Category: Improved Use of Research Evidence
Kimberly Becker, Ph.D. (she/her/hers)
Associate Professor
University of South Carolina
Chapin, South Carolina
Bruce Chorpita, Ph.D. (he/him/his)
Professor
University of California Los Angeles
Los Angeles, California
Jacqueline Persons, Ph.D. (she/her/hers)
Director
Oakland CBT Center/UC Berkeley Department of Psychology
Oakland, California
Kimberly Becker, Ph.D. (she/her/hers)
Associate Professor
University of South Carolina
Chapin, South Carolina
Eleanor Wu, M.A. (she/her/hers)
Graduate Student
University of South Carolina
Columbia, South Carolina
Bruce Chorpita, Ph.D. (he/him/his)
Professor
University of California Los Angeles
Los Angeles, California
Meredith Boyd, M.A. (she/her/hers)
Graduate Student
University of California Los Angeles
Ann Arbor, Michigan
Wendy Chu, M.A. (she/her/hers)
PhD Student
University of South Carolina
San Francisco, California
This symposium features five presentations summarizing more than 15 original research studies emanating from the Reaching Families portfolio, a multisite collaboration sponsored by the William T. Grant Foundation to investigate supervision and treatment quality, proximally focused on improving how evidence informs clinical decision and actions, with the ultimate aim of improving treatment engagement in community mental health for youth and families. The series opens with a discussion of the design of a Coordinated Knowledge System (CKS) that emphasized guided reasoning across a case, rather than focusing primarily on practice fidelity within any given treatment event. The system design and its underlying reasoning model involved articulating controlled vocabularies of engagement problems and practices, as well as documenting problem-practice relationships from 50 published clinical trials. Of note, we share new findings about a 5-factor model of engagement dimensions (Relationship, Expectancy, Attendance, Clarity, Homework; REACH), tested in a sample of 1,807 primarily Hispanic American and African American/Black youth participating in school-based mental health services. The REACH dimensions served as an organizing framework for literature synthesis and practice delivery throughout all of our studies, and these dimensions and their associations with a defined set of practices were embedded into all of the CKS resources. The second presentation showcases an extensible and generalizable new measurement strategy for detecting high-order service activities (e.g., reviewing, planning, preparing, implementing, monitoring) across multiple contexts, and reliability finding are presented based on double-coded transcripts and chart notes from 213 digitally recorded supervision and treatment events. The third presentation represents the official public unveiling of the implementation outcomes from the flagship Reaching Families study: a large multisite cluster randomized clinical trial testing the CKS against a Practice Guidelines (PG) control condition on provider service quality observed in supervision and treatment, situated in the context of three school-based mental health organizations in Los Angeles and South Carolina, serving diverse communities facing multiple social and structural disadvantages. The fourth presentation then drills down on some key insights gained from our detailed coding of 640 supervision events and 425 linked treatment events across 221 cases, outlining specific mechanisms for how supervision drives treatment, how supervision changes over time, and how structures for managing supervision processes are perceived by mental health providers. The fifth and final presentation will highlight several novel and potentially disruptive findings on the topic of treatment engagement, making a larger case for accelerating a research agenda for this critical limiter of the social impact of evidence-based care. Finally, our discussant will synthesize the talks, with an emphasis on clinical reasoning and case formulation approaches that emphasize empirically-informed decision making in the face of the emergent and dynamic challenges ubiquitous in community mental health settings.