Abstract
The industrialization of health care, underway for several decades, offers instructive guidance and models for speeding access of children and families to clinically and cost effective preventive, treatment, and palliative interventions. This industrialization—i.e., the systematized production of goods or services in large-scale enterprises—has the potential to increase the value and effects of care for consumers, providers, and payers (Hayes and Gregg in Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice. Academic Press, San Diego, 2001), and to generate efficiencies in care delivery, in part because workforce responsibilities become more functional and differentiated such that individuals with diverse educational and professional backgrounds can effectively execute substantive clinical roles (Rees in Clin Exp Dermatol, 33, 39–393, 2008). To date, however, the models suggested by this industrialization have not been applied to children’s mental health services. A combination of policy, regulatory, fiscal, systemic, and organizational changes will be needed to fully penetrate the mental health and substance abuse service sectors. In addition, problems with the availability, preparation, functioning, and status of the mental health workforce decried for over a decade will need to be addressed if consumers and payers are to gain access to effective interventions irrespective of geographic location, ethnic background, or financial status. This paper suggests that critical knowledge gaps exist regarding (a) the knowledge, skills, and competencies of a workforce prepared to deliver effective interventions; (b) the efficient and effective organization of work; and (c) the development and replication of effective workforce training and support strategies to sustain effective services. Three sets of questions are identified for which evidence-based answers are needed. Suggestions are provided to inform the development of a scientific agenda to answer these questions.
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References
Ajzen, I., & Fishbein, M. (1981). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice Hall.
Anker, M. G., Duncan, B. L., & Sparks, J. A. (2009). Using client feedback to improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77, 693–704.
Becker, K. D., Nakamura, B. J., Young, J., & Chorpita, B. (2009). What better place than here? What better time than now? ABCT’s burgeoning role in the dissemination and implementation of evidence-based practices. The Behavior Therapist, 32(5), 89–95.
Beutler, L. E., Malik, M., Alimohamed, S., Harwood, T. M., Talebi, H., & Noble, S. (2004). Therapist variables. In M. J. Lambert, et al. (Eds.), Bergin & Garfield’s handbook of psychotherapy and behavior change (5th ed., pp. 227–306). New York: Wiley.
Bickman, L. (1999). Practice makes perfect and other myths about mental health services. American Psychologist, 52(11), 965–978.
Bradshaw, T., Butterworth, A., & Mairs, H. (2007). Does structured clinical supervision during psychosocial intervention education enhance outcome for mental health nurses and the service users they work with? Journal of Psychiatric & Mental Health Nursing, 14, 4–12.
Chamberlain, P. (2003). Treating chronic juvenile offenders: Advances made through the Oregon multidimensional treatment foster care model. Washington, DC: American Psychological Association.
Chorpita, B. F., Bernstein, A. D., & Miranda, J. (in press). Creating public health policy. In D. H. Barlow (Ed.) Handbook of clinical psychology. New York, Oxford.
Chorpita, B. F., & Daleiden, E. L. (2009). Mapping evidence-based treatments for children and adolescents: Application of the distillation and matching model to 615 treatments from 322 randomized trials. Journal of Consulting and Clinical Psychology, 77, 566–579.
Cummings, N. A., & Hayes, S. C. (1996). Now we are facing the consequences: A conversation with Nick Cummings. The Scientist Practitioner, 6(1), 9–13.
Fishbein, M., Bandura, A., Triandis, H. C., Kanfer, F. H., Becker, M. H., & Middlestadt, S. E. (1991). Factors influencing behavior and behavior change. Final report—theorists’ workshop. NIMH Workshop Report.
Fishbein, M., Triandis, H., Kanfer, F., Becker, M., Middlestadt, S., & Eichler, A. (2001). Factors influencing behavior and behavior change. In A. Baum, T. Revenson, & J. Singer (Eds.), Handbook of health psychology. Mahwah, NJ: Erlbaum.
Gagnon, M. P., et al. (2009). Interventions for promoting information and communication technologies adoption in healthcare professionals. Cochrane Database of Systematic Reviews, Issue 4. http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006093/.
Gostin, L. O. (2000). Public health law: Power, duty, restraint (pp. 254–255). Berkley: University of California Press & New York: The Milbank Memorial Fund.
Grimshaw, J. M., Shirran, L., Thomas, R., Mowatt, G., Fraser, C., Bero, L., et al. (2001). Changing provider behavior: an overview of systematic reviews of interventions. Medical Care, 39, 112–145.
Grol, R., & Grimshaw, J. (1999). Evidence-based implementation of evidence-based medicine. Journal on Quality Improvement, 25, 503–513.
Hayes, S. C. (1998). Market-driven treatment development. The Behavior Therapist, 21(2), 32–33.
Hayes, S. C., & Gregg, J. (2001). Practice guidelines and the industrialization of behavioral healthcare delivery. In N. A. Cummings, W. O’Donohue, S. C. Hayes, & V. Follette (Eds.), Integrated behavioral healthcare: Positioning mental health practice with medical/surgical practice (pp. 211–224). San Diego, CA: Academic Press.
Hoge, M., & Morris, J. A. (2002). Introduction: Behavioral health workforce education and training. Administration and Policy In Mental Health, 29, 297–304.
Hoge, M. A., Tondora, J., & Marrelli, A. F. (2005). The fundamentals of workforce competency: Implications for behavioral health. Administration and Policy In Mental Health, 32, 509–531.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. DC: Author.
Isett, K. R., Burnam, M. A., Coleman-Beattie, B., Hyde, P. S., Morrissey, J. P., Magnabosco, J., et al. (2007). The state policy context of implementation issues for evidence-based practices in mental health. Psychiatric Services, 58, 914–921.
Jaccard, J., Dodge, T., & Dittus, P. (2002). Parent adolescent communication about sex and birth control: A conceptual framework. In S. S. Feldman & D. A. Rosenthal (Eds.), Talking sexuality: parent-adolescent communication. New directions for child and adolescent development, No 97 (pp. 9–41). San Francisco: Jossey-Bass.
Jaccard, J., Litardo, H., & Wan, C. (1999). Subjective culture: Social psychological models of behavior. In J. Adamopolis & Y. Kashima (Eds.), Social psychology and cultural context. Newbury Park: Sage.
Kelley, S. D., & Bickman, L. (2009). Beyond outcomes monitoring: measurement feedback systems in child and adolescent clinical practice. Current Opinion in Psychiatry, 22(4), 363–368.
Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Review, 21, 1055–1080.
Lambert, M. J. (2001). Psychotherapy outcome and quality improvement: Introduction to the special section on patient-focused research. Journal of Consulting and Clinical Psychology, 69(2), 147–149.
Marelli, A. (2001). How to implement performance improvement step-by-step. In M. Silberman (Ed.), The consultant’s tool kit (pp. 210–218). New York: McGraw-Hill.
Martin, G. W., Herie, M. A., Turner, B. J., & Cunningham, J. A. (1998). A social marketing model for disseminating research-based treatments to addictions treatment providers. Addiction, 93, 1703–1715.
McKay, M., Paikoff, R., Baptiste, D., Bell, C., Coleman, D., Madison, S., et al. (2004). Family-level impact of the CHAMP Family Program: A community collaborative effort to support urban families and reduce youth HIV risk exposure. Family Process, 43, 77–91.
Perkins, M. B., Jensen, P. S., Jaccard, J., Gollwitzer, P., Oettingen, G., Pappadopulos, E., et al. (2007). Applying theory-driven approaches to understanding and modifying clinicians’ behavior: What do we know? Psychiatric Services, 58, 342–348.
Raghavan, R., Bright, C. L., & Shadoin, A. L. (2008). Toward a policy ecology of implementation of evidence-based practices in public mental health settings. Implementation Science, 3, 1–9.
Real, K., & Poole, M. S. (2005). Innovation implementation: Conceptualization and measurement in organizational research. Research in Organizational Change and Development, 15, 63–134.
Rees, J. L. (2008). Evidence and the industrialization of medicine. Clinical & Experimental Dermatology, 33, 390–393.
Rossi, P. H. (1978). Issues in the evaluation of human services delivery. Evaluation studies review annual (pp. 69–95). Newbury Park: Sage.
Schoenwald, S. K. (2008). Toward evidence-based transport of evidence-based treatments: MST as an example. Journal of Child and Adolescent Substance Abuse, 17, 69–91.
Schoenwald, S. K., Chapman, J. E., Kelleher, K., Hoagwood, K. E., Landsverk, J., Stevens, J., et al. (2008). A survey of the infrastructure for children’s mental health services: Implications for the implementation of empirically supported treatments (ESTs). Administration and Policy in Mental Health and Mental Health Services Research, 35, 84–97.
Sholomskas, D. E., Syracuse-Siewert, G., Rounsaville, B. J., Ball, S. A., Nuro, K. F., & Carroll, K. M. (2005). We don’t train in vain: A dissemination trial of three strategies of training clinicians in cognitive-behavioral therapy. Journal of Consulting and Clinical Psychology, 73, 106–115.
U.S. Public Health Service. (2000). Report of the Surgeon General’s Conference on Children’s Mental Health: A national action agenda. Washington, DC: Department of Health and Human Services.
Weisz, J. R. (2000). Lab-clinic differences and what we can do about them: II. Linking research and practice to enhance our public impact. Clinical Child Psychology Newsletter, 14(2), 1–4.
Acknowledgments
Support for the preparation of this article was provided by NIMH research grants P20 MH078058 (M. Atkins, PI), R01MH073749 (M. Atkins, PI), P20 MH078178 (K. Hoagwood, PI) and P30 MH074678 (J. Landsverk, PI).
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Sonja K. Schoenwald is a Board Member and stockholder in MST Services, LLC, which has the exclusive licensing agreement through the Medical University of South Carolina for the dissemination of MST.
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Schoenwald, S.K., Hoagwood, K.E., Atkins, M.S. et al. Workforce Development and the Organization of Work: The Science We Need. Adm Policy Ment Health 37, 71–80 (2010). https://doi.org/10.1007/s10488-010-0278-z
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DOI: https://doi.org/10.1007/s10488-010-0278-z