27 research outputs found

    A Conversation on Building Resilience and Protecting Children: An Evidence-Based Family Strengthening Approach

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    This Article summarizes a presentation to child mental health scientists, child development experts, neuroscientists, and child health practitioners at a 2017 conference entitled “The Developing Brain: New Directions in Science, Policy, and Law.” We presented an evidence-based approach to strengthening families, referred to as the “4Rs and 2Ss Family Strengthening Program,” as an option for protecting children and enhancing their overall development. We presented data that found child and family outcomes, including child behavior regulation and functioning, and parent depression and stress, improved among families who participated in the intervention. We also found several intervention innovations that were developed as a result of intensive collaboration with adult caregivers, child mental health providers and services researchers. These innovations include: 1) a multiple family group format composed of up to eight families, and in which at least two generations of each family attend the group; 2) family advocates (trained caregivers that have cared for a child with mental health problems) as group co-facilitators; 3) an intervention protocol that is shared with providers and families; and 4) content that increases transparency of the evidence-based principles including establishing family rules, fostering healthy parent/child relationships, enhancing caregiver social support and decreasing stress. Evidence-based interventions that support parenting and family processes offer opportunities to meet challenges threatening positive development. Such challenges may include emerging mental health issues and struggles with behavioral regulation. These interventions may be particularly critical during childhood when conduct-related challenges commonly emerge with associated impairments in key areas of functioning at school, home and in the community

    Child Welfare Involved Caregiver Perceptions of Family Support in Child Mental Health Treatment

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    Families involved in the child welfare system have disproportionately high rates of child mental health difficulties coupled with co-occurring stressors which impede access to child mental health treatment and therapeutic benefits. Peer support providers, an emerging workforce within child-serving settings, show particular promise at facilitating access to services, particularly for individuals with stigmatizing conditions. However, the perceived benefits of utilizing peer support providers from the perspective of child welfare-involved families is unknown. The purpose of this qualitative study is to describe peer support provided services and their perceived benefits within the Multiple Family Group (MFG) service delivery model, a clinician- and peer-led mental health intervention for children with behavioral problems and their families. Methods: In-depth interviews were conducted with 25 predominantly Black and Hispanic adult (ages 26-57) child welfare-involved female caregivers who participated in MFG. Results: The most common benefits reported by caregivers were emotional support, instrumental support, and instructional support from clinician and peer facilitator teams. Caregivers reported they felt more comfortable with peers than clinicians when discussing parenting strategies. Conclusion: Peer support providers offer multiple and varied supports to caregivers. Implications of this study and future research directions are presented

    All over the Map: A Systematic Literature Review and State Policy Scan of Medicaid Buy-In Programs for Working Individuals with Disabilities

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    While supports for people with disabilities have increased, significant healthcare and financial barriers persist. State-administered Medicaid Buy-In programs for working people with disabilities, distinct from broader buy-in discussions that have emerged as some states consider expanding access to health insurance, are intended to incentivize employment and protect against a loss of Long-Term Services and Supports. Loss of these services would be detrimental to a person’s ability to access daily living and workforce participation supporting services. This paper explores identified drivers of and barriers to participation, outcomes, and the current state of programs that are currently in place. Authors conducted a systematic literature search to identify evidence published in peer-review journals. Additionally, a policy scan using information from government sources for the 45 state-administered buy-in programs was completed. The results indicate that state Medicaid Buy-In programs vary dramatically in their construction and presentation, with eligibility and administration information or lack thereof having the potential to significantly affect a person’s decision making around benefit enrollment and employment. Findings are discussed in the context of additional recent state and federal policy efforts to improve outcomes around employment, income, and asset generation for people with disabilities

    Testing the 4Rs and 2Ss Multiple Family Group intervention: study protocol for a randomized controlled trial

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    Abstract Background Oppositional defiant disorder (ODD) is a major mental health concern and highly prevalent among children living in poverty-impacted communities. Despite that treatments for ODD are among the most effective, few children living in poverty receive these services due to substantial barriers to access, as well as difficulties in the uptake and sustained adoption of evidence-based practices (EBPs) in community settings. The purpose of this study is to examine implementation processes that impact uptake of an evidence-based practice for childhood ODD, and the impact of a Clinic Implementation Team (CIT)-driven structured adaptation to enhance its fit within the public mental health clinic setting. Methods/design This study, a Hybrid Type II effectiveness-implementation research trial, blends clinical effectiveness and implementation research methods to examine the impact of the 4Rs and 2Ss Multiple Family Group (MFG) intervention, family level mediators of child outcomes, clinic/provider-level mediators of implementation, and the impact of CITs on uptake and long-term utilization of this model. All New York City public outpatient mental health clinics have been invited to participate. A sampling procedure that included randomization at the agency level and a sub-study to examine the impact of clinic choice upon outcomes yielded a distribution of clinics across three study conditions. Quantitative data measuring child outcomes, organizational factors and implementation fidelity will be collected from caregivers and providers at baseline, 8, and 16 weeks from baseline, and 6 months from treatment completion. The expected participation is 134 clinics, 268 providers, and 2688 caregiver/child dyads. We will use mediation analysis with a multi-level Structural Equation Modeling (SEM) (MSEM including family level variables, provider variables, and clinic variables), as well as mediation tests to examine study hypotheses. Discussion The aim of the study is to generate knowledge about effectiveness and mediating factors in the treatment of ODDs in children in the context of family functioning, and to propose an innovative approach to the adaptation and implementation of new treatment interventions within clinic settings. The proposed CIT adaptation and implementation model has the potential to enhance implementation and sustainability, and ultimately increase the extent to which effective interventions are available and can impact children and families in need of services for serious behavior problems. Trial registration ClinicalTrials.gov, ID: NCT02715414 . Registered on 3 March 2016

    Evaluation of a Modified Bit Device to Obtain Saliva Samples from Horses

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    (1) Background: Accounting for the well-being of equine partners is a responsibility of those engaged in Equine-Assisted Services (EAS). Researchers took heed of this call to action by developing an innovative way to collect data to assess the physiological indicators of stress in equine participants. The collection of saliva is considered to be a minimally invasive method of data collection and is typically performed using a cotton swab; however, in equines, the introduction of a foreign object may induce stress; (2) Methods: Researchers used a modified bit to collect pooled saliva in an effort to further reduce stress during the saliva collection process. Additionally, the collection of pooled saliva, via the bit, increases the opportunity to consider additional analyses, such as oxytocin, which is more reliable in pooled saliva than site-specific saliva captured with a swab; (3) Results: A data analysis demonstrated that ample saliva was captured using the modified bit. Observational data supported that the horses demonstrated fewer physical stress signals to the bit than to the swab. Thus, the modified bit is a feasible and valid method for equine salivary sample collection; (4) Conclusions: The results suggest that the modified bit provides a viable method to collect equine saliva and supports national calls to prioritize animal welfare analysis, specifically for horses used within EAS. Future research should enhance methodological rigor, including in the process and timing, thereby contributing to the bit’s validation