Use of the Breakthrough Series Collaborative to Support Broad and Sustained Use of Evidence-Based Trauma Treatment for Children in Community Practice Settings

  • Lori Ebert
  • Lisa Amaya-Jackson
  • Jan M. Markiewicz
  • Cassandra Kisiel
  • John A. Fairbank
Original Paper

Abstract

Empirically supported treatments for posttraumatic stress reactions in children are not widely available. This observational study evaluates the feasibility and utility of adapting the Institute for Healthcare’s Breakthrough Series Collaborative (BSC) to support the broad implementation and sustained use of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) in community practice settings. Study findings indicated that agency staff in diverse roles viewed the BSC methodology as a valuable and practicable approach for facilitating skillful delivery of TF-CBT with fidelity. Use of TF-CBT increased over the course of the collaborative and findings from a survey conducted one year later indicated that participating agencies were able to sustain and spread the practice.

Keywords

Trauma Evidence-based treatment Implementation Quality collaboratives 

Notes

Acknowledgements

This study was supported in part by grant number 2U79SM054284 from the Center for Mental Health Services (CMHS), Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS). The views, policies, and opinions expressed are those of the authors and do not necessarily reflect those of SAMHSA or HHS. The authors gratefully acknowledge the contributions of the organizations that participated in the National Child Traumatic Stress Network Breakthrough Series for Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and of the developers of TF-CBT, Drs. Judith Cohen, Esther Deblinger, and Anthony Mannarino.

References

  1. Aarons, G. A., & Palinkas, L. A. (2007). Implementation of evidence-based practice in child welfare: Service provider perspectives. Administration and Policy in Mental Health and Mental Health Services Research, 34, 411–419. doi: 10.1007/s10488-007-0121-3.PubMedCrossRefGoogle Scholar
  2. Agosti, J., Ebert, L., Amaya-Jackson, L., Kisiel, C., Markiewicz, J., & Maze, J. (2007). Improving the adoption of evidence-based practice in community agencies. Using the breakthrough series collaborative methodology in child trauma: Final report. Los Angeles, CA: National Center for Child Traumatic Stress.Google Scholar
  3. American Psychological Association Task Force on Evidence-Based Practice for Children and Adolescents. (2008). Disseminating evidence-based practice for children and adolescents: A systems approach to enhancing care. Washington, DC: American Psychological Association.Google Scholar
  4. Asch, S., Baker, D., Keesey, J., Broder, M., Schonlau, M., Rosen, M., et al. (2005). Does the collaborative model improve care for chronic heart failure? Medical Care, 43(7), 667–675.PubMedCrossRefGoogle Scholar
  5. Baumann, B. L., Kolko, D. J., Collins, K., & Herschell, A. D. (2006). Understanding practitioner’s characteristics and perspectives prior to the dissemination of an evidence-based intervention. Child Abuse and Neglect, 30, 771–787. doi: 10.1016/j.chiabu.2006.01.002.PubMedCrossRefGoogle Scholar
  6. California Evidence-Based Clearinghouse for Child Welfare. (2008). Trauma-focused cognitive behavioral therapydetailed report. Retrieved March 15, 2011, from http://www.cebc4cw.org/program/17/detailed
  7. Casey Family Programs. (2007). Supporting kinship care: Promising practices and lessons learned. Report on the breakthrough series collaborative. 003. Retrieved from http://www.casey.org/Resources/Publications/pdf/BreakthroughSeries_Kinship.pdf
  8. Cavaleri, M., Gopalan, G., McKay, M., Appel, A., Bannon, W., Jr., Bigley, M., et al. (2006). Impact of a learning collaborative to improve child mental health service use among low-income urban youth and families. Best Practices in Mental Health: An International Journal, 2(2), 67–79.Google Scholar
  9. Chadwick Center for Children and Families. (2004). Closing the quality chasm in child abuse treatment: Identifying and disseminating best practices. San Diego, CA: Author.Google Scholar
  10. Chaffin, M., & Friedrich, B. (2004). Evidence-based treatments in child abuse and neglect. Children and Youth Services Review, 26, 1097–1113. doi: 10.1016/j.childyouth.2004.08.008.CrossRefGoogle Scholar
  11. Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents. New York, NY: Guilford Press.Google Scholar
  12. Deblinger, E., Cohen, J., Mannarino, A. P., Hanson, R., & Runyon, M. (2005). TF-CBT practice checklistself-report. Unpublished Instrument.Google Scholar
  13. Deyo, R. A., Schall, M., Berwick, D. M., Nolan, T., & Carver, P. (2000). Innovations in education and clinical practice: Continuous quality improvement for patients with back pain. Journal of General Internal Medicine, 15(9), 647–655.PubMedCrossRefGoogle Scholar
  14. Ebert, L., Amaya-Jackson, L., Markiewicz, J. M., & Fairbank, J. A. (in press). Development and application of the NCCTS Learning Collaborative Model for the implementation of evidence-based child trauma treatment. In D. Barlow & K. McHugh (Eds.), Dissemination of evidence-based treatments. New York, NY: Oxford University Press.Google Scholar
  15. Fairbank, J., Putnam, F., & Harris, W. (2007). The prevalence and impact of child traumatic stress. In M. Friedman, T. M. Keane, & P. A. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 229–251). New York, NY: Guilford Press.Google Scholar
  16. Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2008). Exposure to childhood sexual and physical abuse and adjustment in early adulthood. Child Abuse and Neglect, 32(6), 607–619. doi: 10.1016/j.chiabu.2006.12.018.PubMedCrossRefGoogle Scholar
  17. Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: National Implementation Research Network.Google Scholar
  18. Gira, E. C., Kessler, M. L., & Poertner, J. (2004). Influencing social workers to use research evidence in practice: Lessons from medicine and the allied health professions. Research on Social Work Practice, 14(2), 68–79.CrossRefGoogle Scholar
  19. Glisson, C. (2002). The organizational context of children’s mental health services. Clinical Child and Family Psychology Review, 5(4), 233–253. doi: 10.1023/A:1020972906177.PubMedCrossRefGoogle Scholar
  20. Glisson, C., & Schoenweld, S. (2005). The ARC organizational and community intervention strategy for implementing evidence-based children’s mental health treatments. Mental Health Services Research, 7(4), 243–259. doi: 10.1007/s11020-005-7456-1.PubMedCrossRefGoogle Scholar
  21. Goodheart, C. D., Kazdin, A. E., & Sternberg, R. J. (Eds.). (2006). Evidence-based psychotherapy: Where practice and research meet. Washington, DC: American Psychological Association.Google Scholar
  22. Gotham, H. (2006). Advancing the implementation of evidence-based practices into clinical practice: How do we get there from here? Professional Psychology: Research and Practice, 37(6), 606–613. doi: 10.1037/0735-7028.37.6.606.CrossRefGoogle Scholar
  23. Herschell, A., McNeil, C., & McNeil, D. (2004). Clinical child psychology’s progress in disseminating empirically supported treatments. Clinical Psychology: Science and Practice, 11(3), 267–288. doi: 10.1093/clipsy/bph082.CrossRefGoogle Scholar
  24. Hoagwood, K., Burns, B. J., & Weisz, J. R. (2002). A profitable conjunction: From science to service in children’s mental health. In B. J. Burns & K. Hoagwood (Eds.), Community treatment for youth: Evidence-based interventions for severe emotional and behavioral disorders (pp. 327–338). New York, NY: Oxford University Press.Google Scholar
  25. Institute for Healthcare Improvement. (2003). The breakthrough series: IHI’s collaborative model for achieving breakthrough improvement. IHI Innovation Series White Paper. Cambridge, MA: Author. Retrieved from http://www.ihi.org/IHI/Results/WhitePapers/
  26. Institute for Healthcare Improvement. (n.d.). Testing changes. Institute for Healthcare Improvement. Retrieved March 15, 2011, from http://www.ihi.org/IHI/Topics/Improvement/ImprovementMethods/HowToImprove/testingchanges.htm
  27. Kilo, C. M. (1999). Improving care through collaboration [Supplement]. Pediatrics, 103(1), 384–393. doi: 10.1542/peds.103.1.SE1.384.PubMedGoogle Scholar
  28. Kolko, D. J., & Swenson, C. C. (2002). Assessing and treating physically abused children and their families: A cognitive behavioral approach. Thousand Oaks, CA: Sage.Google Scholar
  29. Lieberman, A. F., Ghosh Ippen, C., & Van Horn, P. (2006). Child-parent psychotherapy: 6-month follow-up of a randomized control trial. Journal of the American Academy of Child and Adolescent Psychiatry, 45(8), 913–918. doi: 10.1097/01.chi.0000222784.03735.92.PubMedCrossRefGoogle Scholar
  30. Merikangas, K. R., He, J. P., Brody, D., Fisher, P. W., Bourdon, K., & Koretz, D. S. (2010). Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics, 125(1), 75–81. doi: 10.1542/peds.2008-2598.PubMedCrossRefGoogle Scholar
  31. Miller, O. A., & Ward, K. J. (2008). Emerging strategies for reducing racial disproportionality and disparate outcomes in child welfare: The results of a national breakthrough series collaborative. Child Welfare: Journal of Policy, Practice, and Program, 87(2), 211–240. Retrieved from EBSCOhost. http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2008-15075-013&site=ehost-live&scope=site
  32. Mullen, E. J., Bledsoe, S. E., & Bellamy, J. L. (2008). Implementing evidence-based social work practice. Research on Social Work Practice, 18(4), 325–338. doi: 10.1177/1049731506297827.CrossRefGoogle Scholar
  33. National Alliance for the Mentally Ill. (2003, Fall). An update on evidence-based practices in children’s mental health [Special issue]. NAMI Beginnings, 3. Google Scholar
  34. National Child Traumatic Stress Network. (2008). TF-CBT: Trauma-focused cognitive behavioral therapy fact sheet. Los Angeles, CA & Durham, NC: National Center for Child Traumatic Stress.Google Scholar
  35. Ovretveit, J., Bate, P., Cleary, P., Cretin, S., Gustafson, D., McInnes, K., et al. (2002). Quality collaboratives: Lessons from research. Quality and Safety In Health Care, 11, 345–351. Retrieved from http://qshc.bmj.com.
  36. President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health in America. Final report. Rockville, MD: DHHS. Retrieved from http://www.mentalhealthcommission.gov/reports/FinalReport/downloads/downloads.html
  37. Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36, 24–34. doi: 10.1007/s10488-008-0197-4.PubMedCrossRefGoogle Scholar
  38. Pynoos, R. S., Fairbank, J. A., Steinberg, A. M., Amaya-Jackson, L., Gerrity, E., Mount, M., et al. (2008). The national child traumatic stress network: Collaborating to improve the standard of care. Professional Psychology: Research and Practice, 39(4), 389–395. doi: 10.1037/a0012551.CrossRefGoogle Scholar
  39. S.B. 267, 76th Leg., Reg. Sess. (OR, 2003). Retrieved from http://www.leg.state.or.us/03reg/pdf/ESB267.pdf.
  40. Schonlau, M., Mangione-Smith, R., Chan, K., Keesey, J., Rosen, M., Louis, T., et al. (2005). Evaluation of a quality improvement collaborative in asthma care: Does it improve processes and outcomes of care? Annals of Family Medicine, 3(3), 200–208. doi: 10.1370/afm.269.PubMedCrossRefGoogle Scholar
  41. Schouten, L. M., Hulscher, M. E., Van Everdingen, J. J., Huijsman, R., & Grol, R. P. (2008). Evidence for the impact of quality improvement collaboratives: Systematic review. British Medical Journal, 336(7659), 1491–1494. doi: 10.1136/bmj.39570.749884.BE.PubMedCrossRefGoogle Scholar
  42. Southam-Gerow, M. A., Chorpita, B. F., Miller, L. M., & Gleacher, A. A. (2008). Are children with anxiety disorders privately referred to a university clinic like those referred from the public mental health system? Administration and Policy In Mental Health, 35(3), 168–180. doi: 10.1007/s10488-007-0154-7.PubMedCrossRefGoogle Scholar
  43. Stirman, S., Bhar, S. S., Spokas, M., Brown, G. K., Creed, T. A., Perivoliotis, D., et al. (2010). Training and consultation in evidence-based psychosocial treatments in public mental health settings: The access model. Professional Psychology: Research and Practice, 41(1), 48–56. doi: 10.1037/a0018099.CrossRefGoogle Scholar
  44. Stirman, S. W., Crits-Christoph, P., & DeRubeis, R. J. (2004). Achieving successful dissemination of empirically supported psychotherapies: A synthesis of dissemination theory. Clinical Psychology: Science and Practice, 11(4), 343–359. doi: 10.1093/clipsy/bph091.CrossRefGoogle Scholar
  45. Vargas, R., Mangione, C., Asch, S., Keesey, J., Rosen, M., Schonlau, M., et al. (2007). Can a chronic care model collaborative reduce heart disease risk in patients with diabetes? Society of General Internal Medicine, 22, 215–222. doi: 10.1007/sl1606-006-0072-5.CrossRefGoogle Scholar
  46. Weisz, J. R., & Addis, M. E. (2006). The research-practice tango and other choreographic challenges: Using and testing evidence-based psychotherapies in clinical care settings. In C. D. Goodheart, A. E. Kazdin, & R. J. Sternberg (Eds.), Evidence-based psychotherapy: Where practice and research meet (pp. 179–206). Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  47. Weisz, J., Jensen, A., & McLeod, B. (2005). Development and dissemination of child and adolescent psychotherapies: Milestones, methods, and a new deployment-focused model. In E. D. Hibbs & P. S. Jensen (Eds.), Psychosocial treatments for child and adolescent disorders: Empirically based strategies for clinical practice (2nd ed., pp. 9–39). Washington, DC: American Psychological Association.Google Scholar
  48. Wilson, T., Berwick, D. M., & Cleary, P. D. (2003). Performance improvement: What do collaborative improvement projects do? Experience from seven countries. Joint Commission Journal on Quality and Safety., 29(2), 85–93.PubMedGoogle Scholar
  49. Woltmann, E. M., Whitley, R., McHugo, G. J., Brunette, M., Torrey, W. C., Coots, L., et al. (2008). The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services, 59(7), 732–737. doi: 10.1176/appi.ps.59.7.732.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Lori Ebert
    • 1
  • Lisa Amaya-Jackson
    • 1
  • Jan M. Markiewicz
    • 1
  • Cassandra Kisiel
    • 2
  • John A. Fairbank
    • 1
  1. 1.Department of Psychiatry and Behavioral Sciences, National Center for Child Traumatic StressDuke University Medical CenterDurhamUSA
  2. 2.Department of Psychiatry and Behavioral SciencesNorthwestern University Feinberg School of MedicineChicagoUSA

Personalised recommendations