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Commentary Open Access
Volume 1 | Issue 1 | DOI: https://doi.org/10.46439/pediatrics.1.001

Partnering for success- A prototype for integrating evidence-based practices between referring professionals and mental health professionals

  • 1Professor and Chair, Executive Committee of the Grand Challenges for Social Work, University of Maryland School of Social Work, 525 W Redwood St, Baltimore, MD 21201, United States
  • 2Director of Evidence-Based Programs, University of Maryland School of Social Work, 525 W Redwood St, Baltimore, MD 21201, United States
+ Affiliations - Affiliations

Corresponding Author

Richard P Barth, rbarth@ssw.umaryland.edu

Received Date: November 22, 2020

Accepted Date: January 06, 2021

Abstract

Children who experience abuse and neglect often have behavioral health sequalae which are poorly addressed because services are not evidence-based and partnerships with behavioral health providers lack precise coordination. Partnering for Success provides interprofessional training on EBPs, communication, and data sharing and has now been expanded to address the unique needs of children in treatment foster care.

Children who are involved with Child welfare service (CWS) agencies are among the most disadvantaged in our society. They have high rates of adverse childhood experiences that go well beyond norms (and more often than not grow up in families that experience a plentitude of challenges—namely, poverty, substance abuse, and housing instability). The result is an exceptionally high rate of behavioral health concerns that may precede, concur with, and endure well beyond the abuse [1].
Therefore, many children and youth involved with CWS are referred to mental health services (MHS) although the benefit has not been shown to be impressive [2]. Substantial evidence suggests that MHS efforts are frequently uncoordinated and clinical outcomes are inconsistent. At the same time, coordination of care has not developed a reputation for improving outcomes, ostensibly because the treatments that are delivered at the end of the coordination process may not be evidence-based [3]. Enhancing the coordination with mental health services is a potential mechanism for improving outcomes when combined with the use of evidence-based practices. Further mental health (MH) services are very often not well-matched to client needs [4]. Matching of evidence-based practices (EBPs) to children’s needs requires organizational supports to be in place. The CWS and MHS workforces will remain ill prepared to participate in optimized matching while supervision, quality assurance, and fiscal constraints including lack of resources, remain barriers. 
Mental health providers frequently lack the resources and financial incentives to expend limited resources on evidence-based practice training. Mental health providers face an additional challenge insofar as the social and emotional difficulties of the child welfare population are diverse and it is highly aspirational for any community to have a workforce with training in specific, manualized, evidence-based treatments that match up to the complex needs of youth in the CWS [5]. Lastly, there is growing recognition of the benefits of using online treatment decision report tools to clarify the relationship between symptoms and treatment components in order to achieve better outcomes [6,7].
Primary care providers—largely pediatricians, family physicians, and nurse practitioners—working with CWS-involved children and caregivers also have a need to understand optimal service planning. Primary care providers typically provide medication and parenting consultation to children involved with CWS and, therefore, must also know whether an evidence-informed treatment program is in operation. Recognizing the components of effective partnerships will enhance their ability to provide the mental health-improving care that they seek. A multi-phase approach is required to develop the partnerships to improve mental health outcomes. This includes cross-systems coordination and planning efforts. 
The Partnering for Success (PfS) model [8] promotes greater collaboration between the CW and MH providers by building capacity within each system at multiple organizational levels. Frontline CW providers learn to accurately screen for common child MH issues, link child and families to locally provided evidence-based treatments (EBTs), support engagement in the treatment and monitor progress toward treatment targets. Concurrently, local MH treatment professional are prepared to use Cognitive Behavioral Therapy plus Trauma-Focused treatment components (CBT+). These common elements approach focusing on typical MH issues for CWS-involved children: anxiety, depression, conduct problems, and traumatic stress. Training for both front-line CW and MH professionals includes training, followed by consultation. Further, the model also engages and prepares both CWS and MHS leadership to ensure implementation success.
PfS has been implemented in multiple sites and achieved positive results across these sites indicate that the model is generally feasible and training efforts result in significant knowledge gain for child welfare workers and mental health practitioners [9]. More importantly, over the course of the PfS demonstration project, 2,285 clients were served using the clinical model and, across all treatment targets, significant improvements in children’s symptoms were observed. Symptom data were collected by community-based mental health therapists as part of standard CBT+ treatment adherence procedures. Multilevel linear growth modelling was used to evaluate symptom change over time. Significant improvements were observed across all four treatment targets, with a slight curvilinear relationship found for anxiety, depression, and behavior problems. This promising initial evidence suggests CBT+ is a viable training option for treatment of child welfare-involved children and youth with a range of mental health concerns. 
The demonstration project prepared CW professionals to use the practices described with all children the child welfare system engages-- regardless of whether placed in foster care or receiving early intervention or preventative services. It prepared MH providers to similarly provide CBT+ to these CW involved youth. Frequently the MH providers applied the treatment to youth who were not referred by the child welfare system as well, making an evidence-based MH treatment more broadly available to families and youth in the community. CBT+ trained MH treatment providers are able to deliver the treatment to families for whom the service is subsidized through Medicaid and private insurance. In Baltimore County, Maryland, PfS has now trained 12 cohorts of mental health and child welfare professionals, totaling nearly 500 professionals working in eight agencies. This has led to more uniform and consistent service delivery that is now better understood and delivered by the entire treatment team.

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