Harvesting the Scientific Investment in Prevention Science to Promote Children's Cognitive, Affective, and Behavioral Health Workshop Summary (2015) / Chapter Skim
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3 Overcoming Barriers
3 Overcoming Barriers
Pages 19-36
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From page 19... ...
DEVELOPING METRICS, STANDARDS, AND GUIDELINES Several presenters and participants in breakout groups emphasized the importance of developing the appropriate metrics, standards, and guidelines for desired outcomes to ensure preventive EBIs are appropriately applied and to help make the business case for such interventions. Appropriate Goals, Measures, and Outcomes Bryan Samuels of Chapin Hall at the University of Chicago pointed out that a major flaw in the Adoption and Safe Families Act (ASFA)
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Kelly Kelleher of Ohio State University and Nationwide Children's Hospital in Columbus, Ohio, suggested there be standard outcome measures for children that can guide what accountable care organizations have to do for children and that Medicaid directors would accept as valid. Many proposed outcome measures and accountability measures for adults exist, but no such standards for accountable care currently address pediatrics.
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Bruns suggested combining measurements of the target population, effect size, and reach to assess the overall population impact of a prevention intervention. He discussed one study of two preventive interventions for posttraumatic stress disorder (PTSD)
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He added that the National Institute on Drug Abuse, which funds the community youth development study, has shown that there is a return of $5 for every $1 invested in prevention and that a similar calculation could be followed to figure return on investment for other prevention programs. Members of the health care breakout group suggested there could be greater use of existing measures, such as those used in the National Insti
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and stepped collaborative care flow diagrams specifying target populations for posttraumatic stress disorder (PTSD) prevention.
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A well-respected organization that provides recommendations regarding preventive services to be provided in primary care settings is the U.S. Preventive Services Task Force (USPSTF)
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Kemper responded that this is a topic that the Task Force would evaluate and make recommendations on, although it would have to consider assessing whether all children ought to be screened for child maltreatment. INTEGRATING SILOS A theme question at the workshop was how to integrate silos, including mental, behavioral, public health, and primary care, as well as how to integrate the various government agencies that oversee the domains in which children are cared for, such as public schools, Medicaid, child welfare, and juvenile justice agencies.
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The USPSTF makes recommendations on clinical preventive services to pri mary care clinicians. The USPSTF's scope for clinical preventive services includes screening tests, counseling, and preventive medications.
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High Certainty: Evidence includes consistent results from well-designed, well conducted studies in representative primary care populations, using health out comes. Conclusion unlikely to be strongly affected by the results of future studies.
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However, Sugar expressed caution over using the primary care setting to deliver, rather than refer out, social and emotional training and stressed that "if you treat kids in a primary care setting, you are going to get a very medicalized treatment for social problems, which hasn't worked well." Members of the child welfare and juvenile/family justice breakout group noted that schools and primary care settings are ideally positioned to engage in primary prevention or universal prevention activities, including screening and assessment programs, and that once children enter the child welfare or juvenile justice system, there is a greater need for more targeted and intensive types of prevention programs. Finding funding for such prevention efforts can be problematic, however.
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Participants in the child welfare and juvenile/family justice breakout group also suggested there be greater face-to-face communications of the appropriate personnel in these sectors, such as between a child welfare worker and probation officer or school psychologist. This communication could be a job requirement, such that child welfare workers are expected to interact with representatives from other systems.
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A participant in the schools breakout group added that it would be helpful if, instead of juvenile justice agencies being solely responsible for the education of their incarcerated clients, schools share that responsibility "because the schools are going to do a better job of it." Integration of Disciplines In addition to integrating sectors, members in the schools breakout group suggested there be more integration of disciplines. Participants in the group suggested training teachers and school nurses in behavior management and in child mental health and prevention programs.
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Participants in the schools group also suggested forging partnerships between schools and the communities they are in so different agencies and programs work together at the local level around common child-centered goals. Integration of Agencies Social welfare and juvenile/family justice breakout group members pointed out that in order to have federal and local partnerships for youth prevention programs, there needs to be an alignment of Medicaid demonstration authority with the waiver programs such as Title IV-E that are available for child welfare and juvenile justice.
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One workshop participant pointed out a program under development by the Community Preventive Services Task Force of CDC that plans to offer a decision implementation support system. This learning system will assist decision makers to identify and select programs and evidence-based strategies so they can meet specific goals while matching their needs and financial or other constraints.
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So although the infrastructure to deliver programs would be at the local community organization level, the resources to support them need to be coordinated at a higher level," Chambers said. Bruns added that "states are where resource decisions are made." However, Jennifer Tyson, Office of Juvenile Justice and Delinquency Prevention, highlighted the importance of community engagement -- that though a higher level should coordinate prevention programs, one should not forget the importance of communities knowing best their own structure and which programs are likely to work for them, as well as which local organizations are best suited to carrying out these programs.
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During discussion, Brent suggested there be some economic modeling of resource allocation that could indicate how much funding should be used for prevention programs versus treatment programs. This modeling could consider the cost savings of prevention programs and other factors that might more logically indicate how funding should be divided between the two types of programs.
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"It's not that we've got a problem with the research, but these are the things we should be doing in usual care," he said. For example, Washington State's juvenile justice department developed an integrated treatment model that applied specific relevant types of evidence developed in an academic setting to residential care and parole.
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2009. Using target population specification, effect size, and reach to estimate and compare the population impact of two PTSD preventive interventions.
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