Child Community Mental Health Research Articles

Randomized Feasibility Pilot of an Executive Functioning Intervention Adapted for Children's Mental Health Settings.

The critical role of executive functioning in autism as well as the co-occurring mental health challenges common among autistic youth support to the immense value of interventions targeting executive functioning for enhancing mental health services for autistic children. The goal of the present study was to conduct a randomized feasibility trial of Unstuck and On Target, an executive functioning intervention, adapted for delivery in children's community mental health setting. Mental health therapists (n = 26) enrolled with participating autistic clients (n = 32) were randomized to receive training in and deliver the adapted Unstuck intervention or to deliver care as usual. We completed masked observational measures of Unstuck strategy use (fidelity) during recorded sessions of participating therapist-client dyads and collected measures of acceptability from participating clients and their caregivers. We also collected measures of pre-post changes in executive functioning and mental health symptoms. Therapists trained in Unstuck demonstrated significantly higher use of Unstuck strategies compared to usual care therapists. Caregivers and autistic clients perceive adapted Unstuck as highly acceptability and helpful. Autistic clients whose therapists were trained in adapted Unstuck demonstrated larger pre-post changes in executive functioning compared to usual care. Across all participating clients, changes in executive functioning were significantly related to changes in mental health symptoms. Finally, clients of therapists trained in adapted Unstuck demonstrated moderate improvements in overall mental health symptoms. The current study provides preliminary evidence of the feasibility and impact of Unstuck and On Target for children's community mental health settings.

Implementing Evidence Based Practices for Children's Mental Health: A Case Study in Implementing Modular Treatments in Community Mental Health.

There is strong enthusiasm for utilizing implementation science in the implementation of evidence-based programs in children's community mental health, but there remains work to be done to improve the process. Despite the proliferation of implementation frameworks, there is limited literature providing case examples of overcoming implementation barriers. This article examines whether the use of three implementations strategies, a structured training and coaching program, the use of professional development portfolios for coaching, and a progress monitoring data system, help to overcome barriers to implementation by facilitating four implementation drivers at a community mental health agency. Results suggest that implementation is a process of recognizing and adapting to both predictable and unpredictable barriers. Furthermore, the use of these implementation strategies is important in improving implementation outcomes.

Ethnic minority community therapists' acculturation and reported adaptations to children's evidence-based practices.

This study examined associations between ethnic minority therapists' reports of acculturation and adaptations made to multiple evidence-based practices (EBPs) in children's community mental health services. Multilevel modeling was used to analyze therapist- and practice-level predictors of Augmenting and Reducing/Reordering adaptations, the two subscales of the Adaptations to Evidence-Based Practices Scale (AES; Lau et al., 2017). An online survey was completed by 235 therapists (86% women, Mage = 34.82 years, 68.1% Hispanic/Latino) as part of a larger study examining EBP sustainment in Los Angeles County, California. Acculturation was measured through therapist reports of cultural identity and language use using the Abbreviated Multidimensional Acculturation Scale (Zea, Asner-Self, Birman, & Buki, 2003). Analyses showed that the effect of Heritage Cultural Identity on Augmenting adaptations was moderated by Heritage Language Use. There was a significant interaction between Heritage and United States Cultural Identity dimensions in predicting Reducing/Reordering adaptations. Therapists who reported higher levels of Heritage Cultural Identity and lower levels of United States Cultural Identity reported the fewest Reducing/Reordering adaptations, whereas therapists who reported higher levels of affiliation with both their Heritage Culture and United States Culture reported making the most Reducing/Reordering adaptations. Language acculturation and other cultural factors such as Ethnicity and Generational Status did not predict either adaptation type. Therapists who reported more favorable perceptions of the EBP reported making fewer Reducing/Reordering adaptations. Findings suggest that cultural identity is linked to the likelihood that ethnic minority therapists may adapt EBPs. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Child Trauma Screen: A Follow-Up Validation.

Although the prevalence of exposure to potentially traumatic events and associated outcomes among children is well documented, widespread trauma screening remains limited. This study provides additional data supporting the psychometrics of the Child Trauma Screen (CTS), a free, brief, empirically derived measure that was intended as a trauma screen for use across child-serving systems. Participants were an ethnically diverse sample of 187 children aged 6-18 years recruited from an urban children's community mental health clinic. At intake, children and their caregivers completed the CTS and other standardized measures of posttraumatic stress disorder, externalizing behavior, anxiety, and depression. Results indicated that the CTS had strong properties on both child and caregiver reports, including internal consistency (Cronbach's α = .78 for both), convergent validity (r = .83 and r = .86), divergent validity (mean across measures and reporters, r = .31; range r = .01-.70), and criterion validity (sensitivity = 0.83 and 0.76; specificity = 0.95 and 0.79, correct classification 89.3% and 81.4%). Suggested cut points and recommendations for using the CTS as a trauma screen are provided. This study provides further empirical support for the use of the CTS as a brief trauma screening measure and provides recommendations for further research.

The Effects of Prompts on Minority Children's Screening Attendance at a Community Mental Health Center

This study examined the impact of prompts upon the screening attendence rate at a children's community mental health center (CMHC) serving lower socioeconomic urban minority clients. Subjects (274 children under age 18 and their adult caretakers who contacted the CMHC for screening appointments) were assigned to one of three conditions: (a) a phone prompt one day before the appointment, (b) a letter prompt one to two days before the appointment, and (c) a no-intervention control group. Both phone and letter prompts produced significantly greater attendance than the no-intervention condition. The phone prompt group evidenced a tendency toward greater attendance than the letter prompt group. A cost analysis indicated that the phone prompt generated more net revenue than the other two conditions and had a lower total cost and per subject than the conditon. The data suggest that prompts can be effectively used by mental health facilities to engage minority clients in the intial phase of the treament process.

Evaluating a Community Mental Health Center Program for Children

Mental health professionals are increasingly investing time and effort in the evaluation of their services. The present study describes one such evaluative effort undertaken by a children's Community Mental Health Center located in an inner cily neighborhood. Program results indicated that about two-thirds of children evidenced betler functioning following treatment. When presenting problems were categorized into distinct diagnostic entities, therapist ratings indicated that greater improvements were found with anxiety and situational problems, as compared to acting-out difficulties. Improvement was generally nor associated with demographic variables. On a follow-up consumer satisfaction questionnaire, children's parents reported being satisfied with the services provided at the Mental Healrh Center.

The children's community mental health center emerges

The children's community mental health center emerges