Best Practice Reports

"Best Practices" in Early Childhood Mental Health Programs for Preschool-Age Children

Principal Investigator: Ronna Chamberlain, PhD

Project Staff: Sharon T. Barfield, MSW, LSCSW

Project Dates: Completed January 2004

Social-emotional, early intervention programs for young children focus on fostering protective factors while minimizing risk factors. These risk factors and protective factors are identified in this systematic literature review of early childhood mental health programs. In light of the modest amount of research in the literature on this topic, only ten studies and one promising program are included this review. The programs are given confidence ratings according to established criteria such as the type of study used to examine the program and whether findings have been replicated. All of the programs targeted children with adjustment problem risk factors or externalizing behaviors such as aggression. A majority of the studies focused on promoting resilience. Of the ten studies, two used a quasi-experimental design with comparison groups and eight utilized a true experimental design. A compilation and summary of commonalities across these studies is provided.

Best Practices in Early Childhood Mental Health Programs for Preschool Aged Children Report (pdf)
Adventure Based Therapy and Outdoor Behavioral Healthcare
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Tara McLendon, LSCSW

Project Completed: May 2003

Treatment approaches that are based on experiential learning and incorporate adventure or challenge components have recently received increasing attention and interest from behavioral healthcare providers. This treatment modality knows many names: Adventure-Based Therapy, Therapeutic Camping, Wilderness Therapy, and Adventure Based Counseling, to name a few. These psychotherapeutic interventions can move beyond the traditional office setting and utilize the inherent value of personal challenge and environments unfamiliar to the client. An implicit, though yet undocumented, proposition is that these experimental interventions are also more effective than traditional approaches are at achieving client outcomes. The report discusses the two promising treatment modalities written about most extensively in the literature, Adventure-Based Therapy (ABT) and Outdoor Behavioral Healthcare (OBH). A survey was conducted of the community-based children's (CBS) program directors in the Kansas community mental health center (CMHC) system to assess their desire for the development and enhancement of this type of programming. An overwhelming majority of the CBS directors expressed a desire for knowledge, equipment, and training to provide ABT at their own centers. The author cites one program at Area Mental Health Center in Ulysses, Kansas, that illustrates a combination of Structural Family Therapy and ABT. St. Francis Academy located in Salina and Atchison has ABT programs that may be utilized to train CMHC service providers to replicate the program across the state. Two CMHCs are currently utilizing facilities and programming at St. Francis Academy to serve children who experience Serious Emotional Disturbance. The author cites Internet and email contacts for promising ABT and OBH programs. A survey summary of Kansas CMHC ABT/OBH programs is provided.

Adventure Based Therapy and Outdoor Behavioral Healthcare (pdf)

Attendant Care for Children and Youth with EBD/SED: Part I National Literature Review
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, MSW

Project Completed: Feb 2004

Attendant Care services are frequently offered to children with emotional and behavioral disorders (EBD) and their families but little is known about best practices in the field. The following report presents a review of the national literature to establish state-of-the-art knowledge about attendant care services. Because no empirical or conceptual literature could be found that specifically described attendant care services for children with EBD, the literature search was broadened to gain knowledge from related fields of practice: specifically, paraprofessional services in mental health, special education, and early intervention. Three main questions recur in the literature and are discussed in the following report: 1) How effective are paraprofessional services and when, where, and how would they best be utilized? 2) What are the common roles and responsibilities of paraprofessionals and are they appropriate? 3) Which qualifications, training, and supervision should be required of and afforded to paraprofessionals to improve effectiveness, recruitment, and retention?

Attendant Care for Children and Youth with EBD/SED: Part I National Literature Review (pdf)

Attendant Care for Children and Youth with EBD/SED: Part II Attendant Care in Kansas
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Sharah Davis, LMSW; Angela Logan, LMSW; and Uta M. Walter, MSW

Attendant Care (AC) services provided to youth who experience Severe Emotional Disturbances (SED) are individualized support provided in the least restrictive community settings. AC has been identified as a valuable piece of the system of care in Kansas and elsewhere. Service utilization continues to dramatically increase, yet very little knowledge about AC is available in the literature. This is the first known study of mental health AC evaluating the standards of AC practices in the state of Kansas, stakeholders’ perspective on the usefulness of AC, and the policies and practices that support integration of AC into the system of care.

Attendant Care for Chlildren and Youth with EBD/SED: Part II Attendant Care in Kansas (pdf)

Best Practices for Families with Children Who Experience Substance Abuse, Juvenile Delinquency, and Serious Emotional Disturbance
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Tara McLendon, LSCSW; Don McLendon, PsyD, LSCSW; and Tami Radohl, LSCSW

Project Completed: Mar 2007

This Best Practice Report reviews four helping modalities that specifically recognize the family as an essential agent of change: Multisystemic Therapy (MST), Brief-Strategic Family Therapy (BSFT), Multidimensional Family Therapy (MDFT), and Functional Family Therapy (FFT). This report outlines the history and development of each modality, as well as each research base, fidelity protocol, and strengths and weaknesses. They all have relatively similar histories, in that all four approaches have been in development for at least 25 years and have some level of empirical research base. Additionally, the results of a phone survey of Kansas Community-Based Service Directors are included. The survey addressed estimates of SED children receiving family therapy in the respective CMHCs, models of family therapy utilized, and barriers to family-centered service provision, among other questions. The survey results indicate that family therapy appears to be infrequently utilized among CMHCs. Barriers to utilizing family-centered service, as well as suggestions to address barriers are discussed. Finally, family therapy initiatives in the state are discussed. Current initiatives include an outcome study at two CMHCs, which is measuring the effectiveness of Family-Directed Structural Therapy, an innovative family therapy model that originated in Kansas; and the Home-Based Family Therapy Partnership, a training program for home-based family therapists which is facilitated by Kansas State University.

Best Practices for Families with Children with Substance Use, Juvenile Delinquency, and Serious Emotional Disturbance (pdf)

Best Practices in Community Mental Health Crisis Services for Children and Adolescents
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, MSW; and Stacey Park, MSW

Project Completed: Dec 2004

A review of national, and some international, literature was conducted to determine the state-of-the-art knowledge about best practices in crisis services for children and adolescents. Specific attention was given to community-based approaches, empirical studies of particular models or approaches, and otherwise innovative conceptual or descriptive publications. Despite a growing body of research about children in crisis and the effects of trauma, research generally does not offer guidelines as to how to engage children in crisis, nor do existing guidelines offer much in terms of evaluations of treatment responses. Only a few experimental studies have been conducted on specific community based crisis intervention models for children and youth, and even fewer provide longer term follow-up data. Nonetheless, experimental and non-experimental research provide some evidence that crisis intervention programs can successfully divert hospitalization for many children and adolescents with emotional and behavioral disabilities in favor of less restrictive community-based alternatives.

Best Practices in Community Mental Health Crisis Services for Children and Adolescents (pdf)

Best Practices in Wraparound
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, PhD, MSW

Project Completed: Jun 2008

Results of a national literature review are presented to clarify and summarize state of the art knowledge about wraparound. Since its inception in the 1980s, the idea of wraparound services has gained much appeal around the nation. Also referred to as "Individualized Service Planning" (ISP), or in some cases "family networking," "child and family team planning," or "family-centered intensive case management," an estimated 200,000 youth who have, or are at risk of developing, severe emotional disorders (SED) are served in wraparound each year. Reports by the Surgeon General mention wraparound as a promising approach for delivering evidence-based practices more effectively. At the same time, there is considerable variation in how wraparound is understood or implemented. This report summarizes insights into the specific elements and processes that make for high quality wraparound services.

Best Practices in Wraparound (pdf)

Best Practices to Engage Parents of Children Receiving Mental Health Services
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Tara McLendon, LSCSW

Project Completed: Jan 2008

This best practices report examines consumer, professional, and research perspectives regarding ways to engage parents in the provision of children’s mental health services. Each of the three perspectives is considered; practices identified by each perspective are compared and contrasted with the other two perspectives, and current best practices are identified. Finally, recommendations for potential improvements are made.

Best Practices to Engage Parents of Children Receiving Mental Health Services (pdf)

Children and Adolescents with Asperger Syndrome
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Sharah Davis, LMSW; and Susan Campbell, M.Ed

Project Completed: April 2003

The report summarizes the literature to date, which have focused on clarifying the diagnostic characteristics and describing anecdotal interventions of Asperger Syndrome. The suggested interventions include "structured and focused" supportive psychotherapy (Barnhill, 2001; Lord & Volkmar, 2002) to address life stressors that go along with the diagnosis and Applied Behavioral Analysis (Ozonoff, Dawson, & McPartland, 2002). The field of special education has generated a variety of suggestions for community and school-based interventions that have not been empirically evaluated. These descriptive interventions, however, may be useful in the provision of community-based mental health services to children and adolescents with Asperger Syndrome. The authors encourage collaboration across all community entities that the child or adolescent with Asperger Syndrome may encounter. Additional resources for this population may be realized through increased collaboration with the Community Developmental Disability Organizations, Schools, and Independent Living Centers (as the youth transition to adulthood).

References: 1. Barnhill, G. (2001). What's new in AS research: A synthesis of research conducted by the Asperger Syndrome project. Intervention in School and Clinic, 36(5), 300-306. 2. Ozonoff, S., Dawson, G., & McPartland, J. (2002). A parent's guide to Asperger Syndrome and High-Functioning Autism. New York: The Guilford Press. 3. Lord, C. & Volkmar F. (2002). Genetics of Childhood Disorders: XLII. Autism Part 1: Diagnosis and Assessment in Autistic Spectrum Disorders. Journal of the America Academy of Child and Adolescent Psychiatry. 41(9) 1134-1136.

Children and Adolescents with Asperger Syndrome (pdf)

Co-Occurring Disorders of Substance Abuse and Serious Emotional Disorders in Children and Adolescents
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, MSW; and Angie Logan, LMSW

Project Completed: Apr 2005

The co-occurrence of substance abuse disorders and psychiatric disorders has received increasing national attention since the U.S. Congress required the Substance Abuse and Mental Health Services Administration (SAMSHA) to provide a summary about the problem and the status of services. SAMSHA’s subsequent Report to Congress (2002) constitutes one of the most current and comprehensive reviews on the topic. The national literature review makes significant use of the information provided in the Report to Congress but focuses on the sections pertinent to understanding co-occurring disorders for children and adolescents. Key empirical studies about treatment for children and adolescents mentioned in the Report to Congress were obtained for closer analysis. In addition, an independent search of national literature data bases and internet sites was conducted to identify best practices in the field. While the recent attention to the issue is encouraging, overall knowledge about the needs and evidence about treatment of co-occurring psychiatric and substance abuse disorders, especially in children and adolescents, is still very limited.

Co-Occurring Disorders of Substance Use and Serious Emotional Disorders in Children and Adolescents (pdf)

Family Centered Home-Based Models for Placement Prevention
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Tara McLendon, LSCSW

Project Completed: Feb 2003

Since the 1970's, interest in enabling children at risk for out-of home placement to remain living safely in their families and communities has increased. As a result of this, several family centered home-based models with the goal of preventing removal of the child have developed. This report examines four of these models: Multisystemic Therapy, Homebuilders, Wraparound, and Case Management. Theoretical foundations, provider credentials, caseload size, duration and frequency of service, and research base of the four approaches are examined and compared. These models share the paramount goal of maintaining children in the family home. They also avoid pathologizing the client, family, and surrounding systems.

Family Centered Home Based Models for Placement Prevention (pdf)

Group Care of Children and Adolescents
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Sharon Barfield, LSCSW

Project Completed: Feb 2002

This literature review sought the answers to three questions regarding group care for children and adolescents:

Question 1: Is there empirical literature that supports the "best practices" idea that family foster care is better than group home care? According to the review, the answer to this question is a "strong yes." The empirical base found family foster care significantly more effective on a number of outcomes with a variety of groups of children.

Question 2: Is there empirical literature that says certain types of children do better in group homes than in family foster homes? No well-designed studies were located to answer this question conclusively. However, the author discussed studies conducted with high risk chronic juvenile offenders and reasoned that if chronic juvenile offenders can be better served in family foster care than in group care, it stands to reason that the same is true of other high-risk children with similar problems.

Question 3: If group homes might be better for some children, or if we are always going to have group homes due to "nowhere else to go," which types of group homes programs (treatment models) have shown to be effective for which types of children? Few outcome studies were found that used a rigorous research method to show program curriculums that were effective. The author cites 5 models of group home programming; 4 models show promise and include the Teaching Family Model (Kirigan, 2001); Father Flanagan's Boy's Home Model (Thompson, Smith, Oswood Dowd, Friman, & Daly, 1996); The REPARE model (Landsman, Groza, Tyler, & Molone, 2001); and "Schema" (Bass, Dosser, & Powerll, 2000). "Positive Peer Culture" was identified as an ineffective approach by former recipients in the juvenile correctional system (Kapp, 2000)

References:
1.Bass, L., Dosser, D., & Powerll, J. (2000). Celebrating change: A schema for family-centered practice in residential settings. Residential Treatment for Children & Youth, 17, 123-137.
2. Landsman, M., Groza, V., Tyler, M. & Malone, K. (2001). Outcomes of family centered residential treatment. Child Welfare League of America, 50, 351-378.
3. Kapp, S. (2000). Positive Peer Culture: The viewpoint of former clients. Journal of Adolescent Group Therapy, 10, 175-189.
4.Kirigin, K. (2001). The teaching family model: A replicable system of care. Residential Treatment for Children & Youth, 18, 99-110.
5.Thompson, R., Smith G., Oswood D., Dowd T., Friman P., & Daly D. (1996). Residential care: A study of short and long-term educational effects. Children and Youth Services, 18, 221-241.

Group Care for Children and Adolescents (pdf)

Home-Based Therapy: Effectiveness and Processes--A Brief Review of the National Literature
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, PhD

Project Completed: Jun 2006

Since the late 1980s, home-based family therapy has become an increasingly popular service. The delivery of family therapy in families’ homes presents various advantages and challenges. This review focuses on empirical studies, and some pertinent conceptual literature, highlighting the benefits of home-based services along with strategies for overcoming difficulties that typically arise.

Home-based Therapy: Effectiveness and Processes (pdf)

Inpatient Treatment for Children and Adolescents with Substance Abuse Issues

Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Kirsten Oelklaus, LMSW

Project Completed: Nov 2001

The report revealed that the bulk of the literature collectively examines adults and adolescents, rather than investigating the unique issues that adolescents with substance abuse issues have. The review explored outcome studies for in-patient programs for adolescents with substance abuse issues in order to identify best practices for this population. The author utilized adult success rates (28% abstinence on post treatment measures) to establish a benchmark for including citations of the articles found in the extensive review. The empirically based studies conveyed support for intense and structured milieu-based interventions (individual therapy, family therapy, group therapy, utilization of the AA/NA model, and aftercare services). Trained clinicians provide the interventions maintaining a recovery-focused milieu that encourages healthy relationships and provides clear structure. The studies also noted educational and vocational components included in the treatment. The average lengths of stay that were at least 6 weeks yielded the best results. Recommendations include the demonstration and evaluation of treatment programs designed specifically to meet the needs of adolescents.

Inpatient Treatment for Children and Adolescents with Substance Abuse Issues (pdf)

Inpatient Treatment of Children and Adolescents

Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Sharon T. Barfield, LSCSW

Project Completed: Oct 2001

The report reviews the literature from 1975 to 2001. Conclusions from the report indicate that parental involvement is highly correlated with successful outcomes. Length of stay is not correlated with successful outcomes. Generally, extended hospitalizations provide little added benefit over shorter inpatient programs. Follow-up with community mental health is highly correlated with successful outcomes and is an integral part of maintaining goals. The therapeutic alliance is positively correlated with successful outcomes. Placement may exacerbate the sense of failure and anger, and create a sense of loss of connectedness to the family. Inpatient and residential treatment does not seem any more effective than day treatment, multi-systemic treatment, or community mental health services and is more costly. Inpatient care is generally thought of as a part of a comprehensive treatment program that includes continued treatment as an outpatient following discharge from the inpatient facility. Programs should include a focus on family involvement and establishing good therapeutic alliances. Extended hospitalization should be avoided in favor of intense community-based support and treatment, supported by brief inpatient hospitalizations with coordinated aftercare.

Inpatient Treatment of Children and Adolescents (pdf)
Juvenile Sex Offenders: Best Practices Reports

Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Sharah A. Davis-Groves, LMSW

Project Dates: Completed December 2003

Juvenile Sexual Offending can be conceptualized on a continuum from nuisance offenses to more intrusive offenses resulting in penetration. Though there is evidence that a majority of juvenile sexual offenders were themselves victims of sexual abuse, the majority of victims of child sexual abuse do not end up sexually abusing others. Resiliency literature indicates that "two-thirds" of any population of "at-risk" children (including victims of abuse and neglect) seem to "survive risk experiences" without major developmental disruptions (Kirby and Fraiser, 1997, p. 14). Caution must be used as well with the label "Juvenile Sex Offender" as there is evidence that most juveniles who sexually offend are amenable to treatment with recidivism rates of 8-14% (Righthand and Welch, 2001). There is mild empirical support for community-based interventions such as MST and wraparound. Outpatient clinical interventions incorporating Dynamic Play, Expressive, Relapse Prevention, and Cognitive Behavioral Therapies have also been shown to be effective. Though juvenile sexual offending is a serious problem, service providers and the children themselves benefit from a balanced perspective that conveys the juvenile’s strengths and capabilities as well needs regarding sexual offending behavior.

Juvenile Sex Offenders: Best Practice Reports (pdf)

Outcome Studies of Children and Adolescents with Autism
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Kirsten Oelklaus, LMSW

Project Completed: Dec 2002

This report seeks to answer two questions about services for individuals with autism:

Question 1: What are effective treatments for autism? Effective treatments for autism include early assessments, collaboration of services across child serving systems, duration of treatment (at least 2 years) and intensity of treatment (during waking hours and parents as therapists), and structure interventions (20-40 hours of community based individualized interventions). Empirically-based models include Lovaas (Lovaas, 1987) and Self-Management Treatment (Koegal & Koegal, 1990). Promising practices include Positive Behavioral Support (Horner, 2000) and TEACCH (Campbell, Shopler, Cueva, & Hallin,1996). Promising techniques across models include "Floor Time" (Greenspan cited by Whiteford, 2000) and Discrete Trial Training (Smith, 2001). A few interventions with limited or questionable effectiveness include Auditory Integration (Rimland & Edelson, 1995), Facilitated Communication (Mostert, 2001), and Psychopharmacology (J Am Acad Child & Adol Psychiatry, 1999).

Question 2: What is the role of the mental health system in the provision of services for individuals with autism? The author describes the ways in which the mental health system may intervene with a child who experiences autism. They may take on a lead role - hiring one or more workers to specialize in the provision of services and work collaboratively with all systems in the child's environment. The community mental health system may also take on a supportive role - supplementing services provided by other agencies and treating comorbid conditions. The author notes recent literature that indicates almost 1/5 or 17% of children and adolescents with Autism and Aspergers may have a comorbid (depressive) disorder (Kim, 2000). Finally, the mental health system would be useful in providing emotional support to families adjusting to their family members' disability.

References:

1. Campbell M., Shopler E., Cueva J., & Hallin A. (1996). Treatment of Autistic Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 35,134-144.

2. Horner, R. H. (2000). Positive Behavior Supports. Focus on Autism and Other Developmental Disabilities, 15 (2), 97(15).

3. Journal of American Academy of Child & Adolescent Psychiatry, (1999). Practice parameters for the assessment and treatment of children, adolescents and adults with autism and other pervasive developmental disorders. 38, p32S.

4. Kim J., Szatmari P., Bryson S., Steiner D., & Wilson F. (2000). The prevalence of anxiety and mood problems among children with autism and asperger syndrome. Autism, 4 (2), 117-132.

5. Koegal R., & Koegel L. (1990). Extended Reductions in stereotypic behavior of students with autism through a self-management treatment package. Journal of Applied Behavioral Analysis, 23, 119-127.

6. Lovaas, O. (1987). Behavioral Treatment and normal educational and intellectual functioning in young autistic children. Journal of Consulting and Clinical Psychology, 55, 3-9.

7. Mostert, M. ( 2001). Facilitated Communication Since 1995: A Review of Published Studies. Journal of Autism and Developmental Disorders, 31, 287-313.

8. Rimland B., & Edelson, S. (1995). Brief Report: A Pilot Study of Auditory Integration Training in Autism and Developmental Disabilities. Journal of Autism and Developmental Disorders, 25, 61-70.

9. Smith, T. (2001). Discrete Trial Training in the Treatment of Autism. Focus on Autism and Other Developmental Disabilities, 16, 86-106.

10. Whiteford, H. (2000). Early Intervention Programs for Children with Autism: Conceptual Frameworks for Implementation. American Journal of Orthopsychiatry, 70, 82-95.

Outcome Studies of Children and Adolescents with Autism (pdf)

Reactive Attachment Disorder: Concepts, Treatment, and Research
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta Walter, MSW

Project Completed: Jun 2004

Reactive Attachment Disorder (RAD) is a disorder characterized by controversy, both with respect to its definition and its treatment. By definition, the RAD diagnosis attempts to characterize and explain the origin of certain troubling behaviors in children. The RAD diagnosis presumes that "pathogenic care" of a young child can result in an array of markedly disturbed behaviors in social interactions and poor attachments to caregivers and others. (See full definition in the body of this report). The RAD diagnosis derives from the attachment theories of John Bowlby and Mary Ainsworth. Several authors question whether RAD is a valid diagnostic category, citing the overlap of symptoms with Pervasive Developmental Disorder and other disorders, the inconsistent connection to attachment theory, and the lack of empirical validation. Assessment and diagnosis of RAD is complicated and difficult for several reasons. First, children are not always referred for mental health services for attachment problems per se, but because of a variety of behavioral that may co-exist with RAD. Second, in the abuse and neglect population, there may be over-reporting because of a predeliction to view these children as having attachment disorders stemming from early abuse experiences. Third, differential diagnosis can be problematic because RAD symptoms can overlap or be confused with symptoms of Post Traumatic Stress Disorder, Pervasive Developmental Disorder, depression, anxiety, and other conditions. The Association for the Treatment and Training in the Attachment of Children (ATTACh), as well as other authors, recommend a multi-dimensional assessment including systematic observations, extensive history, school and family reports, and individual and family assessment. The review of the literature uncovered one assessment instrument that has been sufficiently researched and can aid in the assessment process: the Randolph Attachment Disorder Questionnaire (RADQ). The controversy about treatment of children with RAD centers on the practice of "holding therapy," especially when the child is held against his/her will and struggles to resist. Although proponents argue that this experiential method is necessary for the child to establish a bond, or attachment, with a caregiver, critics decry that the experience can be traumatizing, and that any apparent behavioral gains could be the result of trauma bonds, not healthy attachment relations. While ATTACh and other authors attempt to distinguish between coercive and non-coercive holding, the difference between "therapeutic" or "nurturing" holding and coercive traumatizing holding remains a fine line and a matter of interpretation. In addition, there is very little empirical evidence to support the practice of holding therapy, on either an inpatient or outpatient basis. For these reasons, holding therapies should be avoided in favor of less intrusive methods, including trauma-based, family-centered, and community-based interventions.

Reactive Attachment Disorder: Concepts, Research and Treatment (pdf)

Residential Treatment - A Review of the National Literature
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, PhD

Project Completed: Aug 2007

Though the evidence base for the effectiveness of residential treatment is still weak, three main components for increasing successful outcomes have emerged in the empirical literature. There is consistent evidence (1) for the need of family involvement in all aspects of treatment, (2) for the centrality of regular contacts between children and their families, and (3) for the importance of aftercare and support to maintain gains made in RT. Insights from families, youth, and professionals converge with these findings. Based on a review of the national literature, this report summarizes current trends, challenges, and knowledge; examines existing efforts to make RT more family-centered; and offers recommendations for best practices.

Residential Treatment: Review of National Literature (pdf)

School-Based Mental Health: A Review of the National Literature
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, PhD

Project Completed: Feb 2007

The evidence base for the effectiveness of School-Based Mental Health (SBMH) programs is slowly gaining robustness and indicates that SBMH programs can have a positive impact on individual students' attendance, behavioral, and academic functioning, as well as on system-level outcomes. Based on a review of the national literature, this report summarizes current knowledge including ten principles of best practice suggested in the literature, interventions for various presenting problems, models presently used across different states, questions regarding the implementation and sustainability of programs, strategies for financing SBMH, and information about available national resources.

School-based Mental Health: A Review of the National Literature (pdf)

Suicide Prevention for Children and Youth -- Literature Review
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, PhD, MSW

Project Completed: Jan 2008

Each year, about 1,600 youth in the U.S. die by their own hands making suicide the third leading cause of death for children and adolescents. This report summarizes current findings about epidemiology, current trends, risk and protective factors, as well as findings about strategies and programs for suicide prevention and intervention. Specifically highlighted are strategies such as awareness and education, gatekeeper training, screening and assessment, hotlines, means restriction, media education, pharmacological treatment, and cognitive-behavioral treatment and skills training.

Suicide Prevention for Children and Youth: A Review of the National Literature (pdf)

Therapeutic Alliance With Children and Families
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, MSW

Project Completed: Mar 2006

For many years the therapeutic alliance has been recognized as an important common factor that impacts treatment outcomes across models of therapy for adults. While several meta-analytic studies of adult psychotherapy have underscored the predictive value of the therapeutic alliance for better outcomes, empirical evidence for the role of relational factors in treatment of children and adolescents is only beginning to emerge and lags behind adult research. Relatively few studies involving children, adolescents, or families evaluate both the quality of alliance and outcomes. This report summarizes current evidence for best practices in the national literature which overall suggests a moderate impact of the therapeutic alliance on outcomes for children, youth, and families.

Therapeutic Alliance with Children and Families (pdf)

Therapeutic Foster Care for Children and Youth With SED: Literature Review and Inquiry Into Best Practices

Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, MSW; and Tara Swaim, LSCSW

Project Dates: Completed October 2003

Since the 1970s, Therapeutic Foster Care (TFC), also known as "treatment foster care," "family-based treatment," or "specialized foster care," has emerged as an alternative form of care for children and youth with serious emotional and behavioral disorders (SED). Although programs and empirical studies vary widely, there is some evidence that TFC can be an effective form of out of home care, and can serve as a less costly, family-based alternative to residential group treatment for children and youth with SED. This report provides a review of national literature and extracts characteristics of promising practices. A survey of key informants in all five service regions of the state of Kansas provides insights into current practices in the state. Recommendations are provided for the improvement of service delivery, programming, quality, and policies.

Therapeutic Foster Care for Children and Youth with SED: Literature Review and Inquiry into Best Practices in Kansas (pdf)

Therapeutic Foster Care--Update and Brief Summary of Previous Report
Principal Investigator: Chris Petr, PhD, LSCSW

Project Staff: Uta M. Walter, MSW

Project Completed: Oct 2005

Therapeutic Foster Care--Update and Brief Summary of Previous Reports (pdf)


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