Implementation of an Evidenced‐based Parenting Program in a Community Mental Health Setting

Abstract

The process of mental health intervention implementation with vulnerable populations is not well-described in the literature. The authors worked as a community-partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low-income community. We used qualitative ethnographic methods to document the adaption of an evidence-based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0- to 84-month-old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.

Parenting Interventions for Mothers With Problematic Substance Use: A Systematic Review of Research and Community Practice

“…Parenting within the context of problematic substance use can exacerbate parenting challenges and may increase risk for child neglect and harsh parenting behaviors (Roosa Ordway et al, 2018). Importantly, the presence of these risks does not negate the desire of many women to be effective parents.…”

“…Group interventions are also more economical compared to individual interventions, thereby potentially increasing feasibility and sustainability (Cunningham, Bremner, & Boyle, 1995;Niccols, 2008). To date, only the Mothering from the Inside Out program (Suchman et al, 2012(Suchman et al, , 2017 has been explored in relation to implementation factors that support the feasible and sustainable delivery (Roosa Ordway et al, 2018) and this has been in a community mental health rather than an integrated program setting. In addition to group versus individual delivery, further information is needed about key implementation factors such as who can deliver the intervention, training requirements, and cost, as well as other variables relating to the outer setting (e.g., client needs), inner setting (e.g., organizational structure), and individuals (e.g., services-provider attitudes, self-efficacy; Damschroder et al, 2009).…”

“…The second risk pathway is deficits in parenting knowledge, including parenting skills and knowledge of child development (Velez et al, 2004). Some mothers with problematic substance use may have limited parenting knowledge and understanding of appropriate developmental expectations in part due to limited exposure to positive parenting models in their own childhood and current social networks (Bert, Guner, & Lanzi, 2009;Pajulo, Suchman, Kalland, & Mayes, 2006;Roosa Ordway, McMahon, De Las Heras Kuhn, & Suchman, 2018). Such gaps in parenting knowledge may increase risk for misattributing negative intent to children for their behavior, thereby increasing risk for frustration and maladaptive parenting responses (Neger & Prinz, 2015).…”

“…No known research has examined the extent to which risk pathways are addressed in communitybased practice (outside of a research context). Integration of research and community practice data is important for implementation and translation of research knowledge, as it may inform what objectives are viewed as most important or feasible for integrated programs and may also provide new ideas about key aspects of care and approaches developed within the community setting (Damschroder et al, 2009;Roosa Ordway et al, 2018). This may further intervention development, research, and knowledge translation and provide a resource to support the selection and delivery of parenting interventions within integrated programs.…”

Mothering from the Inside Out: Addressing the Intersection of Addiction, Adversity, and Attachment with Evidence-Based Parenting Intervention

“…In a pilot test of 17 mothers (of children up to 7 years of age) receiving outpatient psychiatric treatment, community-based mental health clinicians were able to achieve and maintain adequate fidelity to MIO, and MIO was determined to be both feasible (as evidenced by mothers’ completing 70% of sessions) and acceptable (as evidenced by strong therapeutic alliance) [ 79 ]. Qualitative findings highlighted the importance of building relationships with community providers and stakeholders, adapting MIO (and its training/supervision) to meet the needs of providers and parents, and training an interdisciplinary team (including psychologists, social workers, and nurse practitioners) [ 84 ••]. Quantitative analysis of treatment outcomes were favorable, as evidenced by increases in mothers’ RF (particularly child-focused RF), as well as decreases in parenting stress, depression, and global psychiatric distress [ 79 ].…”