Suzanne Kerns, Ph.D. & Andrew Rivers

1. Partnerships for Success:Supporting Evidence-Based Programming for Children’s Mental HealthWashington State Behavioral Healthcare Conference – June 9, 2011 Suzanne Kerns, Ph.D. & Andrew Rivers Div. of Public Behavioral Health and Justice Policy, University of Washington & Andrea Parrish, MA, CMHS Div. of Behavioral Health and Recovery, DSHS

2. 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

3. Background of EBP implementation and context

4. Background of EBP Implementation • States across the country are increasingly mandating that agencies provide evidence-based services • Mandates a result of • Legislative initiatives • Lawsuits

5. 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

6. 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

7. Some barriers to implementation of empirically-supported treatments money info access time

8. …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

9. 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

10. 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

11. Partnerships for Success

12. 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

13. 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

14. Community Engagement Model Adapted from the Partnerships for Success model used in Ohio

15. GuidingValues

16. PfS Activities

17. 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

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

19. 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 • 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

20. Planning Process Planning is composed of three basic activities Needs Assessment Resource Assessment Identify Strategic Actions Needs 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

21. Mobilization Success 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

22. 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

23. Evaluation Ongoing 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

24. 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

25. 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

26. MST outcomes As of April 1, 2011

27. 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

28. Reason for Discharge

30. Instrumental Outcomes

31. Triple P Outcomes As of DATE

32. 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

33. Target Youth • Gender • Male: 63% • Female: 37% • Age • 3-4: 12% • 5-11: 84% • 12-14: 5%

34. Triple P: Parent/Child Outcomes

35. Triple P: Parent/Child Outcomes

36. 100 80 60 Pre Points Post 40 20 0 Behavioral self-efficacy Setting self-efficacy** Total* Subscale Parenting Tasks Checklist

37. Strengths & Difficulties Questionnaire

38. Parent Problem Checklist / Relationship Quality Index

39. Depression, Anxiety, Stress Scales

40. Clinical Status (all measures)

41. Partnerships for Success: Process Evaluation

42. 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?

43. Process outcomes, continued …

44. Process outcomes, continued …

45. Partnerships for Success: Skokomish Tribal Nation

46. 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

47. 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

48. Skokomish Guiding Principles Focus on Family Focus on Wellness Promoting Competence Community Collaboration Cultural Relevance

49. 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

50. 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