• By Dartington SRU
  • Posted on Thursday 31st May, 2012

The ivory tower’s most profitable exports

As child abuse and neglect costs developed nations billions every year, scientists claim they are developing interventions that can help to limit and repair the damage to families and children. The need is great. The potential is great. But the value of university research is limited unless interventions can be exported from the lab to the community. In a study of one evidence-based intervention, two US scientists propose three factors critical to success when transporting interventions out of the research clinic and into mainstream practice.The first is to ensure that all partners, whether researchers, commissioners, managers, implementers or practitioners, value each other’s expertise and differing perspectives. The second is to anticipate and address the potential challenges of implementation. And the third is to establish an enduring commitment across the systems and to give credence to the strengths of diverse organizations.Sheree Toth, Director of the Mt. Hope Family Center at the University of Rochester, and her graduate student Julie Gravener, explain how these three factors have been critical to establishing that Child-Parent Psychotherapy (CPP) works not only when delivered in the tightly controlled conditions of the research lab, but also when presided over by community agencies in frontline practice. Building Healthy Children: three critical factors in actionThe focus of Toth and Gravener’s paper, published in Child and Adolescent Mental Health, is on their collaboration with community partners in Rochester, New York, under an initiative known as “Building Healthy Children” (BHC). “Born out of recognition that community child welfare services had become focused on treatment rather than prevention,” the aim of the initiative was to prevent maltreatment and maladaptive parenting among young mothers living in poverty. Child-Parent Psychotherapy was among several programs provided as part of the BHC initiative. Child-Parent Psychotherapy (CPP) is a clinical intervention for children from birth to five years who have experienced, or are at serious risk of experiencing, abuse or neglect. Typically such children will display significant emotional and behavioral problems as a result of the dysfunctional relationship they have with their maltreating parents. The mechanics of CPP build on the knowledge that improving a parent’s ability to relate to their child in an adaptive, nurturing way builds the foundation of a positive bond between parent and child. This enables the child to feel safe and secure, and to be less stressed, which in turn improves both their behavior and emotions. The intervention has been shown to be effective in several randomized controlled trials and this most recent study suggests that it is possible to obtain positive outcomes for children and parents when using CPP in community settings. The BHC experience yielded useful learning for those taking steps to combine academic knowledge with community expertise in the development and implementation of evidence-based interventions. In Toth and Gravener’s view, there are three factors critical to ensuring the success of the process.1 - All partners valued each other’s expertise and differing perspectives“Exporting and evaluating an evidence-based model of therapy to the community requires considerable compromise,” the authors say. For example, the Building Healthy Children research team initially proposed a wide-ranging battery of measures and data collection techniques to assess CPP’s impact on outcomes for children and families in the study. But they had to re-think their approach when their collaborators, drawing on their experience in the community, expressed concerns that mothers would drop out of the program if confronted with such a high level of assessment. 2 - Implementation challenges must be anticipatedAnother critical factor is the anticipation of potential problems related to the implementation of the evidence-based program in real-world settings – problems such as infidelity to the core model. “These concerns were avoided in the BHC project by ensuring proper administrative structure to support the implementation of CPP,” according to Toth and Gravener. This included ensuring that therapists had reasonable caseloads and ongoing clinical supervision - both key factors in retaining program fidelity. Without structures in place to head off problems, poor implementation can make programs ineffective or even detrimental to child and family outcomes.3 - Enduring commitment across systems and the ability to recognize and build on the strengths of diverse organizationsUnsurprisingly, trust and commitment also proved to be crucial. Toth and Gravener explain that “the BHC initiative reflects a culmination of over two decades of discussions and the development of trust among Mt. Hope Family Center, a university-based facility, and community service providers, government, and private funding sources. It is clear that such effective partnerships are possible, but that enduring commitment across systems and the ability to recognize and build on the strengths of diverse organizations are integral to success.”It is clear that the rate at which research knowledge is developed in the ivory tower far exceeds the speed at which that knowledge is applied in practice, to the disadvantage of children and families who could benefit from logical, thoroughly tested, evidence-based interventions. Toth and Gravener call for researchers to frame research questions and design studies with the goal of application in mind. They urge the scientific community to be open to feedback from those implementing interventions in the field. Their final word is this: mutual respect and openness to growth across academic and community systems must be fostered if we are to translate research into practice.********Reference: Toth, S., & Gravener, J. (2012). Review: Bridging research and practice: relational interventions for maltreated children. Child and Adolescent Mental Health. DOI: 10.1111/j.1475-3588.2011.00638

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