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

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

Background of EBP implementation and context

States across the country are increasingly mandating that agencies provide evidence-based services

Mandates a result of Legislative initiatives Lawsuits

Background of EBP Implementation

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

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

Some barriers to implementation of empirically-supported treatments

money

time

infoaccess

…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

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

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

Partnerships for Success

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

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

Community Engagement Model

Adapted from the Partnerships for Success model used in Ohio

GuidingValues

PfS Activities

Resource assessment

Strategic Action Identification

ImplementationEvaluation

Mobilization and planning

Needs assessment

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

The PfS Model

The PfS model revolves around a core of data-informed decisions and is encompassed by a continuous need for community mobilization

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

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

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

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

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

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

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

MST OUTCOMES

As of April 1, 2011

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

Reason for Discharge

Instrumental Outcomes

Triple P OutcomesAs of DATE

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

Target Youth

Gender Male: 63% Female: 37%

Age 3-4: 12% 5-11: 84% 12-14: 5%

  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

  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

Parenting Tasks Checklist

0

20

40

60

80

100

Behavioral self-efficacy Setting self-efficacy** Total*

Subscale

Points Pre

Post

Strengths & Difficulties Questionnaire

0

2

4

6

8

10

Emotionalsymptoms

Conductproblems**

Hyperactivity* Peerproblems

Prosocial Total* Impact

Pre

Post

Parent Problem Checklist / Relationship Quality Index

0

2

4

6

8

10

Disagreements (number of)* Severity of disagreements Relationship quality

Pre

Post

Depression, Anxiety, Stress Scales

0

5

10

15

20

Depression Anxiety Stress Total

Pre

Post

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

Partnerships for Success:

Process Evaluation

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?

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

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

Partnerships for Success:Skokomish Tribal

Nation

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

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

Skokomish Guiding Principles

Focus on Family

Focus on Wellness

Promoting Competence

Community Collaboration

Cultural Relevance

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

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

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

Resource Assessment

Very few EBPs available for Skokomish youth Mostly through courts or schools

Popular ‘non-EBP’ programs had little evaluation

Choosing a new program

TF-CBT Motivational Interviewing

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

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

Highlights thus far New programming available

Trauma-Focused CBT being implemented by clinicians at Tuwaduq Family Services

Motivational Interviewing training offered to community members