Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling-out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policy-makers, providers and family support specialists have worked in partnership since 2002 to redesign and evaluate the children’s mental health system. Five system strategies driven by empirically-based practices and organized within a state-supported infrastructure have been used in the child and family service system with over 2,000 providers: (a) business practices; (b) use of health information technologies in quality improvement; (c) specific clinical interventions targeted at common childhood disorders; (d) parent activation; and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems.
In this article, we describe the outcomes associated with a 3-year research demonstration project. It is the second of a two-part article concerned with this research conducted in the Bronx, New York, to examine the efficacy of three models of intensive in-home services—Home-Based Crisis Intervention (HBCI), Enhanced Home-Based Crisis Intervention (HBCI+),and Crisis Case Management—as alternatives to hospitalization for children experiencing a psychiatric crisis. In Part I (Evans, Boothroyd, & Armstrong, 1997), we described the features of the three program models, the research design, data collection measures, and the presenting characteristics of the children and families. In Part 2, we describe the success of maintaining children at home (82%) and the increases in family adaptability, children's self-concept, and parental self-efficacy both at discharge and at 6 months postdischarge. Enrollees in two of the models (HBCI and HBCI+) experienced a significant increase in family cohesion,although this was not maintained at 6 months postdischarge. While enrollees in the enhanced program showed significant increase in social support at discharge, all enrollees experienced this at 6 months postdischarge.
In response to a national call for states to shift from an overreliance on restrictive treatment modalities to community-based systems of care and to the needs identified by the families of children with serious emotional disturbance (SED), the New York State Office of Mental Health has developed Family-Centered Intensive Case Management (FCICM) as part of a research demonstration project. FCICM is intended to empower and support families with children with SED. Staffed by a case manager and parent advocate, FCICM includes respite care, flexible service money, parent support groups, and behavior management skills training. In this study, which had positively controlled experimental conditions, children who were referred for treatment foster care in three rural New York counties were randomly assigned to FCICM or treatment foster care. The present article compares and contrasts the program elements of FCICM and the treatment foster care models, provides an overview of the research design and methods, describes the children and families served, and examines program implementation issues.
Quality indicators for programs integrating parent-delivered family support services for children’s mental health have not been systematically developed. Increasing emphasis on accountability under the Affordable Care Act highlights the importance of quality-benchmarking efforts. Using a modified Delphi approach, quality indicators were developed for both program level and family support specialist level practices. These indicators were pilot tested with 21 community-based mental health programs. Psychometric properties of these indicators are reported; variations in program and family support specialist performance suggest the utility of these indicators as tools to guide policies and practices in organizations that integrate parent-delivered family support service components.
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