Date post: | 20-Nov-2014 |
Category: |
Documents |
Upload: | dentistryinfo |
View: | 440 times |
Download: | 2 times |
Fostering research to improve the health and well-being of children and
youth
Engaging users of child and youth mental health prevention programs?
CYHRNet Annual MeetingNovember 3, 2009
Bonnie Leadbeater, Ph D.
Fostering research to improve the health and well-being of children and
youth
The Ideal
Fostering research to improve the health and well-being of children and
youth
Evaluation
Development & Innovation
Uptake
Infidelity
Abandonment
The Reality Processes of Knowledge Uptake for Mental Health Programs
Fostering research to improve the health and well-being of children and
youth
The PUSH
Program Developer(an academic
or research team)
USERSGATEKEEPERS
Principals Police forceTherapistsCounselors
Fostering research to improve the health and well-being of children and
youth
The PULL
Knowledge USERS
Professional Development
Activities
Marketing
PrivateCommunications
Fostering research to improve the health and well-being of children and
youth
The Solution Community Based Research?
• Involve stakeholders early in program development
• Enhanced knowledge exchange• Increase relevance• Speed uptake
–YES, but ….
Fostering research to improve the health and well-being of children and
youth
How does CBR affect going to scale?
• Programs may be more relevant and acceptable.• But programs are ultimately packaged and
dissemination requires ….. • Pushing and pulling mechanisms to – Recreate interested community partners in new setting– Recreate trained workforce – delivery folks– Reevaluate cultural applicability and local relevance of the
program
»For example
Fostering research to improve the health and well-being of children and
youth
Preventing peer victimization
Fostering research to improve the health and well-being of children and
youth
The WITS Rock Solid Primary Prevention Program is a Partnership
Judy Stevenson, Susan Underwood, Sonya Einstadt
Wendy Holob, John Gaiptman
Bonnie LeadbeaterWendy Hoglund; Rachel Yeung:Tracy
DesjardinPaweena Sa
Tom Woods; Dorian BrownRock Solid Foundation
Fostering research to improve the health and well-being of children and
youth
Moving out of the classroom
• Children grow up in relationships &– A growing number of studies show the promise of
school, parent, and community involvement in interventions for reducing peer victimization.
• WITS strategies convey consistent and developmentally appropriate messages for peaceful conflict resolution across contexts
Fostering research to improve the health and well-being of children and
youth
WITS Program Components
1. Emergency Services Personnel Manual 2. Student/WITS Representative3. WITS Booklist 4. Curriculum for Teachers and Librarians5. Activities for the Classroom and School6. Resources for Parents
www.uvic.ca/WITS
Fostering research to improve the health and well-being of children and
youth
Evaluations
• 2001-2003 (4 waves)– 432 children families & their teachers
• 2007-2008 (3 waves)– 1132 children families & their teachers
Fostering research to improve the health and well-being of children and
youth
More reported victimization and greater rate of decline levels of victimization
Fostering research to improve the health and well-being of children and
youth
Bridging the gap – Transportability
Knowledge Practice
BetterImplementation
Strategies
Fostering research to improve the health and well-being of children and
youth
Obstacles to transportabilityAccess to mental health services/programs:
• Heterogeneity of services delivered (medication, psychotherapy, groups etc.)
• Clogged public systems mainly treats adolescents with severe illness and urgent needs
• Scattered sites for service delivery (schools, child welfare, juvenile justice, health clinics, private offices)
• Multiple service providers – Intervention (physicians, psychologist, therapists,
counselors) & – Prevention (Police: D.A. R. E.) (Teachers: F.R.I.E.N.D.S. for
Life, School Counselors
Fostering research to improve the health and well-being of children and
youth
More obstacles – Complexity of problems and solutions
• Ecology child health and illness creates need for preventions in the context of family, school, neighborhood,
• Complexity of mental health concerns – comorbidity (anxiety, depression, ODD, CD)
• Even Prodromal & subclinical symptoms affect functioning in many domains (physical academic)
Fostering research to improve the health and well-being of children and
youth
More obstacles – Creating Research Evidence
• Lack of empirically-based programs for some concerns (but many do exist)
• Lack of consensus or regulation in what counts as evidence-based (RTCs vs real world)
• Incentives to do intervention research• Longterm commitment is neededVaccination-like
programs don’t work even if wide spread, short term single shot programs show no evidence of lasting effects – e.g. D.A.R.E longitudinal research is needed
• Researchers have short lives!
Fostering research to improve the health and well-being of children and
youth
NOW WHAT ?
• Need for a national, provincial and and local infrastructures committed to facilitating dissemination of effective based mental health treatment programs for children
&Children’s Mental Health
Promotion Programs
Fostering research to improve the health and well-being of children and
youth
Applying Applying Child Policy Initiatives Child Policy Initiatives
(Julius Richmond) (Julius Richmond)
KnowledgeKnowledgeBaseBase
(Growing)(Growing)
PoliticalPoliticalWillWill
(Growing) (Growing)
Social StrategySocial Strategy(Fragmented)(Fragmented)
Fostering research to improve the health and well-being of children and
youth
Alternate approaches to public health problems
• Preventive dentistry– Licensed and accredited providers– Lifespan, prevention oriented perspective– Public and private involvement (fluoride in
water, and tooth paste)
• Put WITS in your water to prevent relationship decay?
Fostering research to improve the health and well-being of children and
youth
Pharmaceutical medicineFood & Drug Act (2005 budget – $170M for 5 years)
• Evidenced-based approaches built into regulatory standards for insuring safety, efficacy and quality
• Industry lead mechanisms for development,dissemination, marketing
• Monetary Incentives for development and dissemination
• Nationally regulated(Health Canada)• Training restrictions related
to for distribution – few gatekeepers
• Public payment for use of medications + private insurance
• Fueled by academic research
Fostering research to improve the health and well-being of children and
youth
Approaches to improve access to Evidence-based mental health programs
• Standardize and clarify training and scope of practice of service providers – teachers don’t just teach
• Public funding of mental health prevention and prevention services to children and youth
• National accreditation of evidenced-based treatments (with clear operational criteria)
• Centralized and accelerated dissemination of evidenced-based programs
• Identifiable settings for mental health treatment
Fostering research to improve the health and well-being of children and
youth
Drug Safety and Effectiveness Network Launched July 2008
• Minister of Health, Leona Aglukkaq:• “Canadians can be confident that this government
is taking the steps necessary to ensure that our drug safety system remains one of the best in the world. The Network complements Canada’s rigorous pre-testing of drugs by studying how Canadians respond over time to already-approved drugs. The results will help in decision making and enhance overall consumer safety” (32M for first 5 years then 10M per year after)
Fostering research to improve the health and well-being of children and
youth
Which system would you choose for your child?
• Regulated, pharmaceutical system with few, easy to access, gatekeepers (physicians) and sound educators (pharmacists) ?
• Unregulated, hard to find, fragmented psychological services with potentially unproven benefits, delivered by variously trained individuals, in multiple settings?
Fostering research to improve the health and well-being of children and
youth
A NATIONAL Mental Health Strategy
Minister of Health, Leona Aglukkaq will make the strong claim that:
“Canadians can be confident that this government is taking the steps necessary to ensure that our children’s mental health is among the best in the world!”
Fostering research to improve the health and well-being of children and
youth
Recommendations for programs for treatment and prevention of mental
health programs in children• National accreditation of evidence-based
programs.• Regulation of training of mental health service
providers.• Enhance access to and use of accredited
programs by schools.• Public payment for mental health care for
children and youth.
Fostering research to improve the health and well-being of children and
youth
First Steps - Federal• The Public Health Agency of Canada – listing of
promising programs and “Innovative strategy to Reduce Health Inequalities in Canada”
• Canadian Mental Health Commission• Canadian Alliance on Mental– Illness and Mental Health (CAMIMH),
• PREVNET –Promoting relationships eliminating violence Network- began with a National Centre for Excellence
Fostering research to improve the health and well-being of children and
youth
First steps – Provincial
• BC Ministry for Child and Family Development: Ten Year Mental Health Plan – Dissemination of FRIENDS For LIFE Program
• Children’s Mental Health Ontario (CMHO) Evidence-Based Practice Technical Assistance Centre
Fostering research to improve the health and well-being of children and
youth
First steps – local
• Toolkits for community engagement and development. – Rand Foundation entitled Getting to Outcomes
http://www.rand.org/pubs/technical_reports/TR101/
Fostering research to improve the health and well-being of children and
youth
Getting to outcomes: Questions
• 1: What Are the Underlying Needs and Conditions in the Community? (Needs/Resources)
• #2: What Are the Goals, Target Populations, and Objectives (i.e., Desired Outcomes)? (Goals)
• #3: Which Evidence-Based Programs Can Be Used to Reach Your Goal? (Best Practice)
• #4: What Actions Need to Be Taken So That the Selected Program “Fits” the Community Context?
• #5: What Organizational Capacities Are Needed to Implement the Program? (Capacities)
Fostering research to improve the health and well-being of children and
youth
Getting to Outcomes (Continued)
• #6: What Is the Plan for this Program? (Plan)• #7: How Will the Quality of Program and/or
Initiative Implementation Be Assessed? (Process)• #8: How Well Did the Program Work? (Outcomes)• #9: How Will Continuous Quality Improvement
Strategies Be Incorporated? (CQI)• #10: If the Program Is Successful, How Will It Be
Sustained? (Sustain)