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Investments in autism spectrum disorder (ASD) research, guided by the Interagency Autism Coordinating Committee (IACC), have focused disproportionately on etiology over a well-established stakeholder priority area: research to improve accessibility and quality of community-based services. This study analyzed National Institutes of Health ASD services research funding from 2008 to 2018 to examine funding patterns, evaluate the impact of IACC objectives, and identify future directions. Approximately 9% of total funds were allocated to services research. This investment remained relatively stable across time and lacked diversity across domains (e.g., area of focus, ages sampled, implementation strategies used). While advancements were observed, including increased prevalence of projects focused on adult samples and on dissemination/implementation and prevention areas, greater investment in service research is critically needed.

Investments in autism spectrum disorder (ASD) research, guided by the Interagency Autism Coordinating Committee (IACC), have focused disproportionately on etiology over a well-established stakeholder priority area: research to improve accessibility and quality of community-based services. This study analyzed National Institutes of Health ASD services research funding from 2008 to 2018 to examine funding patterns, evaluate the impact of IACC objectives, and identify future directions. Approximately 9% of total funds were allocated to services research. This investment remained relatively stable across time and lacked diversity across domains (e.g., area of focus, ages sampled, implementation strategies used). While advancements were observed, including increased prevalence of projects focused on adult samples and on dissemination/implementation and prevention areas, greater investment in service research is critically needed., Author(s): Paige E. Cervantes [sup.1] , Maya Matheis [sup.2] , Jasper Estabillo [sup.3] , Dana E. M. Seag [sup.1] , Katherine L. Nelson [sup.4] , Robin Peth-Pierce [sup.5] , Kimberly [...]

State mental health systems are retraining their workforces to deliver services supported by research. Knowledge about evidence-based therapies (EBTs) for child and adolescent disorders is robust, but the feasibility of their statewide scaling has not been examined. The authors reviewed implementation feasibility for 12 commonly used EBTs, defining feasibility for statewide scaling as an EBT having at least one study documenting acceptability, facilitators and barriers, or fidelity; at least one study with a racially and ethnically diverse sample; an entity for training, certification, or licensing; and fiscal data reflecting the costs of implementation. The authors reviewed materials for 12 EBTs being scaled in New York State and conducted a literature review with search terms relevant to their implementation. Costs and certification information were supplemented by discussions with treatment developers and implementers. All 12 EBTs had been examined for implementation feasibility, but only three had been examined for statewide scaling. Eleven had been studied in populations reflecting racial-ethnic diversity, but few had sufficient power for subgroup analyses to demonstrate effectiveness with these samples. All had certifying or licensing entities. The per-clinician costs of implementation ranged from $500 to $3,500, with overall ongoing costs ranging from $100 to $6,000. A fiscal analysis of three EBTs revealed hidden costs ranging from $5,000 to $24,000 per clinician, potentially limiting sustainability. The evidence necessary for embedding EBTs in state systems has notable gaps that may hinder sustainability. Research-funding agencies should prioritize studies that focus on the practical aspects of scaling to assist states as they retrain their workforces. [ABSTRACT FROM AUTHOR]

Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context.

To systematically review experimental evidence regarding animal-assisted therapies (AAT) for children or adolescents with or at risk for mental health conditions, we reviewed all experimental AAT studies published between 2000-2015, and compared studies by animal type, intervention, and outcomes. Studies were included if used therapeutically for children and adolescents (=21 years) with or at risk for a mental health problem; used random assignment or a waitlist comparison/control group; and included child-specific outcome data. Of 1,535 studies, 24 met inclusion criteria. Of 24 studies identified, almost half were randomized controlled trials, with 9 of 11 published in the past two years. The largest group addresses equine therapies for autism. Findings are generally promising for positive effects associated with equine therapies for autism and canine therapies for childhood trauma. The AAT research base is slim; a more focused research agenda is outlined.

Purpose: Untreated parent mental health problems have deleterious effects upon the family, yet caregivers are unlikely to receive services for their emotional health. We conducted a review of treatments and services for children and adolescents that also offered services to parents. Methods: Child treatment and service studies were included in the present study if they analyzed parent symptoms or diagnoses over time, and the intervention contained a parent component. Results: Of 200 studies reviewed, 20 contained a component for the parent and assessed the parent's emotional health at multiple time points. Depression and anxiety were the most commonly studied parental mental health problem; most parent components consisted of behavioral strategies in service of the child's psychological health. Conclusion: Major shifts in health care policy affecting mental health services provide an opportunity to create integrated and coordinated health and behavioral health systems. Attention must be given to ensure that the workforce of providers, the administrative structures, and the reimbursement strategies are strengthened and connected to serve the needs of parents/caregivers and children in order to enhance family outcomes.

Treatment participation was examined among youth enrolled in an evaluation of cognitive behavioral therapy (CBT) for trauma following the 9/11 World Trade Center disaster. Staff at nine agencies serving a predominantly low-income, ethnically diverse population were trained to deliver CBT and structured engagement strategies. A total of 445 youth ages 5 to 19 were eligible for CBT, and 417 (94%) received at least one treatment session. Pretreatment and treatment show rates and overall dose were examined. Treatment participation rates were higher than those typically reported in community studies of children's mental health services. Regression analyses indicated variability across sites in treatment show rates with the highest rates at sites where services were delivered in schools. However, sites, demographic factors, and trauma symptoms accounted for a small amount of variance in treatment participation overall. The study suggests that structured engagement strategies, linked to evidence-based treatments, may improve treatment participation for youth. (Contains 4 tables and 1 figure.)

The American Psychological Association Task Force on Evidence- Based Practice for Children and Adolescents (2008) recommended a systems approach to enhancing care in order to improve outcomes for children and adolescents with mental health needs and redress persistent systemic problems with the structure of services. Recommendations for enhancing an ecological approach to the adoption and implementation of evidence-based practices are offered through increased attention to practice-based research frameworks for adoption and dissemination. Five criteria are discussed for providing acceptable evidence, including (a) systematic evidence searching and adoption of evidence-based prevention and intervention practices, (b) implementation and adherence to intervention integrity, (c) invoking standards for drawing inferences from interventions, (d) using quality assessments to measure outcomes, and (e) adopting formal data analysis procedures to assess intervention outcomes. Each criterion is illustrated with an example. Future research and policy agendas are outlined. (Contains 3 tables and 3 figures.)

In recent years, several states have undertaken efforts to disseminate evidence-based treatments to agencies and clinicians in their children's service system. In New York, the Evidence Based Treatment Dissemination Center adopted a unique translation-based training and consultation model in which an initial 3-day training was combined with a year of clinical consultation with specific clinician and supervisor elements. This model has been used by the New York State Office of Mental Health for the past 3 years to train 1,210 clinicians and supervisors statewide. This article describes the early adoption and initial implementation of a statewide training program in cognitive-behavioral therapy for youth. The training and consultation model and descriptive findings are presented; lessons learned are described. Future plans include a focus on sustainability and measurement feedback of youth outcomes to enhance the continuity of this program and the quality of the clinical services. (Contains 2 figures, 2 tables, and 2 notes.)

Research Findings: The purpose of this article is to describe current education policies as they relate to the promotion of social, emotional, and academic (SEA) development and competence for young children. Academic and social-emotional competencies are described and conceptualized as developmentally linked, reciprocal processes that should be supported by education in an integrated, holistic manner. Practice or Policy: The article reviews major public policies and national initiatives that have implications for the education of young children (e.g., Head Start, No Child Left Behind, IDEA) and highlights opportunities within these policies to promote programs that can support SEA competencies, as well as the limitations of these policies. The article also includes a review of the limitations of existing resources available to educators to identify evidence-based programs that support SEA competencies and concludes with recommendations for better alignment between research and policy to support SEA competencies. (Contains 1 table.)

The article surveys the various state-level evidence-based practice (EBP) implementation challenges and strategies adopted for children, youths, and families. The federal government also supports EBP through development and intervention research, training and technical assistance, and evaluation of different planning and implementation strategies. [For Part I, see EJ795950.]

A need for the development of a policy research base regarding state implementation pf evidence-based practice (EBP) is emphasized. Efforts are made on how to make use of EBP in everyday clinical practice as a means of improving outcomes in six states.

Following the World Trade Center (WTC) attacks, an extensive screening survey was undertaken to assess mental health needs of New York City's school-age children. This survey demonstrated that as many as 75,000 children in New York City (10.5%) had symptoms of posttraumatic stress disorder (PTSD) and high percentages of children reported other psychiatric symptoms including depression (8.4%), anxiety (12.3%), agoraphobia (15.0%), separation anxiety (12.3%), and conduct disorder (10.9%). Rates of help-seeking by children were low, less than 33%, suggesting that highly affected children and youths were not receiving mental health services. Child and Adolescent Trauma Treatments and Services Consortium (CATS) was created in the aftermath of the WTC attacks to make high-quality evidence-based (EB) treatment available to the most highly affected children and adolescents throughout New York City and adjacent Long Island. This article presents the clinical outcomes and implementation issues of the CATS project. (Contains 1 table.)

Major national, state, and local systems reform efforts are under way to close the gap between science and service through implementation of a range of evidence-based practices (EBPs). A set of rhetorical distinctions and ensuing debates about the relevance of science versus service and efficacy versus effectiveness threatens to widen rather than close the gap. However, methodological and conceptual approaches, drawing upon strong theory-driven models, offer considerable promise for an integrated science on implementation effectiveness. This paper outlines some of the major scientific and policy challenges in strengthening the link between science and service in school psychology within the context of the papers in this series.

Objective: To describe the psychometric properties and test the reliability of a new instrument designed to measure mental health services use within pediatric clinical samples, the Services for Children and Adolescents-Parent Interview (SCAPI), which was developed by the National Institute of Mental Health Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder (MTA). Method: Similarities and differences with other measures of services use are described. Ten types of services are measured by the SCAPI. Formal test-retest reliability testing was carried out in 104 subjects with a mean time between tests of 18 days. Results: Test-retest [kappa] values ranged from 0.49 to 1.00, with an overall [kappa] value for all services of 0.97. Seven of the 10 service types had [kappa] values of 0.75 or higher, indicating excellent reliability. In addition, matched responses on specific questions about reasons for seeking services, starting and ending dates, number and length of visits, and type of provider seen were more than 75% for most service categories, consistently so for reporting of medications and school services. Conclusions: The SCAPI is a reliable instrument for assessing mental health and related services use and may be an especially valuable adjunct in studies involving clinical samples, especially clinical trials. J. Am. Acad. Child Adolesc. Psychiatry, 2004;43(11): 1345-1354. Key Words: mental health services, instruments, services research.

Objective: To date, no instrument has been developed that captures children's services use across primary care, specialty mental health, and other settings, including setting, treatment type, provider discipline, and length and intensity of specific interventions over varying follow-up periods. The authors developed a highly structured services assessment measure [Services for Children and Adolescents-Parent Interview (SCAPI)] for use in the National Institute of Mental Health Multimodal Treatment Study of Children With Attention Deficit Hyperactivity Disorder (MTA). Method: After successfully piloting and refining the SCAPI during initial phases of the MTA, the authors used this measure at 24 months post-randomization to ascertain the previous 6 months of services use for all participating (516 of 579) MTA children and families and 285 age- and gender-matched classroom control children. Results: Findings revealed meaningful, face-valid differences between MTA and control children in levels and types of services used during the previous 6-month period. Services use data reported by parents was substantially in accord with data independently gathered by the research data center. Site variations were found in the level and use of several specific services, such as individual child psychotherapy (sites ranged from 0% to 6.8% among classroom controls compared with 9.7% to 46.1% among MTA participants) and special education services (0% to 14.6% among classroom controls, 27.5% to 34.8% among MTA participants), consistent with differences reported in other studies. Conclusions: These data support the descriptive validity of SCAPI-ascertained services use data and indicate that the SCAPI can provide investigators and policymakers a valid means of assessing services type, intensity, onset and offset, provider type, and content. J. Am. Acad. Child Adolesc. Psychiatry, 2004;43(11):1334-1344. Key Words: mental health services, services research, interviews, attention-deficit/hyperactivity disorder, treatment, services use.

A need for the development of a policy research base regarding state implementation pf evidence-based practice (EBP) is emphasized. Efforts are made which on how to make use of EBP in everyday clinical practice as a means of improving outcomes in six states.

OBJECTIVE. We sought to identify characteristics of pediatricians that were associated with identification or management (referral and/or treatment) of mothers with depression. METHODS. A cross-sectional survey was mailed to a random sample of 1600 of the 50 818 US nonretired members of the American Academy of Pediatrics. Overall, 832 responded, with 745 responses from nontrainee members. The 662 fellow nontrainee members who engaged in direct patient care and completed information on identifying, referring, and treating maternal depression were included in the analyses. RESULTS. A total of 511 of 662 respondents reported identifying maternal depression; of those who reported identifying maternal depression, 421 indicated they referred and 29 that they treated maternal depression in their practices. Pediatricians who are older, work in practices that provide child mental health services, see primarily ([greater than or equal to] 75 %) white patients, use [greater than or equal to] 1 method to address maternal depression, agree that pediatricians should be responsible for identifying maternal depression, think that maternal depression has an extreme effect on children's mental health, and are attitudinally more inclined to identify or manage maternal depression had significantly higher odds of reporting identification of maternal depression. Positive correlates of identification and management of maternal depression included practicing in the Midwest, using [greater than or equal to] 1 method to address maternal depression, working in a practice that provides child mental health services, thinking that caregiving problems attributable to maternal health have an extreme effect on children's physical health, having attitudes that are more inclined to identify and to manage maternal depression, and usually inquiring about symptoms routinely to identify maternal depression. CONCLUSIONS. Pediatricians' practice characteristics and attitudes are associated with their identification and management of mothers with depression., MATERNAL DEPRESSION, A global term encompassing a range of depressive symptoms and syndromes, may affect women immediately after childbirth or later in the child-rearing years. (1,2) For women 15 to [...]