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  • 1. Engaging users of child and youth mental health prevention programs? CYHRNet Annual Meeting November 3, 2009 Bonnie Leadbeater, Ph D.

2. The Ideal 3. EvaluationDevelopment &Innovation Uptake InfidelityAbandonment The Reality Processes of Knowledge Uptake for Mental Health Programs 4. The PUSH Program Developer (an academic or research team) USERS GATEKEEPERS PrincipalsPolice force Therapists Counselors 5. The PULL

  • Knowledge
  • USERS

ProfessionalDevelopmentActivities Marketing Private Communications 6. The SolutionCommunity Based Research?

  • Involve stakeholders early in program development
  • Enhanced knowledge exchange
  • Increase relevance
  • Speed uptake
        • YES, but .

7. 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

8. Preventing peer victimization 9. The WITS Rock Solid Primary Prevention Program is a PartnershipJudy Stevenson,Susan Underwood, Sonya Einstadt Wendy Holob,John Gaiptman Bonnie Leadbeater Wendy Hoglund; Rachel Yeung:Tracy Desjardin Paweena Sa Tom Woods; Dorian Brown Rock Solid Foundation 10. Moving out of the classroom

  • Children grow up in relationships &
    • A growing number of studies show the promise of school, parent, and community involvement ininterventions for reducing peer victimization.
  • WITS strategies convey consistent and developmentally appropriate messages for peaceful conflict resolution across contexts

11. WITS Program Components

  • Emergency Services Personnel Manual
  • Student/WITS Representative
  • WITS Booklist
  • Curriculum for Teachers and Librarians
  • Activities for the Classroom and School
  • Resources for Parents
      • www.uvic.ca/WITS

12. Evaluations

  • 2001-2003 (4 waves)
    • 432 children families & their teachers
  • 2007-2008 (3 waves)
    • 1132 children families & their teachers

13. More reported victimization and greater rate ofdecline levels of victimization 14. Bridging the gap Transportability Knowledge Practice Better ImplementationStrategies 15. Obstacles to transportability Access to mental health services/programs:

  • Heterogeneity of services delivered (medication, psychotherapy, groups etc.)
  • Clogged public systemsmainly 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

16. More obstacles Complexity of problems and solutions

  • Ecology child health and illnesscreates need for preventions in the context of family, school, neighborhood,
  • Complexity of mental health concerns comorbidity (anxiety, depression, ODD, CD)
  • Even Prodromal &
  • subclinical symptoms
  • affectfunctioning in
  • many domains( physical
  • academic)

17. More obstacles Creating Research Evidence

  • Lack ofempirically-based programsfor some concerns ( but many do exist)
  • Lack of consensus or regulation in what counts asevidence-based(RTCs vs real world)
  • Incentivesto do intervention research
  • Longterm commitment is needed Vaccination-like programs dont work even if wide spread,short term single shot programs show no evidence oflasting effects e.g. D.A.R.E longitudinal research is needed
  • Researchers have short lives!

18. NOW WHAT ?

  • Need for a national, provincial and and local infrastructures committed to facilitatingdissemination of effective based mental health treatment programs for children
          • &
  • Childrens Mental HealthPromotion Programs

19. ApplyingChild Policy Initiatives(Julius Richmond)Knowledge Base (Growing) Political Will (Growing)Social Strategy (Fragmented) 20. 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?

21. Pharmaceutical medicine Food & 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 academicresearch

22. Approaches to improve access to Evidence-based mental health programs

  • Standardize and clarify training and scope of practice of service providers teachers dont 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

23. Drug Safety and EffectivenessNetwork Launched July 2008

  • Minister of Health, Leona Aglukkaq:
  • Canadians can be confident that this government is taking the stepsnecessary to ensure that our drug safety system remains one of the best in the world. The Network complements Canadas 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)

24. 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 unprovenbenefits, delivered by variously trained individuals, in multiple settings?

25. A NATIONALMental Health Strategy

  • Minister of Health, Leona Aglukkaq will make the strong claim that:
  • Canadians can be confident that this government is taking the stepsnecessary to ensure that our childrens mental health is among the best in the world!

26. 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.

27. 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),
  • PREVNETP romoting relationships eliminating violence Network- began with a National Centre for Excellence

28. First steps Provincial

  • BC Ministry for Child and Family Development: Ten Year Mental Health Plan Dissemination of FRIENDS For LIFE Program
  • Childrens Mental Health Ontario (CMHO) Evidence-Based Practice Technical Assistance Centre

29. First steps local

  • Toolkits for community engagement and development.
    • R and Foundation entitledGetting to Outcomes http://www.rand.org/pubs/technical_reports/TR101/

30. Getting to outcomes: Questions

  • 1: What Are theUnderlying Needs and Conditionsin the Community? (Needs/Resources)
  • #2