Infrastructure development in children's behavioral health systems of care: essential elements and implementation strategies.

To improve the outcomes of children's behavioral health systems, states must invest in expanding infrastructure; however, infrastructure is a commonly used and poorly understood concept. This paper aims to provide a definition of infrastructure in the context of state-level children's behavioral system of care development and describes five essential infrastructure elements: an integrated governance and decision-making structure; structures and processes for blended and braided funding; a central point of access for information, referral, and linkage; workforce development, training, and coaching in effective practices; and data and quality improvement mechanisms. Suggested implementation activities are offered for each of the five proposed infrastructure components.

Youth Mobile Response and Stabilization Services: Factors Associated with Multiple Episodes of Care.

Mobile response and stabilization services (MRSS) provide short-term, community-based, care to individuals in crisis. Minimal studies have explored which factors are associated with multiple episodes of MRSS care. We used a retrospective cohort design of MRSS electronic health records to explore demographic and clinical characteristics associated with multiple episodes of care among 2,641 youth ages 5-21 years old in New York, USA.

Emergency Department Use by Children and Youth with Mental Health Conditions: A Health Equity Agenda.

There are growing concerns regarding the referral of children and youth with mental health conditions to emergency departments (EDs). These focus on upward trends in utilization, uncertainty about benefits and negative effects of ED visits, and inequities surrounding this form of care. A review was conducted to identify and describe available types of data on ED use.

Evidence-Based Treatments in Community Mental Health Settings: Use and Congruence With Children's Primary Diagnosis and Comorbidity.

Many evidence-based treatments (EBTs) have been identified for specific child mental health disorders, but there is limited research on the use of EBTs in community-based settings. This study used administrative data from a statewide system of care to examine 1) the extent to which EBTs were provided congruent with the child's primary diagnosis, 2) whether there were differences in effectiveness of EBTs that were congruent or incongruent with the child's primary diagnosis, and 3) whether comorbidity moderated the effectiveness of EBTs for children based on congruence with their primary diagnosis. The sample consisted of 23,895 children ages 3-17 with at least one of the most common diagnoses (attention-deficit/hyperactivity disorder, conduct problems, depressive disorders, anxiety disorders, and post-traumatic stress disorder) who received outpatient psychotherapy.

Clinician training, then what? Randomized clinical trial of child STEPs psychotherapy using lower-cost implementation supports with versus without expert consultation.

Objective: Implementation of evidence-based treatments in funded trials is often supported by expert case consultation for clinicians; this may be financially and logistically difficult in clinical practice. Might less costly implementation support produce acceptable treatment fidelity and clinical outcomes?

Method: To find out, we trained 42 community clinicians from four community clinics in Modular Approach to Therapy for Children (MATCH), then randomly assigned them to receive multiple lower-cost implementation supports (LC) or expert MATCH consultation plus lower-cost supports (CLC). Clinically referred youths (N = 200; ages 7-15 years, M = 10.

Impact of Mobile Crisis Services on Emergency Department Use Among Youths With Behavioral Health Service Needs.

Objective: Youths are using emergency departments (EDs) for behavioral health services in record numbers, even though EDs are suboptimal settings for service delivery. In this article, the authors evaluated a mobile crisis service intervention implemented in Connecticut with the aim of examining whether the intervention was associated with reduced behavioral health ED use among those in need of services.

Methods: The authors examined two cohorts of youths: 2,532 youths who used mobile crisis services and a comparison sample of 3,961 youths who used behavioral health ED services (but not mobile crisis services) during the same fiscal year.

Psychiatric Community Crisis Services for Youth.

Each year, increasing numbers of children and families seek care for psychiatric crises; unfortunately, most communities offer limited services to meet these needs. Youth in crisis often present to emergency departments, but may not need or benefit from that level of care. Instead, data reflect improved clinical and financial outcomes when communities offer a continuum of crisis services.

Family-Based Recovery: An Innovative In-Home Substance Abuse Treatment Model for Families with Young Children.

Family-based in-home treatment can effectively meet the needs of mothers and fathers struggling with the dual challenges of substance abuse recovery and parenting infants and toddlers. This article describes one such program, Family-Based Recovery (FBR), which integrates substance abuse treatment for parents and infant mental health intervention with the goal of preventing child maltreatment and family disruption. Program design, implementation, and results are provided.

Parental Knowledge and Substance Use among African American Adolescents: Influence of Gender and Grade Level.

Parental knowledge is defined as parental awareness and information about a child's activities, whereabouts, and associations that is obtained through parental monitoring, parental solicitation, or self-disclosure. Increased parental knowledge is generally associated with lower adolescent substance use; however, the influence of various contextual factors, such as adolescent gender and grade level is not well understood, particularly for different racial or ethnic groups. In the present study, we used Hierarchical Generalized Linear Modeling (HGLM) analyses to examine the longitudinal relationship of parental knowledge to adolescent substance use in the context of adolescent gender and grade level among 207 urban African American adolescents in grades 6-11.

Risk and protective factors associated with patterns of antisocial behavior among nonmetropolitan adolescents.

This study used latent class analysis (LCA) to identify patterns of antisocial behavior (ASB) in a sample of 1,820 adolescents in a nonmetropolitan region of the Northeast. Self-reported ASBs including stealing, fighting, damaging property, and police contact were assessed. LCA identified four classes of ASB including a non-ASB class, a mild, a moderate, and a serious ASB class.

Extended Day Treatment: A Comprehensive Model of After School Behavioral Health Services for Youth.

This paper describes Extended Day Treatment (EDT), an innovative intermediate-level service for children and adolescents with serious emotional and behavioral disorders, delivered in the after school hours. The current paper describes the core components of the EDT model of care within the context of statewide systems of care, including its theoretical foundations, core service components, relation to evidence-based practices, workforce composition and staff training, and data collection and reporting mechanisms. Recommendations are provided for statewide implementation, followed by discussion of model development as an approach to systems reform for the treatment of children and youth with emotional and behavioral disorders.

Maltreatment following reunification: predictors of subsequent Child Protective Services contact after children return home.

Objectives: This study examined risk of maltreatment among children exiting foster care using a statewide sample of children reunified between 2001 and 2004 in Rhode Island. The objectives were: (1) to compare rates of maltreatment following parental reunification for youth in care as a result of maltreatment with those in care for other reasons; and (2) to assess the effects of child, family, and case characteristics on rates of re-maltreatment among children placed in foster care due to maltreatment.

Method: A longitudinal dataset of all reunified cases was matched with state records of substantiated Child Protective Service (CPS) investigations.

Impact of a positive youth development program in urban after-school settings on the prevention of adolescent substance use.

Purpose: Positive youth development (PYD) emphasizes a strengths-based approach to the promotion of positive outcomes for adolescents. After-school programs provide a unique opportunity to implement PYD approaches and to address adolescent risk factors for negative outcomes, such as unsupervised out-of-school time. This study examines the effectiveness of an after-school program delivered in urban settings on the prevention of adolescent substance use.

The impact of parental alcohol or drug removals on foster care placement experiences: a matched comparison group study.

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care.

Changes in Placement among Children in Foster Care: A Longitudinal Study of Child and Case Influences.

Using Cox regression modeling, this longitudinal study examines child and case characteristics associated with changes in placement among 5,909 Rhode Island children in foster care. Results suggest that half of all children experience at least one placement change while in care. Infants change placements least, and risk increases with child age.