes when tested in community child mental health settings that provide services to CW-involved families. The proposed study aims are: (1) to use task shifting to tailor the content, training, and supervision of MFGs for delivery by bachelor's-level caseworkers in CBOs serving CW-involved families; and (2) to assess the feasibility and acceptability of the task-shifted MFGs in CBOs serving CW- involved families. The design and evaluation for this study are informed by the Practical, Robust, Implementation and Sustainability Model (PRISM) to support longer-term implementation efforts. We will use mixed quantitative and qualitative methods to assess for feasibility and acceptability from key stakeholders (caseworkers, supervisors, caregivers). By using the CW system as a non-specialty service sector platform to launch targeted mental health services, the proposed study will provide generalizable knowledge about using task shifting to facilitate cross-setting implementation for similar EBPs. Task shifting may also provide an innovative way to increase EBP access and reduce costs within transforming child-serving systems.