A Survey of the Infrastructure for Children’s Mental Health Services: Implications for the Implementation of Empirically Supported Treatments (ESTs)

  • Sonja K. Schoenwald
  • Jason E. Chapman
  • Kelly Kelleher
  • Kimberly Eaton Hoagwood
  • John Landsverk
  • Jack Stevens
  • Charles Glisson
  • Jennifer Rolls-Reutz
  • The Research Network on Youth Mental Health
Original paper


A structured interview survey of directors of a large national sample (n = 200) of mental health service organizations treating children examined the governance, financing, staffing, services, and implementation practices of these organizations; and, director ratings of factors important to implementation of new treatments and services. Descriptive analyses showed private organizations financing services with public (particularly Medicaid) funds are prevalent and that employment of professional staff, clinical supervision and training, productivity requirements, and outcomes monitoring are common. Results of random effects regression models (RRMs) evaluating associations between governance, financing, and organizational characteristics and the use of new treatments and services showed for-profit organizations more likely to implement such treatments, and organizations with more licensed clinical staff and weekly clinical supervision in place less likely to do so. Results of RRMs evaluating relations between director ratings of the importance to new treatment and service implementation of three factors—fit with existing implementation practices, infrastructure support, and organizational mission and support—suggest greater importance to public than private organizations of these factors. Implications for EST implementation and future research are described.


Children's mental health services Service system infrastructure Clinics and systems Research network on youth mental health 



Preparation of this manuscript was supported by the John D. and Catherine T. MacArthur Foundation and grants 59138 from the National Institute of Mental Health and DA018107 from the National Institute on Drug Abuse, and by the Annie E. Casey Foundation.


  1. Becker, D. R., McHugo, G. J., Halliday, J., & Martinez, R. A. (2006). What predicts supported employment program outcome? Community Mental Health Journal, 42(3), 303–313.PubMedCrossRefGoogle Scholar
  2. Bickman, L. (1999). Practice makes perfect and other myths. American Psychologist, 54, 965–978.CrossRefGoogle Scholar
  3. Bickman, L. (2000). Our quality-assurance methods aren’t so sure. Behavioral Healthcare Tomorrow, June, 41–48.Google Scholar
  4. Blatt, S. J., Sanislow, C. A., Zuroff, D. C., & Pilkonis, P.A. (1996). Characteristics of effective therapists: Further analyses of data from the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Journal of Consulting and Clinical Psychology, 64, 1276–1284.PubMedCrossRefGoogle Scholar
  5. Bond, T. G., & Fox, C. M. (2007). Applying the Rasch model: Fundamental measurement in the human sciences (2nd ed.). Mahwah, NJ: Lawrence Erlbaum Associates.Google Scholar
  6. Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Links: Mental health need and access to mental health services by youthsinvolved with child welfare: a national survey. American Academy of Child and Adolescent Psychiatry, 43(8), 960–70.CrossRefGoogle Scholar
  7. Center for Mental Health Services (2006). In R. W. Manderscheid & J. T. Berry (Eds.), Mental Health United States, 2004. DHHS Pub No. (SMA)-06-4195. Rockville, MD: Substance Abuse and Mental Health Services Administration.Google Scholar
  8. Chapman, J. E., & Schoenwald, S. K. (2007). Rasch Measurement modeling of the dimensions of organizational readiness-revised (DOOR-R) scale in child-serving clinics. Technical report. Charleston, SC: Medical University of South Carolina.Google Scholar
  9. Cohen, W. M., & Levinthal, D. A. (1990). Absorptive capacity: A new perspective on learning and innovation. Administrative Science Quarterly, 35, 128–152.CrossRefGoogle Scholar
  10. Compton, W. M., Stein, J. B., Robertson, E. B., Pintello, D., Pringle, B., & Volkow, N. D. (2005). Charting a course for health services research at the National Institute on Drug Abuse. Journal of Substance Abuse Treatment, 29, 167–172.CrossRefGoogle Scholar
  11. Damanpour, F. (1991). Organizational innovation: A meta-analysis of effects of determinants and moderators. The Academy of Management Journal, 34, 555–590.CrossRefGoogle Scholar
  12. Damanpour, F. (1996). Organizational complexity and innovation: Developing and testing multiple contingency models. Management Science, 42, 693–716.CrossRefGoogle Scholar
  13. Department of Health and Human Services (DHHS) (2005). Final report on the dimensions of organizational readiness (DOOR) in child-serving clinics. National Institutes of Health Grant R24 MH068708–01.Google Scholar
  14. Ferlie, E. B., & Shortell, S. M. (2001). Improving the quality of health care in the United Kingdom and the United States: A framework for change. The Milbank Quarterly, 79, 281–315.PubMedCrossRefGoogle Scholar
  15. Grol, R., & Grimshaw, J. (1999). Evidence-based implementation of evidence-based medicine. Journal on Quality Improvement, 25, 503–513.Google Scholar
  16. Guydish, J., Turcotte Manser, S., Jessup, M., Tajima, B., Sears, C., & Montini, T. (2005). Multi-level assessment protocol (MAP) for adoption in multisite clinical trials. Journal of Drug Issues, Summer, 529–546.Google Scholar
  17. Heinrich, C. J., & Fournier, E. (2005). Instruments of policy and administration for improving substance abuse treatment practice and program outcomes. Journal of Drug Issues, Summer, 485–506.Google Scholar
  18. Henggeler, S. W., Chapman, J. E., Rowland, M. D., Halliday-Boykins, C. A., Randall, J., Shackleford, J., & Schoenwald, S. K. (2007). Statewide adoption and initial implementation of contingency management for substance abusing adolescents. Manuscript under review.Google Scholar
  19. Hoagwood, K., Schoenwald, S. K., & Chapman, J. E. (2003). Dimensions of Organizational Readiness – Revised (DOOR-R). Unpublished Instrument.Google Scholar
  20. Hoge, M.A. (2002). The training gap: An acute crisis in behavioral health education. Administration and Policy in Mental Health, 29(4/5), 305–318.PubMedCrossRefGoogle Scholar
  21. Huppert, J. D., Bufka, L. F., Barlow, D. H., Gorman, J. M., Shear, M. K., & Woods, S. W. (2001). Therapists, therapist variables, and cognitive-behavioral therapy outcome in a multicenter trial for panic disorder. Journal of Consulting and Clinical Psychology, 69, 747–755.PubMedCrossRefGoogle Scholar
  22. Isett, K. R., Burnam, M. A., Coleman-Beattie, B., Hyde, P. S., Morrissey, J. P., Magnabosco, J., Rapp, C. A., Ganju, V., & Goldman, H. H. (2007). The state policy context of implementation issues for evidence-based practices in mental health. Psychiatric Services, 58, 914–921.PubMedCrossRefGoogle Scholar
  23. Knudsen, H. K., & Roman, P. M. (2004). Modeling the use of innovations in private treatment organizations: The role of absorptive capacity. Journal of Substance Abuse Treatment, 26, 51–59.CrossRefGoogle Scholar
  24. Leslie, L. K., Hurlburt, M. S., Landsverk, J., Rolls, J. A., Wood, P. A., & Kelleher, K. J. (2003). Comprehensive assessments for children entering foster care: A national perspective. Pediatrics, 112, 134–142.PubMedCrossRefGoogle Scholar
  25. Linacre, J. M. (2002). Optimizing rating scale category effectiveness. Journal of Applied Measurement, 3, 85–106.PubMedGoogle Scholar
  26. Linacre, J. M. (2006). WINSTEPS Rasch measurement computer program (Version 3.63) [Computer software]. Chicago: Winsteps.com.Google Scholar
  27. Maas, C. J. M., & Hox, J. J. (2005). Sufficient sample sizes for multilevel modeling. Methodology, 1, 86–92M.CrossRefGoogle Scholar
  28. McClellan, A. T., Carise, D., & Kleber, H. D. (2003). Can the national addiction treatment infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment, 25(2), 117–121.CrossRefGoogle Scholar
  29. McFarlane, W. R., McNary, S., Dixon, L., Hornby, H., & Cimett, E. (2001). Predictors of dissemination of psychoeducation in community mental health centers in Maine and Illinois. Psychiatric Services, 52, 935–943.PubMedCrossRefGoogle Scholar
  30. Raiche, G. (2005). Critical eigenvalue sizes in standardized residual principal components analysis. Rasch Measurement Transactions, 19, 1012.Google Scholar
  31. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (2nd ed.). Thousand Oaks, CA: Sage Publications.Google Scholar
  32. Raudenbush, S. W., Bryk, A. S., Cheong, Y. F., Congdon, R., & du Toit, M. (2004). HLM 6: Hierarchical linear & nonlinear modeling (Version 6.02) (Computer software and manual). Lincolnwood, IL: Scientific Software International.Google Scholar
  33. Real, K., & Poole, M. S. (2005). Innovation implementation: Conceptualization and measurement in organizational research. Research in Organizational Change and Development, 15, 63–134.CrossRefGoogle Scholar
  34. Ridgely, M. S., Giard, J., Sern, D., Mulkern, V., & Burnam, A. (2002). Managed behavioral health care: An instrument to characterize critical elements of public sector programs. Health Services Research, 37, 1105–1123.PubMedCrossRefGoogle Scholar
  35. Roman, P. M., & Johnson, A. (2002). Adoption and implementation of new technologies in substance abuse treatment. Journal of Substance Abuse Treatment, 22, 211–218.PubMedCrossRefGoogle Scholar
  36. Saldana, L., Chapman, J. E., Henggeler, S. W., & Rowland, M. D. (2007). The organizational readiness for change scale in adolescent programs: Criterion validity. Journal of Substance Abuse Treatment, 33, 159–169.PubMedCrossRefGoogle Scholar
  37. Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1179–1189.PubMedCrossRefGoogle Scholar
  38. Schoenwald, S. K., Kelleher, K., Hoagwood, K., Landsverk, J., & Glisson, C. (2003). The Clinic System Project (CSP) Director Survey. Unpublished instrument.Google Scholar
  39. Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., & Liao, J. G. (2003). Transportability of multisystemic therapy: Evidence for multi-level influences. Mental Health Services Research, 5, 223–239.PubMedCrossRefGoogle Scholar
  40. Simpson, D. D. (2002). A conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment, 22, 171–182.PubMedCrossRefGoogle Scholar
  41. Snijders, T. A. B., & Bosker, R. J. (1999). Multilevel analysis: An introduction to basic and advanced multilevel modeling. London: Sage.Google Scholar
  42. Tennant, A., & Pallant, J. F. (2006). Unidimensionality matters! (A tale of two Smiths?). Rasch Measurement Transactions, 20, 1048–1051.Google Scholar
  43. Van de Ven, A. H. (1986). Central problems in the management of innovation. Management Science, 32, 590–607.Google Scholar
  44. Wright, B. D., & Masters, G. M. (1982). Rating scale analysis. Chicago: Pluribus Press.Google Scholar
  45. Zahra, S. A., & George, G. (2002). Absorptive capacity: A review, reconceptualization, and extension. Academy of Management Review, 27, 185–203.CrossRefGoogle Scholar
  46. Zammuto, R. F., & Krackower, J. Y. (1991). Quantitative and qualitative studies of organizational culture. Research in Organizational Change and Development, 5, 83 –114.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Sonja K. Schoenwald
    • 1
  • Jason E. Chapman
    • 1
  • Kelly Kelleher
    • 2
  • Kimberly Eaton Hoagwood
    • 3
  • John Landsverk
    • 4
  • Jack Stevens
    • 2
  • Charles Glisson
    • 5
  • Jennifer Rolls-Reutz
    • 4
  • The Research Network on Youth Mental Health
    • 6
  1. 1.Family Services Research CenterMedical University of South CarolinaCharlestonUSA
  2. 2.Columbus Children’s Hospital and the Ohio State UniversityColumbusUSA
  3. 3.Columbia UniversityNew YorkUSA
  4. 4.Children’s HospitalSan DiegoUSA
  5. 5.University of TennesseeKnoxvilleUSA
  6. 6.ChicagoUSA

Personalised recommendations