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Consultation-liaison services are an integral part of many pediatric hospital settings, yet characteristics of this patient population have not been extensively documented. The current study is a retrospective one-year chart review of the consultation-liaison service at a large pediatric hospital in the Southwestern United States. The purpose of this study is twofold: (1) to characterize this hospital’s CL population and (2) to use these characteristics to identify preliminary evidence-based practices that should be considered for CL provider training. Identifying evidence-based practice elements that align with the characteristics of consultation–liaison patient populations may inform trainings for consultation-liaison staff. This would help to ensure that youth seen in hospital consultation-liaison services are getting the best available services, which is critical given the shortened time frame available to work with this patient population.

Successful innovations inevitably evolve over time. Such change presents challenges for implementation, especially given that the contexts interacting with the innovation are evolving too. We discu...

There is strong enthusiasm for utilizing implementation science in the implementation of evidence-based programs in children's community mental health, but there remains work to be done to improve the process. Despite the proliferation of implementation frameworks, there is limited literature providing case examples of overcoming implementation barriers. This article examines whether the use of three implementations strategies, a structured training and coaching program, the use of professional development portfolios for coaching, and a progress monitoring data system, help to overcome barriers to implementation by facilitating four implementation drivers at a community mental health agency. Results suggest that implementation is a process of recognizing and adapting to both predictable and unpredictable barriers. Furthermore, the use of these implementation strategies is important in improving implementation outcomes.

The evidence-base services literature is continually growing, providing the field with rich and important sets of information regarding what works for treating different types of youth and families. Given this burgeoning of information, the PracticeWise Evidence-Based Services (PWEBS) Literature Database has been developed to aid in summarizing and delivering aggregated evidence-based treatment information to providers in the field. Meanwhile, the Child and Adolescent Needs and Strengths-Mental Health (CANS-MH) Scale is a youth mental health assessment tool that was developed by a separate team to assist with treatment planning. In the present study, we developed and tested a system for linking these two related ontological systems so that scientific knowledge can be more widely aggregated and made available to a wider set of audiences for enhanced mental health service delivery. Results revealed the following. First, a construct mapping comparison revealed that the CANS-MH and PWEBS ontologies share a strong core of overlapping content, particularly in the areas of Youth Behavioral/Emotional Needs, Youth Risk Behaviors, and Life Domain Functioning. Second, the CANS-MH areas were able to be used to reliably code the following components of published randomized treatment studies: (a) population sample characteristics (e.g., did the characteristics of the treatment study participant population relate to each CANS-MH area?), and (b) outcome measure targets (e.g., did the treatment study outcome measure target areas relate to each CANS-MH area?). The reliability achieved from this coding process supported the linkage between the CANS-MH areas and the PWEBS Literature Database information. Lastly, high agreement was achieved between an automated translation algorithm and the final ratings from the manual coding of published treatment studies using the CANS-MH scale. The importance of such linkages for the communication of ideas, information, and evidence across differing subfields is discussed, as well as examples of achieving enhanced quality of mental health services by linking system ontologies.

Introduction Strategies are needed to improve the efficacy of paraprofessional home visitors for pregnant women in the United States. This study evaluates the maternal and child outcomes when evidence-based practices (EBP) are replicated with flexibility, rather than fidelity to a manualized intervention. Methods Pregnant mothers (N = 203) in five clinics were recruited in the waiting rooms and randomized to standard clinic care as the control condition (n = 104) or standard care plus home visiting (n = 99). Home visitors (n = 9) were selected, trained in foundational skills common to EBP and four problem domains (weight control, breastfeeding, daily habits, and depression). Independent interviewers assessed targeted outcomes at birth (82%) and 6 months later (83%). Results: Home visitors, called Mentor Mothers [MM], made an average of 14.9 home visits or telephone contacts (SD = 9; total contacts = 1491) addressing maternal daily habits, breastfeeding, and depression. Intervention and control mothers were similar in weight, Body Mass Index (BMI), depression and social support at baseline and 6 months later. The percentage of low birth weight babies was similar; intervention infants’ growth (weight/height Z score) tended to be significantly better compared to the control condition. Discussion: There are many explanations for the failure to find significant benefits: insufficient statistical power; the benefits of repeated assessments by warm, supportive peers to improve outcomes; or the failure of EBP and the need to maintain replication with fidelity. All study mothers had better outcomes than documented among comparable published samples of low-income, Latina and Korean–American mothers in Los Angeles, CA. ClinicalTrials.gov registration NCT01687634.

This paper describes a strategy for using evidence-based interventions (EBI) that does not require replication and fidelity. Eight parents, identified as positive role models, conducted home visits for 101 low-income Latina and Korean pregnant women. The home visitors, called mentor mothers (MM), were trained in 10 of the practice elements common to 80% of child-focused EBI and how to apply these skills to support mothers in obesity prevention, to increase the duration of breastfeeding, and to reduce depression. MM reported the content and skills utilized on each home visit on mobile phones. Each MM made an average of 153 home visits (SD=173.3), with 28 of these visits being phone contacts. Body mass index (BMI) at 6months was significantly associated with the frequency of MM focused on coping with depression (r=.24), but was not related to practice elements used by MM. The duration of breastfeeding was significantly related to the frequency with which MM focused on the topic of breastfeeding (r=.28) and parenting (r=.3), and MM use of attending (r=.24) and relaxation (r=.27). Depression was significantly correlated with the frequency of addressing depression (r=.27), but not to practice elements. MM did use different strategies in the first 150 visits compared to their last 150 visits, reflecting data-informed supervision. Evidence synthesized from EBI was used as a novel training method, with real-time monitoring and data-informed supervision providing evidence of iterative quality improvements in MM behaviors over time, as well as a way for linking implementation processes to outcomes.

The Patient Protection and Affordable Care Act (ACA, 2010) will have a remarkable impact on mental health services, yet enormous implementation challenges exist. This commentary examines some of the issues related to workforce development and performance measures raised by Chor, Olin, and Hoagwood (2014). In particular, we examine inefficiencies related to the Mental and Behavioral Health Education and Training Grants, current training models, national initiatives to identify consensus quality indicators, and electronic health records. We highlight opportunities for psychology to lead effective reform by developing efficient training and knowledge architectures.

We describe the scaling up of an evidence-informed model of care, Managing and Adapting Practice (MAP) in Los Angeles County, California. MAP complemented an array of evidence-based programs selected by the county as part of a large system reform effort designed to improve care for children and adolescents. In addition, we discuss the MAP model for training therapists and present data both on how the training model performed and on the outcomes of youths treated by therapists trained in MAP. We examined the success of two different training pathways for MAP therapists: (a) national training model and (b) MAP agency supervisor model (i.e., train the trainer). We also examined utilization of MAP and outcomes of clients served by MAP. Both the national training and MAP agency supervisor model were successful in producing MAP therapists in a timely fashion and with acceptable competency scores. Furthermore, a large number of clients were receiving MAP services. Finally, outcomes for youth treated with MAP were strong, with effect sizes ranging from .59 to .80 on the Youth Outcome Questionnaire. These data support the notion that scaling up a mental health services approach in a system can be achieved through a strong and broad partnership among relevant stakeholders, can involve a train-the-trainer model, and can result in strong outcomes for clients.

Using the distillation component of the Distillation and Matching Model framework (Chorpita, Daleiden, & Weisz, 2005 ), we examined which engagement practices were associated with three domains of treatment engagement: attendance, adherence, and cognitive preparation (e.g., understanding of, readiness for treatment). Eighty-nine engagement interventions from 40 randomized controlled trials in children' s mental health services were coded according to their engagement practices and outcomes. Analyses examined whether the practices used in successful interventions differed according to engagement domain. Practice patterns differed somewhat depending on whether attendance, adherence, or cognitive preparation was the outcome of interest. For example, assessment of barriers to treatment frequently occurred in successful interventions targeting attendance, whereas homework assignment frequently occurred in successful interventions when adherence was the target outcome. Modeling and expectation setting were frequently used in successful interventions targeting cognitive preparation for treatment. Distillation provides a method for examining the practice patterns associated with different engagement outcomes. An example of the application of these findings to clinical practice includes using certain practices (e.g., assessment, psychoeducation about services, and accessibility promotion) with all youth and families to promote attendance, adherence, and cognitive preparation. Then, other practices (e.g., modeling, homework assignment) can be added on an as-needed basis to boost engagement or to address interference in a particular engagement domain. The use of a distillation framework promotes a common language around engagement and highlights practices that lend themselves well to training, thereby promoting the dissemination of engagement interventions.

The current study examined the extent to which usual care interventions targeting childhood traumatic stress involved the application of practice elements (Chorpita, Daleiden, & Weisz, 2005) represented among the evidenced-based treatments (EBTs) for trauma. Youth age and the presence of conduct problems at intake were examined as potential predictors of differences in the presence of elements from EBTs. Data were obtained from archival records from 814 youth who received services from a large, community-based mental health system. Results showed that usual care clinicians reported a variety of practices, only some of which were common to the evidence base for traumatic stress. ‘Exposure’ stood out as the most common practice element among EBTs for treating traumatic stress, but it was reported in fewer than a quarter of usual care cases. For youth receiving out-of-home services, a diagnosis of PTSD predicted that fewer practice elements from EBTs for trauma were reported. Also, as youth age increased, clinicians reported using more practice elements from the evidence base. These findings point to possible opportunities for service improvement in usual care settings for trauma-exposed youth and at the same time call into question whether aspects of the context or population warrant increased use of techniques not associated with EBTs for traumatic stress (cf. Brookman-Frazee, Haine, Baker-Ericzen, Zoffness, & Garland, 2010; Southam-Gerow, Chorpita, Miller, & Gleacher, 2008).

OBJECTIVE This article reports outcomes from the Child STEPs randomized effectiveness trial conducted over a 2-year period to gauge the longer term impact of protocol design on the effectiveness of evidence-based treatment procedures. METHOD An ethnoracially diverse sample of 174 youths ages 7- 13 (N = 121 boys) whose primary clinical concerns involved diagnoses or clinical elevations related to anxiety, depression, or disruptive behavior were treated by community therapists randomly assigned to 1 of 3 conditions: (a) standard, which involved the use of 1 or more of 3 manualized evidence-based treatments, (b) modular, which involved a single modular protocol (Modular Approach to Treatment of Children With Anxiety, Depression, or Conduct Problems; MATCH) having clinical procedures similar to the standard condition but flexibly selected and sequenced using a guiding clinical algorithm, and (c) usual care. RESULTS As measured with combined Child Behavior Checklist and Youth Self-Report Total Problems, Internalizing, and Externalizing scales, the rate of improvement for youths in the modular condition was significantly better than for those in usual care. On a measure of functional impairment (Brief Impairment Scale), no significant differences were found among the 3 conditions. Analysis of service utilization also showed no significant differences among conditions, with almost half of youths receiving some additional services in the 1st year after beginning treatment, and roughly one third of youths in the 2nd year. CONCLUSIONS Overall, these results extend prior findings, supporting incremental benefits of MATCH over usual care over a 2-year period.

This study compared consistencies and discrepancies in usual care with practices derived from the evidence-base (PDEB) for youth anxiety in a public mental health system. Youth-level factors (diagnosis, functional impairment) as predictors of the discrepancies were also examined. Psychosocial and service data from 2485 youth with an anxiety disorder and/or receiving services for an anxiety treatment target were extracted. Therapists (N = 616) identified the treatment targets and practices youth received. Although many PDEB for youth anxiety were used by therapists in this sample, Exposure was only used in 15% of cases. Practices not consistent with youth anxiety treatment were also reported and included: PDEB for other conditions, practices common to all therapies, and practices that are not consistent with evidence-based care. Age and diagnosis predicted the delivery of PDEB for youth anxiety. Usual care incorporated many components of evidence-based care but was more diffuse and less focused on well-supported practices.

Kazdin and Blase (2011) propose that traditional models of delivering therapy require more resources than are available to address the scope of mental illness. We argue that finding new platforms and avenues for our existing treatments is a good start but that it is not enough. We contend that the field also needs to develop formal strategies to reorganize its increasing abundance of knowledge to address the scarcity of resources for its application. If we can better utilize our existing knowledge, treatment delivery and service resource allocation can become more efficient and effective. If the field continues with its almost singular emphasis on knowledge proliferation (e.g., developing new treatments), as opposed to knowledge management (e.g., developing new ways to design, apply, and organize existing treatments), the problem outlined by Kazdin and Blase cannot be solved.

[Clin Psychol Sci Prac 18: 24–35, 2011] This article provides a follow-up account of efforts associated with a statewide initiative established 10 years ago for identifying and implementing effective treatments for child and adolescent mental health concerns. The manner in which this initiative has evolved and endured within a complex public mental health service infrastructure may provide some important insights and even optimism about the application of science in public sector settings. This 10-year history illuminates the benefits and challenges of maintaining a community-based mechanism for the integration of science and practice. As reported here, such collaborative efforts can produce new ways to conceptualize scientific evidence, overcome interdisciplinary barriers, catalyze other progressive initiatives, and generate a guiding vision for public mental health for youth.

Within a comprehensive mental health service array for youth, Intensive Home Based Services (IHBS) are designed to meet the needs of youth with significant emotional and behavioral problems in their home communities, avoiding the need for out-of-home services, particularly residential care. We examined youth receiving IHBS as their first service in the state of Hawaii system of care (N = 163) to determine how successful IHBS were in preventing the need for more restrictive services within 12 months of intake. Subsequently, we investigated characteristics that might be predictive of a youth’s need for service intensification within 12 months. Logistic regression analyses found that greater age, level of service need, and functional impairment at intake predicted use of more restrictive services within 12 months of intake, whereas gender, ethnicity, diagnosis, service intensity, and clinician credentials did not. Overall, our findings suggested that IHBS were reasonably successful in preventing residential placements, and provided some basis for determining characteristics of youth likely to require more restrictive placements within a one year period.

The present study examined youth characteristics that predict level of impairment at entry into a system of care and rate of improvement over the course of service provision. Youth characteristics studied included gender, age, specific diagnostic categories, and comorbidity. A total of 2,171 youth served in a state-wide public mental health system were included in the study. Hierarchical linear modeling was used to analyze longitudinal data derived from quarterly ratings of functional status. Gender had no relationship to initial level of impairment or rate of improvement. Older youth, those with disruptive behavior disorders, and those with more than one DSM diagnosis were more impaired at system entry. Those with attentional disorders began services less impaired. Older youth improved at faster rates. Youth with a disruptive behavior disorder diagnosis improved at slower rates. Neither comorbidity nor the presence of a mood or attentional disorder affected the rate of improvement. Both researchers and systems of care developers should consider these patterns in their future work.

We examined client outcomes from the implementation of Multisystemic Therapy (MST) in a statewide child and adolescent mental health system. Specifically, we examined (1) the validity of therapist-rated MST outcome measures by comparing them to ratings of functional impairment and level of service needs by CAMHD care coordinators, who provide case management and care coordination services, (2) potential client and service predictors of therapist-rated outcomes, and (3) improvement in youth functioning around the time of entry to and exit from MST compared with rates of improvement reported in randomized controlled trials (RCTs) by the developers of MST. Results suggested that therapist-rated MST outcomes were valid indicators of treatment success. Similar to other findings in the MST literature, few client or service characteristics predicted these outcomes. Finally, although MST entry–exit effect sizes were lower than the mean derived from RCTs published by the developers, they were within the 95% confidence interval. Together, these findings support the implementation of MST in complex systems of care with continued attention to quality assurance and ongoing use of data for evaluation.

This paper illustrates the application of design principles for tools that structure clinical decision-making. If the effort to implement evidence-based practices in com- munity services organizations is to be effective, attention must be paid to the decision-making context in which such treatments are delivered. Clinical research trials commonly occur in an environment characterized by structured deci- sion making and expert supports. Technology has great potential to serve mental health organizations by supporting these potentially important contextual features of the research environment, through organization and reporting of clinical data into interpretable information to support deci- sions and anchor decision-making procedures. This article describes one example of a behavioral health reporting system designed to facilitate clinical and administrative use of evidence-based practices. The design processes underly- ing this system—mapping of decision points and distillation of performance information at the individual, caseload, and organizational levels—can be implemented to support clinical practice in a wide variety of settings.

Science has fostered renewed optimism in mental health practice over the last decade through advances in the development of treatment supported by research (Kazdin and Weisz, 2003; Task Force on Promotion and Dissemination of Psychological Procedures, 1995; Wilson, 1995). The challenge that continues to confront both the scientific and applied domains of psychology and psychiatry is the widespread promotion and implementation of empirically supported treatments in general, and in children_s mental health in particular (Barlow, 2000; Chorpita et al., 2002; Schoenwald and Hoagwood, 2001; Weisz et al., 1995). With more than 500 documented treatments available for children and adolescents (Kazdin, 2000), how do practicing clinicians begin to identify the appropriate evidence-based interventions for their clients? On the one hand, it would appear that practitioners could consult the literature to learn more about efficacious interventions for particular problem areas. On the other hand, the increasing proliferation of guidelines, lists, and definitions that has followed has been rather complex (e.g., Chorpita et al., 2002; Lonigan et al., 1998; Schinke et al., 2002; Weisz, 2003), and in some ways has paradoxically increased the complexity of identifying Bbest candidate[ interventions for treating children_s disorders. Contributing to the complexity of identifying evidence-based interventions is ambiguity surrounding the meaning of the term Bevidence-based.[ Traditionally, albeit a recent tradition, the term has denoted specific treatment protocols with a particular degree and type of empirical support (e.g., Chambless and Hollon, 1998). Thus, the Bmanualization[ of interventions (e.g., Coping Cat, Kendall, 1990; Defiant Children, Barkley, 1997) has lent itself to a method of defining evidence-based treatments. At this manual level of analysis, practitioners may choose from a variety of specific treatment programs that have demonstrated their efficacy in research trials. However, evidencebased, manualized treatments often have overlapping strategies, and it is difficult for practitioners to determine the relative appropriateness of one given treatment manual over another for particular clients and situations (Kazdin et al., 1990).

We select and comment on concepts and examples from the target articles in this special issue on measurement feedback systems, placing them in the context of some of our own insights and ideas about measurement feedback systems, and where those systems lie at the intersection of technology and decision making. We contend that, connected to the many implementation challenges relevant to many new technologies, there are fundamental design challenges that await a more elaborate specification of the clinical information and decision models that underlie these systems. Candidate features of such models are discussed, which include referencing multiple evidence bases, facilitating observed and expected value comparisons, fostering collaboration, and allowing translation across multiple ontological systems. We call for a new metaphor for these technologies that goes beyond measurement feedback and encourages a deeper consideration of the increasingly complex clinical decision models needed to manage the uncertainty of delivering clinical care.

Objective This study empirically examined options for building an evidence-informed service array, comparing strategies to maximize the application of evidence-based treatment literature in a clinical service system. The overall goal was to determine the smallest set of treatments that could serve the largest percentage of clients. Solutions to this problem differ depending on how one defines "treatment." Method Treatments were conceptualized as (a) programs (integrated treatments produced by specific research laboratories or investigators), and (b) collections of their constituent common procedures, referred to as practice elements. Programs listed by 2 separate government-sanctioned registries were selected to illustrate the effects of "program" conceptualizations, and all available clinical trials testing the programs were analyzed. Practice elements were identified from these same studies and from studies of other treatments that met a standard of evidence but had not been organized into programs on these lists. Relevance mapping methodology was used to identify optimal sets of programs and practice elements. Results Among a large, diverse clinical population, results identified 11%-22% of youths for whom practice elements provide an evidence-informed treatment option whereas no programs meeting the standard of evidence were available on the registries. Results for the practice elements were able to be matched by a hybrid combination: "best" programs, which were then extended by practice elements. Conclusions These results demonstrated that there are multiple ways to conceptualize treatments when planning a service array, and these options have significant implications regarding who can be served by treatments supported by evidence.

Diversity is a hallmark of behavioral health care systems. Many different people, with many different backgrounds and interests, are involved in many different activities through many different human organizations. Given this diversity, it is not surprising that multiple conflicting views emerge about how limited resources should be distributed, who should be served, and what services should be provided. Among this diversity, one common rallying point is the notion that when services are provided, better quality of life should result. During the past 10 years, public mental health services for children and youths in Hawaii experienced a major system restructuring. The five current goals of the Department of Health Child and Adolescent Mental Health Division (CAMHD) strategic plan are shared ownership, accountable business practices, system of care principles, evidence-based practices, and performance evaluation (Child and Adolescent Mental Health Division, 2003). Before the system reform, child and adolescent mental health services in Hawaii were generally delivered through a direct service model by small teams at regional guidance centers. At present, CAMHD orchestrates a public-private collaboration with eight regional public family guidance branches providing care coordination and administrative services and approximately 35 contracted private provider agencies delivering the majority of direct care. The comprehensive system of care framework, which was locally demonstrated through the federally funded Ohana project, is the statewide model for delivery of intensive mental health services, except on the island of Kauai, where an integrated schoolbased program is used. Elsewhere, educationally supportive, less intensive (e.g., day treatment), and outpatient services are arranged through the schoolbased behavioral health program of the Department of Education. For the Medicaid-eligible population, less intensive and outpatient services are provided through the state-contracted health plans. This latest reorganization was largely completed in 2002. A major evidence-based services initiative was implemented following the initial development of the system of care (Table 1; see Chorpita and Donkervoet, 2005). Approximately 5 years into the system of care reform, an evaluation identified marked increases in the number of youths accessing services, as well as the amount, types, and total cost of mental health services. In addition, qualitative analyses identified weaknesses in the provider array in the form of undesirable use of restrictive levels of care (e.g., serving youths with conduct disorders in hospital settings) and use of therapeutic approaches with uncertain efficacy. It was unclear whether this expanded investment was associated with better child and family functioning. To move forward, system leaders initiated quarterly quantitative child status assessments and explored large-scale dissemination of evidence-based services as an initiative Accepted January 5, 2006. Drs. Daleiden and Arensdorf, Ms. Brogan, and Ms. Donkervoet are with the Hawaii Department of Health Child and Adolescent Mental Health Division, Honolulu; and Dr. Chorpita is with the Department of Psychology, University of Hawaii at Manoa, Honolulu. This project was funded with state general funds through the Hawaii Department of Health Child and Adolescent Mental Health Division. The findings described in this column were produced through the collaborative efforts of countless youths, families, and professionals who contribute to the Hawaii system of care for child and adolescent mental health. Correspondence to Dr. Eric Daleiden, 3627 Kilauea Avenue, Room 101, Honolulu, HI 96816; e-mail: eldaleid@camhmis.health.state.hi.us. 0890-8567/06/4506-0749 2006 by the American Academy of Child and Adolescent Psychiatry. DOI: 10.1097/01.chi.0000215154.07142.63 E V I D E N C E B A S E D P R A C T I C E Assistant Editor: John D. Hamilton, M.D., M.Sc.

Background: Population and service characteristics were compared for youth (age 3–18 years) with and without schizophrenia-spectrum disorders, who received public mental health services in Hawaii’s comprehensive system of care between July 1, 2000 and June 30, 2001. Methods: Electronic records of youth with a diagnosis in the schizophrenia-spectrum (n ¼ 71) were compared to all other youth (n ¼ 13,904) who received services with respect to age, gender, ethnicity, comorbidity, type of service, and service cost. Results: The schizophrenia-spectrum group had higher Asian representation, greater comorbidity, and was more likely to receive restrictive services for a higher average annual expense. When restrictive services were provided, they were of similar duration and intensity across groups. Almost all youth received less intensive services, but the schizophrenia-spectrum group received a higher frequency or longer duration of such services. Conclusions: Although youth with schizophrenia-spectrum disorders were uncommon, collectively they represented a distinct population with above average service consumption. Future monitoring of interventions and outcomes may help develop systematic and effective treatment strategies for youth with schizophrenia-spectrum disorders. Keywords: Schizophrenia spectrum, services, demographics.

This paper introduces the concept of modularity as an approach to therapeutic protocol design and application. Modularity is defined in terms of four key properties, and a detailed example of a modular psychotherapy protocol is presented. By explicitly outlining clinical strategies and algorithms, modular design of psychotherapy protocols provides a promising framework for testing many of the assumptions underlying traditional therapy protocols. Modular design also offers numerous potential advantages in terms of design efficiency (reusability of modules, ease of updating or reorganizing protocols) and effectiveness (e.g., greater adaptability for applied contexts, increased therapist satisfaction). Finally, preliminary evidence for the efficacy of modular protocols is encouraging, and suggests that such design should preserve and could even enhance the efficacy of existing therapy protocols.

A model is proposed whereby the intervention literature can be empirically factored or distilled to derive profiles from evidence-based approaches. The profiles can then be matched to individual clients based on consideration of their target problems, as well as demographic and contextual factors. Application of the model is illustrated by an analysis of the youth treatment literature. Benefits of the model include its potential to facilitate improved understanding of similarities and differences among treatments, to guide treatment selection and matching to clients, to address gaps in the literature, and to point to possibilities for new interventions based on the current research base.

Recurrent abdominal pain is associated with a host of adverse social and financial consequences. Theoretical models have suggested numerous psychosocial factors that may contribute to the formation and maintenance of recurrent abdominal pain. To date, studies comparing groups with organically and nonorganically based pain on psychosocial variables have yielded inconsistent results. Adolescents diagnosed with organic (n = 25) and nonorganic (n = 24) abdominal pain and a control group of siblings of children with chronic constipation (n = 19) were compared on psychological, behavioral, and familial dimensions. Adolescents with nonorganic abdominal pain reported a significantly higher frequency of related symptoms than both com- parison groups. However, groups did not significantly differ on adolescent or maternal-reported measures of anxiety, locus of control, life events, family environment, or behavior problems. Greater methodological rigor and selection of control group participants who shared the contex...

The enduring needs of our society highlight the importance of a shared vision to improve human functioning and yield better lives for families and communities. Science offers a powerful strategy for managing the inevitable uncertainty in pursuit of these goals. This article presents ideas and examples of methods that could preserve the strengths of the two major paradigms in children's mental health, evidence-based treatments and individualized care models, but that also have the potential to extend their applicability and impact. As exemplified in some of the articles throughout this issue, new models to connect science and service will likely emerge from novel consideration of better ways to structure and inform collaboration within mental health systems. We contend that the future models for effective systems will involve increased attention to (a) client and provider developmental pathways, (b) explicit frameworks for coordinating people and the knowledge and other resources they use, and (c) a balance of evidence-based planning and informed adaptation. We encourage the diverse community of scientists, providers, and administrators in our field to come together to enhance our collective wisdom through consideration of and reflection on these concepts and their illustrations.

The current study examines targets of treatment and intervention strategies of youths with and without schizophrenia–spectrum diagnoses utilizing services within a state public mental health system of care. Service records of youths with schizophrenia–spectrum diagnoses were compared to all other youths receiving services. Specific treatment targets and techniques were more frequently reported in the spectrum group relative to the non-spectrum group. This research on targets of treatment and specific treatment strategies offers preliminary insight into common goals of treatment and clinical practices employed in this under studied population.

Two studies were performed to examine the presence and stability of specific recommendations for treatment practices in a system of care. Study 1 evaluated the reliability of an instrument designed to quantify specific elements of treatment planning documents. Study 2 used reliably coded data from Study 1 to assess stability of treatment practices and targets across the treatment planning process. This study indicated a generally low level of agreement of between documents, with many specific recommendations being dropped between stages of planning. The implications of these findings and the potential for future research are discussed.

The goal of this article is to illustrate various strategies that the Hawaii Child and Adolescent Mental Health Division (CAMHD) adopted to increase the use of empirical evidence to improve the quality of services and outcomes for youth. We operate from the premise that evidence-based decision making extends beyond the use of treatment outcome literature to inform decisions regarding treatment selection. We elaborate a list of common clinical decisions, discuss multiple evidence bases that may inform these decisions, and use a model of the phases of evidence to illustrate multiple quality improvement strategies used within the Hawaii system of care for youth. This article provides a broad overview to various quality initiatives for promoting evidence-based practices rather than indepth discussion of any specific strategy.

Given the impressive amount of knowledge relevant to prevention efforts, this paper articulates strategies to capitalize on such knowledge through evidence-based decision making. Knowledge, or "evidence," is understood here as coming from multiple sources, including research, individual people, group history, and relevant theory. The presented strategies to facilitate evidence-based decision making are: (1) intervention knowledge management; (2) collaborative design; (3) knowledge resources for intervention; and (4) developmentally sensitive training and supervision. Examples and benefits are outlined for each strategy. It is ultimately argued that evidence-based decision making embodies the scientific approach, and is worth consideration within primary prevention, given its early success in secondary intervention of youth mental health.