Implementation strategies support the dissemination, adoption, and scaling of evidence-based programs and practices. Grouping implementation strategies into a small set of meaningful clusters helps guide and support implementation research and practice. This study used an empirically derived technique called Participatory Theme Elicitation to characterize the Expert Recommendations for Implementing Change (ERIC) implementation strategies for use in implementation efforts in community-based behavioral health settings. Five clusters were identified using the Louvaine method and associated network diagram. The identified clusters of strategies were (1) Systems Change, (2) Funding and Fiscal Sustainability, (3) Community Engagement and Support, (4) Purveyor Support/Training Technical Assistance, and (5) Monitoring and Evaluation. These five clusters present a simplified taxonomy that can be used in future research and practice.

Youth with significant behavioral problems present challenges for the child welfare system and effective treatments are needed. Few interventions have stronger evidence than Multisystemic Therapy (MST) for reducing adolescent behavior problems and out-of-home placement. However, standard delivery of MST does not provide tailored guidance for working collaboratively within the child welfare setting and, in some cases, may not address the needs of the service system. The need for modification to address system challenges to the treatment model became evident during implementation of MST in a large child welfare preventive services system. This paper utilizes the Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS; Miller et al., 2021; Wiltsey Stirman et al., 2019) to describe how modifications, labeled MST-Prevention (MST-PRV), were developed, evaluated, and documented while retaining the evidence base of the original treatment model. Pilot data compared outcomes for families receiving MST-PRV versus standard MST in 2024. Results suggest that MST-PRV was model-adherent and delivered strong outcomes typical of MST, including a high proportion of youth who completed treatment, remained living at home, attended school or work, had no new arrests or maltreatment reports, and demonstrated significant improvements in problematic behaviors. Potential benefits of the MST modifications to child welfare preventive service system partners are discussed.

Children with conduct problems and elevated callous-unemotional (CU) traits whose parents participate in parent management training (PMT) start and end treatment with higher levels of conduct problems than those with conduct problems alone and face a higher risk of negative outcomes. Because these children have deficits in emotion recognition and empathy, incorporating an emotion-focused intervention into PMT may enhance child outcomes. This study describes the development and evaluation of a brief parent-focused emotion-coaching (EC) intervention combined with an evidence-based PMT program, Helping the Noncompliant Child (HNC; McMahon & Forehand, 2003), for use with clinic-referred children (3-7 years) with conduct problems and elevated CU traits (N = 43; M age = 6.08 years, SD = 1.39, 83.7% male). We employed a treatment deployment (i.e., effectiveness) model to inform the EC content and integrate it with HNC. HNC-EC is one of a growing number of interventions targeting known developmental mechanisms related to child CU traits. We examined parent and child outcomes from a pilot randomized controlled trial comparing HNC-EC and HNC. Parent-report, direct observation, and laboratory measures were employed at baseline, mid-treatment, and post-treatment. Intention-to-treat and completer analyses demonstrated that both HNC and HNC-EC led to significant improvements in children's conduct problems and CU traits. There were relatively few differences between the two groups; however, those differences favored HNC-EC in the domains of conduct problems, emotion recognition, parenting, and parent adjustment. Findings support the effectiveness of both HNC and HNC-EC in addressing the needs of this high-risk population, and suggest the added benefit of incorporating EC into PMT.

This special issue brings together three parenting interventions grounded in emotion socialization theory and research. The interventions described in this issue are Let's Connect (R), Tuning Into Kids (R), and Helping the Noncompliant Child - Emotion Coaching. This issue pairs a theoretical exposition with empirical findings for each intervention, describing each intervention's conceptual foundation and child and parent impact. The theory papers detail the psychological frameworks and design rationales that shape each program, while the accompanying empirical studies evaluate program effectiveness across key developmental outcomes. This dual approach to the special issue supports understanding of how and why these interventions work and provides actionable insights for researchers and practitioners committed to enhancing child social emotional competence, mental and behavioral health, and resilience through evidence-based parenting strategies.

Background Clinicians need supports beyond training to deliver evidence-based treatments with fidelity. Workplace-based clinical supervision often is a commonly provided support in community mental health, yet too few studies have empirically examined supervision and its impact on clinician fidelity and treatment delivery. Method Building on a Washington State-funded evidence-based treatment initiative (CBT+), we conducted a randomized controlled trial (RCT), testing two supervision conditions delivered by workplace-based supervisors (supervisors employed by community mental health organizations). The RCT followed a supervision-as-usual (SAU) phase for comparison. The treatment of focus was trauma-focused cognitive behavioral therapy (TF-CBT). Clinicians ( N = 238) from 25 organizations participated in the study across the SAU baseline and RCT phases. In the RCT phase, clinicians were randomized to either symptom and fidelity monitoring (SFM) or SFM and behavioral rehearsal (SFM + BR). For BR, clinicians engaged in a short role play of an upcoming treatment element. Supervisors delivered both conditions, with regular study monitoring for drift. Clinicians audiorecorded therapy sessions with enrolled clients, and masked coders coded a subset of recordings for adherence to TF-CBT. One hundred and thirty-three clinicians had recorded TF-CBT session data for 258 youth. We examined six adherence outcomes, including potential moderators. Results Results of generalized estimating equations indicated that there were no real differences on adherence outcomes for experimental conditions (SFM, SFM + BR) compared to SAU. Adherence scores in the baseline SAU phase and the RCT conditions were high. Only one interaction was significant. Conclusions Contrary to our hypotheses, we did not see improvements in adherence with the RCT conditions. However, nonsignificant findings seem best explained by clinicians’ acceptable/high adherence in SAU. This study was conducted within the context of a long-standing, state-funded EBT initiative, in which clinicians and their supervisors receive training and support, and in which participating community mental health organizations have adopted and supported TF-CBT. ClinicalTrials.gov ID NCT01800266

Children with conduct problems and elevated callous-unemotional (CU) traits show poor prognosis. We describe a new parenting intervention that combines a behaviorally focused parenting management training intervention (i.e., "Helping the Noncompliant Child" [HNC]; McMahon & Forehand, 2003) with an emotion coaching (EC) intervention (Katz et al., 2020) for young children (3-7 years) with conduct problems and elevated CU traits. The new integrated intervention (HNC-EC) targets the emotional deficits and parenting difficulties in this subgroup of children with conduct problems. Because the two interventions have different theoretical orientations, several conceptually based decisions were made during treatment development to facilitate integration. We describe the emotional and parenting processes targeted by the combined HNC-EC intervention, provide an overview of its content, and describe decision points where differences between basic principles of HNC and EC were addressed.

Evidence-based parenting interventions (EBPI) support children and families to promote resilience, address emotional and behavioral concerns, and prevent or address issues related to child maltreatment. Critiques of EBPIs include concerns about their relevance and effectiveness for diverse populations when they are implemented at population scale. Research methods that center racial equity and include community-based participatory approaches have the potential to address some of these concerns. The purpose of the present review was to document the extent to which methods associated with promoting racial equity in research have been used in studies that contribute to the evidence base for programs that meet evidentiary standards for a clearinghouse that was developed to support the Family First Prevention Services Act in the United States. We developed a coding system largely based on the Culturally Responsive Evaluation model. A sample of 47 papers that are part of the evidence base for ten in-home parent skill-based programs were reviewed and coded. Only three of 28 possible codes were observed to occur in over half of the studies (including race/ethnicity demographic characteristics, conducting measure reliability for the study sample, and including information on socioeconomic status). Although the overall presence of equity-informed methods was low, a positive trend was observed over time. This review highlights ways in which rigorous research can incorporate racial equity into the planning, design, execution, and interpretation and dissemination of programs of study. We posit that doing so improves the external validity of studies while maintaining high-quality research that can contribute to an evidence base.

This study was part of a larger study of Partnering for Success, a federally funded initiative focused on providing evidence-based outpatient mental health treatment to children involved with or at risk for involvement with the child welfare system. With a sample of 782 children, the study explored strategies that therapists can use to reduce racial and ethnic disparities in treatment for behavioral problems in children. The results provide promising evidence that racial and ethnic disparities in treatment receipt for behavioral problems are reduced when therapists administer and adhere to the results of standardized screening instruments and participate in clinical consultation.

of research, clinical, and training activities designed to reduce child maltreatment and enhance child wellbeing.

Ensuring high quality implementation of evidence-based programs (EBP) is critical for achieving outcomes in community-based settings. However, more is known about how to support implementation than is used in practice settings; this is referred to as the implementation gap. This study is the second in a series examining the implementation gap for EBPs relevant to the child welfare system. The purpose of this study was to document the extent to which existing and well-regarded EBPs incorporate pre-implementation readiness supports in their program dissemination process. The sample consisted of 210 different programs on the California Evidence-Based Clearinghouse (CEBC). The pre-implementation materials from these programs were coded to determine extensiveness of pre-implementation readiness supports using an established rubric. Only 40.5

As evidence-based interventions (EBIs) become more widely disseminated, fidelity of implementation (FOI) often wanes. This study explores the association between FOI and malleable variables within classrooms that could be targeted to optimize resources without compromising FOI as school-based EBIs are disseminated across real-world settings. We utilized process evaluation data from a national dissemination project of the Botvin LifeSkills Training (LST) middle school program, a universal prevention intervention shown to reduce substance use. The sample included 1,626 teachers in 371 schools across 14 states. Hierarchical linear models examined the relationship between observational measures of implementation factors and three domains of fidelity (e.g., adherence, student responsiveness, and quality of delivery). Findings suggest that curriculum modifications, student misbehavior, and shortage of time to implement the LST middle school program were factors most associated with lower FOI. Class size, access to program materials, and whether LST was delivered in a traditional classroom setting that is well-suited for instruction (versus in a less structured environment such as the school cafeteria) are less predictive. In scale-up of classroom-based universal interventions targeting behavioral health outcomes, our findings indicate that carefully vetting modifications, supporting classroom management strategies, and ensuring sufficient class time for implementation of highly interactive EBIs such as LST are important considerations. Since changes to EBIs are inevitable, efforts are needed to guide facilitators in making adjustments that improve program fit without compromising the essential intervention activities deemed necessary to produce desired outcomes.

Background The delivery of evidence-supported treatments (EST) in children’s mental health could be a valuable measure for monitoring mental healthcare quality; however, efforts to monitor the use of EST in real world systems are hindered by the lack of pragmatic methods. This mixed methods study examined the implementation and agency response rate of a pragmatic, claims-based measure of EST designed to be applied as a universal quality measure for child psychotherapy encounters in a state Medicaid system. Methods Implementation potential of the EST measure was assessed with healthcare leader rankings of the reporting method’s acceptability, appropriateness and feasibility ( n = 53), and post-implementation ratings of EST rate accuracy. Ability of the healthcare system to monitor EST through claims was measured by examining the agency responsivity in using the claims-based measure across 98 Medicaid-contracted community mental health (CMH) agencies in Washington State. Results The analysis found the reporting method had high implementation potential. The method was able to measure the use of an EST for 83% of children covered by Medicaid with 58% CMH agencies reporting > 0 ESTs in one quarter. Qualitative analyses revealed that the most significant barrier to reporting ESTs was the operability of electronic health record systems and agencies’ mixed views regarding the accuracy and benefits of reporting. Conclusions Measurement of child mental health ESTs through Medicaid claims reporting has acceptable implementation potential and promising real world responsiveness from CMH agencies in one state. Variation in reporting by agency site and low to moderate perceived value by agency leaders suggests the need for additional implementation supports for wider uptake.

Cross-system implementation efforts can support needed mental health (MH) service utilization among children involved in the child welfare (CW) system. The Partnering for Success (PfS) initiative is one such effort that promotes greater collaboration between the CW and MH providers by building capacity within and across each system. Frontline CW providers learn to accurately identify child MH treatment targets, link families to locally-provided evidence-based treatments (EBTs), and monitor treatment progress. Concurrently, local MH providers are trained along with CW workers to utilize Cognitive Behavioral Therapy plus Trauma-Focused CBT (CBT +), a common elements training and consultation approach focusing on typical MH issues for CW-involved children: Anxiety, Depression, Behavioral Problems, and Traumatic Stress. Finally, agency leadership receive support around promoting implementation and sustainment. This paper examines factors identified by participating CW and MH staff which impacted PfS implementation. Twenty-nine frontline, supervisory, and executive CW and MH providers were interviewed via audio-recorded web-based calls in six focus groups and 10 individual interviews. Factors facilitating implementation success included training/consultation, support from supervisors and agency leadership, improved referral processes, high quality relationships and communication between CW and MH frontline staff, PfS tools and resources, opportunities to use PfS, as well as buy-in from providers and families. Implementation barriers included poor communication between CW and MH providers, conflicts over role expectations, workload and turnover challenges, lack of buy-in, as well as provider (e.g., not aligned with CBT +) and client characteristics (e.g., frequent crises).

As U.S. policy and practice further constrains the prevalence of residential treatment for youth with emotional and behavior challenges, treatment foster care (TFC) placements are expected to expand and serve challenging youth who were previously receiving group care placement. Treatment foster parents play an essential role in the delivery of TFC and its potential to be a transformative and healing environment for youth. Using qualitative analysis of semi-structured interviews from 23 experts in TFC practice as well as more general child welfare training and implementation science, this paper seeks to build knowledge around the training and support needs of TFC parents from the perspectives of TFC experts. Findings suggest the importance of TFC parents viewing themselves as treatment providers and not just parents. They need to have competencies specific to working as a member of a treatment team, knowledge of public systems, and skills to manage youth challenging behaviors. Best practices in equipping TFC parents should follow adult learning principles that focus on experiential learning with peer support and ongoing coaching or reinforcement.

There is an implementation gap in which more is known about what works to support implementation than what is done in practice. This paper uses information from programs rated on the California Evidence-Based Clearinghouse (CEBC), a web-based repository of information on the evidence base for programs that serve children and families, to examine the extent of this gap as it relates to the availability of fidelity measurement implementation supports. Fidelity measures and materials supplied during the CEBC data collection process by representatives of programs rated on the CEBC Scientific Rating Scale as having well-supported, supported, or promising research evidence were examined. Over 30% of these programs did not have a fidelity assessment approach. For the rest, using the available data, the program's fidelity characteristics, including source, type, and frequency of use, were coded. The extent to which fidelity supports are incorporated into these programs remains variable. No relationship was found between the level of scientific rating and the existence of fidelity measures. Overall, a range of fidelity strategies were used, including those considered gold standard (e.g., live or video observation). However, rarely are these strategies required. Results underscore the substantial implementation gap as it applies to fidelity measurement.