Children's Mental Health Agency Research Articles

33.2 Training Clinical Staff in Genuine CBT and Using Competency-Based Supervision and Measurement-Based Care to Improve Client Outcomes

With the goal to improve client outcomes by providing them with high-quality, adherent, and flexible CBT, a large children's mental health agency implemented systematic training, a competency-based supervision model, and measurement-based care. We will describe how this agency redeveloped their service delivery system using the highest, evidence-based standards.

Leader–member exchange and organizational climate effects on clinician turnover intentions

PurposeClinician turnover in mental health settings impacts service quality, including availability and delivery of evidence-based practices. Leadership is associated with organizational climate, team functioning and clinician turnover intentions (TI). This study examines leader–member exchange (LMX), reflecting the relationship between a supervisor and each supervisee, using mean team LMX, dispersion of individual clinician ratings compared to team members (i.e. relative LMX) and team level variability (i.e. LMX differentiation), in relation to organizational climate and clinician TI.Design/methodology/approachSurvey data were collected from 363 clinicians, nested in children's mental health agency workgroups, providing county-contracted outpatient services to youth and families. A moderated mediation path analysis examined cross-level associations of leader–member exchange with organizational climate and turnover intentions.FindingsLower relative LMX and greater LMX differentiation were associated with higher clinician TI. Higher team-level demoralizing climate also predicted higher TI. These findings indicate that poorer LMX and more variability in LMX at the team level are related to clinician TI.Originality/valueThis study describes both team- and clinician-level factors on clinician TI. Few studies have examined LMX in mental health, and fewer still have examined relative LMX and LMX differentiation associations with organizational climate and TI. These findings highlight the importance of leader–follower relationships and organizational climate and their associations with clinician TIs. Mental health service systems and organizations can address these issues through fostering more positive supervisor–supervisee relationships.

Predicting Dropout from Children's Mental Health Services: Using a Need-Based Definition of Dropout.

Dropout from children's mental health services has negative impacts on children, families and service providers. To target interventions aimed to reduce dropout, it is essential to predict individuals who dropout. This study compares predictors of dropout using a novel need-based definition, to existing definitions of dropout. Children (N = 650; 61% male) aged 5-13 attended five children's mental health agencies in Ontario. A mixed effects logistic regression was used to model binary outcome variables (i.e., dropout or treatment completion), for each definition of dropout. Using the need-based definition, older child age, lower child problem presentation, higher child risk behaviors, higher caregiver needs, and more child strengths predicted an increased likelihood of dropout. The need-based definition results in different predictors of dropout than existing definitions in the literature. High caregiver needs was the only predictor of dropout across all definitions. Caregiver needs represent a prospective target when distributing interventions aimed to reduce dropout.

Defining Episodes of Care in Children's Mental Health Using Administrative Data.

Criteria to define an episode of care in children's mental health services are needed. Various criteria were applied to 5 years of visit data from children 4-11 years (N = 5,206) at their first visit to 1 of 3 children's mental health agencies. A minimum of 3 visits with 180 days between episodes optimized agreement with other dates (e.g., telephone intake assessment) marking the start and end of an episode, and clinician-rated number of episodes. Grouping visits into episodes provides a clearer representation of how services are distributed over extended periods of time, facilitating research and enhancing accuracy in service planning.

Interorganizational relationships among family support organizations and child mental health agencies.

This study examined: (1) qualitative aspects of close working relationships between family support organizations and child mental health agencies, including effective and ineffective characteristics of the relationship and aspects that they would change, and (2) the impact of the working relationship upon the family support organization. Semi-structured interviews were conducted with 40 directors of family support organizations characterized as having a close working relationship with a child mental health agency. Three main themes emerged regarding the quality of the working relationship: (a) interactional factors, including shared trust, communication, collaboration and service coordination; (b) aspects of the inner context of the family support organization, mental health agency, or both, including alignment of goals and values and perceptions of mental health services; and (c) outer contextual factors external to the organizations, such as financial and county regulations. Responses to the perceived impact of the relationship was divided into two themes: positive impacts (e.g. gained respect, influence and visibility), and negative impacts (e.g. lack of trust). This study lays the foundation for future research to better understand the mechanisms underlying interorganizational relationships in communities among different types of providers to create a more seamless continuum of services for families of children with mental health conditions.

An Institutional Case Study: Emotion Regulation with HeartMath at Santa Cruz County Children's Mental Health

This case study from Santa Cruz County Children's Mental Health Agency (CMH), California, reviews the use of measurement of heart rate variability (HRV) to enhance emotional regulation of patients. CMH serves seriously emotionally disturbed youths, many of whom have been separated from their parents for a prolonged period or have been vulnerable without the consistent presence of their caregivers. In this study, the HRV pattern was calculated as high coherence, medium coherence, or low coherence. According to Thurber et al, heart rhythm coherence “is experienced as a calm, balanced, yet energized and responsive state that is conducive to everyday functioning and interaction, including the performance of tasks requiring mental acuity, focus, problem solving and decision making, as well as physical activity and coordination.”1(p39) In the HeartMath program, there was a game in which high coherence was rewarded with a rainbow that dropped coins into a vessel. When coherence was low, the rainbow and coins disappeared until coherence was reached again. We measured HRV using a finger or ear sensor in individual sessions using a computer-based program from HeartMath Institute, Boulder Creek, California.After juvenile offenders overcame their initial fear of being hooked up to a potential lie detector, I instructed them in “Quick Coherence”1 and asked them to imagine breathing into the area of their heart. The participants created a library of positive feelings, thoughts, and memories on which they could focus. After a period of positive focus and rhythmic breathing, the clients were often able to move into medium or high coherence. In this state, they noticed that they felt calmer. I explained that they could use this tool to improve their mood. I also practiced alongside the youths in order to demonstrate the technique.The detained youths learned quickly, requested repeated sessions, and learned to combine breathing with recalling the good people, places, foods, and feelings in their lives that sustained them. We could also decrease coherence through the use of negative words such as “loss of privileges” on their side or “pay cut” on mine and then move back to coherence with suggestions of positive mental images.

Motivations to Pursue Accreditation in Children's Mental Health Care: A Multiple Case Study

AbstractAccreditation is a growing, worldwide phenomenon that has spread to a range of industries and fields, including nonprofit social services and mental health care. Thousands of organizations are accredited, but it is not known what is driving the growth of this phenomenon. Using a multiple case study design, this exploratory study aimed to understand children's mental health agencies' motivations to pursue accreditation. In‐depth interviews, focus groups, document reviews, and limited observations were conducted at five children's mental health agencies that had recently undergone or were undergoing the Council on Accreditation process. Agencies were influenced by external factors, such as policies that require accreditation, wanting to assert their positions in the field, and the need to increase funding opportunities. Other factors were internal, related to agency leadership using accreditation as a platform for change and agencies' genuine intent to improve services. Implications for agencies, accreditors, and future research are offered.

Sandy and Sandy in Seven Weeks: A Group Worker Reflects

The editor-in-chief of this journal was immersed in the recovery effort post-Hurricane Sandy, as a provider and survivor. Just weeks later, in his role as executive director of a children's mental health agency, his focus shifted as parents and children across the United States were destabilized by the news of the slaughter of innocents at Sandy Hook Elementary School. This essay traces those seven weeks and offers a reflection on reverberating disasters, emphasizing the important role that group work can play in the aftermath of traumatic events.

Continuity of Care in Children’s Mental Health: Development of a Measure

A new measure, Continuity of Care in Children's Mental Health (C3MH), is presented. The study involved item generation, pre-testing, pilot testing, and validation. The C3MH was administered to 364 parents recruited from 13 children's mental health agencies in Ontario, Canada. The measure includes five scales supported by confirmatory factor analysis. Scale validity was supported through analyses of relationships with established measures of satisfaction, problem severity, and therapeutic alliance, as well as through known-group differences. The results of a pilot youth-report version (N = 57) are presented. The C3MH will be a useful tool for assessing improvements in system integration.

Help-Seeking for Children with Mental Health Problems: Parents’ Efforts and Experiences

Parents who contacted 1 of 15 children's mental health agencies in Ontario, Canada reported on where and why they were seeking mental health services for their 4- to 17-year-old children. Parents contacted an average of four agencies (± 1.7; range = 1-14) in the previous year. Approximately one-half of parents were looking for either multiple types of treatment, or help for different problems, across agencies. The complex pattern of help-seeking evidenced in our study likely increases the burden on the mental health care system and on families, and may reduce the likelihood that families will connect with the most appropriate treatment.

Multilevel Confirmatory Factor Analysis of a Scale Measuring Interagency Collaboration of Children's Mental Health Agencies.

Multilevel confirmatory factor analysis was used to evaluate the factor structure underlying the 12-item, three-factor Interagency Collaboration Activities Scale (IACS) at the informant level and at the agency level. Results from 378 professionals (104 administrators, 201 service providers, and 73 case managers) from 32 children's mental health service agencies supported a correlated three-factor model at each level and indicated that the item loadings were not significantly (p < .05) different across levels. Reliability estimates of the three factors (Financial and Physical Resource Activities, Program Development and Evaluation Activities, and Collaborative Policy Activities) at the agency level were .81, .60, and .72, respectively, while these estimates were .79, .82, and .85 at the individual level. These multilevel results provide support for the construct validity of the scores from the IACS. When the IACS was examined in relation to level-1 and level-2 covariates, results showed that participants' characteristics (i.e., age, job role, gender, educational level, and number of months employed) and agency characteristics (i.e., state location and number of employees) were not significantly (p > .05) related to levels of interagency collaboration.

The Use of Group Work to Fight Acute External Threats to a Community-Based Organization During Harsh Economic Times

This article addresses the use of group work in a community-based outpatient children's mental health agency to respond to financial threats by county and state government during the economic downturn of 2008–2009. Three specific threats that came within months of one another are discussed: (1) the threat to close down a chemical dependency treatment service for youth, (2) severe funding cuts to an outreach program for immigrant youth and their families, and (3) a state government plan to restructure/reform reimbursement for outpatient mental health services that promises to reduce access to care for underinsured families. Group work was used to organize, educate, and activate staff, board, community, and consumer groups, in large and small groups, to counter the threats and build a culture of advocacy. Lending a vision, empowering advocates, managing polarity, and shaping the advocacy message were essential elements of the advocacy process.

The Status of States' Policies to Support Evidence-Based Practices in Children's Mental Health

This study examined the efforts of states' mental health authorities to promote the use of evidence-based practices through policy. Data were drawn from three components of a national study, including a survey of state children's mental health directors (N=53), which was developed using a three-step process that involved stakeholders. Data from the directors' survey revealed that over 90% of states are implementing strategies to support the use of evidence-based practices. The scope of these efforts varies, with 36% reporting statewide reach. Further, states' strategies for implementing evidence-based practices are often not accompanied by comparable efforts to enhance information systems, even though enhancing such systems can bolster opportunities for successful implementation. Variability in the adoption of evidence-based practices, poor attention to information systems, and inconsistent fiscal policies threaten states' efforts to improve the quality of children's mental health services.

The effect of a learning collaborative to improve engagement in child mental health services

This study examined the impact of a learning collaborative composed of five child mental health agencies which was conducted from November 2005 to November 2006 in a suburban community adjacent to New York City. Data submitted by each agency (in November/December 2005, and then monthly between April 2006 and November 2006) regarding: 1) initial show-rates for first intake appointments for all new evaluations of children and adolescents, and/or; 2) attendance at any scheduled clinic appointment subsequent to the first kept intake appointment, were retrospectively analyzed. Agencies reported an increase in kept initial appointments ranging from 5% to 21% over the previous year, while kept subsequent appointments evidenced an increase between 2% and 16%. In contrast, one site that did not administer the engagement strategies noted a decrease in both engagement and subsequent appointment rates during the course of the collaborative between 9% and 13% respectively. These findings support the effectiveness of learning collaboratives for improving service use among youth with mental health difficulties and their families.

Integrating evidence-based practice in the child mental health agency: A template for clinical and organizational change.

This article describes a linked set of activities designed to address the present "science-to-service" gap in evidence-based practice from the perspective of the nonprofit child mental health agency: (a) implementing "systems-of-care" principles; (b) logic modeling; (c) strategic partnerships with external researchers; (d) selective, in-depth program evaluation; (e) critical comparison with a limited number of evidence-based practice models of national significance; and (f) internal and external dissemination activities oriented to evidence-based practice. Implications are drawn both for continuous quality improvement of existing clinical services and for the potential for agencies to contribute high quality, science-based information to child mental health services, singly and through the future development of a national network of experimenting child mental health agencies.

Creating a Group Work Culture in a Children's Mental Health Agency: A Professional Memoir

Creating a Group Work Culture in a Children's Mental Health Agency: A Professional Memoir

Maintaining High Subject Retention in Follow-Up Studies of Children with Mental Illness

Measuring a program's success in enabling a child to improve functioning at home, school, and the community requires careful tracking of children's progress during the intervention and after it is completed. Attrition is often a major problem in carrying out longitudinal research. I present a number of strategies for maintaining high rates of response in follow-up studies, including how to choose a study design that enhances participation, how to locate study participants, how to engage study participants, and how to select and train high quality interviewers. The strategies presented have been used with success by a children's mental health agency and may be helpful to other researchers as they evaluate programs, measure outcomes, and study the life course of children with mental illness.

Tracking Behavioral Progress Within a Children's Mental Health System

In recent years, children's mental health agencies have been called on to demonstrate increased accountability for the services they provide. At the same time, the advent of managed care approaches to service provision for children and their families has placed increased emphasis on the use of outcome measures to monitor client progress as well as track system efficiency. In this article, we begin by discussing the role of behavioral adjustment as an outcome variable for children's mental health. Then, the Vermont Community Adjustment Tracking System (VT-CATS), which includes four behavioral instruments designed to provide intensive, ongoing, and interpretable behavioral assessment of a service system's most challenging children and adolescents, is described. Next, the adjustment indicator checklists that compose VT-CATS are described, including the rationale behind their development, structures, and psychometric properties. Finally, the ability of VT-CATS to address agencies' multiple evaluation demands is discussed, including examples of behavior tracking of individual clients, evaluation of the impact of an intervention, and the use of behavioral data to guide service system policy.

Planning mental health services for children and youth: Part II—Findings of a value-based community consultation project

The main purpose of this paper is to describe the empirical results of a community consultation process designed to help a children's mental health agency review its mandate. We report in this article findings related to three essential ingredients of the renewal project: values, needs, and services. Data from 557 people representing various stakeholder groups were collected using mailout questionnaires and 12 focus groups. Findings reveal that stakeholders envision a Center that is both accessible and responsive to its clients. In terms of the mental health needs of children and youth, three areas were highlighted: (a) conduct disorders and behavioral problems, (b) emotional problems, and (c) problems related to sexual abuse. Youth reported significant difficulties with substance abuse and family problems. Adult respondents recommended a change in the Center's budget to allow for more prevention-oriented services. The challenge for the Center was to incorporate the community's suggestions into their mandate and to continue to involve relevant stakeholders throughout the agency's renewal process. Some of the changes that have taken place since the mandate review are reported.

Planning mental health services for children and youth: Part I—A value-based approach

The main purpose of the paper is to introduce a value-based approach to planning in mental health and human services. Based on the values of self-determination, collaboration and democratic participation, and distributive justice, we present a sequential planning framework that allows stakeholders to consider the following six facets of a service-oriented organization: (a) values, (b) needs, (c) vision, (d) resources, (e) mission, and (f) service. Following an explanation of the rationale and need for such framework, we describe in a case study how we implemented this approach in helping a children's mental health agency conduct a mandate review. We describe how we attempted to enact the values mentioned above during the pre-entry, entry, work, and separation phases of the consultative process. The case study concludes with a 30 month followup report. Finally, we discuss the benefits and challenges encountered in applying this framework, and encourage evaluators and program planners to make explicit and share with others the values, assumptions, and premises that guide their work.