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Partnerships for Success:Supporting Evidence-Based Programming for Children’s Mental HealthWashington State Behavioral Healthcare Conference – June 9, 2011
Suzanne Kerns, Ph.D. & Andrew RiversDiv. of Public Behavioral Health and Justice Policy, University of Washington
&Andrea Parrish, MA, CMHSDiv. of Behavioral Health and Recovery, DSHS
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Session Goals
Describe the Partnerships for Success participatory approach
Practical application of the model in two WA communities Thurston-Mason Counties Skokomish Tribal Nation
Discuss strategies for expansion and application of the model with other communities
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Background of EBP implementation and context
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States across the country are increasingly mandating that agencies provide evidence-based services
Mandates a result of Legislative initiatives Lawsuits
Background of EBP Implementation
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In Washington State……
Children’s Mental Health Initiative (through DMH) devised an “EBP Matrix”
Goal to bridge the science-to-service gap What gets done versus what we know
Current legislation addresses the equally important implementation gap What gets done versus what (ideally)
should get done
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Science to Service Gap
Evidence that many types of practices work (at least within the University setting)
Less evidence about how effective programs are best implemented in the field
Most programs being implemented have not been evaluated for effectiveness
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Some barriers to implementation of empirically-supported treatments
money
time
infoaccess
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…more potential barriers
Traditional mental health settings place a high value on clinician creativity and intuition
Manualized interventions may be viewed as overly simplified, “cookie-cutter” approaches that are dehumanizing to the client and stifling to the therapist
Some programs not evaluated on adequately diverse populations
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Systemic Challenges
Impact of new practice on more traditional organizational structure
Identifying and selecting EBPs within a context of a community planning process
Inter-system ‘ownership’ of program/ service
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Financial Challenges
Often takes new ‘bridge’ funding up front to finance start up
Very difficult to alter long-established funding patterns
Anticipating all the costs Mechanics of reimbursement and
limitations of fee for service Potential conflict with traditional
productivity approaches
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Partnerships for Success
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Partnerships for Success
Partnerships for Success is “a comprehensive approach to building capacity at the county or Tribal level to prevent and respond effectively to child and adolescent problem behaviors while promoting positive youth development”
Strategically targets known barriers and challenges towards implementing evidence-based practices
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Introduction
PfS is based on the Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) comprehensive strategy model
Successfully used by Thurston-Mason and Skokomish Tribe in Washington State
Currently being applied to Yakima Valley Systems of Care grantee site
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Community Engagement Model
Adapted from the Partnerships for Success model used in Ohio
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GuidingValues
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PfS Activities
Resource assessment
Strategic Action Identification
ImplementationEvaluation
Mobilization and planning
Needs assessment
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Expected outcomes of the PfS model
Mobilize the community around efforts
Reduce duplication of efforts
Use funds strategically
Evaluation that is meaningful to the local
community
Sustainability
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The PfS Model
The PfS model revolves around a core of data-informed decisions and is encompassed by a continuous need for community mobilization
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Data are used to:• Identify areas of need (needs assessment)• Select risk/protective factors and assets (needs
assessment)• Determine evidenced-based and feasible practices to
address high need areas• Evaluate progress of PfS and programs in the
community
Data Informed Decisions
Model processes are data-informed rather than data-driven
Strategic and time-limited review of data
Incorporates community values
Builds on previous community efforts
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Planning Process
Planning is composed of three basic activities
Needs Assessment
Resource Assessment
Identify Strategic ActionsNeeds Assessment
- Indentify areas of need - Risks and Protective factors
Resource Assessment- Realistic view of current programs and services
Identify Strategic Actions- Address gap between needs and services- Five year plan
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MobilizationSuccess of the PfS model depends on ongoing and sustained mobilization of the community.
Core Team
Workgroups
Community stakeholder group
Broader community involvement
•Include a diverse team in Core, Work and Stakeholder groups•Use outreach and survey methods to reach large community group•Press releases and public reports may be helpful
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Implementation
Implementation is the process of turning a recommendation into a series of “action steps” that are subsequently executed and evaluated against PfS guiding principles.
Implementation options
Implement a new program
Enhance an existing program
Change or enhance local infrastructure to support youth programming
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EvaluationOngoing evaluation informs the progress of the model and provides outcomes for accountability.
Community level
Agency level
Individual level
Evaluation activities might include
Administrative data
Surveys (community, agencies, therapists, youth, parents)
Focus groups
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Consultative Role of UW PBHJP
Through utilization of the PfS model and consultation with UW PBHJP, communities will be supported to:
Build upon the strengths of the community
Provide information about culturally competent evidenced-based practices
Assist with data evaluation and analysis
Facilitate connections to developers and purveyors of treatment models
Bring expertise in implementation to anticipate and troubleshoot potential implementation barriers
Plan for sustainability
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Expected outcomes Increase access to effective services through
community- and culturally-relevant programming addressing high-priority needs related to youth and family emotional and behavioral health for youth and families
Improve emotional and behavioral health outcomes consistent with community-identified targeted impacts
Enhance cross-agency collaborations and relationships that directly benefit the experience of youth and families accessing services for emotional and behavioral health needs
Sustainability of programming through: Development of a learning community capable of continuing
the work Consideration of blended and/or braided funding strategies Enhanced capacity to seek future funding opportunities
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MST OUTCOMES
As of April 1, 2011
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Multisystemic Therapy
NEEDS TO BE UPDATED!!!! Fully operational for three years! As of March 22nd, approximately 150
youth enrolled in services 15 active clients
Program sustainability being addressed through Medicaid reimbursement Thurston County Treatment Sales Tax
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Reason for Discharge
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Instrumental Outcomes
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Triple P OutcomesAs of DATE
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Families
Records for 38 families (47 respondents) who received Triple P services Complete data (pre & post) on 18 families
All received Level 4 Triple P Family structure
Biological family: 24% Stepfamily: 26% Single parent: 39% Relative caregiver: 11%
Ethnicity: 91% Caucasian 97% Thurston Co. Majority Medicaid-eligible 65% Prior CPS involvement
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Target Youth
Gender Male: 63% Female: 37%
Age 3-4: 12% 5-11: 84% 12-14: 5%
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Pre Post Change p
Parenting Tasks Checklist
Behavioral self-efficacy 72.97 81.09 8.11 a
.072
Setting self-efficacy 52.50 70.77 18.28 **.00
9
Total score 62.86 76.75 13.89 *.01
1
Strengths and Difficulties
Emotional symptoms 4.15 3.83 -0.32.53
7
Conduct problems 5.17 3.67 -1.50 **.00
3
Hyperactivity scale 7.72 6.61 -1.11 *.02
0
Peer problems 3.67 3.50 -0.17.66
8
Prosocial 5.75 6.33 0.58 a.06
7
Total difficulties 20.73 17.61 -3.11 *.03
2
Impact score 23.24 17.65 -5.59 *.03
2
Triple P: Parent/Child Outcomes
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Pre Post Change p
Parent Problem Checklist
Disagreement (number of issues) 7.69 5.42
-2.28 *
.014
Severity of disagreement 3.65 3.11-
0.53.32
5
Relationship Quality Index
Relationship quality26.7
530.7
5 4.00 a.09
2
Depression/Anxiety/Stress Scales
Depression11.4
4 8.44-
3.00.12
9
Anxiety 7.28 6.15-
1.13.43
9
Stress16.5
513.3
9-
3.16.10
9
Total35.2
1 28.0
1 -
7.20 .14
0
Triple P: Parent/Child Outcomes
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Parenting Tasks Checklist
0
20
40
60
80
100
Behavioral self-efficacy Setting self-efficacy** Total*
Subscale
Points Pre
Post
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Strengths & Difficulties Questionnaire
0
2
4
6
8
10
Emotionalsymptoms
Conductproblems**
Hyperactivity* Peerproblems
Prosocial Total* Impact
Pre
Post
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Parent Problem Checklist / Relationship Quality Index
0
2
4
6
8
10
Disagreements (number of)* Severity of disagreements Relationship quality
Pre
Post
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Depression, Anxiety, Stress Scales
0
5
10
15
20
Depression Anxiety Stress Total
Pre
Post
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Clinical Status (all measures)
0%
20%
40%
60%
80%
100%
Emoti
onal
sym
ptom
s*
Condu
ct p
robl
ems
Hyper
activ
ity*
Peer p
robl
ems
Proso
cial
Total
Impa
ct
Paren
t disa
gree
men
t
Relati
onsh
ip qu
ality
Depre
ssio
n
Anxiet
y
Stress
% a
t Clin
ica
l Le
vels
PrePost
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Partnerships for Success:
Process Evaluation
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Process Evaluation
Interviewed 5 representatives of the core team, 2 from RSN, and administrator at MHD
Selected research questions: How effective has the overall TM community
process been? How has TM community changed over time in
ability to collaborate, identify needs, coordinate resources implement effective practices, etc.?
Has implementation of EBPs (MST, Triple P, TF-CBT) been in alignment with community goals?
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Process outcomes, continued …
0
1
2
3
4
5
Reducingdisparities for
minorityyouth
Increasingfunding
opportunities
Increasemobilization
Ability toserve
children incommunity
Increaseaccess toeffectiveservices
Cost savings Fiscalblending
2008 2009
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Process outcomes, continued …
0
1
2
3
4
5
Increased ability torespond to youth
needs
Better servicecoordination
Enhanced cross-agency
relationships
Agency-levelbenefits
Would participateagain
2008 2009
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Partnerships for Success:Skokomish Tribal
Nation
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Skokomish Tribal Nation
Outgrowth of Thurston-Mason Partnerships effort
Goal: Identify programming for children’s emotional and behavioral health for Skokomish youth and their families
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PfS planning process Skokomish Tribe
Process guided by by: Core team
Representatives from: Tuwaduq Family Services Hood Canal School Tribal management Indian Child Welfare
Public Behavioral Health & Justice Policy
Community input
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Skokomish Guiding Principles
Focus on Family
Focus on Wellness
Promoting Competence
Community Collaboration
Cultural Relevance
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Needs Assessment
Overview of Skokomish Reservation ~730 individuals 40% of families have a child under 18 in the
home Data from 2006 Healthy Youth Survey
More challenges in symptoms of substance abuse and depression than other youth
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Skokomish Survey
Completed by 102 people 36% family members of youth with mental health needs 7% youth 48% concerned community members 5% direct service providers or administrators for mental
health services 17% working in agencies serving youth who have mental
health needs, including schools 13% other
74% identified as being an adult community member, a youth, or a caregiver of a youth with mental health needs
**categories not exclusive
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Priority need areas: substance use and parenting/family life Attention to community needs, how a program impacts
community (incl. non-Native community) perceptions of Native youth, inclusion criteria, and attention to cross agency communication and confidentiality will be critical components of any implementation plan.
Priority programming areas: parenting and family support, mental and behavioral health and substance use programs Prevention programs are preferred After-school model would be desirable Less interest in community-based family interventions or
therapeutic foster care Current challenges: Some concern that current programming
not well aligned with cultural beliefs and traditions. Current strengths: Schools are doing an overall good job with
effective programming; Current infrastructure could possibly support new programming, although there is room for improvement.
Findings
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Resource Assessment
Very few EBPs available for Skokomish youth Mostly through courts or schools
Popular ‘non-EBP’ programs had little evaluation
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Choosing a new program
TF-CBT Motivational Interviewing
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Unique Challenges
Contracts Deployment of funds through typical channels not
aligned with general practice of Tribe Coordination with Thurston-Mason project
(Tribe nested within Mason County) Geographic
Community size “committeed out” Confidentiality
Location
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Highlights thus far Evolving response to project
Enhanced relationships between child-serving agencies
Participation in Needs Assessment Nearly 15% of the community responded
to the Needs Assessment (over 100 respondents)
Broad, representative groups
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Highlights thus far New programming available
Trauma-Focused CBT being implemented by clinicians at Tuwaduq Family Services
Motivational Interviewing training offered to community members