Toward a policy ecology of implementation of evidence-based practices in public mental health settings

BACKGROUND: Mental health policymaking to support the implementation of evidence-based practices (EBPs) largely has been directed toward clinicians. However, implementation is known to be dependent upon a broader ecology of service delivery. Hence, focusing exclusively on individual clinicians as targets of implementation is unlikely to result in sustainable and widespread implementation of EBPs. DISCUSSION: Policymaking that is informed by the implementation literature requires that policymakers deploy strategies across multiple levels of the ecology of implementation. At the organizational level, policies are needed to resource the added marginal costs of EBPs, and to assist organizational learning by re-engineering continuing education units. At the payor and regulatory levels, policies are needed to creatively utilize contractual mechanisms, develop disease management programs and similar comprehensive care management approaches, carefully utilize provider and organizational profiling, and develop outcomes assessment. At the political level, legislation is required to promote mental health parity, reduce discrimination, and support loan forgiveness programs. Regulations are also needed to enhance consumer and family engagement in an EBP agenda. And at the social level, approaches to combat stigma are needed to ensure that individuals with mental health need access services. SUMMARY: The implementation literature suggests that a single policy decision, such as mandating a specific EBP, is unlikely to result in sustainable implementation. Policymaking that addresses in an integrated way the ecology of implementation at the levels of provider organizations, governmental regulatory agencies, and their surrounding political and societal milieu is required to successfully and sustainably implement EBPs over the long term

Evaluating Children’s Advocacy Centers’ Response to Child Sexual Abuse

Children’s Advocacy Centers (CACs) play an increasingly significant role in the response to child sexual abuse and other child maltreatment in the United States. First developed in the 1980s, CACs were designed to reduce the stress on child abuse victims and families created by traditional child abuse investigation and prosecution procedures and to improve the effectiveness of the response. According to several experts (Fontana, 1984; Pence and Wilson, 1992; Whitcomb, 1992), child victims were subjected to multiple, redundant interviews about their abuse by different agencies, and were questioned by professionals who had no knowledge of children’s developmental limitations or experience working with children. Child interviews would take place in settings like police stations that would further stress already frightened children. Moreover, the response was hampered because the multiple agencies involved did not coordinate their investigations, and children’s need for services could be neglected

Toward a policy ecology of implementation of evidence-based practices in public mental health settings

Abstract Background Mental health policymaking to support the implementation of evidence-based practices (EBPs) largely has been directed toward clinicians. However, implementation is known to be dependent upon a broader ecology of service delivery. Hence, focusing exclusively on individual clinicians as targets of implementation is unlikely to result in sustainable and widespread implementation of EBPs. Discussion Policymaking that is informed by the implementation literature requires that policymakers deploy strategies across multiple levels of the ecology of implementation. At the organizational level, policies are needed to resource the added marginal costs of EBPs, and to assist organizational learning by re-engineering continuing education units. At the payor and regulatory levels, policies are needed to creatively utilize contractual mechanisms, develop disease management programs and similar comprehensive care management approaches, carefully utilize provider and organizational profiling, and develop outcomes assessment. At the political level, legislation is required to promote mental health parity, reduce discrimination, and support loan forgiveness programs. Regulations are also needed to enhance consumer and family engagement in an EBP agenda. And at the social level, approaches to combat stigma are needed to ensure that individuals with mental health need access services. Summary The implementation literature suggests that a single policy decision, such as mandating a specific EBP, is unlikely to result in sustainable implementation. Policymaking that addresses in an integrated way the ecology of implementation at the levels of provider organizations, governmental regulatory agencies, and their surrounding political and societal milieu is required to successfully and sustainably implement EBPs over the long term.</p

Nonoffending Caregiver and Youth Experiences With Child Sexual Abuse Investigations

Qualitative responses by caregivers (n = 203) and youth (aged 8 and older; n = 65) about their experiences with sexual abuse investigations were analyzed in conjunction with quantitative ratings of satisfaction. Respondents described mostly high levels of satisfaction, although dissatisfaction was reported with some key aspects of investigations. The features cited as worse than expected by caregivers were the investigators’ commitment to prosecuting the alleged offender and the absence of clear and regular communication about the status of the case. The features mentioned most often by caregivers as better than expected were the emotional support and interviewing skills of investigators. Youth focused both praise and criticism on investigators’ interviewing skills. There were relatively few complaints by either caregivers or youth about the duration of the investigation, medical exams, lack of services, or failures of interagency communication, areas of considerable reform in the past several decades. Implications for investigator training and reform initiatives are discussed

A comparison of two computer-aided instruction methods with traditional instruction in freshmen college mathematics classes

Computer Aided Instruction (CAI) has vast possibilities that are just beginning to emerge as the medium is being utilized by more and more institutions nationwide. The new educational software industries have the potential to meet the educational needs of a large and increasingly diverse student population. The purpose of the present study is to compare achievement among remedial college algebra students in classes where predominantly computer-aided instruction was used to that of students in classes using traditional lecture instruction. The researcher aimed to identify key aspects that may translate into student success and achievement in remedial college algebra classes. Theoretically, CAI should enhance learning according to well-known principles of behaviorism and constructivism. In reality, studies of learning outcomes using CAI report mixed results about whether the use of CAI actually provides educational benefit beyond that of traditional instruction. This study was comparative study using an ex-post-facto design. Class sections were randomly assigned to instructional methods. Students, although not randomly assigned to sections, were blind to instructional methods when registered for classes. The study evaluated student performance using scores on individual semester tests, a comprehensive final exam, and overall course grade. Regardless of whether achievement is measured in terms of single semester test, comprehensive final exam, course average, or test performance across the semester the results presented here indicate that students perform better in traditional classes than in CAI classes regardless of the CAI curriculum used. Moreover, despite instructional method, students perform better on tests at earlier and later points in the semester than in the middle. Comparison of the two CAI curricula used in this study indicated that student test performance is better for students using Thinkwell CAI than those receiving the MyMathLab CAI curriculum. These results have implications for math educators considering how best to use CAI to teach remedial college algebra. (Published By University of Alabama Libraries