After-Action Reviews for Mental Health in Child Welfare Services

(R34-1 Trial)

Overseen By Marisa Sklar, PhD.

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: University of California, San Diego

Disqualifiers: Non-English/Spanish speakers, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

320 Participants Needed

Trial Summary

What is the purpose of this trial?

This project proposes to improve successful mental health service linkage in Child Welfare Services (CWS) by adapting and testing the After Action Review (AAR) team effectiveness intervention to augment the Child Family Team (CFT) services intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including children and families as intended. By inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with Action Plans and linkage to mental health care for children.

Do I have to stop taking my current medications to join the trial?

The trial protocol does not specify whether you need to stop taking your current medications. It seems focused on service planning and mental health service linkage rather than medication changes.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on improving mental health service connections rather than medication changes.

What data supports the idea that After-Action Reviews for Mental Health in Child Welfare Services is an effective treatment?

The available research shows that After-Action Reviews (AAR) are being adapted to improve mental health service connections in child welfare services. The study protocol suggests that AAR can enhance the effectiveness of child and family team meetings, which are crucial for planning services. Although the research does not provide specific data on outcomes, it indicates that AAR aims to address the inconsistency and lack of child and family involvement in these meetings, which are common issues in usual care. This suggests that AAR could be a promising strategy to improve mental health service delivery in child welfare settings. ^{1 2 3 4 5}

What data supports the effectiveness of the treatment After-Action Review (AAR) for mental health in child welfare services?

The After-Action Review (AAR) process is being adapted to improve mental health service connections in child welfare, as it aims to enhance team effectiveness and ensure the voices of children and families are included in planning. While specific effectiveness data for AAR in this context is not provided, the approach is based on improving service linkage and collaboration, which are known challenges in child welfare services. ^{1 2 3 4 5}

What safety data exists for After-Action Reviews in child mental health services?

The provided research does not specifically mention After-Action Reviews (AAR) or similar processes in the context of child mental health services. However, it highlights the importance of monitoring and reporting adverse events in pediatric psychosocial interventions. The need for comprehensive and standardized reporting of adverse events is emphasized to ensure the safety and effectiveness of psychological interventions for children. This suggests that while specific safety data for AAR may not be available, the general principles of adverse event monitoring apply to ensure treatment safety. ^{6 7 8 9 10}

Is the After-Action Review process safe for use in mental health treatments for children?

There is no specific safety data available for the After-Action Review process in mental health treatments for children, but general safety in psychological interventions requires careful monitoring and reporting of any adverse events (unintended negative effects) to ensure they are not harmful. ^{6 7 8 9 10}

Is the treatment in the trial 'After-Action Reviews for Mental Health in Child Welfare Services' a promising treatment?

Yes, the treatment is promising because it aims to improve mental health service connections for children in child welfare by using after-action reviews. This approach helps ensure that the voices of children and families are included in planning, which can lead to better mental health outcomes. ^{2 3 11 12 13}

How does the after-action review treatment differ from other treatments for mental health in child welfare services?

The after-action review treatment is unique because it focuses on improving mental health service linkage by enhancing the effectiveness of child and family team meetings, which are often inconsistent and lack the involvement of children and families. This approach aims to ensure that mental health services are better integrated into child welfare services, addressing a gap in current practices. ^{2 3 11 12 13}

Eligibility Criteria

This trial is for Child Welfare Services (CWS) leaders, caseworkers, team members involved in child family teams (like mental health providers), and parents/caregivers of children aged 6-17 with open CWS cases needing mental health services. Participants must speak English or Spanish and plan to remain employed for at least six months after the study starts.

Inclusion Criteria

My child is 6-17 years old with an open CWS case and identified mental health needs.

Exclusion Criteria

Individuals who do not meet inclusion criteria are not eligible to participate in this study.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Qualitative Needs Assessment

Conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention through interviews and focus groups with key stakeholders.

4-6 weeks

Intervention Adaptation

Adapt and tailor the After Action Review (AAR) implementation strategy to address the CFT services intervention needs.

4-8 weeks

Implementation and Assessment

Assess mechanisms of the AAR team effectiveness intervention for CFT implementation and conduct the intervention.

9 months

Follow-up

Participants are monitored for safety and effectiveness after the intervention.

4 weeks

Treatment Details

Interventions

• After-Action Review

Trial Overview The trial is testing an After Action Review (AAR) intervention aimed at improving the effectiveness of Child Family Team meetings. The goal is to increase parental satisfaction, decision-making collaboration, and follow-through with action plans leading to better linkage to mental health care for children.

Participant Groups

Group I: Child Family Team (CFT) with After Action Review (AAR) Experimental Treatment 1 Intervention

CFT is being augmented with the after-action review.

Group II: Child Family Team (CFT) as Usual Active Control 1 Intervention

The CFT is a family meeting model that is an existing mechanism being implemented systemwide in San Diego County Child Welfare Services (CWS). Each child or youth is required to have a CFT meeting within sixty days of entering the CWS to identify areas of behavioral, emotional, or social needs, and to complete an initial case Action Plan.

Who Is Running the Clinical Trial?

University of California, San Diego

Lead Sponsor

Trials

1,215

Recruited

1,593,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Findings from Research

The chapter emphasizes the importance of assessing patient outcomes in mental health and substance abuse to improve treatment effectiveness and patient care.

It provides recommendations for advancing assessment methods, which could lead to better understanding and management of these conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

State of the science of mental health and substance abuse patient outcomes assessment. Smith, GR.[2019]

This study aims to enhance mental health service linkage for children in child welfare services by adapting the after-action review (AAR) intervention to improve child and family team (CFT) meetings, which often lack fidelity and family involvement.

By including the voices of children and families, the AAR-enhanced CFT is expected to increase adherence to service plans and improve parental satisfaction, ultimately leading to better mental health treatment outcomes for children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol. Sklar, M., Kenneally, R., Aarons, GA., et al.[2023]

The Children's and Family Services Reviews (CFSR) process aims to evaluate the effectiveness of services for children and families by focusing on client outcomes, but there are concerns that the current measures may not adequately capture meaningful results.

California's response to the 2001 federal mandate for accountability in child welfare outcomes highlights the need for improved measurement strategies, as existing literature suggests that the CFSR may have measurement problems that could affect the evaluation of service effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Understanding and measuring child welfare outcomes. D'Andrade, A., Osterling, KL., Austin, MJ.[2019]

There is a critical need to enhance community-based mental health care for children and families, as current 'usual care' practices have been shown to be ineffective in multiple studies.

The review identifies and synthesizes empirically-supported strategies to improve mental health services, focusing on increasing access, delivering evidence-based practices, and ensuring accountability for outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Improving community-based mental health care for children: translating knowledge into action. Garland, AF., Haine-Schlagel, R., Brookman-Frazee, L., et al.[2022]

In a study involving 1446 cases in Child and Adolescent Mental Health Services, clinician ratings of clinical outcomes were successfully obtained for 93% of cases, demonstrating a high level of engagement and reliability in measuring treatment effectiveness.

Approximately 55% of cases were rated as improved, with strong test-retest reliability (Pearson r = 0.94) and significant correlations between clinician and parent ratings, indicating that clinician assessments can provide valid insights into patient progress.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Are clinician ratings useful in evaluating outcomes in Child and Adolescent Mental Health Services (CAMHS)? A study of a continuous series of 1446 cases from an inner city CAMHS. Fuggle, P.[2019]

In a systematic review of 117 studies on psychosocial interventions for childhood mental disorders, only 31% monitored adverse events, highlighting a significant gap in safety reporting.

Among the studies that did monitor adverse events, there was a lack of consistency in how these events were defined and assessed, with only 11% evaluating the causes of the events, which is crucial for understanding the risks associated with these treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review. Lodewyk, K., Bagnell, A., Courtney, DB., et al.[2023]

The safety of psychological interventions is critical, as adverse events (AEs) can occur and must be carefully evaluated to ensure that these interventions do not cause harm before being deemed beneficial.

There is a pressing need for standardized protocols for assessing and reporting AEs in psychological interventions to improve transparency, consistency, and ultimately enhance clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Editorial: Primum non nocere - are adverse events accurately reported in studies on psychological interventions for children? Purgato, M., Cortese, S.[2023]

In a study of 110,310 anesthetic procedures involving 65,985 patients, 3,904 critical incidents were reported, indicating a 3.5% incidence rate of complications during anesthesia.

The most common critical incidents included technical difficulties with regional anesthesia, hypotension, and unexpected difficult intubation, highlighting key areas for improving patient safety and informing future reporting systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reporting critical incidents in a tertiary hospital: a historical cohort study of 110,310 procedures. Munting, KE., van Zaane, B., Schouten, AN., et al.[2018]

The study analyzed administrative data from 125,123 adolescents aged 12-17 to determine how adverse experiences, such as parental mental illness and child abuse, contribute to mental health and substance abuse problems.

Key findings showed that factors like parental death and child abuse or neglect significantly increased the risk of mental illness and substance abuse, highlighting the importance of early identification and intervention for at-risk youth.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Childhood adversity and behavioral health outcomes for youth: An investigation using state administrative data. Lucenko, BA., Sharkova, IV., Huber, A., et al.[2022]

The comprehensive body system review (BSR) in the Safety Monitoring Uniform Report Form (SMURF) identified 129 additional adverse events (AEs) in pediatric patients, significantly more than the 48 AEs from the general inquiry and 16 from the drug-specific inquiry, highlighting its effectiveness in capturing important safety data.

Parents found the detailed BSR acceptable and satisfactory, while clinicians did not share the same level of acceptance, indicating a potential gap in the perceived utility of detailed adverse event reporting methods in pediatric psychopharmacology.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of increasingly detailed elicitation methods for the assessment of adverse events in pediatric psychopharmacology. Greenhill, LL., Vitiello, B., Fisher, P., et al.[2007]

The implementation of managed care processes and accountability mechanisms in mental health and child welfare services could significantly impact abused and neglected children, affecting their access to and the quality of care they receive.

Research is needed to understand how these systems-level changes will influence the outcomes for maltreated children, ensuring that the reforms ultimately benefit this vulnerable population.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A systems perspective on research and treatment with abused and neglected children. Clyman, RB.[2019]

The Gateway CALL service cascade showed strong initial implementation fidelity in addressing the mental health needs of 175 children in the child welfare system, but fidelity decreased when multiple service systems were involved.

Despite challenges in implementation, there was a significant reduction in parent-reported child behavior problems over time, indicating that service cascades can effectively improve mental health outcomes for children in these systems.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children's Mental Health Systems: A Case Study of the Gateway CALL Demonstration. Bunger, AC., Yoon, S., Maguire-Jack, K., et al.[2023]

The study found that initiating external citizen reviews 14 to 45 days after a child enters the court system can significantly improve planning and service delivery for children in foster care.

Early citizen reviews were associated with reduced time in foster care, fewer placements, and better outcomes in achieving permanent placements for children.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Early citizen review: does it make a difference? Jennings, MA., McDonald, T., Henderson, RA.[2019]

References

1. United States pubmed.ncbi.nlm.nih.gov

State of the science of mental health and substance abuse patient outcomes assessment. [2019]

2. England pubmed.ncbi.nlm.nih.gov

Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Understanding and measuring child welfare outcomes. [2019]

4. United States pubmed.ncbi.nlm.nih.gov

Improving community-based mental health care for children: translating knowledge into action. [2022]

5. England pubmed.ncbi.nlm.nih.gov

Are clinician ratings useful in evaluating outcomes in Child and Adolescent Mental Health Services (CAMHS)? A study of a continuous series of 1446 cases from an inner city CAMHS. [2019]

6. England pubmed.ncbi.nlm.nih.gov

Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review. [2023]

7. England pubmed.ncbi.nlm.nih.gov

Editorial: Primum non nocere - are adverse events accurately reported in studies on psychological interventions for children? [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Reporting critical incidents in a tertiary hospital: a historical cohort study of 110,310 procedures. [2018]

9. England pubmed.ncbi.nlm.nih.gov

Childhood adversity and behavioral health outcomes for youth: An investigation using state administrative data. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Comparison of increasingly detailed elicitation methods for the assessment of adverse events in pediatric psychopharmacology. [2007]

11. England pubmed.ncbi.nlm.nih.gov

A systems perspective on research and treatment with abused and neglected children. [2019]

12. United States pubmed.ncbi.nlm.nih.gov

Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children's Mental Health Systems: A Case Study of the Gateway CALL Demonstration. [2023]

13. United States pubmed.ncbi.nlm.nih.gov

Early citizen review: does it make a difference? [2019]