Treatment of Child Abuse: Common Ground for Mental Health, Medical, and Legal Practitioners

23. Statewide Efforts for Implementation of Evidence-Based Programs

care treatments to make their way to community populations . Despite the development of so many child behavioral health EBPs, there has been a limited impact on public health (DeAngelis, 2010). Although EBPs exist for child victims of abuse and other forms of trauma exposure, few children and families receive these treatments (Chadwick Center for Children and Families, 2004; Landsverk et al., 2006; Stahmer et al., 2005). In fact, 75% of children in the child welfare system who need mental health treatment do not receive it (Burns et al., 2004). Children who do receive services rarely receive targeted EBPs (Landsverk et al., 2009). This is a cause of concern, given the scarcity of evidence that treatment traditionally delivered in community agencies is effective (McLennan et al., 2006; Weiss, Catton, & Harris, 2000). Several reasons for the limited availability of EBPs are therapists’ lack of exposure to the models, resistance to changes in practice, lack of funding and resources, and lack of leadership and administrative support to overcome implementation challenges (Chadwick Center for Children and Families, 2004). Increasingly, systems of care at the local, regional, and state levels have attempted to broadly disseminate EBPs in order to increase access to quality care and improve child, family, and public health outcomes. These efforts are well underway despite our limited knowledge about the most effective methods of EBP dissemination in public settings (McHugh & Barlow, 2010). Common implementation challenges include organizational, policy, and staffing barriers (Ganju, 2003) and the limitations of traditional didactic training methods, which have been minimally effective at creating sustainable changes in practice (Beidas & Kendall, 2010; Jensen-Doss, Cusack, & de Arellano, 2008). Implementation within a statewide system of care presents a unique set of challenges. Typically, decisions to disseminate an EBP statewide are made by key champions, GENERAL CONSIDERATIONS A number of evidence-based programs (EBPs) have been developed to treat children who are victims of abuse, neglect , and other forms of trauma exposure. The availability of these programs in community-based mental health settings remains limited, however, and the potential public health impact of EBPs has not been realized. The goals of this chapter are to summarize the current state of implementation science and to describe three statewide approaches to EBP implementation, in Connecticut, Washington State, and Colorado. We summarize common themes and challenges from these initiatives and make some recommendations for future statewide EBP implementation efforts. IMPLEMENTATION OF EVIDENCE-BASED PROGRAMS IN CHILD-SERVING SYSTEMS Over the past two decades, a great deal has been learned about developing more effective programs in mental health, juvenile justice, child welfare, and other childserving systems. This has led to an increasing emphasis on evidence-based practice, defined as “integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (American Psychological Association, 2005, p. 1). Development of a range of evidence-based programs, or specific models of practice supported by research, has followed. In fact, there is now a national registry of more than 250 EBPs—including more than 160 intended for children and adolescents (www .nrepp.samhsa.gov). These EBPs are sought after to prevent or treat a variety of mental health and substance abuse concerns , including child abuse and neglect. However, the Institute of Medicine (2004) reports that it takes an average of 17 years for the implications of research on effective health Statewide Efforts for Implementation of Evidence-Based Programs JASON M. LANG, PH.D. LUCY BERLINER, M.S.W. MONICA M. FITZGERALD, PH.D. ROBERT P. FRANKS, PH.D. 23 Statewide Efforts for Implementation of Evidence-Based Programs 247 dren, particularly those in the child welfare system, suffered from undiagnosed or untreated traumatic stress symptoms secondary to physical abuse, sexual abuse, violence exposure , and other forms of trauma. Administrators also recognized that Connecticut had very limited availability of EBPs for victims of trauma, particularly in the DCF-contracted outpatient provider network through which most children in the DCF system are served. These factors, along with several previous successful statewide implementations of inhome EBPs, led the DCF to develop plans for disseminating a trauma-focused EBP in Connecticut’s outpatient behavioral health agencies to increase the state’s capacity to serve victims of child abuse and other forms of trauma. During the initial planning, DCF staff consulted with the National Child Traumatic Stress Network’s (NCTSN) National Center at Duke University and the University of California , Los Angeles. The NCTSN is funded by the Substance Abuse and Mental Health Services Administration (SAMHSA ), part of the...