Leveraging implementation science to reduce inequities in Children’s mental health care: highlights from a multidisciplinary international colloquium

Abstract

Background and purpose: Access to evidence-based mental health care for children is an international priority. However, there are significant challenges to advancing this public health priority in an efficient and equitable manner. The purpose of this international colloquium was to convene a multidisciplinary group of health researchers to build an agenda for addressing disparities in mental health care access and treatment for children and families through collaboration among scholars from the United States and Europe engaged in innovative implementation science and mental health services research. Key highlights: Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, presentations related to inner, outer, and bridging context factors that impact the accessibility and quality of mental health evidence-based practices (EBPs) for children and families. Three common topics emerged from the presentations and discussions from colloquium participants, which included: 1) the impact of inner and outer context factors that limit accessibility to EBPs across countries, 2) strategies to adapt EBPs to improve their fit in different settings, 3) the potential for implementation science to address emerging clinical and public health concerns. Implications: The common topics discussed underscored that disparities in access to evidence-based mental health care are prevalent across countries. Opportunities for crosscountry and cross-discipline learnings and collaborations can help drive solutions to address these inequities, which relate to the availability of a trained and culturally appropriate workforce, insurance reimbursement policies, and designing interventions and implementation strategies to support sustained use of evidence-based practices.

Aligning dissemination and implementation science with health policies to improve children’s mental health.

“…These include practical barriers of time, location, and cost of attendance (Haine-Schlagel & Walsh, 2015); stigma and perceived usefulness of treatment (Alegría, Atkins, Farmer, Slaton, & Stelk, 2010; Owens et al, 2002; Reardon et al, 2017); difficulties engaging families in care, particularly for the most vulnerable and high-risk families (Bornheimer, Acri, Gopalan, & McKay, 2018; McKay & Bannon, 2004); and lack of perceived need (Green et al, 2020). Recently, a multidisciplinary international colloquium convened to explicitly examine how to leverage D&I science to reduce decades-long disparities in mental health care access and treatment for children and families (Stadnick et al, 2020). Stadnick and colleagues report that potential solutions to solving these inequities involve two policy-driven solutions: an appropriate and trained workforce and insurance reimbursement.…”

“…These EBP implementation studies have apparently met with inner and outer context challenges. Furthermore, this is a problem that is not unique to the United States (Stadnick et al, 2020).…”

Future Directions in Lay Health Worker Involvement in Children’s Mental Health Services in the U.S.

“…In RE-AIM, reach is defined as the number of eligible individuals who receive an EBP divided by the number of eligible individuals (Glasgow et al, 1999). Though the intention of EBP implementation is often to improve access to highquality mental health services for marginalized populations, inequities might be exacerbated if EBPs only reach more advantaged populations and marginalized populations receive lower quality care (Stadnick et al, 2020). Therefore, a recent extension of RE-AIM suggested research identify if populations are equitably reached when an EBP is implemented, identifying reasons why they are not being reached if that is the case, and finally develop solutions to reach those experiencing inequities (Shelton et al, 2020).…”

Adaptation to family-based treatment for Medicaid-insured youth with anorexia nervosa in publicly-funded settings: Protocol for a mixed methods implementation scale-out pilot study

“…Implementation science can improve the uptake of effective treatments into routine clinical settings [3]. Economically disadvantaged youth have poor access to evidence-based treatments, and their implementation is more complex because these treatments are often not tested with low-income, racially/ethnically diverse patients served in the public sector [4]. Generally, implementation efforts in mental health treatments have focused on more common concerns (e.g., mood/ anxiety, disruptive behavior), which are likely to have the broadest impact.…”