The Child System and Treatment Enhancement Projects consist of sponsored activities and initiatives designed to evaluate and improve effective mental health service delivery for children. Among other things, the portfolio of projects includes four central endeavors: the Scientific Review, the Clinic Systems Project, the Clinic Treatment Project, and the Dissemination and Implementation Study. These projects work on concert toward the larger mission of the network. For example, treatments tested in the Clinic Treatment Project were selected based on the initial Scientific Review, and the Clinic Systems Project involves a large scale survey of clinics that places the aims of the Clinic Treatment Project in a national context. Descriptions of each of these projects follows:
In the first phase of its work together, the Network undertook a review of the scientific evidence to identify the strongest treatment approaches, held a series of group meetings with diverse experts to examine the science-practice gap and identify causes and cures, and developed several research and writing projects to illuminate related issues.
Clinic Systems Project
The Clinic Systems Project (CSP) involves a descriptive study of a sample of large community mental health clinics serving a representative sample of counties in the U.S across 38 states. In each clinic, two primary measurement methods are used to assess service system and service provider organization characteristics pertinent to the adoption and implementation of evidence-based practices. First, semi-structured interviews are conducted with directors of the clinics to assess their perspectives on regulations, policies, governance structures within and across pertinent service sectors, and financing structures and mechanisms that influence the child mental health treatment in their clinics. Second, clinicians who treat children complete a battery of validated measures assessing organizational constructs known to be associated with service quality and outcomes in other human services sectors (i.e., child welfare, substance abuse, health). The data collected from this survey will enable our network to characterize the performance of a national sample of mental health clinics in terms of the organizational domains that are relevant to innovation and adoption of evidence-based practices.
Clinic Treatment Project
The Clinic Treatment Project focuses on children aged 8-13 referred to community-based mental health agencies for problems involving disruptive conduct, depression, anxiety, or any combination of these. Seven agencies in Honolulu and Boston are participating in the project. As part of the study, children are assigned to be treated with the standard treatment procedures in their agencies or with selected evidence-based practices identified in our earlier Scientific Review. These evidence-based practices are being tested in two forms: (a) standard manual treatment, using full treatment manuals, in the manner they have been tested in previous research trials, and (b) modular manual treatment in which therapists learn all the component practices of the evidence-based treatments but individualize the use of the components for each child using a guiding clinical algorithm. Assessments across multiple time periods include measures of (a) child and parent-reported problems, disorders, and functioning, (b) child, parent, and therapist satisfaction with treatment; (c) child, parent and therapist views on the quality of the therapeutic relationship; (d) patterns of service use, (e) therapist beliefs and attitudes about the therapy and their workplace; and (f) treatment costs. Findings from this investigation will allow our network to understand what practices work best in the agency settings, and which ones appear to be most sustainable in this context.
Dissemination and Implementation Study
The Dissemination and Implementation Study qualitatively examines the experiences associated with learning and applying evidence-based practices among participants and agencies in the Clinic Treatment Project. Using interview and focus group methods characteristic of anthropology, a team of ethnographic field workers collect participants’ views on the impact of the new procedures on their clinic organization, on themselves (their morale, level of support from others, ability to implement the treatment procedures as trained), and facilitators and barriers experienced in their use of evidence-based practices. This project should assist in characterizing the cultural and organizational change process associated with practice innovation.