Mixed methods for implementation research: application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services.

Many public sector service systems and provider organizations are in some phase of learning about or implementing evidence-based interventions. Child welfare service systems represent a context where implementation spans system, management, and organizational concerns. Research utilizing mixed methods that combine qualitative and quantitative design, data collection, and analytic approaches are particularly well suited to understanding both the process and outcomes of dissemination and implementation efforts in child welfare systems.

Transformational leadership moderates the relationship between emotional exhaustion and turnover intention among community mental health providers.

Public sector mental health care providers are at high risk for burnout and emotional exhaustion which negatively affect job performance and client satisfaction with services. Few studies have examined ways to reduce these associations, but transformational leadership may have a positive effect. We examine the relationships between transformational leadership, emotional exhaustion, and turnover intention in a sample of 388 community mental health providers.

Smoking behavior of US youths: a comparison between child welfare system and community populations.

Objectives: We compared rates of smoking for 2 groups of youths aged 12 to 14 years: those involved in the child welfare system (CW) and their counterparts in the community population. We then investigated factors associated with smoking for each group.

Methods: We drew data from 2 national-level US sources: the National Survey of Child and Adolescent Well-Being and the National Longitudinal Study of Adolescent Health.

A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping.

Background: The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States.

Methods: Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system.

Prevalence of maltreatment among youths in public sectors of care.

Few studies have investigated the prevalence of maltreatment among youths in public sectors of care despite the critical public health concern and the burden of suffering on such youths. The current study examined the prevalence of multiple types of maltreatment across five public sectors of care. Youths aged 11-18 (n = 1,135) enrolled in one of five public sectors of care reported on their maltreatment history using the Childhood Trauma Questionnaire.

Use of the evidence base in substance abuse treatment programs for American Indians and Alaska Natives: pursuing quality in the crucible of practice and policy.

Background: A variety of forces are now shaping a passionate debate regarding the optimal approaches to improving the quality of substance abuse services for American Indian and Alaska Native communities. While there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches, some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities. This longstanding tension has now been complicated by the emergence of a number of evidence-based treatments that, while holding promise for improving treatment for American Indian and Alaska Natives with substance use problems, may conflict with both American Indian and Alaska Native and 12-step healing traditions.

Predisposing, enabling, and need factors associated with high service use in a public mental health system.

The purpose of this study was twofold: (1) To investigate the individual- and system-level characteristics associated with high utilization of acute mental health services according to a widely-used theory of service use-Andersen's Behavioral Model of Health Service Use -in individuals enrolled in a large, public-funded mental health system; and (2) To document service utilization by high use consumers prior to a transformation of the service delivery system. We analyzed data from 10,128 individuals receiving care in a large public mental health system from fiscal years 2000-2004. Subjects with information in the database for the index year (fiscal year 2000-2001) and all of the following 3 years were included in this study.

Advancing a conceptual model of evidence-based practice implementation in public service sectors.

Implementation science is a quickly growing discipline. Lessons learned from business and medical settings are being applied but it is unclear how well they translate to settings with different historical origins and customs (e.g.

Parental awareness of substance use among youths in public service sectors.

Objective: When asked about substance use, youths typically endorse higher levels of use than parents, suggesting that parents are often unaware of their child's drug and alcohol use. This study sought to examine the level of concordance between reports of youths enrolled in public sectors of care and their parents, and identify potential predictors of parental awareness of substance use and related problems.

Method: Youths receiving services in one or more public sectors of care (N = 985; 67% male) and their parents were interviewed about the youths' substance use and substance use problems, as well as associated demographic, parental, and youth factors.

Mixed method designs in implementation research.

This paper describes the application of mixed method designs in implementation research in 22 mental health services research studies published in peer-reviewed journals over the last 5 years. Our analyses revealed 7 different structural arrangements of qualitative and quantitative methods, 5 different functions of mixed methods, and 3 different ways of linking quantitative and qualitative data together. Complexity of design was associated with number of aims or objectives, study context, and phase of implementation examined.

Expanding the domains of attitudes towards evidence-based practice: the evidence based practice attitude scale-50.

Mental health and social service provider attitudes toward evidence-based practice have been measured through the development and validation of the Evidence-Based Practice Attitude Scale (EBPAS; Aarons, Ment Health Serv Res 6(2):61-74, 2004). Scores on the EBPAS scales are related to provider demographic characteristics, organizational characteristics, and leadership. However, the EBPAS assesses only four domains of attitudes toward EBP.

Psychometric properties and U.S. National norms of the Evidence-Based Practice Attitude Scale (EBPAS).

The Evidence-Based Practice Attitude Scale (EBPAS) assesses mental health and social service provider attitudes toward adopting evidence-based practices. Scores on the EBPAS derive from 4 subscales (i.e.

Rates of psychotropic medication use over time among youth in child welfare/child protective services.

Objective: The aim of this study was to examine rates of psychotropic medication use over time among a national probability sample of youths involved with child welfare/child protective services (CW/CPS) in the National Survey of Child and Adolescent Well-Being (NSCAW).

Methods: Growth mixture modeling was used to classify 2,521 youths into groups based on individual medication use trajectories. Determinants associated with groupings were examined using logistic regression.

Behavior problems and placement change in a national child welfare sample: a prospective study.

Objective: There is ongoing debate regarding the impact of youth behavior problems on placement change in child welfare compared to the impact of placement change on behavior problems. Existing studies provide support for both perspectives. The purpose of this study was to prospectively examine the relations of behavior problems and placement change in a nationally representative sample of youths in the National Survey of Child and Adolescent Well-Being.

The eye of the beholder: youths and parents differ on what matters in mental health services.

The goal of this study was to examine the degree to which youths and caregivers attend to different factors in evaluating their experiences with mental health programs. Youth (n = 251) receiving mental health services at community agencies and their caregivers (n = 275) were asked open-ended questions regarding the positive and negative aspects of the services. Qualitative analyses revealed some agreement but also divergence between youth and caregivers regarding the criteria by which services were evaluated and aspects of services that were valued most highly.

Evidence-based practice implementation: the impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice.

Background: The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use.

Implementing evidence-based practice in community mental health agencies: a multiple stakeholder analysis.

Objectives: We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies.

Methods: Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers.

Results: Participants generated 105 unique statements identifying implementation barriers and facilitators.

Evidence-based practice implementation and staff emotional exhaustion in children's services.

Understanding the implementation of evidence-based practice (EBP) in community service settings is critical for the successful translation of research to practice. However, we have limited research evidence about the impact of EBP implementation on the mental health and social service workforce. In a previous study we demonstrated reduced staff turnover where an EBP was implemented with fidelity monitoring in the form of supportive ongoing supervision and consultation.

The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect.

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children's services system.

Substance involvement among youths in child welfare: the role of common and unique risk factors.

This study examines risk factors for substance involvement for youths involved with the child welfare (CW) system. In addition to common risk factors examined in general population studies; this research examines risk factors unique to youths in the CW system, including age at entry into CW and number of out-of-home placements. Participants included 214 youths ages 13 to 18, randomly sampled from youths active to CW in San Diego County, California.

Health insurance discontinuities among adolescents leaving foster care.

Purpose: To determine whether adolescents who lose Medicaid entitlements when they leave foster care are subsequently able to secure employer-sponsored or student health insurance coverage.

Methods: This was a 2-year follow-up study of a cohort of 404 adolescents leaving foster care in eight counties in a midwestern state. We conducted survival analysis to study predictors of time to first insurance loss, and logistic regression analysis to determine factors associated with insurance reacquisition, among these youth.

Association between mental and physical health problems in high-risk adolescents: a longitudinal study.

Purpose: This longitudinal study examined the relationship between mental and physical health problems in a sample of high-risk youth served in the public sector.

Methods: Participants included youth aged 9-18 years at baseline, randomly sampled from one of five public service sectors in San Diego County, California, and youths may have been active to more than one sector. Diagnoses for mood, anxiety, and disruptive disorders based on structured diagnostic interviews were determined at baseline and data regarding health-related problems were collected 2 years post-baseline.

Direct and indirect links between childhood maltreatment, posttraumatic stress disorder, and women's health.

The authors evaluated the relationships among childhood maltreatment, sexual trauma in adulthood, posttraumatic stress disorder (PTSD), and health functioning in women. Female Veterans' Affairs (VA) primary care patients (N = 200) completed self-report measures of childhood maltreatment, adult sexual trauma, PTSD symptoms, and current health functioning. The authors used structural equation modeling to test models of the relationship among these variables.

Longitudinal patterns of health insurance coverage among a national sample of children in the child welfare system.

Objectives: We sought to describe health insurance coverage over time among a national sample of children who came into contact with child welfare or child protective services agencies.

Methods: We used data from 4 waves of the National Survey of Child and Adolescent Well-Being to examine insurance coverage among 2501 youths. Longitudinal insurance trajectories were identified using latent class analyses, a technique used to classify individuals into groupings of observed variables, and survey-weighted logistic regression was used to identify variables associated with class membership.

Assessment of family functioning in Caucasian and Hispanic Americans: reliability, validity, and factor structure of the Family Assessment Device.

The purpose of this study was to examine the factor structure, reliability, and validity of the Family Assessment Device (FAD) among a national sample of Caucasian and Hispanic American families receiving public sector mental health services. A confirmatory factor analysis conducted to test model fit yielded equivocal findings. With few exceptions, indices of model fit, reliability, and validity were poorer for Hispanic Americans compared with Caucasian Americans.