Three intensive community-based programs for children and youth with serious emotional disturbance and their families

Systems of care for children with serious emotional disturbance and their families have generally lacked intensive community-based programs. We describe three types of newly established community-based programs in New York State and present a general evaluation plan for determining which programs work for various children and their families. The three community-based programs are Intensive Case Management, Family-Based Treatment, and Family-Centered Intensive Case Management. Process and outcome evaluations are being conducted for each of these programs. These evaluations make use of common intake and termination instruments, based on a minimum data set, standardized assessment instruments, and a common logic model, thus facilitating the comparison of findings across evaluations.     

Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.     

Using a Person-Centered Approach in Community-Based Instruction for Adults with Developmental Disabilities

Instruction is a variable that has enhanced community access for adults with developmental disabilities. Community-based instruction emerged as an especially useful format to teach individuals daily living and work skills in the settings where skills would be used. As advocacy and self-advocacy for individuals with developmental disabilities increased, professionals recognized the importance of empowerment and self-determination in gaining community access. Adult education that incorporates the values of person-centered planning will evolve beyond what has traditionally been viewed as community-based instruction. This article describes the characteristics of community-based instruction designed to enhance not only community access, but also the participant's overall quality of life.     

BEHAVIOR ANALYSIS APPLIED TO ENVIRONMENTAL/ECOLOGICAL PROBLEMS; A REVIEW1

Recent applications of operant technology, including the manipulation of environmental conditions and response consequences, have been directed toward the improvement of man-environment relations. This document summarizes the research designs, procedures, results, and conclusions of these recent behavioral interventions for ecological rebalance. Each of the 32 studies reviewed was undertaken since 1970; all studies were relatively successful in changing the probability of an ecology-related response; all studies incorporated basic methodologies applicable for large-scale, community programs; most of the investigations were conducted in field settings (e.g., college campuses, grocery stores, mobile-trailer parks, homes, movie theaters, public campgrounds, and a football stadium). Several of the studies are as yet unpublished. Sources for receiving documentation of the unpublished research are provided in this document. About 50% of the investigations reviewed were designed to influence behaviors related to environmental litter; the others were of behavior-modification programs that substantially increased bus-ridership, decreased lawn-trampling, promoted the purchase of drinks in returnable rather than throwaway containers, initiated a recycling process, or reduced energy consumption. Essentially, the interventions were either preventive in nature (i.e., designed to discourage environment-destructive behaviors before they occur), or remedial (i.e., designed to encourage behaviors that correct an existing environmental problem). Usually, the preventive measures emphasized responses priming (or prompting), while the corrective measures applied some form of positive reinforcement. Response priming was accomplished with modelling techniques, or with written and/or verbal prompts presented either publicly or on a personal, one-to-one basis. Among the positive reinforcement procedures were field applications of token economies, lottery systems, feedback programming, and intergroup contests, as well as individual contingency contracting. Some experimental designs provided for comparisons between the behavioral effects of response priming and positive reinforcement.     

Facilitating paper recycling: effects of prompts, raffles, and contests

The effects of prompts and reinforcement to promote paper recycling were compared in six university dormitories. For a Prompt condition, residents were urged to recycle paper for ecological reasons via flyers distributed to each room. For a Raffle contingency, residents were given one raffle ticket for every pound of paper brought to a collection center. For a Contest contingency, two dorms were paired and the dorm whose residents delivered the most paper won $15 for its treasury. Contingency awareness was strengthened via a flyer placed under the door of each resident's room. Flyers alone had little effect in increasing paper-recycling behaviors, but the raffle (substantially) and the contest (somewhat) increased the amount of paper brought to a dorm's recycling center. Students whose rooms were closest to the collection center showed the greatest participation. Removal of the reinforcement contingencies resulted in a return to baseline levels.     

Quality and Individualization in Wraparound Team Planning

In children’s mental health, collaborative, team-based individualized service planning is most commonly known as wraparound, and has become one of the primary strategies for improving services and outcomes for children with the highest levels of need. We report on analyses of data gathered at 72 wraparound team meetings from communities around the United States. We describe the composition of the teams and the quality of the planning process they engaged in, and explore the extent to which these factors were associated with team member satisfaction and the individualization of plans. Teams in our study were numerically dominated by professionals. Parents attended a large majority of meetings, participation by youth and family advocates was frequent, participation by other family members infrequent, and participation by other members of the family’s informal or natural support networks rare. Observed teams varied considerably in the quality of their planning process and the degree of individualization of plans. Higher-quality planning was significantly associated with increased individualization of plans and with team member satisfaction with meeting productivity.     

Ethical Ambiguities in Participatory Action Research With Unauthorized Migrants

There is increased recognition of the importance of well-designed scholarship on how immigration status and policies impact migrants in the United States, including those who are unauthorized. Some researchers have looked to community-based and participatory methods to develop trust, place migrants’ voices at the forefront, and engage collaboratively in using research as a tool for social change. This article reviews three ethical ambiguities that emerged in the process of a series of participatory action research (PAR) projects with migrants in the United States, many of whom were unauthorized. Specifically, three themes are discussed: (a) the tension between the human desire to respond to injustices, and the challenges of doing so in ways that recognize one’s privilege and power as an outsider and supports the migrants’ agency and autonomy; (b) the complex definition, explanation, and dimensions of “risk”; and (c) the complexity of using a methodology (PAR) that prioritizes participants’ collective identity and community in the context of regulations that are designed primarily to protect individuals.     

The Social Ecological Model and Physical Activity in African American Women

Little is known about the social and contextual correlates (e.g., social norms, environment, social networks, and organizational support) influencing the adoption and maintenance of regular physical activity among minority and underserved populations. The purpose of this review was to apply the social ecological model to better understand physical activity among African American women. A review of the literature pertaining to correlates of physical activity among African American women was conducted and applied to a social ecological perspective. Understanding and addressing social and contextual correlates of physical activity behavior among African American women are necessary to establish comprehensive programs, particularly within community settings. The social ecological model provides a strong theoretical basis to guide physical activity intervention in this population.     

Community-Based Participatory Research for Improved Mental Health

Community-based participatory research (CBPR) focuses on specific community needs, and produces results that directly address those needs. Although conducting ethical CBPR is critical to its success, few academic programs include this training in their curricula. This article describes the development and evaluation of an online training course designed to increase the use of CBPR in mental health disciplines. Developed using a participatory approach involving a community of experts, this course challenges traditional research by introducing a collaborative process meant to encourage increased participation by special populations and narrow the parity gap in effective mental health treatment and services delivery.     

The Relationship Between Caregiver Capacity and Intensive Community Treatment for Children with a Mental Health Crisis

We studied 9,220 children referred to a comprehensive mental health crisis stabilization program to examine the impact of caregiver capacity on crisis worker decisions to refer children for intensive community-based treatment as opposed to inpatient psychiatric hospitalization. Due to the different role of caregivers in the child welfare system, analyses were stratified by state custody status. Among both groups, there was a significant inverse association between child mental health need and referral to intensive community-based treatment. For children not in state custody with low mental health need, there was no difference in the likelihood of referral to intensive community-based treatment across levels of caregiver capacity. However, for children not in state custody with medium and high mental health needs, those whose caregivers were deficient or severely deficient were significantly more likely to be referred for intensive community-based treatment than were those who had capable caregivers. Multivariate analyses demonstrated similar results after controlling for potential confounding variables and confirmed that caregiver capacity contributes significantly to the logistic model’s classification accuracy. Results suggest further investigation of the impact of caregiver capacity on mental health crisis worker referral decisions is needed.