Abstract
BackgroundOppositional defiant disorder (ODD) is a major mental health concern and highly prevalent among children living in poverty-impacted communities. Despite that treatments for ODD are among the most effective, few children living in poverty receive these services due to substantial barriers to access, as well as difficulties in the uptake and sustained adoption of evidence-based practices (EBPs) in community settings. The purpose of this study is to examine implementation processes that impact uptake of an evidence-based practice for childhood ODD, and the impact of a Clinic Implementation Team (CIT)-driven structured adaptation to enhance its fit within the public mental health clinic setting.Methods/designThis study, a Hybrid Type II effectiveness-implementation research trial, blends clinical effectiveness and implementation research methods to examine the impact of the 4Rs and 2Ss Multiple Family Group (MFG) intervention, family level mediators of child outcomes, clinic/provider-level mediators of implementation, and the impact of CITs on uptake and long-term utilization of this model. All New York City public outpatient mental health clinics have been invited to participate. A sampling procedure that included randomization at the agency level and a sub-study to examine the impact of clinic choice upon outcomes yielded a distribution of clinics across three study conditions. Quantitative data measuring child outcomes, organizational factors and implementation fidelity will be collected from caregivers and providers at baseline, 8, and 16 weeks from baseline, and 6 months from treatment completion. The expected participation is 134 clinics, 268 providers, and 2688 caregiver/child dyads. We will use mediation analysis with a multi-level Structural Equation Modeling (SEM) (MSEM including family level variables, provider variables, and clinic variables), as well as mediation tests to examine study hypotheses.DiscussionThe aim of the study is to generate knowledge about effectiveness and mediating factors in the treatment of ODDs in children in the context of family functioning, and to propose an innovative approach to the adaptation and implementation of new treatment interventions within clinic settings. The proposed CIT adaptation and implementation model has the potential to enhance implementation and sustainability, and ultimately increase the extent to which effective interventions are available and can impact children and families in need of services for serious behavior problems.Trial registrationClinicalTrials.gov, ID: NCT02715414. Registered on 3 March 2016.
Highlights
Oppositional defiant disorder (ODD) is a major mental health concern and highly prevalent among children living in poverty-impacted communities
Poverty is one of the greatest risk factors for the onset and perpetuation of disruptive behavior disorder (DBD) [2,3,4]: studies indicate that the accumulation of risk factors associated with poverty, including increased exposure to violence and traumatic events, devastating impact of substance abuse, criminal activity, and chronic disease, as well as family strain have an additive effect, in that the more risk factors a child is exposed to increases their likelihood of exhibiting serious behavioral challenges [1, 5]
Provider motivation waned in the presence of high levels of family engagement and intensity of family need. These findings suggested that the implementation of the 4Rs and 2Ss Multiple Family Group (MFG) required attention to multi-level implementation processes to modify service delivery practices on a sustainable level
Summary
Oppositional defiant disorder (ODD) is a major mental health concern and highly prevalent among children living in poverty-impacted communities. Despite that treatments for ODD are among the most effective, few children living in poverty receive these services due to substantial barriers to access, as well as difficulties in the uptake and sustained adoption of evidence-based practices (EBPs) in community settings. Poverty is one of the greatest risk factors for the onset and perpetuation of DBDs [2,3,4]: studies indicate that the accumulation of risk factors associated with poverty, including increased exposure to violence and traumatic events, devastating impact of substance abuse, criminal activity, and chronic disease, as well as family strain have an additive effect, in that the more risk factors a child is exposed to increases their likelihood of exhibiting serious behavioral challenges [1, 5]. Even though children who live in poor communities are at the highest risk for DBDs, they are the least likely to receive effective mental health services
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