Enhancing Early Engagement (E3) in mental health services training for children's advocacy center's victim advocates: feasibility protocol for a randomized controlled trial

Erin K Taylor, Alex R Dopp, Kaitlin Lounsbury, Yutian Thompson, Michelle Miller, Ashley Jorgensen, Jane F Silovsky, Erin K Taylor, Alex R Dopp, Kaitlin Lounsbury, Yutian Thompson, Michelle Miller, Ashley Jorgensen, Jane F Silovsky

Abstract

Background: Child maltreatment is a major public issue in the United States, yet most children affected by abuse or neglect never engage in evidence-based practices (EBP) for child mental health. Children's Advocacy Centers (CACs') are uniquely situated to serve as Family Navigators who connect children impacted by maltreatment to appropriate EBPs. In fact, the CAC position of Victim Advocate mirrors the Mental Health Family Navigator national initiative.

Methods: The feasibility study protocol is to develop, implement, and evaluate web-based and consultative training for Victim Advocates to enhance early engagement in services (E3 training). The interactive web-based training embeds key targets of knowledge and skills related to family engagement, trauma, and EBP services. Participating CACs were randomized to E3 webinar-based training, E3 webinar plus consultation, or delayed training. The project will test the E3 training's impact on key mechanisms of change (e.g., knowledge, skills) to improve rates of screening, referral, and access to EBP services. The feasibility of implementing the training program and differential impact and costs by level of training will be examined.

Discussion: The overarching goal of this project is to test the feasibility of training that is readily implemented through CACs and examine the mechanisms for improving early engagement and, ultimately, child, and adolescent mental health outcomes. Results and cost findings will be used to plan a large-scale comprehensive, mixed-methods hybrid type II effectiveness-implementation and cost-effectiveness trial of family navigator E3 training. If outcomes are positive, considerable infrastructure exists to support the scale-up and sustainability of E3 training nationwide, by embedding the training in national CAC training protocols.

Trial registration: NCT04221633 DATE AND VERSION IDENTIFIER: March 25, 2021; Vers. 1.0 (original); September 11, 2021; Vers 2.0 (revision); October 29, 2021; Vers. 3.0 (revision).

Keywords: Child maltreatment; Children’s Advocacy Centers; Consultation; Service navigation; Training.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Flow chart of study premise and hypotheses
Fig. 2
Fig. 2
Flow diagram of site enrollment and randomization
Fig. 3
Fig. 3
Data collection time points

References

    1. U.S. Department of Health & Human Services, Administration for children and families, administration on children, youth and families, children’s bureau. Child Maltreatment. 2019. . Accessed 24 Mar 2021.
    1. Jaffee SR. Child maltreatment and risk for psychopathology in childhood and adulthood. Annu Rev Clin Psychol. 2017;13:525–551.
    1. Ford JD, Racusin R, Daviss WB, et al. Trauma exposure among children with oppositional defiant disorder and attention deficit–hyperactivity disorder. J Consult Clin Psychol. 1999;67(5):786–789.
    1. Stouthamer–Loeber M, Loeber R, Homish DL, Wei E. Maltreatment of boys and the development of disruptive and delinquent behavior. Dev Psychopathol. 2001;13(4):941–955.
    1. Toth SL, Manly JT, Cicchetti D. Child maltreatment and vulnerability to depression. Dev Psychopathol. 1992;4(1):97–112.
    1. Friedrich WN, Davies W, Feher E, Wright J. Sexual behavior problems in preteen children: developmental, ecological and behavioral correlates. Ann N Y Acad Sci. 2003;989:95–104.
    1. Fang X, Brown DS, Florence CS, Mercy JA. The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse Negl. 2012;36(2):156–165.
    1. Gustavsson A, Svensson M, Jacobi F, et al. Cost of disorders of the brain in Europe 2010. Eur Neuropsychopharmacol. 2011;21:718–779.
    1. Chorpita BF, Daleiden EL, Ebesutani C, et al. Evidence-based treatments for children and adolescents: an updated review of indicators of efficacy and effectiveness. Clin Psychol Sci Prac. 2011;18:154–172.
    1. Burns BJ, Phillips SD, Wagner HR, et al. Mental health need and access to mental health services by youths involved with child welfare: a national survey. J Am Acad Child Adolesc Psychiatry. 2004;43(8):960–970.
    1. Horwitz SM, Hurlburt MS, Heneghan A, et al. Mental health problems in young children investigated by US child welfare agencies. J Am Acad Child Adolesc Psychiatry. 2012;51(6):572–581.
    1. Hurlburt MS, Leslie LK, Landsverk J, et al. Contextual predictors of mental health service use among children open to child welfare. Arch Gen Psychiatry. 2004;61(12):1217–1224.
    1. Garcia A, Courtney M. Prevalence and predictors of service utilization among racially and ethnically diverse adolescents in foster care diagnosed with mental health and substance abuse disorders. J Public Child Welf. 2011;5(5):521–545.
    1. Stein RE, Hurlburt MS, Heneghan AM, et al. For better or worse? Change in service use by children investigated by child welfare over a decade. Acad Pediatr. 2016;16(3):240–246.
    1. Vanderzee KL, Pemberton JR, Conners-Burrow N, Kramer TL. Who is advocating for children under six? Uncovering unmet needs in child advocacy centers. Child Youth Serv Rev. 2016;61:303–310.
    1. National Children’s Alliance . NCA organizational history and background. Washington, DC: NCA; 2016.
    1. National Children’s Alliance . NCA national statistics – Final report. Washington, DC: NCA; 2019.
    1. National Children’s Alliance . Healing, justice, & trust – a national report on outcomes for Children’s Advocacy Centers: Member edition. Washington, DC: NCA; 2019.
    1. National Children’s Alliance . Thriving Kids 2019: a national report on mental health outcomes in Children’s Advocacy Centers. Washington, DC: NCA; 2019.
    1. McKay MM, McCadam K, Gonzales J. Addressing the barriers to mental health services for inner city children and their caretakers. Community Ment Health J. 1996;32(4):353–361.
    1. McKay MM, Nudelman R, McCadam K, Gonzales J. Evaluating a social work engagement approach to involving inner-city children and their families in mental health care. Res Soc Work Pract. 1996;6(4):462–472.
    1. Wilsie CC, Hunter M, Wilson K. Oklahoma Trauma Assessment and Service Center Collaborative Final Report. Washington, D.C.: Department of Health and Human Services, Children's Bureau; 2018.
    1. Conners-Burrow NA, Tempel AB, Sigel BA, Church JK, Kramer TL, Worley KB. The development of a systematic approach to mental health screening in Child Advocacy Centers. Child Youth Serv Rev. 2012;34(9):1675–1682.
    1. Harrison ME, McKay MM, Bannon WM. Inner-city child mental health service use: the real question is why youth and families do not use services. Community Ment Health J. 2004;40(2):119–131.
    1. McKay MM, Harrison ME, Gonzales J, Kim L, Quintana E. Multiple-family groups for urban children with conduct difficulties and their families. Psychiatr Serv. 2002;53(11):1467–1468.
    1. Beasley LO, Silovsky JF, Ridings LE, Smith T, Owora AH. Understanding program engagement and attrition in child abuse prevention: a mixed-methods approach. J Family Strengths. 2014;14(1):1–24.
    1. Damashek A, Doughty D, Ware L, Silovsky JF. Predictors of treatment engagement and attrition in home-based child maltreatment prevention services. Child Maltreat. 2011;16(1):9–20.
    1. Dempster R, Winders Davis D, Jones VF, Keating A, Wildman B. The role of stigma in parental help-seeking for perceived child behavior problems in urban, low-income African American parents. J Clin Psychol Med Settings. 2018;22:265–275.
    1. Becker KD, Boustani M, Gellatly R, Chorpita BF. Forty years of engagement research in children’s mental health services: multidimensional measurement and practice elements. J Clin Child Adolesc Psychol. 2018;47(1):1–23.
    1. Miller WR, Rollnick S. Motivational interviewing: preparing people for change. New York, NY: Guilford Press; 1991.
    1. Potocky M, Guskovict KL. Project MIRACLE: increasing empathy among psychosocial support staff working with refugees through brief training in motivational interviewing. Intervention. 2019;17(1):59–68.
    1. Simon P, Ward NL. An evaluation of training for lay providers in the use of motivational interviewing to promote academic achievement among urban youth. Adv Sch Ment Health Promot. 2014;7(4):255–270.
    1. McKay MM, Stoewe J, McCadam K, Gonzales J. Increasing access to child mental health services for urban children and their caregivers. Health Soc Work. 1998;23(1):9–15.
    1. Romano M, Peters L. Evaluating the mechanisms of change in motivational interviewing in the treatment of mental health problems: a review and meta-analysis. Clin Psychol Rev. 2015;38:1–12.
    1. Baker A, Hambridge J. Motivational interviewing: enhancing engagement in treatment for mental health problems. Behaviour Change. 2002;19(3):138–145.
    1. Chaffin MC, Silovsky JF, Funderburk B, et al. Parent-child interaction therapy with physically abusive parents: efficacy for reducing future abuse reports. J Consult Clin Psychol. 2004;72(3):500–510.
    1. Chaffin M, Valle L, Funderburk B, et al. A motivational intervention can improve retention in PCIT for low-motivation child welfare clients. Child Maltreat. 2009;14(4):356–368.
    1. Chaffin MC, Funderburk B, Bard D, Valle LA, Gurwitch RA. Combined motivation and parent–child interaction therapy package reduces child welfare recidivism in a randomized dismantling field trial. J Consult Clin Psychol. 2010;79(1):84–95.
    1. Cooper JL, Aratani Y. The status of states’ policies to support evidence-based practices in children’s mental health. Psychiatr Serv. 2009;60(12):1672–1675.
    1. Becker EM, Smith AM, Jensen-Doss A. Who’s using treatment manuals? A national survey of practicing therapists. Behav Res Ther. 2013;51(10):706–710.
    1. Wherry JN, Huey CC, Medford EA. A national survey of child advocacy center directors regarding knowledge of assessment, treatment referral, and training needs in physical and sexual abuse. J Child Sex Abus. 2015;24(3):280–299.
    1. Herschell AD, Kolko DJ, Baumann BL, Davis AC. The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev. 2010;30(4):448–466.
    1. Bearman SK, Weisz JR, Chorpita BF, et al. More practice, less preach? The role of supervision processes and therapist characteristics in EBP implementation. Admin Policy Ment Health. 2013;40(6):518–529.
    1. Funderburk BW, Ware LM, Altshuler E, Chaffin M. Use and feasibility of telemedicine technology in the dissemination of parent-child interaction therapy. Child Maltreat. 2008;13(4):377–382.
    1. Zoumenou V, Sigman-Grant M, Coleman G, et al. Identifying best practices for an interactive webinar. J Fam Consum Sci. 2015;107(2):62–69.
    1. Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap) – a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–381.
    1. Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software partners. J Biomed Inform. 2019;95:103208.
    1. Ho MK. Use of Ethnic Sensitive Inventory (ESI) to enhance practitioner skills with minorities. J Multicult Soc Work. 1991;1:57–67.
    1. Eisenberger R, Huntington R, Hutchison S, Sowa D. Perceived organizational support. J Appl Psychol. 1986;17(3):200–507.
    1. Eisenberger R, Stinglhamber F, Vandenberghe C, Sucharski IL, Rhoades L. Perceived supervisor support: contributions to perceived organizational support and employee retention. J Appl Psychol. 2002;87(3):565–573.
    1. Chen G, Gully SM, Eden D. Validation of a new general self-efficacy scale. Organ Res Methods. 2001;4(1):62–83.
    1. Roth RM, Isquith PK, Gioia GA. Behavioral rating inventory of executive function—adult version. Lutz: Psychological Assessment Resources, Inc.; 2005.
    1. Noe RA, Schmitt N. The influence of trainee attitudes on training effectiveness: a test of a model. Pers Psychol. 1986;39:497–523.
    1. Noe RA, Wilk SL. Investigation of the factors that influence employees’ participation in development activities. J Appl Psychol. 1993;78(2):291–302.
    1. Jellinek MS, Murphy JM, Little M, Pagano ME, Comer DM, Kelleher KJ. Use of the Pediatric Symptom Checklist to screen for psychosocial problems in pediatric primary care: a national feasibility study. Arch Pediatr Adolesc Med. 1999;153(3):254–260.
    1. Dorsey S, Pullmann MD, Berliner L, Koschmann E, McKay M, Deblinger E. Engaging foster parents in treatment: a randomized trial of supplementing trauma-focused cognitive behavioral therapy with evidence-based engagement strategies. Child Abuse Negl. 2014;38(9):1508–1520.
    1. Miller WR, Moyers TB, Ernst D, Armhein P. Manual for the motivational interviewing skill code (MISC) 2008.
    1. Moyers TB, Rowell LN, Manuel JK, Ernst D, Houck JM. The motivational interviewing treatment integrity code (MITI 4): rationale, preliminary reliability and validity. J Subst Abuse Treat. 2016;65:36–42.
    1. Candel MJ, Van Breukelen GJ. Varying cluster sizes in trials with clusters in one treatment arm: Sample size adjustments when testing treatment effects with linear mixed models. Stat Med. 2009;28(18):2307–2324.
    1. Spybrook J, Raudenbush SW, Congdon R, Martinez A. Optimal design for longitudinal and multilevel research: Documentation for the “optimal design” software. Available from: [Accessed 13 Feb 2018].
    1. Wood AM, White IR, Royston P. How should variable selection be performed with multiply imputed data? Stat Med. 2008;27(17):3227–3246.
    1. US Department of Health and Human Services, Food and Drug Administration, Center for Drug Evaluation and Research, Center for Biologics Evaluation and Research . Adaptive designs for clinical trials of drugs and biologics guidance for industry. Washington, DC: US Department of Health and Human Services; 2019.
    1. Raudenbush SW, Bryk AS. Hierarchical linear models: applications and data analysis methods. Thousand Oaks: Sage; 2002.
    1. Bates D, Mächler M, Bolker B, Walker S. Fitting linear mixed-effects models using lme4. arXiv preprint arXiv:1406.5823. 2014 Jun 23.
    1. Enders CK. Applied missing data analysis. New York: Guilford Press; 2010.
    1. Little RJ, Rubin DB. Statistical analysis with missing data. Hoboken, NJ: Wiley; 2020.
    1. R Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing. Available from: URL [Accessed 15 Dec 2019].
    1. Heckman J. Shadow prices, market wages, and labor supply. Econometrica. 1974;42(4):679–694.
    1. Bureau of Labor Statistics. Consumer Price Index inflation calculator. [Accessed 10 July 2020].
    1. Council for Community and Economic Research. Cost of living index. [Accessed 10 July 2020].
    1. Dube SR, Anda RF, Whitfield CL, Brown DW, Felitti VJ, Dong M, et al. Long-term consequences of childhood sexual abuse by gender of victim. Am J Prev Med. 2005;28:430–438.
    1. Edwards VJ, Anda RF, Dube SR, Dong M, Chapman DF, Felitti VJ. The wide-ranging health consequences of adverse childhood experiences. In: Kendall-Tackett K, Giacomoni S, editors. Victimization of children and youth: patterns of abuse, response strategies. Kingston: Civic Research Institute; 2005.
    1. Merrick MT, Guinn AS. (2018). Child abuse and neglect: breaking the intergenerational link. J Am Public Health Assoc. 2018;108(9):1117–1118.
    1. California Evidence-Based Clearinghouse for Child Welfare. Trauma-focused cognitive-behavioral therapy (TF-CBT). Available from: [Accessed 15 July 2020].
    1. Deblinger E, Mannarino AP, Cohen JA, Steer RA. A multisite, randomized controlled trial for children with sexual abuse related PTSD symptoms. J Am Acad Child Adolesc Psychiatry. 2006;45:1474–1484.
    1. Natale-Pereira A, Enard KR, Nevarez L, Jones LA. The role of patient navigators in eliminating health disparities. Cancer. 2011;117(S15):3541–3550.
    1. Ferrante JM, Cohen DJ, Crosson JC. Translating the patient navigator approach to meet the needs of primary care. J Am Board Fam Med. 2010;23:736–744.
    1. Szilagyi PG, Humiston SG, Gallivan S, Albertin C, Sandler M, Blumkin A. Effectiveness of a citywide patient immunization navigator program on improving adolescent immunizations and preventive care visit rates. Arch Pediatr Adolesc Med. 2011;165(6):547–553.
    1. Van Walleghem N, MacDonald CA, Dean HJ. The Maestro Project: a patient navigator for the transition of care for youth with type 1 diabetes. Diabetes Spectr. 2011;24(1):9–13.
    1. National Children’s Alliance. CAC Coverage Maps [internet]. Washington, DC: National Children’s Alliance; 2019. Available at: [Accessed 22 July 2020].
    1. Drake B, Jonson-Reid M. Poverty and child maltreatment. In: Korbin J, Krugman R, editors. Handbook of Child Maltreatment. Dordrecht: Springer; 2014. pp. 131–148.
    1. Putnam-Hornstein E, Needell B, King B, Johnson-Motoyama M. Racial and ethnic disparities: a population-based examination of risk factors for involvement with child protective services. Child Abuse Negl. 2013;37(1):33–46.
    1. Aarons GA, Chaffin M. Scaling-up evidence-based practices in child welfare services systems. CYF News. 2013;5. .
    1. Brueck M. Promoting access to school-based services for children’s mental health. AMA J Ethics. 2016;18:1218–1224.
    1. Kelley A, Shawler P, Shields JD, Silovsky JF. A qualitative investigation of policy for youth with problematic sexual behavior. Am J Community Psychol. 2019;47(6):1347–1363.
    1. Chapman JE, McCart MR, Letourneau EJ, Sheidow AJ. Comparison of youth, caregiver, therapist, trained, and treatment expert raters of therapist adherence to a substance abuse treatment protocol. J Consult Clin Psychol. 2013;81(4):674.
    1. Hogue A, Dauber S, Henderson CE, Liddle HA. Reliability of therapist self-report on treatment targets and focus in family-based intervention. Adm Policy Ment Health. 2014;41(5):697–705.
    1. Aarons GA, Sommerfeld D, Hecht D, Silovsky JF, Chaffin M. The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: evidence for a protective effect. J Consult Clin Psychol. 2009;77(2):270–280.
    1. Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care. 2012;50(3):217–226.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit