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  • Average Levels of Physical Victimization The rate of decline in physical victimization was significantly greater in program than control schools Note: Children in program schools reported higher initial levels of both physical and relational victimization. This may be due to a greater awareness of victimization created by the WITS Program. Children learn that reporting victimization and seeking help is the right thing to do.
  • Knowledge base: Educate policy makers, business executives, and civic leaders about the basic science of early childhood and early brain development and the applied science of early childhood intervention. Political will: Build broad-based leadership capacity and motivation to close the gap between what we know and what we do to promote healthy development. Social strategy: Identify potential partners in the public and private sectors to advance innovative, evidence-based policies and services at the state level.
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    1. 1. Engaging users of child and youth mental health prevention programs? CYHRNet Annual Meeting November 3, 2009 Bonnie Leadbeater, Ph D.
    2. 2. The Ideal
    3. 3. Evaluation Development & Innovation Uptake Infidelity Abandonment The Reality Processes of Knowledge Uptake for Mental Health Programs
    4. 4. The PUSH Program Developer (an academic or research team) USERS GATEKEEPERS Principals Police force Therapists Counselors
    5. 5. The PULL <ul><li>Knowledge </li></ul><ul><li>USERS </li></ul>Professional Development Activities Marketing Private Communications
    6. 6. The Solution Community Based Research? <ul><li>Involve stakeholders early in program development </li></ul><ul><li>Enhanced knowledge exchange </li></ul><ul><li>Increase relevance </li></ul><ul><li>Speed uptake </li></ul><ul><ul><ul><ul><li>YES, but …. </li></ul></ul></ul></ul>
    7. 7. How does CBR affect going to scale? <ul><li>Programs may be more relevant and acceptable. </li></ul><ul><li>But programs are ultimately packaged and dissemination requires ….. </li></ul><ul><li>Pushing and pulling mechanisms to </li></ul><ul><ul><li>Recreate interested community partners in new setting </li></ul></ul><ul><ul><li>Recreate trained workforce – delivery folks </li></ul></ul><ul><ul><li>Reevaluate cultural applicability and local relevance of the program </li></ul></ul><ul><ul><ul><ul><ul><li>For example </li></ul></ul></ul></ul></ul>
    8. 8. Preventing peer victimization
    9. 9. The WITS Rock Solid Primary Prevention Program is a Partnership Judy 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. 10. Moving out of the classroom <ul><li>Children grow up in relationships & </li></ul><ul><ul><li>A growing number of studies show the promise of school, parent, and community involvement in interventions for reducing peer victimization. </li></ul></ul><ul><li>WITS strategies convey consistent and developmentally appropriate messages for peaceful conflict resolution across contexts </li></ul>
    11. 11. WITS Program Components <ul><li>Emergency Services Personnel Manual </li></ul><ul><li>Student/WITS Representative </li></ul><ul><li>WITS Booklist </li></ul><ul><li>Curriculum for Teachers and Librarians </li></ul><ul><li>Activities for the Classroom and School </li></ul><ul><li>Resources for Parents </li></ul><ul><ul><ul><li>www.uvic.ca/WITS </li></ul></ul></ul>
    12. 12. Evaluations <ul><li>2001-2003 (4 waves) </li></ul><ul><ul><li>432 children families & their teachers </li></ul></ul><ul><li>2007-2008 (3 waves) </li></ul><ul><ul><li>1132 children families & their teachers </li></ul></ul>
    13. 13. More reported victimization and greater rate of decline levels of victimization
    14. 14. Bridging the gap – Transportability Knowledge Practice Better Implementation Strategies
    15. 15. Obstacles to transportability Access to mental health services/programs: <ul><li>Heterogeneity of services delivered (medication, psychotherapy, groups etc.) </li></ul><ul><li>Clogged public systems mainly treats adolescents with severe illness and urgent needs </li></ul><ul><li>Scattered sites for service delivery ( schools, child welfare, juvenile justice, health clinics, private offices) </li></ul><ul><li>Multiple service providers </li></ul><ul><ul><li>Intervention (physicians, psychologist, therapists, counselors) & </li></ul></ul><ul><ul><li>Prevention (Police: D.A. R. E.) (Teachers: F.R.I.E.N.D.S. for Life, School Counselors </li></ul></ul>
    16. 16. More obstacles – Complexity of problems and solutions <ul><li>Ecology child health and illness creates need for preventions in the context of family, school, neighborhood, </li></ul><ul><li>Complexity of mental health concerns – comorbidity (anxiety, depression, ODD, CD) </li></ul><ul><li>Even Prodromal & </li></ul><ul><li>subclinical symptoms </li></ul><ul><li>affect functioning in </li></ul><ul><li>many domains ( physical </li></ul><ul><li>academic) </li></ul>
    17. 17. More obstacles – Creating Research Evidence <ul><li>Lack of empirically-based programs for some concerns ( but many do exist) </li></ul><ul><li>Lack of consensus or regulation in what counts as evidence-based (RTCs vs real world) </li></ul><ul><li>Incentives to do intervention research </li></ul><ul><li>Longterm commitment is needed Vaccination-like programs don’t work even if wide spread, short term single shot programs show no evidence of lasting effects – e.g. D.A.R.E longitudinal research is needed </li></ul><ul><li>Researchers have short lives! </li></ul>
    18. 18. NOW WHAT ? <ul><li>Need for a national, provincial and and local infrastructures committed to facilitating dissemination of effective based mental health treatment programs for children </li></ul><ul><ul><ul><ul><ul><li>& </li></ul></ul></ul></ul></ul><ul><li>Children’s Mental Health Promotion Programs </li></ul>
    19. 19. Applying Child Policy Initiatives (Julius Richmond) Knowledge Base (Growing) Political Will (Growing) Social Strategy (Fragmented)
    20. 20. Alternate approaches to public health problems <ul><li>Preventive dentistry </li></ul><ul><ul><li>Licensed and accredited providers </li></ul></ul><ul><ul><li>Lifespan, prevention oriented perspective </li></ul></ul><ul><ul><li>Public and private involvement (fluoride in water, and tooth paste) </li></ul></ul><ul><ul><ul><li>Put WITS in your water to prevent </li></ul></ul></ul><ul><ul><ul><li>relationship decay? </li></ul></ul></ul>
    21. 21. Pharmaceutical medicine Food & Drug Act (2005 budget – $170M for 5 years) <ul><li>Evidenced-based approaches built into regulatory standards for insuring safety, efficacy and quality </li></ul><ul><li>Industry lead mechanisms for development,dissemination, marketing </li></ul><ul><li>Monetary Incentives for development and dissemination </li></ul><ul><li>Nationally regulated </li></ul><ul><li>(Health Canada) </li></ul><ul><li>Training restrictions related to for distribution – few gatekeepers </li></ul><ul><li>Public payment for use of medications + private insurance </li></ul><ul><li>Fueled by academic research </li></ul>
    22. 22. Approaches to improve access to Evidence-based mental health programs <ul><li>Standardize and clarify training and scope of practice of service providers – teachers don’t just teach </li></ul><ul><li>Public funding of mental health prevention and prevention services to children and youth </li></ul><ul><li>National accreditation of evidenced-based treatments (with clear operational criteria) </li></ul><ul><li>Centralized and accelerated dissemination of evidenced-based programs </li></ul><ul><li>Identifiable settings for mental health treatment </li></ul>
    23. 23. Drug Safety and Effectiveness Network Launched July 2008 <ul><li>Minister of Health, Leona Aglukkaq: </li></ul><ul><li>“ Canadians can be confident that this government is taking the steps necessary to ensure that our drug safety system remains one of the best in the world. The Network complements Canada’s 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) </li></ul>
    24. 24. Which system would you choose for your child? <ul><li>Regulated, pharmaceutical system with few, easy to access, gatekeepers (physicians) and sound educators (pharmacists) ? </li></ul><ul><li>Unregulated, hard to find, fragmented psychological services with potentially unproven benefits, delivered by variously trained individuals, in multiple settings? </li></ul>
    25. 25. A NATIONAL Mental Health Strategy <ul><li>Minister of Health, Leona Aglukkaq will make the strong claim that: </li></ul><ul><li> “ Canadians can be confident that this government is taking the steps necessary to ensure that our children’s mental health is among the best in the world!” </li></ul>
    26. 26. Recommendations for programs for treatment and prevention of mental health programs in children <ul><li>National accreditation of evidence-based programs. </li></ul><ul><li>Regulation of training of mental health service providers. </li></ul><ul><li>Enhance access to and use of accredited programs by schools. </li></ul><ul><li>Public payment for mental health care for children and youth. </li></ul>
    27. 27. First Steps - Federal <ul><li>The Public Health Agency of Canada – listing of promising programs and “Innovative strategy to Reduce Health Inequalities in Canada” </li></ul><ul><li>Canadian Mental Health Commission </li></ul><ul><li>Canadian Alliance on Mental </li></ul><ul><ul><li>Illness and Mental Health (CAMIMH), </li></ul></ul><ul><li>PREVNET –P romoting relationships eliminating violence Network- began with a National Centre for Excellence </li></ul>
    28. 28. First steps – Provincial <ul><li>BC Ministry for Child and Family Development: Ten Year Mental Health Plan – Dissemination of FRIENDS For LIFE Program </li></ul><ul><li>Children’s Mental Health Ontario (CMHO) Evidence-Based Practice Technical Assistance Centre </li></ul>
    29. 29. First steps – local <ul><li>Toolkits for community engagement and development. </li></ul><ul><ul><li>R and Foundation entitled Getting to Outcomes http://www.rand.org/pubs/technical_reports/TR101/ </li></ul></ul>
    30. 30. Getting to outcomes: Questions <ul><li>1: What Are the Underlying Needs and Conditions in the Community? (Needs/Resources) </li></ul><ul><li>#2: What Are the Goals, Target Populations, and Objectives (i.e., Desired Outcomes)? (Goals) </li></ul><ul><li>#3: Which Evidence-Based Programs Can Be Used to Reach Your Goal? (Best Practice) </li></ul><ul><li>#4: What Actions Need to Be Taken So That the Selected Program “Fits” the Community Context? </li></ul><ul><li>#5: What Organizational Capacities Are Needed to Implement the Program? (Capacities) </li></ul>
    31. 31. Getting to Outcomes (Continued) <ul><li>#6: What Is the Plan for this Program? (Plan) </li></ul><ul><li>#7: How Will the Quality of Program and/or Initiative Implementation Be Assessed? (Process) </li></ul><ul><li>#8: How Well Did the Program Work ? (Outcomes) </li></ul><ul><li>#9: How Will Continuous Quality Improvement Strategies Be Incorporated? (CQI) </li></ul><ul><li>#10: If the Program Is Successful, How Will It Be Sustained ? (Sustain) </li></ul>