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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to improve mental health service connections for children involved with Child Welfare Services (CWS). It tests whether adding an After-Action Review (AAR) to the usual Child Family Team (CFT) meetings helps families adhere to their plans and access mental health care more effectively. The trial examines whether this approach leads to better planning and increased satisfaction for parents. It seeks participants such as parents or caregivers with children aged 6-17 in CWS who have not yet had their first CFT meeting and speak English or Spanish. As an unphased trial, this study offers a unique opportunity to contribute to innovative strategies that could enhance mental health support for families.

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 prior data suggests that this method is safe for improving mental health service linkage in Child Welfare Services?

Research has shown that the After-Action Review (AAR) is generally well-received in child welfare settings. The World Health Organization (WHO) provides guidance on using AARs, highlighting their effectiveness in various situations without noting specific safety issues. Previous studies have used AARs to enhance connections to mental health services in child welfare, achieving positive results without reporting major negative effects. This study is labeled "Not Applicable" for trial phases, indicating a focus on improving processes rather than testing a new medical treatment. This typically suggests a good safety profile, as the intervention aims to enhance team processes and communication, not to administer drugs or physical treatments. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how augmenting the existing Child Family Team (CFT) meetings with After-Action Review (AAR) might improve mental health outcomes in child welfare services. Unlike the standard CFT meetings, which are already used to create action plans for children entering care, the AAR method involves a structured review process to reflect on what went right or wrong and why, which may help teams make more informed decisions. By incorporating this reflective practice, the hope is to enhance the effectiveness of CFT meetings, potentially leading to better support for the emotional, behavioral, and social needs of children in the welfare system.

What evidence suggests that the After-Action Review is effective for improving mental health service linkage in Child Welfare Services?

Research has shown that the After-Action Review (AAR) can improve connections to mental health services in child welfare. AAR is a tool that helps teams learn and perform better by evaluating successes and areas for improvement. In this trial, one group will participate in Child Family Team (CFT) meetings as usual, while another group will have CFT meetings enhanced with AAR. Studies have found that using AAR in CFT meetings can lead to better planning and decision-making. As a result, children and families might have more effective meetings and be more likely to follow through on action plans. Early evidence suggests this approach could increase parental satisfaction and make services more consistent. ^{1 2 5 6 7}

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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 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]

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)

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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]

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)

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

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

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]

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]

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 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)

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

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.

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

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.

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Citations

1. implementationsciencecomms.biomedcentral.com implementationsciencecomms.biomedcentral.com/articles/10.1186/s43058-023-00479-3

Applying after-action reviews to child and family teams to ... This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT05629013

TEAMS R34 #1 After-Action Reviews in Child Welfare ... This project proposes to improve successful mental health service linkage in Child Welfare Services (CWS) by adapting and testing the After Action Review ...

3. reporter.nih.gov reporter.nih.gov/project-details/10677045

Project Details The after-action review (AAR) is a relatively simple, inexpensive, quick, and powerful tool to improve learning, performance, and the effectiveness of teams and ...

4. escholarship.org escholarship.org/uc/item/53f9g08m

Applying after-action reviews to child and family teams to ... This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) ...

5. researchgate.net researchgate.net/publication/374475866_Applying_after-action_reviews_to_child_and_family_teams_to_improve_mental_health_service_linkage_within_child_welfare_services_a_study_protocol

Applying after-action reviews to child and family teams to ... This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) ...

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9931844/

Implementation and Mental Health Outcomes of a Service ... Does mental health screening and assessment in child welfare improve mental health service receipt, child safety, and permanence for children in out-of-home ...

7. who.int who.int/publications/i/item/WHO-WHE-CPI-2019.4

Guidance for after action review (‎‎AAR) The WHO guidance for after action review (AAR) presents the methodology for planning and implementing a successful AAR to review actions taken in response to ...