Increasing Abused Children's Access to Evidence-Based Treatment: Diffusion via Parents as Consumers

Abstract

This investigation evaluated an experimental protocol employed by nurses with parents to increase access to evidence-based mental health treatment for children who are suspected victims of abuse. The protocol was compared with typical services during forensic medical examinations, first in a quasi-experimental design, then as a randomized controlled trial. In both studies, the protocol produced a significant increase in parental reports of having discussed evidence-based treatment during a mental health appointment within 1 month after the forensic medical examination. Likewise, both studies showed that the protocol produced a significant increase in parent-reported satisfaction with the forensic medical examination. Similarly, nurses viewed the protocol favorably. These findings suggest that this approach may be sustainable as a standard component of forensic medical examinations for children who are suspected victims of abuse.

Quality improvement, implementation, and dissemination strategies to improve mental health care for children and adolescents: a systematic review

“…We found 19 eligible articles representing 19 studies [13, 14, 46–62] (one article reported on two different studies [55] and another two articles [51, 60] reported outcomes for the same trial). These studies represent 18 strategies.…”

“…No study addressed the moderators of harms. The evidence base included RCTs (some of which were cluster RCTs) [13, 14, 46–48, 50, 51, 53, 55–62], (nonrandomized) controlled clinical trials (CCTs) [52, 54], interrupted time series [49], and cohort designs [55]. Full evidence tables for articles identified via searches through January 14, 2016, are available at http://srdr.ahrq.gov/projects/530.…”

“…In this instance, implementation competence was defined as therapists demonstrating competent delivery of all components of at least one Adolescent Community Reinforcement Approach (A-CRA, an EBP program) treatment procedure during the same treatment session for 1 month. Other outcomes for which we found evidence of benefit (low strength of evidence of benefit) included:Improved practitioner adherence to EBPs or guidelines: by training practitioners to monitor metabolic markers [49], providing computer decision support plus an electronic health record (EHR) that included diagnosis and treatment guidelines [46], or offering an Internet portal for practitioner access to practice guidelines [56]Improved practitioner morale, engagement, and stress: by implementing a program to enhance organizational climate and culture [51]Improved patient access to care, parent satisfaction, treatment engagement, and therapeutic alliance: by training nurses to educate parents about EBPs [55]Improved patient functional status: by giving practitioners weekly feedback on patient symptoms and functioning [13]Improved service utilization: by training practitioners about monitoring medications [49] and appropriately identifying and referring patients with mental health problems [48]. …”

“…Improved patient access to care, parent satisfaction, treatment engagement, and therapeutic alliance: by training nurses to educate parents about EBPs [55]…”

“…We graded benefits of pay for performance as moderate strength of evidence [53]. We graded the strength of evidence of benefit as low for at least one outcome among strategies that contained:Reminders (i.e., a component that included patient- or encounter-specific information, provided verbally, on paper, or on a computer screen, that was designed or intended to prompt a health professional to recall information) [46, 49, 56]A patient-mediated component (i.e., one that collected new clinical information directly from patients that was then given to the provider to review) [46, 55, 56]Enhanced referrals and patient choice of treatment [52] …”