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Standardized assessment measures are important for accurate diagnosis of mental health problems and for treatment planning and evaluation. However, little is known about youth mental health providers' typical use of standardized measures across disciplines and outside the context of evidence-based practice initiatives. A multidisciplinary national survey examined the frequency with which 674 youth mental health providers administer standardized and unstandardized measures, and the extent to which organizational (i.e., implementation climate, rigid hierarchical organizational structure) and provider (i.e., attitudes toward standardized assessment measures, highest degree, practice setting) characteristics are associated with standardized measure use. Providers used unstandardized measures far more frequently than standardized measures. Providers' perceptions (a) that standardized measures are practical or feasible, (b) that their organization supports and values evidence-based practices, and (c) that their organization has a rigid hierarchical structure predicted greater use of standardized measures. Working in schools predicted less frequent SMU, while working in higher education and other professional settings predicted more frequent SMU. Standardized measures were not routinely used in this community-based sample. A rigid hierarchical organizational structure may be conducive to more frequent administration of standardized measures, but it is unclear whether such providers actually utilize these measures for clinical decision-making. Alternative strategies to promote standardized measure use may include promoting organizational cultures that value empirical data and encouraging use of standardized measures and training providers to use pragmatic standardized measures for clinical decision making. [ABSTRACT FROM AUTHOR]

Transition-age youth with mental health conditions from low socio-economic backgrounds often drop out of mental health services and, as such, do not receive therapeutic doses of treatment. Cornerstone is an innovative team-based, multi-component intervention designed to address the clinical needs of this understudied population through coordination and extensive provision of services in vivo (in the community). The present study used a convergent parallel mixed-methods design. Researchers collected quantitative and qualitative data during a small developmental trial, analyzing the two data types independently and then exploring them side-by-side to evaluate feasibility, acceptability, and preliminary implementation. Semi-structured interviews and quantitative surveys were conducted with transition-age youth, clinic staff, and policy makers. Qualitative interview guides were developed using the Consolidated Framework for Implementation Research to build understanding on implementation determinants alongside feasibility and acceptability. A two-group preliminary randomized trial was conducted to assess feasibility outcomes, such as recruitment, randomization, measurement performance, and trends in pre- to post- outcomes. Using grounded theory coding techniques, transcripts were coded by multiple coders, and themes were identified on acceptability and implementation. The team recruited fifty-six transition-age youth. Randomization was used in the study and the intervention was provided without incident. Results suggest individual components with both the social worker and mentor were more acceptable to participants than group-based approaches. Thematic analyses revealed themes associated with the inner, outer, and policy contexts describing a range of critical implementation determinants. Findings suggest that Cornerstone is feasible, acceptable, and promising for transition-age youth. It represents an innovative multi-component intervention worth exploring for transition-age youth with mental health conditions in a larger efficacy trial. Trial registration: The trial was registered at ClinicalTrials.gov (NCT02696109) on 22 April 16, Protocol Record R34-MH102525-01A1, New York University, Cornerstone program for transition-age youth with serious mental illness: study protocol for a randomized controlled trial. [ABSTRACT FROM AUTHOR]

Purpose: Treatment focus diffusion (TFD), dividing focus across multiple concerns during treatment, is common in public mental health care and differs from the more narrowly focused empirically supported treatments for youth reported in the literature. The present study examined whether and to what extent TFD is associated with youth functional improvement over the course of therapy. Method: This study utilized multi-level modeling techniques to analyze 12 consecutive years of standardized routine clinical service data from youth receiving treatment in one of two intensive in-home service settings: (a) Multisystemic Therapy (MST; n = 776 youths, 99 therapists), an implemented evidence-based treatment based on ecological theories of behavior in which therapists work with the multiple systems a youth interacts with (school, community, family), and (b) a standards-based service (n = 1854 youth, 413 therapists). Both service settings operate in the context of a publicly funded mental health care system which serves youth and families who are typically from underserved and low-income backgrounds. Majority of youth in this sample identified as multi-ethnic and male, and they, on average, were approximately 13 years old with three co-occurring diagnoses. Results: A significant TFD by service format interaction on youth functional improvement (alone and in the overall model) and follow up simple effects indicated that higher TFD was associated with significantly poorer outcomes in MST. The parameter estimate for TFD on functional improvement in the standards-based service format was in the same direction, but not statistically significant. Conclusion: Our findings suggest that maintaining a narrower treatment focus might be beneficial to clients, particularly in implemented evidence-based treatments. Likewise, TFD could be a helpful case monitoring tool for clinicians, supervisors, and systems leaders when reviewing intensive-in-home cases. [ABSTRACT FROM AUTHOR]

Publicly funded initiatives are underway to improve implementation of evidence-based practices (EBP) in youth mental health services. However, we know little about the success of these initiatives or about EBP implementation independent of such initiatives. We examined EBP implementation in a treatment as usual (TAU) state and in six states with publicly funded EBP initiatives (EBPIs). In Study 1, we examined providers' use of practices derived from the evidence base (PDEB) and their predictors among 780 providers in a TAU state. In Study 2, we conducted a systematic review of implementation strategies, outcomes, and predictors of EBP use in six state funded EBPIs. Study 1 suggests TAU providers use PDEB alongside practices without consistent research support; provider racial/ethnic minority status, learning theory orientation, and manual use predict greater PDEB use. Study 2 indicates EBPIs employ multiple recommended implementation strategies with variable outcomes across studies and measurement approaches. Predictors of EBP use in EBPIs also varied, though training, setting, and youth age were consistent predictors across studies. While sample differences and inconsistent measurement across studies made direct comparisons somewhat tenuous, rates of PDEB use in the TAU sample appeared similar to those in publicly funded EBPIs. However, two states reported comparisons with TAU samples and found higher EBP implementation under EBPI. Different predictors impacted EBP use in TAU versus EBPIs. Our findings highlight the need for improved evaluation of EBPIs including clear reporting standards for outcomes and more consistent, standardized measurement of EBP use in order to better understand and improve EBPIs. [ABSTRACT FROM AUTHOR]

Youth with autism spectrum disorder (ASD) have high rates of co-occurring mental health needs that necessitate mental health interventions. Given the unique clinical characteristics of youth with ASD, there have been significant efforts to adapt and test mental health interventions for this population. Yet, characterization of the nature and types of interventions adaptations is limited, especially across the wide range of interventions tested for youth with ASD with a focus on implementation factors. Additionally, understanding how these interventions may be implemented in community services is limited. The aims of this systematic review are to characterize the (1) types of interventions tested for co-occurring mental health conditions for youth with ASD; (2) adaptations to mental health interventions for use with youth with ASD; and (3) implementation strategies, outcomes, and determinants of mental health interventions to inform their translation to community service settings. Eighty-three articles testing interventions targeting mental health symptoms in youth with ASD that included implementation factors in analyses were reviewed. The Stirman et al. (2013; 2019) FRAME adaptation, Powell et al. (2012;2015) implementation strategies, and Proctor et al. (2011) implementation outcomes taxonomies were applied to characterize the nature and types of adaptations for use with youth with ASD and types of implementation strategies, outcomes, and determinants used, when available, respectively. Of the interventions examined, the majority (64.1%) were originally designed to target youth mental health concerns and were then adapted to be used with ASD. The most common adaptations included those to the intervention content, particularly adding elements with tailoring or refining aspects of the intervention while maintaining core functions. Half of the articles described at least one implementation strategy used during intervention testing. Fidelity and acceptability were the most frequently examined implementation outcomes, with some examination of appropriateness and feasibility. Nineteen percent of articles described implementation determinants (i.e. barriers/facilitators) of these implementation outcomes. The common adaptations for ASD provide direction for future intervention development and for training community therapists. Further examination, specification, and reporting of implementation strategies and outcomes within ongoing efforts to adapt and interventions to meet the co-occurring mental health needs of youth ASD are needed to facilitate their translation to community settings. Areas for future research as well as clinical implications are discussed. [ABSTRACT FROM AUTHOR]

Advancements in evidence-based psychosocial interventions, digital technologies, and implementation strategies (i.e., health services research products) for youth mental health services have yet to yield significant improvement in public health outcomes. Achieving such impact will require that these research products are easy to use, useful, and contextually appropriate. This paper describes how human-centered design (HCD), an approach that aligns product development with the needs of the people and settings that use those products, can be leveraged to improve youth mental health services. We articulate how HCD can advance accessibility, effectiveness, and equity, with specific consideration of unique aspects of youth mental health services. [ABSTRACT FROM AUTHOR]

This study examined providers' reflections on delivering managing and adapting practice (MAP), an evidence-informed framework that guides decision-making from scientific and client data. Consensual qualitative research methods were used to analyze the reflections of 201 youth mental health providers. Results indicated that providers approached MAP according to their own preferences and particular cases. While most appeared to approach MAP from a practice management standpoint, when faced with challenging cases, providers used coordination and outcomes management resources. Regardless of approach, most providers came to appreciate the full framework through reflective practice. Their diverse approaches offer lessons for evidence-based practice implementation and sustainment. [ABSTRACT FROM AUTHOR]