The fickle fates of push and pull in the dissemination of mental health programs for children.

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As the demand for evidence-based programs has increased, considerable research has concentrated on the development and testing of innovative and promising prevention and treatment programs. However, a knowledge gap remains between research in children's mental health and the educational and health services providers who could use the programs produced. In contrast to the elaborate national system set up for monitoring and disseminating medications, the infrastructures to support the evaluation and dissemination of prevention and treatment programs targeting children's mental health have only begun to be developed. Based on my experiences in a community-based research project that has worked for the last decade to develop and evaluate the WITS (Walk away, Ignore, Talk it out, and Seek help) programs for the prevention of peer victimization, I illuminate obstacles to the dissemination of evidence-based prevention programs for children and solutions that are beginning to address these obstacles. In particular, I argue that enduring, integrated community, provincial and federal infrastructures are needed to improve program dissemination and to monitor their effects on children's well-being. Keywords: knowledge transfer, diffusion of innovation, mental health, children adolescence The reality that children and adolescents suffer from mental health problems is no longer questioned. There is also no doubt that the social, emotional and behavioural problems that are symptomatic of their mental health problems can have pervasive consequences for healthy child development: childhood and adolescent mental illnesses can disrupt school readiness and academic achievement; compromise relationships with family, teachers and peers; undermine attention; exacerbate physical complaints, and even damage the architecture of the developing brain (Gunner, 2007; Shonkoff & Phillips, 2000; Tolan & Dodge, 2005). The fact that few children who have mental health problems receive the care that they need is also widely recognised. Canadian and United States data indicates that only 5-18% of children with a diagnosable psychological problem receive any form of treatment (Kirby & Keon, 2006; Tolan & Dodge, 2005). Two widely circulated reports Out of the Shadows at Last: Highlights and Recommendations of the Final Report on Mental Health, Mental Illness and Addiction (Kirby & Keon, 2006) and Mental Health: A Report of the Surgeon General (U.S. Department of Health & Human Services, 1999) make clear that early detection of childhood mental health concerns can help to prevent school failure, poor employment opportunities and criminal activities. Considerable research also shows that even prodromal or subclinical symptoms, those that do not meet criteria for diagnosis of a disorder, can affect children's development and their relationships with their parents, peers, teachers, and so forth. However, universal mental health promotion programs or secondary prevention programs addressing these concerns are not widely available. What role can prevention programs play in the gathering momentum to improve children's mental health? Prevention of mental health problems in children shows benefits in reducing treatment costs in the United States (Weissberg, Kumpfer, & Selligman, 2003), but in Canada universal and even secondary prevention programs - particularly involving mental health concerns typically are not widely distributed and their effectiveness and cost savings are not monitored. Indeed, despite extensive research on the development and evaluation of innovative programs, only a few are adopted, often only locally, and typically for only short periods. In this paper, I argue that there are serious obstacles embedded in our traditional reliance on relationships between individual researchers and service providers for the development and dissemination of evidence-based programs to promote children's mental health and prevent illness. …