ABSTRACT 1: Cross-collaboration example
Geetha Gopalan1, Alicia Bunger2, Byron Powell3
1School of Social Work, University of Maryland-Baltimore, Baltimore, MD, USA; 2College of Social Work, Ohio State University, Columbus, OH, USA; 3Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Correspondence: Geetha Gopalan (ggopalan@ssw.umaryland.edu)
Title: Skills for developing and maintaining community-partnerships for implementation research in children’s behavioral health: Implications for research infrastructure and training of early career investigators
Background
Children and youth often receive substandard mental health and child welfare services [1 – 4]. Evidence-based treatments (EBTs) are underutilized, and when they are adopted, problems with implementation can diminish their impact [5]. Thus, the National Institutes of Health (NIH) and the Institute of Medicine (IOM) have prioritized efforts to advance implementation science [6, 7]. These efforts will require that researchers partner closely with a wide range of community stakeholders to improve outcomes for children, youth, and families [8]. The purpose of this paper is to identify skills for developing and maintaining community partnerships within the context of implementation research in child welfare services.
Materials and Methods
Two case studies are presented, showcasing efforts of early-career investigators to partner with child welfare systems to improve the quality of behavioral health services for children, youth, and families. Case #1 focuses on a National Institute of Mental Health (NIMH)-funded exploratory/ developmental study which utilizes task-shifting strategies to implement the 4Rs and 2Ss Strengthening Families Program (4R2S) [9], originally provided by advanced mental health practitioners to reduce child disruptive behavior difficulties, so that it can be delivered by child welfare caseworkers providing placement prevention services. Case #2 involves a Children’s Bureau-funded demonstration where behavioral health screening, assessment, and referral practices are implemented within a public child welfare agency.
Results
Cross-cutting issues include managing stakeholder relationships, navigating regulatory constraints and human subjects review board procedures, adapting to delays and plan changes, attending to organizational culture and climate, and securing additional resources. Case studies highlight the ways in which early-career investigators are supported by the NIMH-funded Implementation Research Institute [10] to conduct community-engaged research. Moreover, recommendations are identified to enhance training and research infrastructures supporting early-career investigators who aim to partner with community stakeholders.
Conclusions
Strong partnerships with community stakeholders have potential to advance implementation research but can be challenging to develop and maintain. Experiences of two early career investigators provide insight into the difficulties and opportunities when working within child welfare systems to promote use of effective child behavioral health interventions.
References
1. Garland AF, Brookman-Frazee L, Hurlburt MS, Accurso EC, Zoffness RJ, Haine-Schlagel R, Ganger W. Mental health care for children with disruptive behavior problems: a view inside therapists’ offices. Psychiatr Serv. 2010;61:788-95.
2. Kohl PL, Schurer J, Bellamy JL. The state of parent training: program offerings and empirical support. Fam Soc. 2009;90:247-54. https://doi.org/10.1606/1044-3894.3894.
3. Raghavan R, Inoue M, Ettner SL, Hamilton BH. A preliminary analysis of the receipt of mental health services consistent with national standards among children in the child welfare system. Am J Public Health. 2010; 100:742-9. https://doi.org/10.2105/AJPH.2008.151472.
4. Zima BT, Hurlburt MS, Knapp P, Ladd H, Tang L, Duan N, et al. Quality of publicly-funded outpatient specialty mental health care for common childhood psychiatric disorders in California. J Am Acad Child Adolesc Psychiatry. 2005;44:130-44.
5. Durlak JA, DuPre EP. Implementation matters: a review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2010;41:327-50. https://doi.org/10.1007/s10464-008-9165-0.
6. Institute of Medicine. Psychosocial interventions for mental and substance use disorders: A framework for establishing evidence-based standards. Washington, D. C.: The National Academies Press. 2015.
7. National Institutes of Health. Dissemination and implementation research in health (R01). 2016. Bethesda, Maryland: National Institutes of Health. Retrieved from http://grants.nih.gov/grants/guide/pa-files/PAR-16-238.html
8. Chambers DA, Azrin ST. Partnership: a fundamental component of dissemination and implementation research. Psychiatr Servi. 2013;64(16):509-11. https://doi.org/10.1176/appi. ps.201300032
9. Gopalan G. Feasibility of improving child behavioral health using task-shifting to implement the 4Rs and 2Ss program for strengthening families in child welfare. Pilot Feasibility Stud. 2016;2:21. doi:10.1186/s40814-016-0062-2
10. Proctor EK, Landsverk J, Baumann AA, Mittman BS, Aarons GA, Brownson RC, et al. The implementation research institute: training mental health implementation researchers in the United States. Implement Sci. 2013;8:105.