Evaluation of a Skills Enhancement Training Intervention With Remote Coaching for Young Adults Providing Peer Support.

This column reports on a study that investigated a skills enhancement and role clarification training intervention for young adult peer support specialists (YPSSs). Young adults who had received intensive mental health services­including young adults who had experience as YPSSs­were partners in developing the intervention and in completing all aspects of the study. Study participants were YPSSs who were already providing one-on-one, person-centered planning in community settings before the study. The results, based on YPSSs' self-reports and rated video recordings of YPSSs' practice, showed postintervention gains in participants' skills and confidence in providing person-centered planning to the young people they worked with as well as reduced job-related anxiety and high training satisfaction.

Provider Perspectives on Principle-Adherent Practice in Empirically Supported Interventions for Emerging Adults with Serious Mental Health Conditions.

In recognition of the need to create new treatment approaches that will be appealing to and effective for emerging adults with serious mental health conditions, researchers have begun to create and evaluate programs and interventions that are specifically tailored to reflect the preferences and needs of the population. The literature that describes these new approaches-including both descriptions of interventions and guidelines based on expert consensus-expresses a high degree of agreement regarding practice principles that should guide intervention. However, beyond naming these principles, the literature provides little information about what the principles mean, or how principle-adherent practice can be recognized. This article describes a qualitative investigation of providers' understanding of principle-driven practice in the context of programs and interventions for emerging adults with serious mental health conditions. The goal was to learn about how providers conceptualize the principles that drive their practice, and how they describe principle-adherent practice.

A theory of change for positive developmental approaches to improving outcomes among emerging adults with serious mental health conditions.

Recent evidence attests to the shortcomings of typical services for improving outcomes among emerging adults with serious mental health conditions (SMHCs). Researchers and providers have responded by developing new programs and interventions for meeting the unique needs of these young people. A significant number of these programs and interventions can be described as taking a positive developmental approach, which is informed by a combination of theoretical sources, including theories of positive development, self-determination, ecological systems, and social capital. To date, however, there has been no comprehensive theoretical statement describing how or why positive change should occur as a result of using a positive developmental approach when intervening with this population. The goal of this article is to propose a general model that "backfills" a theory behind what appears to be an effective and increasingly popular approach to improving outcomes among emerging adults with SMHCs.

Community and state systems change associated with the healthy transitions initiative.

People engaged in efforts to improve services to emerging adults with serious mental health challenges have reached the conclusion that service change at the program or agency level is not sustainable without related changes at the systems or policy level. This article focuses on one set of efforts to create intentional system change at both the community and state levels. These changes were pursued by states and communities that received grants under the federally funded Healthy Transitions Initiative (HTI), with the aim of creating more effective services for emerging adults with serious mental health conditions. The article reviews the development of a measure to assess systems change efforts at the state and community levels and describes the findings that emerged when the measure was used to assess the change that occurred in the HTI sites over a period of approximately three and a half years.

Family voice with informed choice: coordinating wraparound with research-based treatment for children and adolescents.

The wraparound process is a type of individualized, team-based care coordination that has become central to many state and system efforts to reform children's mental health service delivery for youths with the most complex needs and their families. Although the emerging wraparound research base is generally positive regarding placements and costs, effect sizes are smaller for clinical and functional outcomes. This article presents a review of literature on care coordination and wraparound models, with a focus on theory and research that indicates the need to better connect wraparound-enrolled children and adolescents to evidence-based treatment (EBT). The article goes on to describe how recently developed applications of EBT that are based on quality improvement and flexible application of "common elements" of research-based care may provide a more individualized approach that better aligns with the philosophy and procedures of the wraparound process. Finally, this article presents preliminary studies that show the feasibility and potential effectiveness of coordinating wraparound with the Managing and Adapting Practice system, and discusses intervention development and research options that are currently under way.

Does team-based planning "work" for adolescents? Findings from studies of wraparound.

OBJECTIVE: This article focuses on wraparound as an example of a team planning process, and uses data from several sources to reflect on questions about whether-and under what conditions-collaborative teams are successful in engaging young people-and their caregivers-in planning. METHODS: We used data collected in three studies to address our research questions. The first data set comes from a study on wraparound service planning in Nevada. We examined data collected from 23 matched pairs of caregivers and youth at 6 months after wraparound planning began. Our second data set came from a national study of 41 local wraparound programs throughout the United States. Our analyses use data from 366 matched pairs of caregivers/youth. The third dataset comes from the pilot test of the Achieve My Plan! intervention. Data was gathered from eight teams before and after the intervention was implemented. RESULTS: Taken together, the findings suggest that teams' success in managing caregiver and adolescent perspectives simultaneously during care and treatment planning is more strongly related to the quality of the team process than to youth age. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Through attention to youth engagement, preparation, and tem process, it appears possible to increase meaningful youth participation in planning without sacrificing caregiver satisfaction with the team experience.

Intervening in the lives of youth with complex behavioral health challenges and their families: the role of the wraparound process.

Wraparound is an individualized, team-based service planning and care coordination process intended to improve outcomes for youth with complex behavioral health challenges and their families. In recent years, several factors have led wraparound to become an increasingly visible component of service systems for youth, including its alignment with the youth and family movements, clear role within the systems of care and public health frameworks, and expansion of the research base. In this paper, we provide a review of the place of the wraparound process in behavioral health, including a discussion of the opportunities it presents to the field, needs for further development and research, and recommendations for federal actions that have the potential to improve the model's positive contribution to child and family well-being.

Defining practice: flexibility, legitimacy, and the nature of systems of care and wraparound.

In human services, clear definition of key concepts and strategies is critical to facilitating training, implementation, and research. This article reflects on methods undertaken to specify the wraparound process for children and families, and considers lessons that may be relevant to defining the system of care concept.

Defining "necessary" services and supports: why systems of care must take direction from service-level processes.

A crucial element of the system of care definition is the specification of its purpose, namely, "to ensure access to and availability of necessary services and supports." This article discusses the structures and processes that must be in place so that systems of care can acquire and respond to high-quality information about what services and supports are truly necessary.

Children's beliefs about causes of childhood depression and ADHD: a study of stigmatization.

OBJECTIVE: Children's causal attributions about childhood mental health problems were examined in a national sample for prevalence; relative stigmatization; variation by age, race and ethnicity, and gender; and self-report of a diagnosis of depression or attention-deficit hyperactivity disorder (ADHD). METHODS: A national sample of 1,091 children were randomly assigned to read vignettes about a peer with depression, ADHD, or asthma and respond to an online survey. Causal attributions and social distance were assessed, and correlations were examined. Logistic regression models for each causal item tested main effects and interaction terms for conditions, demographic characteristics, and self-reported diagnosis. RESULTS: The beliefs that parenting, substance abuse, and low effort caused the condition were all strongly intercorrelated and were moderately correlated with social distance. The depression condition was the strongest predictor of endorsement of the most stigmatizing causal beliefs. Stigmatizing causal beliefs were evident for ADHD, but with more modest effects. Children who reported a diagnosis were more likely to endorse parenting and substance abuse as causes (attenuated for ADHD). Modest to moderate effects were found for variation in causal beliefs across ethnic groups. CONCLUSIONS: This study demonstrated a consistent presence of stigmatization in children's beliefs about the causes of childhood mental health problems. Low effort, parenting, and substance abuse together tapped a moralistic and blaming view of mental health problems. The results reinforce the need to address stigmatization of mental disorders and the relative stigmatization of different causal beliefs. The findings of variation by ethnicity and diagnosis can inform and target antistigmatization efforts.

Children's stigmatization of childhood depression and ADHD: magnitude and demographic variation in a national sample.

OBJECTIVE: To estimate the magnitude of stigmatizing attitudes toward peers with depression or attention-deficit/hyperactivity disorder (ADHD) in a national sample of children ages 8 to 18 and to examine variation in level of stigma by school location, region of the United States, grade level, race/ethnicity, or sex. METHOD: Surveys were administered to 1,318 children and adolescents. Respondents were randomly assigned to depression, ADHD, or asthma conditions and were presented with a vignette about a peer with one of the conditions. Participants responded to items assessing positive and negative attributions, social distance, and family attitudes. Mean differences were tested for statistical significance and effect sizes were computed. RESULTS: Respondents were more likely to make negative attributions about peers with ADHD and depression versus asthma, particularly regarding the likelihood of antisocial behavior and violence (Cohen d range 0.78-1.35, large effect sizes). Moderate effect sizes were found for preferences for social distance from peers with ADHD(d = 0.37) and depression (d = 0.45). Effects were found for perceptions of negative family attitudes toward both mental health conditions, with depression (d = 0.78) seen as even more stigmatized than ADHD (d = 0.47). The level of stigmatization was relatively constant across demographic variables, with the exception of greater stigmatization evident in Asian/Pacific Islander youths. CONCLUSIONS: Across most items, both depression and ADHD were more stigmatized than asthma, with depression more stigmatized than ADHD. The perception of likelihood of violence and antisocial behavior was particularly high for both ADHD and depression, greatly exceeding the real-world association for depression.

Grounded theory and backward mapping: exploring the implementation context for wraparound.

Within children's mental health, there is an increasing demand for wider implementation of wraparound and other interventions that can provide comprehensive, individualized, family-driven care. Unfortunately, implementation has proven difficult because these approaches do not necessarily flourish within traditionally organized agencies and systems. This has highlighted the need for information about how mental health agencies and systems must evolve if they are to provide a hospitable implementation environment for these interventions. A first step in developing this information is through research that advances conceptual and theoretical understanding of the impact of contextual factors on implementation. At the same time, there is an immediate need for practical information to guide decision making and policy development in settings where implementation is being undertaken. This article describes a study of wraparound implementation that used a combination of qualitative strategies to meet both of these needs simultaneously. It is argued that these strategies are particularly well suited to the study of emerging practices that reflect-and help drive-transformation in mental health systems.

Building on practice-based evidence: using expert perspectives to define the wraparound process.

OBJECTIVE: In order to expand the research base on effective community-based mental health treatments, methods are needed to define and evaluate promising interventions that have not been systematically developed and tested. In this report, the authors describe the results of an effort to better define the wraparound process for children and adolescents with serious emotional and behavioral problems. METHODS: A broad review of wraparound treatment manuals and model descriptions was conducted. With the help of a small group of experts, this review was synthesized into an initial description of the phases and activities of the wraparound process. This model was then presented to a multidisciplinary advisory panel of 31 experts on the wraparound process who provided structured and semistructured feedback. RESULTS: Overall, respondents expressed a high level of agreement with the proposed set of activities. For 23 of the 31 activities presented, there was unanimous or near-unanimous agreement (that is, one dissenter) that the activity was an essential component of the wraparound process. For 20 of the 31 activities, there was unanimous agreement that the description was phrased acceptably. A final model was created on the basis of feedback from reviewers. CONCLUSIONS: Results indicate that using the experience of a wide base of stakeholders to operationalize a complex model such as wraparound is feasible and holds many potential benefits, including building consensus in the field, improving service quality, and accelerating the incorporation of evaluation results into real-world practice.