Implementation Of Effective Services Research Articles

Embedding social emotional learning from the bottom up in multi‐tiered services and supports frameworks

AbstractStudent mental health needs continue to rise across the United States and many students and families rely on schools to provide services to meet these needs. Yet, an overwhelming number of available frameworks and approaches to school mental health (SMH) and overlapping terminology surrounding SMH supports like trauma‐informed (TI) approaches, social and emotional learning (SEL), and others can lead to confusion and potentially less effective implementation of services and supports for students. In this paper, we aim to mitigate this confusion and offer a solution that integrates several of these approaches into a single complementary model with a special emphasis on the role of SEL. We first present an overview of commonly used SMH frameworks. Next, we present the Trauma‐Informed Multi‐Tiered Systems of Support Model (TI‐SEL MTSS)–an adaptation of the TITI‐SEL MTSS–to include and emphasize the specific role of SEL as a critical foundational layer within a multi‐tiered system of support. The proposed adapted model maintains the key structure of a MTSS while highlighting the importance of embedding SEL pedagogy in daily teaching practices and all aspects of school life. A case study is used to illustrate how the proposed model adaptations can be used in practice and in tandem with TI and SMH services without being conflated as the same service as SEL. Practical implications for implementation are discussed.

Correlates of Maternal Mortality

Maternal death is an indicator of quality and efficiency of reproductive health services and is regarded as a composite measure of the country’s progress. Reduction in maternal mortality is one of the eight globally accepted Millennium Development Goals (MDGs). To achieve the goal of 109, by 2015, the developing world needs to take challenge where the burden of maternal mortality is 99 per cent. This study attempts to understand the strength of relationship of the correlates of maternal mortality with actual maternal mortality ratio (MMR) to come out with policy implications to lessen maternal deaths. Based on the National Family Health Survey (NFHS)-3 data on maternal health indicators and sample registration systems (SRS) estimates of maternal mortality, the relationships are explored. Maternal deaths would significantly reduce when fertility declines, that is, when contraception increases, when status of women enhances, they are sufficiently fed to have normal body mass index (BMI) and have awareness of reproductive health issues. The most prominent correlate is utilization of reproductive health care services. When all antenatal, natal and postnatal services are utilized to a large extent, maternal deaths would diminish significantly. Effective implementation of services is a key to trim down maternal mortality.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

PROTOCOL: Strategies for scaling up the implementation of interventions in social welfare: protocol for a systematic review.

Developing safeguarding services to protect children – what are the key components?

This paper, drawing on UK and international experiences, suggests that the key components of an effective national system of services to safeguard children from being maltreated have to not only be in place but also functioning effectively in an integrated manner if they are to achieve their aims. The United Nations Convention on the Rights of the Child (UNCRC) provides a common international framework for all governments, organisations and professionals to work within. It should be incorporated into domestic legislation, which is supported by national frameworks and protocols that are underpinned by a commitment to multi-disciplinary, multi-agency working. Effective implementation of services that are based on the most up to date evidence requires the allocation of adequate resources, both human and financial. Organisations providing services to children and families require competent staff who have opportunities for training at all levels, including continuing professional development. All staff, no matter how senior, benefit from good quality, regular professional supervision and consultation. Effective data collection systems are required to collect information to support planning the allocation of adequate services to meet the needs of children and families both locally and nationally as well as the evaluation of these services. Research and ongoing evaluation are essential to enhance practitioners, managers and politicians understanding of whether the services being provided are preventing abuse and neglect and protecting children from further harm. The voices of children help keep key stakeholders fully informed about the quality of service provision, and their views provide the best indicators of how well the system is meeting their needs and upholding their rights. Above all it is important that all parts of the system work effectively together and maintain their focus on improving outcomes for children.

Adverse Childhood Experiences and Poor Mental Health Outcomes Among Racially Diverse Foster Care Alumni: Impact of Perceived Agency Helpfulness

The etiology of poor mental health outcomes among foster care alumni of color remains largely unknown. We examined the influence of a subset of adverse childhood experiences (ACEs), placement instability, and childhood disability in uniquely predicting mental health outcomes among racially diverse foster care alumni from a private foster care agency. Multiple group path modeling was used to examine direct and indirect relationships between the individual level risk factors, mediators (perceived agency helpfulness), and past-year psychiatric disorder. Results showed that while the overall model was moderated by race/ethnicity, no significant group differences occurred in which ACEs increased the likelihood of psychiatric diagnoses. However, there were racial/ethnic differences in whether perceived agency helpfulness mediated the relationship between a subset of ACEs and diagnosis with a psychiatric disorder. Implications for future research to inform the development and implementation of effective services and supports that can promote positive developmental outcomes among racially diverse alumni are discussed.

Introduction to the Special Section on Practice Contexts: A Glimpse into the Nether World of Public Mental Health Services for Children and Families

If scientific trends about strengthening knowledge on installation of evidence-based practices are to ever gain a foothold, then a necessary complement—if not precursor— to these studies will be knowledge about the practice contexts that surround new services. It is difficult and perhaps foolhardy to try to improve what you do not understand. Implementation of effective services in the absence of knowledge about the contexts of their delivery is likely to be impractical, inefficient, and costly. The three papers in this issue are firmly ensconced in what is fondly called ‘‘real world.’’ Each comes at the challenge of evidence-based installation in a different way. The first paper by Kolko et al. describes a national survey of four hundred therapists participating in an EBP training on Trauma-focused CBT for children and adolescents. The second paper also by Kolko et al. describes findings from interviews conducted with a sample of 89 child welfare administrators across the country about agency and system issues that impede or facilitate delivery of mental health services. The third paper by Herschell et al. describes different methods for improving knowledge about and skills for delivering a specific evidencebased practice—parent–child interaction therapy—among community based mental health therapists. All three of these papers describe from different vantage points—i.e., therapists, administrative managers, and program evaluators–core elements of real world practice that are likely to impact uptake and delivery of evidence-based practices. The elements that are described include provider attitudes, beliefs, and expectations as well as agency structures, financing methods, linkages and supervisory practices. Each of these elements, if not acknowledged and understood, can pose enormous obstacles to the introduction of new practices. There are several reasons why a glimpse into the nether world of service practices is needed. First, the databases that are available to describe the public mental health system for children and families are severely limited in their scope, availability and content about both services and about the workforce that delivers these services. Basic descriptive data about agency or program operations, staffing patterns, supervisory practices, and electronic technologies for tracking service visits, much less the content of services, are simply not available to either the public or to researchers. Consequently, program implementers or services researchers wanting to embed new practices in routine care settings are unable to anticipate the many challenges ahead because the context of delivery has not been elucidated, operationalized, or deconstructed. If a more thorough understanding about real world practices existed, then factors that mediate or moderate implementation could be identified and potentially manipulated. In the absence of such knowledge, implementation studies are often launched in a vacuum. Second, these papers set the stage for an important next generation of studies that can take advantage of the robust basic science on behavior change and the emerging cognitive neurosciences to apply innovative approaches to change the practices of providers, organizations and potentially even communities. For example, drawing on theory of reasoned action (Fishbein 1980) theory of planned behavior (Ajzen 1991), and more recently the unified theory of behavior change (Jaccard et al. 2002), new K. Hoagwood (&) Division of Mental Health Policy & Services Research, Columbia University, New York, NY, USA e-mail: hoagwood@childpsych.columbia.edu

Interdisciplinary Training for Effective Implementation of Services in Response to a Social Policy Change

ABSTRACT This article describes an interdisciplinary (law and social work) training program for child welfare staff and attorneys that was implemented and tested in an extremely socially disadvantaged region in response to the legislative mandates of the Adoption and Safe Families Act of 1997. This project was undertaken by university-public agency collaboration and as such is part of a nation-wide trend to encourage partnerships that can enhance the delivery of quality services to children and families coming to the attention of the child welfare system. Coming at a time when the federal government is emphasizing the need for safety, permanency, and child well-being for children entering foster care, an interdisciplinary project that is effective in training staff to meet these objectives is timely.