Community Development Teams to Scale-Up MTFC in California

描述（由申请人提供）：尽管在开发和测试干预措施方面取得了巨大进展，并在儿童和青少年随机试验中显示出一致的积极效果，但超过90%的公共资助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，需要研究将有效的干预措施转移到现实世界的社区环境中。在本应用程序中，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，旨在促进在尚未使用多维治疗寄养（MTFC）的加州县采用，实施和可持续性。为了检验CDT干预的有效性，各县将被随机分配到CDT加MTFC标准实施组（CDT）或仅MTFC标准实施组（SI）。CDT县和SI县都将获得实施MTFC所需的资源，县将支付向儿童和家庭提供的所有直接服务。CDT干预模式是由加州心理健康研究所（CIMH）开发的，旨在参与和支持整个州的循证规划。在本研究中，我们将测试一组固定的背景因素（即，作为CMHS护理系统站点，贫困水平，城市/农村，消费者倡导的存在，合作历史）是否会调节假设的干预效果。此外，我们将研究一系列动态背景因素（即心理和组织气候，以及对循证实践的态度）的变化是否介导随机分配与干预效果之间的关联。将采用涉及系统决策者、消费者代表、机构管理人员、从业人员、寄养父母、青年及其家庭的多层次干预和评估方法。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，以及假设的固定因素的调节作用和动态因素的中介作用。本研究的设计将提供信息，增进对“需要什么”的理解，以参与和支持社区中以证据为基础的项目的吸收、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.