An ecological process model of systems change.

In June 2007 the American Journal of Community Psychology published a special issue focused on theories, methods and interventions for systems change which included calls from the editors and authors for theoretical advancement in this field. We propose a conceptual model of systems change that integrates familiar and fundamental community psychology principles (succession, interdependence, cycling of resources, adaptation) and accentuates a process orientation. To situate our framework we offer a definition of systems change and a brief review of the ecological perspective and principles. The Ecological Process Model of Systems Change is depicted, described and applied to a case example of policy driven systems level change in publicly funded social programs. We conclude by identifying salient implications for thinking and action which flow from the Model.

Research utilization among children's mental health providers.

BACKGROUND: Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH) service provider organizations in Ontario, Canada. METHODS: A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. RESULTS: There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use - access, assess, adapt, and apply - research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. CONCLUSION: These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.

A feasibility study to assess service providers' perspectives regarding the use of the child and adolescent functional assessment scale in Ontario.

This brief report describes a feasibility study conducted to assess the level of satisfaction with the Child and Adolescent Functional Assessment Scale (CAFAS) rater reliability training, the ease of achieving interrater reliability in rating CAFAS, and the clinical utility of CAFAS as an outcome measurement tool for the province of Ontario, from the perspective of service providers. This study has been instrumental in the development of a 4-year province-wide measurement initiative. The study proved useful to government policy and decision-makers, mental health administrators, clinicians, and mental health service researchers interested in the implementation of outcome measurement tools. It highlighted the fact that at least 85% of respondents were satisfied with CAFAS training and the ease of achieving interrater reliability. The majority identified the usefulness of the tool in case formulation and the value in tracking changes over time.

Overview of Ontario's Screening and Outcome Measurement Initiative in Children's Mental Health.

INTRODUCTION: Ontario's mental health practitioners strive to provide the best services for the most children and youth in the face of limited resources and increasing demand. METHOD: To do this efficiently and ethically necessitates identifying those at greatest risk, determining which services are most effective for a variety of children, and demonstrating improved functioning post-treatment. Standardized screening can assist in triaging those at greatest risk and outcome measurement can demonstrate improvement and treatment effectiveness. RESULTS: To this end, Ontario has initiated systematic screening and outcome measurement for children ages 6 to 17 years receiving mental health services in selected hospital-based and community organizations. CONCLUSION: Standardized screening and outcome tools are key building blocks for improving the quality of service and promoting the use of evidence-based practices across the system. The lessons learned to date suggest there is a need to build individual and organizational readiness for change, to improve the state of technological literacy and infrastructure across the sector, and to improve the exchange of knowledge among stakeholders regarding the clinical benefits of the toolsand the data they will produce regarding the state of children and youth receiving mental health service in Ontario.