State Strategies for Enhancing Access and Quality in Systems of Care for Youth with Complex Behavioral Health Needs

Graaf, Genevieve; Snowden, Lonnie R.

doi:10.1007/s10488-020-01061-y

Cited by 10 publications

(5 citation statements)

References 51 publications

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“…For example, at the therapist–client level, research has suggested the potential importance of match on demographic variables such as race (e.g., Cabral & Smith, 2011; Jerrell, 1995; Zane et al, 2005) and understanding and adapting to client preferences (e.g., Schatz et al, 2015; Wills & Holmes-Rovner, 2006) as potentially influential variables. At a more systemic or structural level, evidence suggests that ensuring access to evidence-based services, including reducing documented ethnic and racial disparities (e.g., Sanchez et al, 2016; Vander Wielen et al, 2015), may be an important driver to address when seeking to improve clinical outcomes (e.g., Graaf & Snowden, 2020; Hoagwood et al, 2018b). Identifying potent, pre-treatment variables like these may lead to the development of useful dissemination and implementation efforts.…”

Section: Discussionmentioning

confidence: 99%

Are therapist adherence and competence related to clinical outcomes in cognitive-behavioral treatment for youth anxiety?

Southam‐Gerow¹,

Chapman

Martinez³

et al. 2021

Journal of Consulting and Clinical Psychology

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Introduction: Studies have found that psychological treatments produce positive clinical outcomes for many problems experienced by youth. However, there is limited research on whether therapist adherence and competence in delivering these treatments are related to differential clinical outcomes. Method: We examined the relationship of therapist adherence and competence to clinical outcomes in a sample of 51 youth aged 7-14 years (M age = 10.36, SD = 1.90; 86.3% white; 60.8% male) treated for anxiety disorders with a manualized individual cognitive-behavioral therapy. Adherence and competence were measured via coding of recorded treatment session content and outcomes were measured by caregiver and youth report across multiple timepoints. We used two-level mixed-effects regression models to test the degree to which adherence and competence predicted differential youth clinical outcomes. Results: Across multiple caregiver-and child-reported symptom and diagnostic outcomes, we found no statistically significant relationship between adherence or competence and clinical outcomes. Discussion: Although there was variability in both treatment integrity and clinical outcome, neither adherence to nor competence in youth anxiety treatment was related to clinical outcomes for youth with anxiety disorders treated with individual cognitive-behavioral treatment (CBT) in a research clinic-based efficacy trial. Public Health StatementResults suggest the possibility that symptom reduction experienced by clients from cognitive-behavioral treatment (CBT) for child anxiety may not be related to the degree to which therapists followed the CBT treatment procedures closely or competently.

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Section: Discussionmentioning

confidence: 99%

Are therapist adherence and competence related to clinical outcomes in cognitive-behavioral treatment for youth anxiety?

Southam‐Gerow¹,

Chapman

Martinez³

et al. 2021

Journal of Consulting and Clinical Psychology

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“…While policymakers place significant emphasis on service quality and system outcomes [27,28], providers report that funding to support the delivery of high-quality care continues to be insufficient [29]. Increases in resources could come through policies that authorize payment for care coordination activities or higher payment rates for empirically supported interventions requiring rigorous training [30]. Additionally, research attention to service quality and system outcomes, as of 2011, continued to lag behind empirical examinations of interventions targeting clinical or functional outcomes [14,31].…”

Section: Implications For System Of Care Practice and Researchmentioning

confidence: 99%

Behavioral Health Services Outcomes That Matter Most to Caregivers of Children, Youth, and Young Adults with Mental Health Needs

Graaf,

Kitchens,

Sweeney

et al. 2024

IJERPH

Self Cite

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This project documents the service outcomes that caregivers value most. A diverse group of caregivers, representing six regions of the United States, participated in two rounds of virtual one-hour focus groups. In round 1, participants identified what they hoped to gain from using behavioral health services for themselves, their families, and their child and discussed what made services a positive experience for them. They then reported their top-three most-hoped-for outcomes. In round 2, groups validated and refined summary findings from round 1. Caregivers prioritized service quality outcomes, primarily. They expressed a desire for an accessible, respectful, and supportive treatment environment, underpinned by well-trained and culturally responsive professionals. Caregivers also desire seamless cross-sector provider collaboration and care transitions, which integrate the insights and preferences of families and children themselves to craft a customized care plan. Priority outcomes not related to service quality included hoping to gain increased knowledge, resources, and tools and techniques to support the mental health needs of their children, to see their children improve their daily functioning and for their child develop more effective interpersonal communication skills. Caregivers also reported hoping to experience less stigma related to the mental health needs of their children and to achieve personal fulfillment for themselves and their children. Research, policies, and mental health services should prioritize and be designed to address the outcomes that matter to youth and families.

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“…State and local zoning and catchment decisions also impact the physical location and environment of social service providers, including the population size and physical area of the population it serves (Bancroft, 2012). State and county funding policies determine the settings in which services can be provided (Graaf & Snowden, 2020).…”

Section: Place Features Across Macro Practice Activitiesmentioning

confidence: 99%

“…Threshold aspects of assessment include understanding the guidelines and policies that shape the gatekeeping functions dictating eligibility, intake, and discharge practices and how these operate across each level of a social service system (e.g., outpatient, inpatient, long-term care) (Miles & Goetz, 1999). Relational assessment of macro-level relations include how organizational or professional guidelines, policies, and practices interact with each other and with key referral systems in the community, including the health, behavioral health, disability, housing, education, child and elder welfare, and carceral sectors (Bell et al, 2019; Graaf & Snowden, 2019, 2020). Further, attention should be paid to how the social service workforce reflects the communities being served.…”

Section: Application Of Place-based Principles In Social Work Practicementioning

confidence: 99%

“…Funding allocations with timed boundaries affects service capacity (and as a result, accessibility), as many local communities expend their annual block grant or state general fund allocation for services six months into their fiscal year (Graaf & Snowden, 2019). Related mandates, and their enforcement through documentation and reporting requirements, set the criteria for threshold features of service including service eligibility, intake processes, assessment requirements, and expectations for discharge (Graaf & Snowden, 2020).…”

Section: Application Of Place-based Principles In Social Work Practicementioning

confidence: 99%

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Orienting social work to incorporate place-based principles: A practical guide to the use of place in social work practice

Ratliff

Graaf

Choy-Brown

2023

Journal of Social Work

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Social work has long history with practice in diverse places. Indigenous social work traditions have long been grounded in place and land. There has been little attention to the role of place in Western and Northern social work practices. Place-based theories attend to the fundamental role of place in social work practice and provide principles that social workers can use to recognize place in their practice. There has been little practical guidance on how social workers can apply these principles to identify and modify place-based levers for improving practice and outcomes within Western contexts. To address these gaps and advance the use of place in practice, principles of place-based power dynamics are described here in relation to the micro, mezzo, and macro levels of the key areas of social work practice: assessment, intervention, and evaluation. Place-based principles of form, function, location, time, threshold, and relations, provide a framework that social workers can incorporate into social work practices at all levels and throughout social work practice phases. Social workers can use these principles to examine how social work practice can better assess, intervene, and evaluate the role of place in the social environment and in the daily lives of the participants and populations they serve. Incorporating place-based principles can illuminate malleable place-based levers to fit the needs of service users. Attending to place in social work practice can also heighten practitioners’ awareness of power and decision-making to identify and intervene at the root causes of social problems.

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State Strategies for Enhancing Access and Quality in Systems of Care for Youth with Complex Behavioral Health Needs

Cited by 10 publications

References 51 publications

Are therapist adherence and competence related to clinical outcomes in cognitive-behavioral treatment for youth anxiety?

Are therapist adherence and competence related to clinical outcomes in cognitive-behavioral treatment for youth anxiety?

Behavioral Health Services Outcomes That Matter Most to Caregivers of Children, Youth, and Young Adults with Mental Health Needs

Orienting social work to incorporate place-based principles: A practical guide to the use of place in social work practice

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