Reclaiming futures and juvenile reentry: The case for joining forces

More than a decade earlier than the launching of Reclaiming Futures, federally funded work began on the reentry of juvenile offenders returning to the community from state secure correctional facilities. This work led to the development of a juvenile reentry model referred to as the Intensive Aftercare Program model. Work has continued in adapting the model to other populations and settings. This article discusses the compatibility of the juvenile reentry and Reclaiming Futures models, examining their components with respect to overarching case management, continuity of care, and evidence-based practices. Lessons learned from juvenile reentry and the implications for policy and programming are highlighted as they apply to the Reclaiming Futures model.     

Barriers and Facilitators to Implementing Functional Family Therapy in a Community Setting: Client and Practitioner Perspectives

While Functional Family Therapy (FFT) is known to be effective in addressing adolescent behavioral problems, there has been little exploration of issues relevant to its transport from the tightly controlled setting of clinical trials into routine service delivery. This study sought the views of key stakeholders, clients, and practitioners, on barriers and facilitators to the successful implementation of FFT. Undertaken in a community setting in Scotland, interviews were carried out with 12 adolescents, 14 parents/caregivers, and 6 practitioners. Results focus on: Referral process and pre‐intervention contact; Engagement of families; Structure and delivery; Organizational factors. Although barriers to engagement were identified, FFT was viewed as an acceptable, appropriate and feasible intervention with the potential to improve adolescent wellbeing in ‘real‐world’ settings.     

A learning collaborative approach to training school-based health providers in evidence-based mental health treatment

Collaborative care models among pediatric primary care and child and adolescent mental health providers are increasingly emphasized to improve quality of and access to mental health services. The current case example of a multi-site clinical training opportunity in school-based collaborative care settings illustrates the success of a learning collaborative approach to improve children's mental health care in schools. Quality improvement data from participating sites indicated an increase in use of evidence-based practices (i.e., “core skills”) and an improvement in quality service delivery indicators for children's mental health (i.e., screening, risk assessment, diagnostic processes, associated diagnostic coding, use of core skills, associated procedural coding, and follow-up assessment and referral) over time. Clinician self-report and chart review data are supplemented by qualitative data from site leader interviews conducted following completion of the project. Implications for mental health workforce development to improve the quality of care to children and adolescents in schools and other community mental health settings are discussed.     

Evidence-based practice in group care: the effects of policy, research, and organizational practices

This article describes the effect of a province-wide vision of evidence-based and outcome-based services for children and youth and the challenges of implementing evidence-based practice (EBP) and evidence-based treatment (EBT) approaches within group care settings. The paper is based on the results of a survey of group care settings in the province of Ontario, Canada, which was designed to understand the factors affecting the use of EBP and EBT. The critical roles of policy, access to research, and organizational structure as they affect the frontline workforce were explored. The results identified key differences between programs who implemented an evidence-based approach and those who are struggling to do so. Differences in case management practices as well as organizational factors affect the program's ability to use an evidence-based approach.     

A multi-level examination of how the organizational context relates to readiness to implement prevention and evidence-based programming in community settings

Prior theoretical and empirical research suggests that multiple aspects of an organization's context are likely related to a number of factors, from their interest and ability to adopt new programming, to client outcomes. A limited amount of the prior research has taken a more community-wide perspective by examining factors that associate with community readiness for change, leaving how these findings generalize to community organizations that conduct prevention or positive youth development programs unknown.Thus for the current study, we examined how the organizational context of the Cooperative Extension System (CES) associates with current attitudes and practices regarding prevention and evidence-based programming. Attitudes and practices have been found in the empirical literature to be key indicators of an organization's readiness to adopt prevention and evidence-based programming. Based on multi-level mixed models, results indicate that organizational management practices distinct from program delivery may affect an organization's readiness to adopt and implement new prevention and evidence-based youth programs, thereby limiting the potential public health impact of evidence-based programs. Openness to change, openness of leadership, and communication were the strongest predictors identified within this study. An organization's morale was also found to be a strong predictor of an organization's readiness. The findings of the current study are discussed in terms of implications for prevention and intervention.     

MUNICIPAL GOVERNMENT APPROACHES TO SERVICE DELIVERY: AN ANALYSIS FROM A TRANSACTIONS COST PERSPECTIVE

Municipal governments are less likely to contract out for service delivery if citizen preferences for the service are heterogeneous. This conclusion is based on an analysis that extends to the public sector the empirical industrial organization literature on transaction costs and the "make or buy" decision faced by private firms. Service delivery practices for sixty-three municipal services are examined. The findings are consistent with the proposition that the cost for writing and monitoring contracts may be an important consideration in municipal service delivery approach and that bureaucratic supply may not be as inefficient as some previous studies indicate.     

Translating Research into Practice: The Role of Web-Based Education

SUMMARY

Clinical Practice Guidelines (CPGs) constitute a major focus of recent efforts to narrow the gap between research and practice. However, CBGs cannot effectively change clinical practice unless they are effectively disseminated. The present article describes a web-based course designed to teach nurses about a CPG for the management of alcohol withdrawal. In it, we outline the details of our web-based course, including its technical characteristics, organization, structure, and clinical content. Next, we outline several adjunctive strategies that may improve the effectiveness of such web-based educational interventions. Finally, we discuss other ways that web-based education may prove useful in disseminating evidence-based practices in human service delivery settings.     

Approaching ADHD as a chronic condition: implications for long-term adherence

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common chronic conditions of childhood. Although evidence-based treatments for ADHD, including stimulant medication and behavior modification, have long been established, and guidelines for care of ADHD in primary care settings have been developed, adherence to long-term therapy is poor among youth with ADHD. This article proposes use of the Chronic Care Model for Child Health, the purpose of which is to develop informed, activated patients who will interact with a prepared, proactive health care team. Six "pillars" make up the model: decision support, delivery system design, clinical information systems, family and self-management support, community resources and policies, and health care organizations. Each of these is discussed, and an individual example is described. Adopting the Chronic Care Model for Child Health has the potential to improve the quality of care for ADHD.     

Accuracy in communication. A contextual approach to child behavior assessment

This article analyzes the problem of accuracy of communication in clinical settings and argues that clinical language is replete with theoretical constructs that may not have shared meaning among speakers and listeners in mental health settings. It is suggested that mental health providers be trained in a contextually based data language. The value of such a data language employed in behavioral assessment is emphasized. The authors contend that events and behavior are products of the contextual environment; contextual variables are more accurately identified and agreed on; and the use of contextual variables in treatment intervention increases consequential validity. A developmental ecological approach, coupled with applied behavior analysis, are discussed and offered as a foundation on which clinical interventions should be planned and assessed. Using objective methods that yield demonstrable and meaningful outcomes can help improve children's mental health service delivery and the lives of children.     

Integrating cultural competency and empirically-based practices in child welfare services: A model based on community psychiatry field principles of health

Acknowledging the existence of racism in our society is crucial to understanding the need for a culturally competent approach to developing empirically-based practices in child welfare, thereby providing a foundation for evidence-based practice in the field. Advancements have already been made in mental health to address cultural competence and evidence-based practice. This article presents a model of seven field principles of health promotion successfully used in the mental health services. Examples of the use of the model in various settings and evaluation projects are provided. Each of the seven principles – rebuilding/supporting the village; providing access to health care; improving bonding, attachment and connectedness; improving self-esteem; increasing social skills of target recipients; reestablishing/strengthening the adult protective shield; and minimizing residual effects of trauma (Bell et al., 2002) – is elaborated. The model's critical role in establishing culturally competent evidence-based practice is further outlined for application in the field of child welfare.     

Clinician Perspectives on Relationship,Therapeutic Strategy,and Gender Responsiveness in Child Welfare Substance Abuse Settings

There is a growing acknowledgment of client–provider relationship as a determining factor within evidence-based practice implementation. This collective case study of 20 service providers examined the approaches used by clinicians working with substance-abusing mothers involved in child welfare to shed light on their use of empirically informed, gender-specific interventions. Analyses revealed that clinicians struggle to articulate specific evidence-based frameworks, and their approach relies on an intuitively driven client–provider relationship. Clinicians report little institutional support for integration of empirically supported practices into settings where workforce stress plays a critical role, and thus rely on relationship skills to frame practice approach.     

Preventing Juvenile Delinquency Through Early Family Intervention

ABSTRACT

Any professional working in the field of juvenile corrections can attest to the impact of family dynamics in contributing to and maintaining delinquent behavior, and studies have for years linked family dysfunction with the problem of juvenile delinquency. While most research has been done by professionals in other fields, social workers frequently provide intervention with these families. This article offers an overview of the aspects of family dysfunction which increase the risk of juvenile delinquency and offers suggestions for social work intervention in four areas: identification of families at risk, early intervention, service delivery, and preventive education. All may be considered preventive methods if used effectively.     

A systematic review of evidence-based interventions for students with challenging behaviors in school settings

The author's systematic review of 2,294 articles from 10 journals in the fields of education, special education, school social work, school psychology, and school counseling identified 42 articles meeting search criteria of addressing evidence-based interventions for students with challenging behaviors in school settings. Interventions were considered evidence-based if they were (a) manualized or structured to facilitate replication; (b) evaluated with an experimental design; and (c) demonstrated to be effective. Current practices available to address students who require evidence-based interventions for challenging behaviors are summarized. Suggestions for intervention development to address the needs of students with difficult behaviors are offered.     

Building an evidence-base for the training of evidence-based treatments in community settings: Use of an expert-informed approach

In order to make EBTs available to a large number of children and families, developers and expert therapists have used their experience and expertise to train community-based therapists in EBTs. Understanding current training practices of treatment experts may be one method for establishing best practices for training community-based therapists prior to comprehensive empirical examinations of training practices. A qualitative study was conducted using surveys and phone interviews to identify the specific procedures used by treatment experts to train and implement an evidence-based treatment in community settings. Twenty-three doctoral-level, clinical psychologists were identified to participate because of their expertise in conducting and training Parent–Child Interaction Therapy. Semi-structured qualitative interviews were completed by phone, later transcribed verbatim, and analyzed using thematic coding. The de-identified data were coded by two independent qualitative data researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to construct a training protocol to be empirically tested. The goal of this paper is not only to understand the current state of training practices for training therapists in a particular EBT, Parent–Child Interaction Therapy, but also to illustrate the use of expert opinion as the best available evidence in preparation for empirical evaluation.     

A Preliminary Evaluation of the 1-2-3-Magic Parenting Program in an Australian Community Services Setting

Cognitive-behavioural parenting programs provide caregivers with alternative strategies to harsh disciplining practices but the choice of programs that are evidence-based in Australia is limited. Australian community service workers suggest that having a choice of evidence-based programs is important when matching programs to client needs, and that 1-2-3 Magic is a program used widely in Australia despite its small Australian evidence base. The efficacy of the 1-2-3 Magic program has previously been shown in a controlled trial in an Australian university research setting but little is known about its effectiveness in a “real-world” setting. This study examined a three-session group-format of the Australian 1-2-3 Magic & Emotion Coaching program in a typical metropolitan community service setting. Thirty-eight caregivers with children aged 2–6 years reported a significant decrease in disruptive child behaviour (ECBI), permissive parenting (PS), and parental depression and stress (DASS) from pre- to post-intervention, with results maintained at 3-month follow-up. While these findings suggest that a brief 1-2-3 Magic program is beneficial, it is important to note that methodological limitations (intervention-group only study design and possible confounding variables) do not allow ruling out alternative causes for these improvements. Further research will be needed to confirm that this program can generalise to “real-world” settings.     

Traditional birth attendant training and local birthing practices in India

Training birth attendants (TBAs) provide essential maternal and infant health care services during delivery and ongoing community care in developing countries. Despite inadequate evidence of relevance and effectiveness of TBA training programmes, there has been a policy shift since the 1990s in that many donor agencies funding TBA training programmes redirected funds to providing skilled attendants during delivery. This study aimed to assess the ways in which a TBA training programme in India has been successful in disseminating evidence-based knowledge on birthing practices. TBAs practicing within 16 villages targeted by training programme initiatives were administered with structured questionnaires. The post training birthing practices of trained (24) and untrained (14) TBAs was compared and birthing practices adopted by women assisted by trained (16) and untrained (9) TBAs was analysed. Positive post training practices were hand washing, use of a clean blade for cutting the cord, immediate breastfeeding and weighing of babies. Nevertheless, the training could be further improved with up to date and evidence-based information and more comprehensive instructions. The findings suggest an integration of local and evidence-based knowledge is needed to improve the training. Raising community awareness of public health measures related to maternal and child health is also recommended.     

Advancing Evidence-Based Practices for Juvenile Justice Reform Through Community Development

There is a general agreement in the literature concerning what works and what does not work in reducing delinquent behavior with juvenile offenders in communities; however, this knowledge has had limited penetration into general public, political, and policymaking venues, as it is reported that less than 10% of juvenile offenders are afforded evidence-based community services. This article describes how Louisiana, through a combination of state, local, university, and national partnerships, adopted a community development model that has led to a 27% increase in juvenile-justice-involved youth having access to evidence-based services while the state witnessed a simultaneous 46% drop in juvenile arrests between 2006 and 2010.     

Statewide dissemination of an evidence-based practice using Breakthrough Series Collaboratives

The emerging field of implementation science has begun to inform the increasing efforts to disseminate evidence-based practices. The Breakthrough Series Collaborative (BSC) model was used to disseminate trauma-focused cognitive behavioral therapy (TF-CBT) across Connecticut over three years. Participants were 179 outpatient clinical staff across 16 community-based agencies that implemented TF-CBT. A total of 588 children and families received TF-CBT. Children completing treatment showed significant reductions in PTSD and depression symptoms. Quantitative and qualitative data about the BSC model are presented. The BSC is a promising approach for dissemination of evidence-based practices, and recommendations for additional research on BSCs and sustainment of evidence-based practices are made.     

Evidence-based practices in the field of intellectual and developmental disabilities: an international consensus approach

As evidence-based practices become increasingly advocated for and used in the human services field it is important to integrate issues raised by three perspectives on evidence: empirical-analytical, phenomenological-existential, and post-structural. This article presents and discusses an evidence-based conceptual model and measurement framework that integrates these three perspectives and results in: multiple perspectives on evidence-based practices that involve the individual, the organization, and society; and multiple interpretation guidelines related to the quality, robustness, and relevance of the evidence. The article concludes with a discussion of five issues that need to be addressed in the future conceptualization, measurement and application of evidence-based practices. These five are the need to: expand the concepts of internal and external validity, approach evidence-based practices from a systems perspective, integrate the various perspectives regarding evidence-based practices, develop and evaluate evidence-based practices within the context of best practices, and develop a set of guidelines related to the translation of evidence into practice.     

Sex,drugs and matrices: Mathematical prediction of HIV infection

The purpose of this paper is to consider a very simple model of the AIDS epidemic. This model illustrates how the spread of AIDS can be affected by parameters whose values, at the present time, are very imprecise or unknown. Of particular interest are the data related to sexual encounters and practices, data which are often unreliable or ambiguous. In this regard, the present model also suggests that the epidemiology of AIDS is particularly sensitive to the limitations in the assessment of sexuality/drug‐related behavior. Using a system of elementary differential equations, the present paper illustrates (using 3 examples) that depending upon the value of critical parameters, one could predict either very rapid increases of seropositivity or a decreasing rate of seropositivi‐ty. Thus, in order to diminish the ambiguity, it becomes crucial to make careful estimates of the sexual “interaction” coefficients, along with all other parameters, to insure that reasonable predictions can be made.