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

描述（由申请人提供）：有破坏性行为障碍的儿童在儿童福利（CW）参与的家庭中长大，未来遭受虐待和家庭外安置的风险增加。然而，由于缺乏可用的提供者和难以让家庭参与精神卫生机构，往往限制了获得治疗的机会。社区卫生组织当局与社区卫生组织签订合同，以防止家庭外安置，这可能是提供儿童心理健康循证实践作为现有安置预防服务的补充的理想场所。因此，参与化武的家庭的需求可以在一个环境中得到全面满足。不幸的是，很少有ebp在连续精神卫生环境中成功实施，特别是那些最初设计由高级精神卫生提供者（即硕士或博士）提供的ebp。鉴于CBO通常雇用缺乏高级心理健康培训的学士级个案工作者，这是实施的一个重大障碍。作为一种潜在的解决方案，任务转移为促进在缺乏精神卫生专业人员的地方实施EBP提供了一种实用而有效的策略，包括：(1)调整EBP以供非精神卫生提供者提供；(2)对非精神卫生服务提供者进行个性化EBP培训；(3)建立由精神卫生专家对非精神卫生提供者的定期监督和监测。拟议的R21研究将改进任务转移策略，以实施EBP来减少儿童破坏性行为困难，最初设计由高级心理健康从业人员（硕士或博士）提供，现在可以由cbo的学士水平的个案工作者提供，为涉及暴力行为的家庭提供安置预防服务。我们将利用多家庭群体MFG （MFG）服务交付模式来减少儿童破坏性行为障碍，作为EBP的例子，因为在社区儿童心理健康机构中进行测试时，它对参与、儿童行为和家庭过程产生了有益的影响，这些社区儿童心理健康机构为参与家庭提供服务。本研究的主要目的是：(1)利用任务转换的方法，为社区服务组织本科级个案工作者提供的家庭护理服务量身定制内容、培训和监督；(2)评估任务转移型家庭教师在社区服务组织中服务涉痛家庭的可行性和可接受性。本研究的设计和评估以实用、稳健、实施和可持续性模型（PRISM）为依据，以支持长期的实施工作。我们将使用混合的定量和定性方法来评估关键利益相关者（个案工作者、主管、照顾者）的可行性和可接受性。本研究通过将心理健康服务系统作为一个非专业服务平台来开展有针对性的心理健康服务，将为使用任务转移来促进类似ebp的交叉设置实施提供可推广的知识。任务转移也可能提供一种创新的方式来增加EBP的使用，并在转变儿童服务系统中降低成本。

DESCRIPTION (provided by applicant): 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, an 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.