In 2001 The CIBHS Center for Child and Family Services launched
its first efforts to support the availability of services based
upon practices that have strong research support. This has grown
to become the CIBHS Values-Driven Evidence-Based Practices
Initiative. This initiative is designed to increase the
availability of mental health practices supported by research –
evidence-based practices – and is guided by the following
principles:
Consumers, family members, service providers, managers,
administrators and all members of our communities should have
information regarding the effectiveness of particular mental
health practices to assure fully informed decision making.
The adoption of new practices must take into account many
significant priorities unique to its context; however, it should
prioritize consumer and family choice, cultural competency, and
practices with scientific research supporting their
effectiveness. Community, agency, and personal values must guide
the process of selecting to implement and/or participate in an
evidence-based practice.
Effective implementation processes, which adequately support
practitioners, managers, and administrators, are key to improving
quality of practices offered to consumers of mental health
services.
The California Institute for Behavioral Health Solutions (CIBHS)
is working with a wide range of partner agencies to engage in the
model adherent implementation of evidence-based
practices. Informed by experiences of county mental health
departments and other public agencies, non-profit community-based
organizations, and foundations CIBHS has created an approach
designed to support the full and sustained implementation of
practices and programs – The Community Development Team (CDT)
Model. A detailed description of the CDT Model is available:
Community Development Team Model: Supporting the
Model Adherent Implementation of Programs and
Practices.
The Community Development Team (CDT) Model is a multilevel
training and technical assistance strategy that has grown out of
the CIBHS’s effort to promote innovation in services and
operations of mental health programs. CDTs are designed to
promote high-adherence adoption of program and/or operational
innovations by publicly operated/administered agencies and
nonprofit community-based organizations. The CDT structure
is designed so that participants are able to develop a realistic
and concrete implementation plan, learn and apply clinical or
technical information about a specific innovation, and overcome
barriers to change.
A CDT is composed of a group of counties or agencies that are
committed to implementing a new practice. Each
participating agency/county has a team of participants including
consumers, administrators, managers/supervisors, and direct
service staff. Training and technical assistance is
provided through a series of multi-agency meetings and augmented
by individualized agency specific assistance as needed. CDT
meetings involve four sets of activities:
Clinical or Technical Training —Typically didactic with
discussion, activities and role-playing presented by a
“content-expert,” usually program developers.
Planning—Provides an opportunity for the team of individuals
from each agency/county to integrate the new information and
develop or amend plans for local implementation. CDT trainers
assist with county planning activities and assist the counties to
develop strategies to overcome barriers to adoption, for example
federal, state and county regulation, funding, and so forth.
Peer-to-peer support —Provides opportunities for counties to
share their plans for local implementation. This
peer-to-peer component is a distinguishing characteristic of the
CDT approach. Participating /agencies benefit from learning
about the strategies being used by other counties/agencies and by
receiving feedback from their peers about their own strategies.
Outcome and Evaluation Support
Publication: Community Development Team Model:
Supporting the Model Adherent Implementation of Programs and
Practices.
Practice Description – The following practices
are currently supported by CIBHS Values Driven Evidence-based
Practices Implementation Projects.
Multi-Dimensional Treatment Foster Care (MTFC)
was developed in the 1980’s to assist youth with stabilization
and reunification with a parent, relative or other permanent
caregiver. It has been subject to numerous random assignment
clinical studies in which youth participating in MTFC showed
significantly better outcomes than control groups, including
youth in group care. Youth involved with MTFC often show
emotional and behavioral problems that present a challenge for
adults. The project focuses on decreasing problem behaviors
and increasing developmentally appropriate social skills and
behaviors, to help youth experience success at home, at school
and in the community. This is accomplished by providing:
Close supervision
Fair and consistent limits
Predictable rewards and sanctions for following or breaking
rules
A supportive relationship with at least one mentoring adult
Reduced exposure to delinquent peers
Emphasis on school performance
The intervention is multifaceted and occurs in multipole
settings. The intervention components include:
Behavioral parent training and support for MTFC foster
parents and biological parents (or other after-care resources)
Skills training for the youth
Family therapy for biological families (or other after-care
resources)
Supportive therapy for the youth and involved adults
School-based behavioral interventions and academic support
Psychiatric consultation and medication management when
needed.
Functional Family Therapy (FFT) is a
multi-phased family intervention targeting youth (11-18 years of
age) and their families, including youth with problems such as
conduct disorder, violent acting-out, and substance
abuse. FFT intervention ranges from, an average of 8
to 12 one-hour sessions, up to 30 sessions of direct service for
more difficult situations. FFT is conducted both in clinic
settings as an outpatient therapy and as a home-based
model. It is a treatment technique that is appealing because
of its clear identification of specific phases, which organize
intervention in a coherent manner, thereby allowing clinicians to
maintain focus in the context of considerable family and
individual disruption. Each phase includes specific goals,
assessment foci, specific techniques of intervention, and
therapist skills necessary for success
FFT was developed by James Alexander and his colleagues from the
University of Utah. FFT has a number of studies
demonstrating positive outcomes including reductions in criminal
behavior (from 25-60%) and improved family relationships and
school performance. FFT has been successfully adopted by
numerous diverse communities throughout the nation.
Teaching Prosocial Skills (including Aggression
Replacement Training™ curriculum) is a
multi-component cognitive-behavioral treatment to promote
pro-social behavior by addressing factors that contribute to
aggression in children and adolescents including limited
interpersonal social and coping skills, impulsiveness,
over-reliance on aggression to meet daily needs, and egocentric
and concrete values. Teaching Prosocial Skills (TPS) utilizes
Aggression Replacement Training™ curriculum and has consistently
shown positive outcomes across a number of quasi-experimental
studies including:
Reduced criminal behavior
Decreased conduct problem behaviors
Increased pro-social behaviors
Improved anger control
TPS is a group intervention (6-8 youth per group) that consists
of three components: Skillstreaming, Anger Control Training, and
Moral Reasoning Training. Skillstreaming, developed by
Arnold Goldstein, teaches youth pro-social skills. Anger
Control Training by Eva Feindler and her colleagues teaches youth
how to manage angry feelings. Moral Reasoning Training,
through social perspective taking opportunities, teaches youth
higher levels of moral reasoning, characterized by mutuality
(treating others as you would hope they would treat you), and
interdependence and cooperation for the sake of
society.
Multidimensional Family Therapy (MDFT) is an
intensive community- and home-based program that primarily
targets substance abusing juvenile offenders and at-risk youth
(12-18 years of age). Appropriate for youth residing in
their homes but at-high risk of out-of-home placement.
MDFT was developed by Howard Liddle and his colleagues from the
University of Miami School of Medicine. MDFT has been
subject to numerous random clinical trails and shows positive
outcomes including reductions in use of drugs and alcohol and
affiliations with antisocial peers, and improvements in family
relationships and school performance. MDFT research has
focused upon African – American and Latino youth and has been
successfully adopted by numerous diverse communities throughout
the nation.
Depression Treatment Quality Improvement (DTQI)
is a clinic-based cognitive-behavioral intervention that utilizes
quality improvement processes to guide the provision of
therapeutic services to adolescents who have depression.
This model was developed and studied by Joan Asarnow PhD, UCLA
and Margaret Mason-Rea PhD, UCD and has been successfully
implemented in Michigan. In Michigan-based studies comparing
youth receiving DTQI to those receiving usual care reported that
80% of adolescents receiving DTQI service experienced meaningful
change, and faired significantly better than adolescents
receiving usual care with:
Reductions in depressive symptoms;
Improved quality of life ratings
Higher participation in mental health services.
The Wraparound approach to treatment began
in the 1980s with efforts to help families with the most
challenging children function more effectively. It is a
definable planning process resulting in a unique set of community
services and natural supports individualized for a child and
family. Wraparound has been implemented in mental health,
education, child welfare and juvenile justice sectors.
CIBHS is partnering with the National Wraparound Initiative (NWI)
to support the model adherent implementation of Wraparound as a
strategy for improving outcomes. The following outlines
key Wraparound elements:
Wraparound must be community-based.
Wraparound must be a team-driven process involving the child,
family, natural supports, agencies and community services
collaborating to develop, implement and evaluate an
individualized plan.
Families must be full and active partners in every level of
the Wraparound process.
Services and supports must be individualized and built on
strengths, meeting the needs of children and families across life
domains to promote success, safety and permanence in home school
and community.
The process must be culturally competent, building on the
unique values, preferences and strengths of children and families
and their communities.
Wraparound child and family teams must have flexible
approaches and adequate/flexible funding.
Wraparound plans must balance formal services and informal
community andfamily supports.
There must be an unconditional commitment to serve children
and their families.
The plans should be developed and implemented based on an
interagency community—based collaborative process.
Outcomes must be determined and measured for the system for
the program and for the individual child and family.
(adapted from Burchard, J.D., Bruns, E.J., & Burchard, S.N.
(2002) The Wraparound Process. In B.J. Burns & K Hoagwood,
Community-based Treatment for
youth. Oxford:Oxford University Press.)
Incredible Years (IY) is a three component
curriculum for children 2-12 years old who have, or are at risk
for, behavior and conduct problems. The three components
include parent training (BASIC and ADVANCED), teacher training
(Classroom Management Training and Dina Dinosaur Classroom
Curriculum), and a child small group program (Dina
Dinosaur). The BASIC Parenting Program is required in
implementing IY, and the others are optional. All programs
rely upon video vignettes to guide group discussion.
Developed and researched by Carolyn Webster-Stratton PhD, IY has
been subject to numerous random clinical trials.
Outcomes for the various components include:
Increases positive parental behavior (for ex., praise) and
reduced use of criticism and negative commands.
Increases in parent use of effective limit-setting by
replacing spanking and harsh discipline with non-violent
discipline techniques and increased monitoring of children.
Reductions in parental depression and increases in parental
self-confidence.
Increases in positive family communication and
problem-solving.
Reduces conduct problems in children’s interactions with
parents and increases in their positive affect and compliance to
parental commands.
Increases in teacher use of praise and encouragement and
reduced use of criticism and harsh discipline.
Increases in children’s positive affect and cooperation with
teachers, positive interactions with peers, school readiness and
engagement with school activities.
Reductions in peer aggression in the classroom.
Increases in children’s appropriate cognitive problem-solving
strategies and more prosocial conflict management strategies with
peers.
Reductions in conduct problems at home and school.
The term “evidence-based practice” usually refers to a broad
range of practices with varying levels of demonstrated
effectiveness.However, there is no standard definition for this
term, and it is frequently used to mean different things.This
is also the case for other terms and labels, such as model
programs, promising practices, best
practices, and so forth, that are utilized in this
field. There are a variety of rich resources,
particularly websites, now available that provide analyses and
summar
The CIBHS Caring for Foster Youth Project, supported by the
Zellerbach Family Foundation, published the report Evidence-based
Practices in Mental Health Services for Foster Youth in March
2002. This report outlined and organized the best research
information available at the time, regarding the mental health
needs of children in foster care as well as the state of research
in the area of mental health services for this population.