The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO. Final Outcomes Report. Initiative 341.

Transcription

1 The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO Final Outcomes Report Initiative 341 Initiative Title: Using the Maltreatment and Adolescent Pathways (MAP) Project as a Foundation for Child and Youth Mental Health Knowledge Translation Principal Investigator: Dr. Chris Wekerle

2 1. Summary report on how the initiative goals and objectives have been met, as well as a summary of the outcomes/deliverables achieved over the award term. The objective of this initiative was to use the existing Maltreatment and Adolescent Pathways (MAP) dataset (funded by The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO and The Canadian Institutes of Health Research) as the basis for the development of a knowledge translation (KT) portal that supports the actualization of evidencebased practice for front-line, supervisory, administrative, policy-maker stakeholders in the child welfare service sector. With respect to supporting evidence-based practice, this initiative was designed to support the development of a website and website-specific KT products that would: (a) Support an evidence basis for end-user readiness for mental health KT via an end-user web -usage survey (see Results Section below) (b) Support the transfer of initiative-produced products to the CHEO Centre s website, as well as the Centre s KT strategic plan (i.e., product development). (c) Collect initial usage statistics. The MAP-KT portal partners with existing Ontario-wide reach of child welfare staffers by having the portal hosted on the Ontario Association of Children s Aid Societies (OACAS) member website. The OACAS has a restricted members-only website, with pre-approved users, reaching over 50,000 members. The cost of the OACAS website servers is an in-kind contribution to this initiative. The MAP Project Research Advisory Board, which meets every month to two months, provided an initial reference group for the development of the website. The MAP Project Advisory Board has representatives from Toronto Children s Aid Society (CAS), Toronto Catholic CAS, and Peel Region CAS, including supervisors and front-line staff members. Input of the MAP Project Research Advisory Board is an in-kind contribution. The MAP Project Research Staff provided demonstrations, incorporated feedback, provided broader training to selected groups, surveyed CAS staff members on web-usage, and had planning meetings with OACAS, Toronto CAS, CCAS, and Peel staff IT persons. The MAP-KT portal serves a critical communication function via its links to individual agency intranets, which enhances ease of access and provides the only conduit where cross talk among CAS agency staffers can take place. The MAP-KT website generates its own database with all MAP products creating searchable and automatic linkage archives. The MAP-KT portal, in being university-based, provides an otherwise unavailable service in using a widely-available and known search engine (i.e., Google Scholar) to identify peerreviewed scholarly literature and provide (a) a request function to retrieve a PDF of selected articles and (b) a request function that provides a researcher s summary of up to 3 selected articles.

3 The MAP-KT website homepage is formatted along an electronic magazine concept with multimedia materials (ipod video and audio casts), a MAP Research Project product box (which can also accommodate other relevant study product boxes, such as the Canadian Incidence Study on Reported Child Abuse & Neglect), RSS feeds from high quality relevant mental health sources, etc. As of the completion of this final report, the MAP KT website has been designed and fully implemented. It consists of five main sections: (1) A research/clinical practice web-log that encourages discussion of current topics in child welfare and mental health, as well as highlight broad/high interest cultural materials (written by Dr. Wekerle, Dr. Goldstein, both Ph.D.s in clinical psychology and MAP Project Research staff); (2) A scholarly article search function that is designed to source high impact and highly relevant articles in a chosen area of child welfare and mental health (i.e., tagged search word child maltreatment to all inputted searches) (3) A best-practice search function that provides guidelines, screening and assessment, and recommendations in a number of areas within adolescent mental health and health in general, with attached PDFs on (a) guidelines (b) screening tools and (c) recommendations; (4) An outcomes statistics section that compares functioning of child welfare youth to population-based samples of youth across a number of health (and mental health) areas; (5) A researcher-on-call service, that provides OACAS members with a personalized rapidresponse (within 24 hours to 1 week) to adolescent and child welfare health and mental health inquiries that is evidence-based and expert-driven. MAP-KT Portal Website Statistics Development & Results In addition to being a user-specific KT initiative, the MAP-KT can be considered a template for other service audience KT efforts to support evidence-to-practice transfer. The MAP-KT portal provides a template for: (i) the collection of back end statistics to evaluate KT usage as it relates to other relevant factors (e.g., level of mental health training of the KT user); (ii) web-based product formats that have a demonstrated utility for an end-user group subpopulation that are of interest to the Centre (i.e., CAS staff); (iii) the process of expertise mobilization that will support the uptake of evidence-based practice in mental health. The collection of back end statistics on the KT website users has been accomplished with the inclusion of a KT website evaluation survey embedded within the site. Users are invited to complete the survey to provide feedback on the site. The survey includes questions about the mental health training level of the user as well as other statistics. The results of this survey indicate that 100% of participating frontline workers, supervisors and administrators have access to computer at home, 80% have internet access at home. 73% spend more than 1hr/wk searching for information from the web.

4 72% reported that the web is the primary source of information they rely on to assist practice, more so than colleagues, agency resources or the library. Most frequently asked questions: Research on youth mental health Research-base practice guidelines Prevalence and statistics of prognosis and diagnosis While 82% of those who participated either never blogged before or blogged less than an hour per week, when asked to rank order the importance of services provided by a future knowledge translation portal, blogs was most frequently ranked as the most likely used service (36%) compared to other more search-based services. Participant also welcomed a quick turn-around research-to-practice consultation service. The results of these user surveys have also been used to update and improve the MAP KT website to make it more user-friendly, accessible, and applicable to CAS staff needs. During the month of April 07, the site has been visited 715 times, the Scholarly Article Search Engine has been used 309 time, Best Practice Material Search was used 303 times and Outcome Statistics was searched 264 times. Our Knowledge Synthesis service (provide synopsis to articles) was requested 6 time, and our Research-to-Practice consultation service was requested 3 times. Initiative Deliverables Our experience with developing the MAP KT website will be reported in an upcoming special issue of the Journal of Child Abuse and Neglect. This issue of the journal will focus on knowledge translation in child protective services (CPS) and will be based on a lead article about the MAP KT website development. Chris Wekerle will be a guest editor for this issue. There is a research proposal to support the evaluation of the MAP-KT portal using a MAP user test-site, whereby high versus low-usage can be linked to MAP youth functioning as tested in the MAP study (youth are tested every 6 months). The hypothesis is that high users will show greater referral activity than low users; that high users will have youth with higher worker attachment ratings than low users; and that high user MAP youth will show better mental health functioning than low user MAP youth. 2. Report on the lessons learned over the award term. A dynamic, evergreen website can be tailored to child welfare stakeholders in a format that highlights ease of use, web navigation, and real-time expertise response. 3. Describe how the outcomes of this project have been and / or will be disseminated to others within the community and / or province.

5 The outcomes of this initiative, as measured by the development and implementation of a knowledge translation (KT) web portal that provides evidence-based information on health and mental health among Children s Aid Society (CAS) youth, will be disseminated to others in a number of ways. The MAP KT web portal is being hosted on the Ontario Association of Children s Aid Societies (OACAS) internal member s website. As such, any CAS worker in the province of Ontario who logs in to the OACAS member site will see the MAP KT web portal and have direct access to the site. Furthermore, marketing campaigns are currently being developed that will inform CAS workers of the KT website and encourage use of the site. The core message of this marketing campaign will consist of informing CAS workers that the site exists and how they can access it (via the OACAS internal member s website) as well as demonstrating the utility of the site. Specifically, the five sections of the MAP KT site will be highlighted. The message will reach CAS workers via numerous channels. CAS agency management and supervisors have and will continue to attend demonstrations of the site that will be conducted by MAP research staff. Managers and supervisors will be encouraged to discuss the site with CAS staff and to demonstrate its useful features. Furthermore, MAP research staff members have and will continue to conduct brief presentations at various CAS branch and team meetings. CAS staff will also receive paper flyers in their mailboxes at each agency. These flyers will remind them of the MAP KT website and how they can access it. These same flyers will also be distributed to all CAS staff via . Finally, a web link to the MAP KT website will be posted on CAS agencies internal webpage. As such, the web link to the MAP KT portal will be available every time CAS staff members open a web-browsing program on their computers. The implementation of the MAP KT website will also be disseminated via traditional research channels. Specifically, the development of the web portal will be discussed in an journal articles submitted by MAP research staff, and will also be highlighted in any conference presentations / posters presented by MAP research staff. Work has already begun on several journal articles for a special edition of the Journal of Child Abuse and Neglect that will focus on knowledge translation in child protective services (CPS). Furthermore, a talk entitled From Research to Practice: The Development of a Child Welfare Best Practices Knowledge Translation Website has already been submitted for presentation at the Canadian Injury Prevention and Safety Promotion Conference. 4. Describe the knowledge exchange activities that have been implemented to share knowledge learned with others in the field of child and youth mental health. The purpose of this initiative, which was the development of the MAP KT website, was to provide a forum for the exchange of knowledge with others in the field of child and youth mental health, as well as those in the field of child and youth health more generally. The development of the MAP KT website provides a unique forum for the exchange of statistics, research studies, expert opinion, and practice materials among professionals in the fields of child welfare, child and adolescent health, and child and adolescent mental health in particular. The collection of

6 these statistics and practice materials has been an extremely labour-intensive process that has resulted in numerous collaborations with researchers and mental health experts throughout Canada and internationally. These collaborations have led to an unprecedented exchange of data and knowledge between child and youth mental health professionals. For example, the outcome statistics section of the MAP KT website draws on data from the MAP study, the Ontario Student Drug Use Survey (OSDUS), which focuses on Ontario youth, and the Youth Risk Behavior Surveillance Survey (YRBSS), which focuses on U.S. youth. The practice materials section of the MAP KT website draws on the research and expertise of approximately 60 groups of child and youth health professionals to provide practice guidelines in areas such as anxiety, post-traumatic stress disorder, conduct disorder, depression, violence and aggression, and selfharm. 5. Describe how the Centre has been profiled in all Knowledge Exchange activities The CHEO Centre s logo is profiled on the home page of the MAP KT website, along with the logos for all the other research partner and funding agencies associated with the MAP project and the MAP KT website. The Centre is also acknowledged in all academic knowledge exchange activities such as journal publications, conference presentations, and poster presentations. 6a. Provide a 1-page overview (in lay language) of the project outcomes and key knowledge learned from the initiative. The objective of this initiative was to use the existing Maltreatment and Adolescent Pathways (MAP) project dataset (a project that is funded by The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO and The Canadian Institutes of Health Research) as the basis for the development of a knowledge translation (KT) portal that provides evidence-based information on health and mental health among children s aid society (CAS) youth with a history of maltreatment. The identified end-users of this KT portal are CAS staff and policy makers throughout the province of Ontario. This objective has been achieved. The MAP KT website, which is being hosted on the internal member s website of the Ontario Association of Children s Aid Societies (OACAS), is launched and fully functional. The MAP KT website is composed of five sections: 1) A web-log that encourages discussion of current topics in child welfare and mental health. 2) A scholarly article search function that is designed to source high impact and highly relevant articles in a chosen area of child welfare and mental health. 3) A best-practice search function that provides guidelines, screening and assessment, and recommendations in a number of areas within adolescent mental health and health in general. 4) An outcomes statistics section that compares functioning of child welfare youth to populationbased samples of youth across a number of health (and mental health) areas. 5) A researcher-on-call service, that provides OACAS members with a personalized rapidresponse to adolescent and child welfare health and mental health inquiries that is evidencebased and expert-driven.

7 The MAP KT website was developed in conjunction with the OACAS, which has provided inkind technical support for the hosting of the MAP KT website. All CAS staff in the province of Ontario who have access to the OACAS website via internal agency web links can access the MAP KT site. CAS supervisors, quality-assurance managers, and front-line staff provided recommendations and insight regarding the development of the website. In this way, the development of the MAP KT web portal has been a collaborative effort between MAP project staff and CAS agencies. The benefits of the implementation of the MAP KT website are numerous. We have demonstrated that researchers and CAS agency staff can effectively collaborate in an effort to improve the outcomes of youth in the CAS system. The outcomes of research being conducted on this population of youth can be quickly and effectively directed back to staff and policymakers in CAS agencies. The timely availability of research data is more likely to impact practice and support youth outcomes by empowering CAS staff with the knowledge they require to make the best possible care and service decisions. At the same time, we have learned that the development of a KT website will not necessarily impact youth outcomes. CAS staff members need to be aware of the website and make use of it, essentially incorporating it into their daily practice. To accomplish this goal, it is necessary to have a comprehensive marketing plan that will notify CAS staff of the site and encourage them to use its many features. As such, MAP project research staff continue to promote the site via flyers, messages, presentations, and the training of supervisors and managers at CAS agencies. We believe that once enough CAS staff members are aware of the site, a tipping point will be attained whereby word-of-mouth marketing among CAS staff will have a measurable impact on site traffic. 6b. Provide a 3-5 page technical summary (in lay language) of the project outcomes and key knowledge learned from the initiative. The objective of this funding initiative was to use the existing Maltreatment and Adolescent Pathways (MAP) dataset (funded by The Provincial Centre of Excellence for Child and Youth Mental Health at CHEO and The Canadian Institutes of Health Research) as the basis for the development of a knowledge translation (KT) web portal that supports the actualization of evidence-based practice for front-line, supervisory, administrative, policy-maker stakeholders in the child welfare service sector. The MAP-KT portal partners with existing Ontario-wide reach of child welfare staff members by having the web portal hosted on the Ontario Association of Children s Aid Societies (OACAS) member website. The OACAS has a restricted members-only website, with pre-approved users, reaching over 50,000 members. As such, any CAS worker in the province of Ontario who logs in to the OACAS member site will see the MAP KT web portal and have direct access to the site. Furthermore, marketing campaigns are currently being developed that will inform CAS workers of the KT website and encourage use of the site. The core message of this marketing campaign will consist of informing CAS workers that the site exists and how they can access it (via the

8 OACAS internal member s website) as well as demonstrating the utility of the site. Specifically, the five sections of the MAP KT site will be highlighted. The message will reach CAS workers via numerous channels. CAS agency management and supervisors have and will continue to attend demonstrations of the site that will be conducted by MAP research staff. Managers and supervisors will be encouraged to discuss the site with CAS staff and to demonstrate its useful features. Furthermore, MAP research staff members have and will continue to conduct brief presentations at various CAS branch and team meetings. CAS staff will also receive paper flyers in their mailboxes at each agency. These flyers will remind them of the MAP KT website and how they can access it. These same flyers will also be distributed to all CAS staff via . Finally, a web link to the MAP KT website will be posted on CAS agencies internal webpage. As such, the web link to the MAP KT portal will be available every time CAS staff members open a web-browsing program on their computers. The MAP Project Research Advisory Board, which meets every month to two months, provided an initial reference group for the development of the website. The MAP Project Advisory Board has representatives from Toronto Children s Aid Society (CAS), Toronto Catholic CAS, and Peel Region CAS, including supervisors and front-line staff members. The MAP Project Research Staff provided demonstrations, incorporated feedback, provided broader training to selected groups, surveyed CAS staff members on web-usage, and had planning meetings with information technology specialists at OACAS, Toronto CAS, CCAS, and Peel CAS. The benefits of the MAP-KT web portal are already becoming apparent. It is serving as a critical channel of communication between CAS staff via its links to individual agency intranets, which enhances ease of access and provides the only conduit where cross talk among CAS agency staff members can take place. Furthermore, the MAP-KT website generates its own database with all MAP products creating searchable and automatic linkage archives. The MAP-KT portal, being university-based, provides an otherwise unavailable service to CAS staff members by using a widely available and known search engine (i.e., Google Scholar) to identify peer-reviewed scholarly literature in the area of child maltreatment. This scholarly search section of the MAP KT website includes (a) a request function to retrieve a PDF of selected articles and (b) a request function that provides a researcher s summary of up to 3 selected articles. Finally, the MAP-KT website homepage is formatted along a electronic magazine concept with multimedia materials (ipod video and audio casts), a MAP Research Project product box (which can also accommodate other relevant study product boxes, such as the Canadian Incidence Study on Reported Child Abuse & Neglect), RSS feeds from high quality relevant mental health sources, etc. As of the completion of this final report, the MAP KT website has been designed and fully implemented. It consists of five main sections: (1) A research/clinical practice web-log that encourages discussion of current topics in child welfare and mental health, as well as highlight broad/high interest cultural materials (written by Dr. Wekerle, Dr. Goldstein, both Ph.D.s in clinical psychology and MAP Project Research staff); (2) A scholarly article search function that is designed to source high impact and highly relevant articles in a chosen area of child welfare and mental health (i.e., tagged search word child maltreatment to all inputted searches)

9 (3) A best-practice search function that provides guidelines, screening and assessment, and recommendations in a number of areas within adolescent mental health and health in general, with attached PDFs on (a) guidelines (b) screening tools and (c) recommendations; (4) An outcomes statistics section that compares functioning of child welfare youth to population-based samples of youth across a number of health (and mental health) areas; (5) A researcher-on-call service, that provides OACAS members with a personalized rapidresponse (within 24 hours to 1 week) to adolescent and child welfare health and mental health inquiries that is evidence-based and expert-driven. Further research studies have been developed from the implementation of the MAP KT website. There is a research proposal to support the evaluation of the MAP KT portal using a MAP user test site, whereby high versus low-usage can be linked to MAP youth functioning as tested in the MAP study (youth are tested every 6 months). The hypothesis is that high users will show greater referral activity than low users; that high users will have youth with higher worker attachment ratings than low users; and that high user MAP youth will show better mental health functioning than low user MAP youth. The purpose of this initiative, which was the development of the MAP KT website, was to provide a forum for the exchange of knowledge with others in the field of child and youth mental health, as well as those in the field of child and youth health more generally. The development of the MAP KT website provides a unique forum for the exchange of statistics, research studies, expert opinion, and practice materials among professionals in the fields of child welfare, child and adolescent health, and child and adolescent mental health in particular. The collection of these statistics and practice materials has been an extremely labour-intensive process that has resulted in numerous collaborations with researchers and mental health experts throughout Canada and internationally. These collaborations have led to an unprecedented exchange of data and knowledge between child and youth mental health professionals. For example, the outcome statistics section of the MAP KT website draws on data from the MAP study, the Ontario Student Drug Use Survey (OSDUS), which focuses on Ontario youth, and the Youth Risk Behavior Surveillance Survey (YRBSS), which focuses on U.S. youth. The practice materials section of the MAP KT website draws on the research and expertise of approximately 60 groups of child and youth health professionals to provide practice guidelines in areas such as anxiety, post-traumatic stress disorder, conduct disorder, depression, violence and aggression, and selfharm.