Introducing and Evaluating Parent-Child Interaction Therapy in a System of Care

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What is a system of care?

Before embarking on a description of EBTs and the TES, it is important to understand the service context in which the TES was developed and implemented. In 1993, the Child and Family Branch of the Center for Mental Health Services in the Federal Substance Abuse and Mental Health Services Administration launched the Comprehensive Community Mental Health Service for Children and Their Families Program. The goal of this program was to establish or develop service systems for children with severe

Why evidence-based treatments?

The Comprehensive Community Mental Health Services for Children and Their Families Program includes a congressionally mandated national evaluation that has been conducted in grant communities since 1994. When this evaluation was initiated there was significant interest in understanding how services provided in communities funded to implement systems of care compared with mental health services provided “as usual” or without the aid of federal funding. Child and family-level change was of

Implementation of the treatment effectiveness study

Implementation of the TES involved a multistage process. The process was initiated with a treatment nominations process [14]. Experts in the field of children's mental health and mental health services were asked to nominate clinical treatment modalities that proved effective in the reduction of emotional or behavioral problems among children and met standard criteria for EBP [15]. Submitted nominations were reviewed and scored according to EBT criteria. This process resulted in a list of 11

The evidence-based treatment

Once communities were selected, a local treatment selection process ensued. Agency directors reviewed the list of EBTs selected through the nomination process and considered their local needs and child and family characteristics. Both communities selected parent-child interaction therapy (PCIT) [16]. PCIT is a therapeutic technique for children aged 3 to 9 who have a disruptive behavior disorder. PCIT combines the teachings of play therapy and cognitive behavior therapy and uses data-driven

Implementation of parent-child interaction therapy

Simpson [24] proposed a model of program change for introducing research in the drug treatment area to practice in community settings. This model incorporates an understanding of institutional and personal readiness, organizational dynamics, staff needs related to exposure to the practice and ultimate buy-in for practice, institutional support needs, and resulting organizational change and program improvement. There are four action steps included with in this framework: (1) exposure to the

The treatment effectiveness study evaluation design

The TES is part of a larger evaluation effort designed to assess the development and success of EBPs introduced to systems of care funded by the Center of Mental Health Services. This evaluation is comprehensive in scope and involves a study that serves to describe basic demographic characteristics of children served and their families and assesses a broad range of emotional, behavioral, educational, and child and family functioning outcomes and service use experiences. Data are obtained upon

Lessons learned in the real world

The evaluation team and CCMH staff learned many practical lessons about what it takes to implement an EBT. The lessons learned by evaluation team members and agency staff are similar in many ways but also are related directly to their needs and expectations. These similarities and differences emphasize the importance of the need for collaboration when implementing a successful evaluation for the EBT.

Summary

In an effort to increase the nation's understanding of how well EBTs work in community-based settings and, more specifically, in communities that apply a system-of-care philosophy, the national evaluation of the Comprehensive Community Mental Health Services Program collaborated with community-based mental health agencies. Evaluating and implementing an EBT greatly adds knowledge to the field and may help leverage future funding streams for communities. This article described a TES and outlined

Acknowledgments

The authors wish to specially thank Wayne Holden for his input and review of this article and Stacy Johnson for all her efforts as the field coordinator of the study in Clackamas County, OR.

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      A novel field trial of TF-CBT and CBITS following the trauma of Hurricane Katrina has provided helpful case examples and findings regarding clinical benefits among treated children, but also documented limited uptake and a need to enhance overall level of treatment response among traumatized children (Cohen et al., 2009; Jaycox et al., 2010). Other EBTs are likewise being applied in diverse community settings, including PCIT (Franco, Soler, & McBride, 2005; Herschell et al., 2009), MST (Swenson, 2010; Swenson & Chaffin, 2006), and Multidimensional Treatment Foster Care (Chamberlain et al., 2008; Price et al., 2008). With the extensive dissemination of numerous EBTs targeting abused and neglected children, it is important to document empirical evidence describing the application and clinical effects of these EBTs in real-world, community settings (Dean et al., 2008; McHugh & Barlow, 2010) For example, there is limited information regarding the treatment repertoires of practitioners who have been trained in several EBTs and the extent to which they actually use their procedures (Kolko, Hoagwood, & Springgate, 2010).

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    Work on this article was supported by contract number 280-00-8040 with the Child and Family Branch of the Center for Mental Health Services (CMHS) in the Federal Substance Abuse and Mental Health Services Administration (SAMHSA).

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