Skip to main content

Translating and Implementing Evidence-Based Mental Health Services in Child Welfare

Administration and Policy in Mental Health and Mental Health Services Research volume 47, pages 693–704 (2020)Cite this article

Abstract

Children in the child welfare system with mental health difficulties seldom receive evidence-based treatment (EBT) despite the abundance of validated interventions that exist. This manuscript describes two projects aimed at increasing access to EBTs. The first is a completed field trial of an adapted parent–child interaction therapy intervention with foster-parent child dyads. New findings are presented from variable- and person-centered analyses of impact on diverse symptom profiles. The second is an ongoing statewide initiative that is increasing access to multiple EBTs while navigating implementation barriers. Lessons learned for bridging gaps between children’s mental health research, services, and policy are discussed.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1

References

  • Aarons, G. A., Fettes, D. L., Sommerfeld, D. H., & Palinkas, L. A. (2012). Mixed methods for implementation research: Application to evidence-based practice implementation and staff turnover in community-based organizations providing child welfare services. Child Maltreatment,17(1), 67–79.

    PubMed  Google Scholar 

  • 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(4), 411–419.

    PubMed  Google Scholar 

  • Achenbach, T. M., & Rescorla, L. (2001). ASEBA school-age forms & profiles.

  • Aldao, A., Nolen-Hoeksema, S., & Schweizer, S. (2010). Emotion-regulation strategies across psychopathology: A meta-analytic review. Clinical Psychology Review,30(2), 217–237.

    PubMed  Google Scholar 

  • American Academy of Pediatrics. Task Force on Health Care for Children in Foster Care. (2005). Fostering health: Health care for children and adolescents in foster care. American Academy of Pediatrics.

  • Bai, Y., Wells, R., & Hillemeier, M. M. (2009). Coordination between child welfare agencies and mental health service providers, children's service use, and outcomes. Child Abuse & Neglect,33(6), 372–381.

    Google Scholar 

  • Berking, M., & Wupperman, P. (2012). Emotion regulation and mental health: Recent findings, current challenges, and future directions. Current Opinion in Psychiatry,25(2), 128–134.

    PubMed  Google Scholar 

  • Bickman, L., Kelley, S. D., Breda, C., de Andrade, A. R., & Riemer, M. (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services,62(12), 1423–1429.

    PubMed  Google Scholar 

  • Burns, B. J., Phillips, S. D., Wagner, H. R., Barth, R. P., Kolko, D. J., Campbell, Y., & Landsverk, J. (2004). Mental health need and access to mental health services by youths involved with child welfare: A national survey. Journal of the American Academy of Child Adolescent Psychiatry,43(8), 960–970.

    PubMed  Google Scholar 

  • Center for Substance Abuse Treatment. (2014). Treatment Improvement Protocol (TIP) Series 57. Trauma-informed care in behavioral health services. Rockville, MD: Substance Abuse and Mental Health Services Administration.

    Google Scholar 

  • Chase, R. M., & Eyberg, S. M. (2008). Clinical presentation and treatment outcome for children with comorbid externalizing and internalizing symptoms. Journal of Anxiety Disorders,22(2), 273–282.

    PubMed  Google Scholar 

  • Child Welfare League of America. (1988). Child Welfare League of America standards for health care services for children in out-of-home care. Washington, DC: Child Welfare League of America.

    Google Scholar 

  • Clement, S., Schauman, O., Graham, T., Maggioni, F., Evans-Lacko, S., Bezborodovs, N., … Thornicroft, G. (2015). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine,45(1), 11–27.

    CAS  PubMed  Google Scholar 

  • Cohen, J. A., Mannarino, A. P., & Deblinger, E. (Eds.). (2012). Trauma-focused CBT for children and adolescents: Treatment applications. New York: Guilford Press.

    Google Scholar 

  • Collishaw, S. (2015). Annual research review: Secular trends in child and adolescent mental health. Journal of Child Psychology and Psychiatry,56(3), 370–393.

    PubMed  Google Scholar 

  • DePanfilis, D., & Zlotnik, J. L. (2008). Retention of front-line staff in child welfare: A systematic review of research. Children and Youth Services Review,30(9), 995–1008.

    Google Scholar 

  • Dozier, M., Lindhiem, O., Lewis, E., Bick, J., Bernard, K., & Peloso, E. (2009). Effects of a foster parent training program on young children’s attachment behaviors: Preliminary evidence from a randomized clinical trial. Child and Adolescent Social Work Journal,26(4), 321–332.

    PubMed  Google Scholar 

  • Ebert, L., Amaya-Jackson, L., Markiewicz, J., & Fairbank, J. A. (2012). Development and application of the NCCTS learning collaborative model for the implementation of evidence-based child trauma treatment. In R. K. McHugh & D. H. Barlow (Eds.), Dissemination and implementation of evidence-based psychological interventions (pp. 97–123). New York, NY: Oxford University Press.

    Google Scholar 

  • Ehrenreich-May, J., & Bilek, E. L. (2012). The development of a transdiagnostic, cognitive behavioral group intervention for childhood anxiety disorders and co-occurring depression symptoms. Cognitive and Behavioral Practice,19(1), 41–55.

    Google Scholar 

  • Fernandez, K. C., Jazaieri, H., & Gross, J. J. (2016). Emotion regulation: A transdiagnostic perspective on a new RDoC domain. Cognitive Therapy and Research,40(3), 426–440.

    PubMed  PubMed Central  Google Scholar 

  • Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

  • Ford, J. D., & Greene, C. A. (2017). Posttraumatic stress disorder and acute stress disorder in childhood and adolescence. In Handbook of DSM-5 disorders in children and adolescents (pp. 293–316). Cham: Springer.

  • Garcia, A. R., Palinkas, L. A., Snowden, L., & Landsverk, J. (2013). Looking beneath and in-between the hidden surfaces: A critical review of defining, measuring and contextualizing mental health service disparities in the child welfare system. Children and Youth Services Review,35(10), 1727–1733.

    Google Scholar 

  • Gershater-Molko, R. M., Lutzker, J. R., & Wesch, D. (2003). Project SafeCare: Improving health, safety, and parenting skills in families reported for, and at-risk for child maltreatment. Journal of Family Violence,18(6), 377–386.

    Google Scholar 

  • Ghandour, R. M., Sherman, L. J., Vladutiu, C. J., Ali, M. M., Lynch, S. E., Bitsko, R. H., et al. (2019). Prevalence and treatment of depression, anxiety, and conduct problems in US children. The Journal of Pediatrics,206, 256–267.

    PubMed  Google Scholar 

  • Gordon, J. A., Sherrill, J. T., Avenevoli, S., & Heinssen, R. K. (2018). Trends in children’s mental health services research funding: Response to Hoagwood and colleagues’ commentary. Journal of the American Academy of Child & Adolescent Psychiatry,57(7), 515–516.

    Google Scholar 

  • Government Accountability Office. (2013). Child welfare: States use flexible federal funds, but struggle to meet service needs (GA-13-170). Retrieved on May 1, 2019, from https://www.gao.gov/assets/660/651667.pdf.

  • Gurwitch, R. H., Messer, E. P., Masse, J., Olafson, E., Boat, B. W., & Putnam, F. W. (2016). Child-Adult Relationship Enhancement (CARE): An evidence-informed program for children with a history of trauma and other behavioral challenges. Child Abuse & Neglect,53, 138–145.

    Google Scholar 

  • Herman, K. C., Borden, L. A., Reinke, W. M., & Webster-Stratton, C. (2011). The impact of the Incredible Years parent, child, and teacher training programs on children's co-occurring internalizing symptoms. School Psychology Quarterly,26(3), 189–201.

    PubMed  PubMed Central  Google Scholar 

  • Herschell, A. D., Kolko, D. J., Scudder, A. T., Taber-Thomas, S., Schaffner, K. F., Hiegel, S. A., … Mrozowski, S. (2015). Protocol for a statewide randomized controlled trial to compare three training models for implementing an evidence-based treatment. Implementation Science,10(1), 133.

    PubMed  Google Scholar 

  • Hoagwood, K. E., Atkins, M., Kelleher, K., Peth-Pierce, R., Olin, S., Burns, B., … Horwitz, S. M. (2018). Trends in children’s mental health services research funding by the National Institute of Mental Health from 2005 to 2015: A 42% reduction. Journal of the American Academy of Child & Adolescent Psychiatry,57(1), 10–13.

    Google Scholar 

  • Horwitz, S. M., Chamberlain, P., Landsverk, J., & Mullican, C. (2010). Improving the mental health of children in child welfare through the implementation of evidence-based parenting interventions. Administration and Policy in Mental Health and Mental Health Services Research,37(1–2), 27–39.

    PubMed  Google Scholar 

  • Horwitz, S. M., Hurlburt, M. S., Heneghan, A., Zhang, J., Rolls-Reutz, J., Fisher, E., … Stein, R. E. (2012). Mental health problems in young children investigated by US child welfare agencies. Journal of the American Academy of Child & Adolescent Psychiatry,51(6), 572–581.

    Google Scholar 

  • Insel, T. R. (2014). The NIMH research domain criteria (RDoC) project: Precision medicine for psychiatry. American Journal of Psychiatry,171(4), 395–397.

    PubMed  Google Scholar 

  • Ivanova, M. Y., Achenbach, T. M., Rescorla, L. A., Harder, V. S., Ang, R. P., Bilenberg, N., … Dobrean, A. (2010). Preschool psychopathology reported by parents in 23 societies: Testing the seven-syndrome model of the child behavior checklist for ages 1.5–5. Journal of the American Academy of Child & Adolescent Psychiatry,49(12), 1215–1224.

    Google Scholar 

  • Kaplan, R. M., Johnson, S. B., & Kobor, P. C. (2017). NIH behavioral and social sciences research support: 1980–2016. American Psychologist,72(8), 808–821.

    PubMed  Google Scholar 

  • Kemp, S. P., Marcenko, M. O., Hoagwood, K., & Vesneski, W. (2009). Engaging parents in child welfare services: Bridging family needs and child welfare mandates. Child Welfare,88(1), 101–126.

    PubMed  Google Scholar 

  • Kerns, S. E., Pullmann, M. D., Putnam, B., Buher, A., Holland, S., Berliner, L., et al. (2014). Child welfare and mental health: Facilitators of and barriers to connecting children and youths in out-of-home care with effective mental health treatment. Children and Youth Services Review,46, 315–324.

    Google Scholar 

  • Lewis-Fernandez, R., Rotheram-Borus, M. J., Betts, V. T., Greenman, L., Essock, S. M., Escobar, J. I., … DiClemente, R. J. (2016). Rethinking funding priorities in mental health research. The British Journal of Psychiatry,208(6), 507–509.

    PubMed  Google Scholar 

  • Lieberman, A. F., Van Horn, P., & Ippen, C. G. (2005). Toward evidence-based treatment: Child-parent psychotherapy with preschoolers exposed to marital violence. Journal of the American Academy of Child & Adolescent Psychiatry,44(12), 1241–1248.

    Google Scholar 

  • Lyons, J. S., Griffin, E., Fazio, M., & Lyons, M. B. (1999). Child and adolescent needs and strengths: An information integration tool for children and adolescents with mental health challenges (CANS-MH), manual. Chicago: Buddin Praed Foundation.

    Google Scholar 

  • Marchette, L. K., & Weisz, J. R. (2017). Practitioner review: Empirical evolution of youth psychotherapy toward transdiagnostic approaches. Journal of Child Psychology and Psychiatry,58(9), 970–984.

    PubMed  Google Scholar 

  • McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist,65(2), 73–84.

    PubMed  Google Scholar 

  • Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., … Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry,49(10), 980–989.

    Google Scholar 

  • Mersky, J. P., Topitzes, J., Janczewski, C. E., & McNeil, C. B. (2015). Enhancing foster parent training with Parent-Child Interaction Therapy: Evidence from a randomized field experiment. Journal of the Society for Social Work and Research,6(4), 591–616.

    PubMed  PubMed Central  Google Scholar 

  • Mersky, J. P., Topitzes, J., Grant-Savela, S. D., Brondino, M. J., & McNeil, C. B. (2016). Adapting Parent–Child Interaction Therapy to foster care: Outcomes from a randomized trial. Research on Social Work Practice,26(2), 157–167.

    Google Scholar 

  • Messer, E. P., Greiner, M. V., Beal, S. J., Eismann, E. A., Cassedy, A., Gurwitch, R. H., … Greenwell, S. (2018). Child adult relationship enhancement (CARE): A brief, skills-building training for foster caregivers to increase positive parenting practices. Children and Youth Services Review,90, 74–82.

    Google Scholar 

  • Muthén, L. K., & Muthén, B. O. (1998–2017). Mplus user’s guide (8th ed.). Los Angeles, CA: Muthén & Muthén.

  • Nylund, K. L., Asparouhov, T., & Muthén, B. O. (2007). Deciding on the number of classes in latent class analysis and growth mixture modeling: A Monte Carlo simulation study. Structural Equation Modeling: A Multidisciplinary Journal,14(4), 535–569.

    Google Scholar 

  • Olds, D. L. (2006). The nurse–family partnership: An evidence-based preventive intervention. Infant Mental Health Journal,27(1), 5–25.

    PubMed  Google Scholar 

  • Perou, R., Bitsko, R. H., Blumberg, S. J., Pastor, P., Ghandour, R. M., Gfroerer, J. C., … Parks, S. E. (2013). Mental health surveillance among children: United States, 2005–2011. MMWR Supplements,62(2), 1.

    PubMed  Google Scholar 

  • Raghavan, R., Inkelas, M., Franke, T., & Halfon, N. (2007). Administrative barriers to the adoption of high-quality mental health services for children in foster care: A national study. Administration and Policy in Mental Health and Mental Health Services Research,34(3), 191–201.

    PubMed  Google Scholar 

  • Raghavan, R., Inoue, M., Ettner, S. L., Hamilton, B. H., & Landsverk, J. (2010). A preliminary analysis of the receipt of mental health services consistent with national standards among children in the child welfare system. American Journal of Public Health,100(4), 742–749.

    PubMed  PubMed Central  Google Scholar 

  • Reinke, W. M., Herman, K. C., & Dong, N. (2018). The Incredible Years teacher classroom management program: Outcomes from a group randomized trial. Prevention Science,19(8), 1043–1054.

    PubMed  Google Scholar 

  • Rodríguez, G. M., Bagner, D. M., & Graziano, P. A. (2014). Parent training for children born premature: A pilot study examining the moderating role of emotion regulation. Child Psychiatry & Human Development,45(2), 143–152.

    Google Scholar 

  • Rodriguez, N., Steinberg, A., & Pynoos, R. S. (1998). UCLA posttraumatic stress disorder reaction index for DSM-IV, child, adolescent, and parent versions. Los Angeles, CA: University of California at Los Angeles.

    Google Scholar 

  • Rosinsky, K., & Connelly, D. (2016). Child welfare financing SFY 2014: A survey of federal, state, and local expenditures (Publication #2016-53). Retrieved May 1, 2019, from https://www.childtrends.org/wp-content/uploads/2016/10/2016-53ChildWelfareFinancingSFY2014-1.pdf

  • Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology,33(6), 906.

    CAS  PubMed  Google Scholar 

  • Sigel, B. A., Benton, A. H., Lynch, C. E., & Kramer, T. L. (2013). Characteristics of 17 statewide initiatives to disseminate trauma-focused cognitive-behavioral therapy (TF-CBT). Psychological Trauma: Theory, Research, Practice, and Policy,5(4), 323.

    Google Scholar 

  • Sloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017). Emotion regulation as a transdiagnostic treatment construct across anxiety, depression, substance, eating and borderline personality disorders: A systematic review. Clinical Psychology Review,57, 141–163.

    PubMed  Google Scholar 

  • Stoltzfus, E. (2014). Child welfare: An overview of federal programs and their current funding. Washington, DC: Congressional Research Service.

    Google Scholar 

  • Tarren-Sweeney, M. (2008). The mental health of children in out-of-home care. Current Opinion in Psychiatry,21(4), 345–349.

    PubMed  Google Scholar 

  • Thomas, R., Abell, B., Webb, H. J., Avdagic, E., & Zimmer-Gembeck, M. J. (2017). Parent-child interaction therapy: A meta-analysis. Pediatrics,140(3), e20170352.

    PubMed  Google Scholar 

  • U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2019). Child Maltreatment 2017. Retrieved from https://www.acf.hhs.gov/cb/research-data-technology/ statistics-research/child-maltreatment.

  • Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., … Gray, J. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry,69(3), 274–282.

    PubMed  Google Scholar 

  • Wilsie, C., Campbell, C., Chaffin, M., & Funderburk, B. (2017). Parent–child interaction therapy in child welfare parenting and family processes in child maltreatment and intervention (pp. 107–125). Cham, CH: Springer.

    Google Scholar 

  • Zimmer-Gembeck, M. J., Kerin, J. L., Webb, H. J., Gardner, A. A., Campbell, S. M., Swan, K., et al. (2019). Improved perceptions of emotion regulation and reflective functioning in parents: Two additional positive outcomes of parent–child interaction therapy. Behavior Therapy,50(2), 340–352.

    Google Scholar 

Download references

Funding

This study was funded by National Institutes of Health (Award Number R15HD067829-01) and the Substance Abuse and Mental Health Services Administration (Award Number SM063270-01).

Author information

Authors and Affiliations

  1. Helen Bader School of Social Welfare, University of Wisconsin-Milwaukee, 2400 E. Hartford Ave., Milwaukee, WI, 53211, USA

    Joshua P. Mersky, James Topitzes, Colleen E. Janczewski & Chien-Ti Plummer Lee

  2. Children’s Hospital of Wisconsin, Milwaukee, WI, USA

    Gabriel McGaughey

  3. Department of Psychology, West Virginia University, Morgantown, WV, USA

    Cheryl B. McNeil

Authors
  1. Joshua P. Mersky
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. James Topitzes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Colleen E. Janczewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Chien-Ti Plummer Lee
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gabriel McGaughey
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cheryl B. McNeil
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Joshua P. Mersky.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the University of Wisconsin-Milwaukee Institutional Review Board (Federal Wide Assurance 00006171) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mersky, J.P., Topitzes, J., Janczewski, C.E. et al. Translating and Implementing Evidence-Based Mental Health Services in Child Welfare. Adm Policy Ment Health 47, 693–704 (2020). https://doi.org/10.1007/s10488-020-01011-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-020-01011-8

Keywords

  • Mental health
  • Evidence-based treatment
  • Children
  • Implementation
  • Translational research