When you need to translate, communicate!

Concerns about mental health figure prominently and too frequently in all aspects of child welfare.

In one US study, it was found that approximately 50% of children between the ages of two and 14 involved with the child welfare system were within “clinical range” on the Achenbach Child Behaviour Checklist for emotional or behavioral problems.

By a similar reckoning, in the Midwestern state of Missouri, more than a third of 17-year-olds in the foster care system had a psychological disorder.

All of the US evidence suggests that children in foster care are as much as five times more likely to have emotional or behavioral disorders than those in general community-based samples.

To address this epidemic, in the Los Angeles Unified School District (the second largest in the US) Erin Maher and colleagues used an evidence-based program called Cognitive Behavioral Intervention for Trauma in Schools [1] to attempt to reduce symptoms, build resilience, and increase peer and parent support.

The outcome of this effort is yet to emerge, but important lessons learned about the attempt to adapt an evidence-based program to a child welfare population are already published – and they confirm a series of increasingly familiar translation research principles.

First, when encouraging separate systems to work together – in this case the child welfare system and a school district – it is critical that representatives of both are involved in the planning of the project right from the start.

Second, the only thing more important than communication is regular and consistent communication. Using a protocol across and within systems is a vital component of keeping everyone on board and committed.

Third, rolling out an evidence-based program into a child welfare context calls for an iterative process to identify participants, notify relevant parties, obtain consent and reach a common understanding.

Fourth, if implementation in different contexts or with different populations is to be successful, routines are needed for making and adjusting adaptations.

It follows, fifthly, that any adaptations must be carefully accommodated that in time the program becomes more versatile and damaging iatrogenic effects are avoided.

With rigorous evaluation come three more hurdles. One is the need to identify a large sample across a well dispersed population – a time consuming and resource-intensive process.

It also requires the approval of each system’s policy and procedures committee or its equivalent, and involves significant data collection and personnel costs.

Beyond that, the report suggests, it is a matter of continuous practice and training.

See: Maher E J, Jackson L J, Pecora P J, Schultz D J, Chandra A and Barners-Proby D S (2009) “Overcoming challenges to implementing and evaluating evidence-based interventions in child welfare: A matter of necessity,” Children and Youth Services Review, 31, pp 555-562.

[• For more about today’s picture see, Portraits of Autumn in peril win UK photo scholarship [2]]