Improving Quality of Care in Child Mental Health Service Settings

Child engagement will be measured via coding of audiotaped sessions by independent, trained raters who are blind to study purpose and hypotheses. The Child Involvement Ratings Scale (CIRS) will be used to code child engagement. Ten child involvement items-6 positive, 4 negative- are rated for each session on a 6-point scale. The minimum total score will be 0 and the maximum score is 50. For the outcome, a single average value will be presented. The positive-involvement items emphasize the extent to which children initiate discussions, demonstrate enthusiasm, self-disclose, and demonstrate understanding. Negative-involvement items address withdrawal or avoidance in treatment. Coders provide ratings based on two 10-min segments of session audiotapes (beginning at min 10 and min 40). Screening was conducted on enrolled participants.

Time frame: 3 Month Timeline

Population: Measure was used on enrolled participants (Children).

Fidelity to the TF-CBT protocol will be measured by independent, trained raters who are blind to the study purpose and hypotheses, coding audiotaped treatment sessions. The TF-CBT Version of the Therapy Process Observational Coding System for Child Psychotherapy (TF-CBT TPOCS-S), modified for the eTF-CBT condition, will be used to assess provider fidelity to each TF-CBT component. Two raters will review video-recorded treatment sessions, assessing the presence or absence of specific techniques and rating their extensiveness on a 6-point scale. The total score will range from a minimum of 0 to the maximum 78. The outcome will be presented as a single average value.

Time frame: 3 Month Timeline

Population: Measure was used on enrolled Randomized Providers

12-item measure to monitor and evaluate implementation efforts. This measure has been shown to have solid psychometric properties. Scaling is ranged from 1 to 5, with 1 being the lowest value with ('Completely Disagree') and 5 being the highest value ('Completely Agree'). With the total possible score ranging 12-60. With the lowest possible total score being 12 and the highest possible score being 60. The higher the values represent a better outcome. The higher scores indicate greater acceptability, appropriateness, and feasibility. Screening completed with enrolled providers.

Time frame: baseline, Post baseline at 12 months

Population: We encountered several challenges in conducting this study. First, some enrolled participants (enrolled providers) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or no longer working with the agency/clinic

The BPM is a 19-item measure of emotional and behavioral functioning in children. The BPM is well-validated and comparable to the lengthier Child Behavior Checklist. The values range from 0-2 with 0 being the lowest value of 'Not True' and 2 being the highest value of 'Very True'. The lowest possible total score is 0 and the total highest possible score being 38. The higher the total score the worse outcome. Screening was completed with enrolled caregivers/parents.

Time frame: Baseline, 3 Month, 6 Month, 9 Month, 12 Month

Population: We encountered several challenges in conducting this study. First, some enrolled participants (caregivers and children) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or children moving to a different foster home.

screener that assesses providers' feelings about their work, and their perceptions of how their co-workers feel about the work they do. Scorings will range from 4- 28. Scaling value between 1-7, with 1 being the lowest value of 'Never' and 7 with the highest value of 'everyday'. Higher scores will mean worse outcome. Screening complete by enrolled providers.

Time frame: baseline

The Caregiver Satisfaction Questionnaire is a 15-item instrument that assesses caregiver satisfaction with mental health treatment. The last three questions are open ended questions that do not provide value (these will not be measured/scored). The first twelve questions have a scoring scale between 1-5, with 1 being the lowest value ('Very much False') and 5 being the highest value with ('Very much True').The minimum total score being 12 and the maximum total scores being 60. The higher the score represents a better outcome. Assessment given to only enrolled parent/caregivers and children. Screening was completed by enrolled caregivers/parents.

Time frame: 3 Month

Population: Caregiver completed these assessments for each of their children. There are a number of parents that completed this assessment multiple times for each of their children who were enrolled.

assesses the severity of depressive symptomatology in children. It is a 20-item self-report measure with possible scores ranging from 0-60. Each questions has a scaling score of 0-3. With 0 being the lowest value stating 'Not at all' and 3 being the highest value stating 'A lot'. Total score over 15 is indicative of significant levels of depressive symptoms, showing worse outcome.

Time frame: Baseline, 3 Month, 6 Month, 9 Month, 12 Month

Population: We encountered several challenges in conducting this study. First, some enrolled participants (caregivers and children) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or children moving to a different foster home.

The Center for Epidemiologic Studies Depression Scale is a 20-item self-report scale of depression completed by the enrolled caregiver. It is widely used and demonstrates excellent psychometric properties. Response options range from 0 to 3 for each item (0 = Rarely or None of the Time, 1 = Some or Little of the Time, 2 = Moderately or Much of the time, 3 = Most or Almost All the Time). Scores range from 0 to 60, with high scores indicating greater depressive symptoms. A score equal to or above 15 indicates a person at risk for clinical depression. Enrolled caregivers had multiple children enrolled meaning that caregivers with multiple children were asked more than once for each time point.

Time frame: baseline, 3, 6, 9, 12 months Timeline

Population: We encountered several challenges in conducting this study. First, some enrolled participants (caregivers and children) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or children moving to a different foster home.

The Child/Adolescent Satisfaction Questionnaire is a 15-item instrument that assesses child satisfaction with mental health treatment. The last three questions are open ended questions that do not provide value (these will not be measured/scored). The first twelve questions have a scoring scale between 1-5, with 1 being the lowest value ('Very much False') and 5 being the highest value with ('Very much True'). The total minimum score is 12 and the maximum total score being 60. The higher the total score represents a better outcome. Screening was given to enrolled children.

Time frame: 3 Month

8-item measure design to assess attitudes toward computer use in treatment. Scaling on each question ranges 1-5 with 1 being the lowest value ('Strongly Disagree') and 5 being the highest value ('Strongly Agree'). The minimum total score would be 8 and the maximum total score being 40. The higher the value represents a better outcome. Assessment given only to enrolled providers.

Time frame: baseline, post baseline at 12 months

Population: We encountered several challenges in conducting this study. First, some enrolled participants (enrolled providers) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or no longer working with the agency/clinic

15 items, assessing providers' perceptions of appeal of Evidence-Based Therapy, openness to innovation, perceived divergence with usual care (alphas .59-.90; M=.77).Scoring ranges from 0-4, with 0 being the lowest value ('Not at all') and 4 being the highest value ('To a Very Great Extent'). With the minimum score being 0 and the maximum score being 60. The higher Evidence-Based Practice Attitude Scale total score indicating more global positive attitudes toward adoption of Evidence-Based Practice.The higher the value reprents a better outcome. This assessment was given to enrolled providers.

Time frame: baseline, post baseline at 12 Months

Population: We encountered several challenges in conducting this study. First, some enrolled participants (enrolled providers) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or no longer working with the agency/clinic

Assess understanding of the application of behavioral principles to youth. With the minimum score of 0 and maximum score of 25. the higher values represent a better outcome. Internal consistency=.42-.84; sensitivity to change. Screening completed with Enrolled Providers.

Time frame: Baseline, Post Baseline at 12 months

12-item measure designed to assess an organization's readiness to implement new policies, programs, and practices. With values ranging between 1-5, 1 being the lowest of 'Disagree' and 5 being the highest with 'Agree'. The total minimum score being 12 and total maximum number being 60. The higher values represent a better outcome. Lower scores represent less organizational readiness for implementing change; Higher scores represent a more favorable organizational readiness for implementing change

Time frame: baseline, post baseline at 12 months

Population: We encountered several challenges in conducting this study. First, some enrolled participants (enrolled providers) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or no longer working with the agency/clinic

19-item instrument to assess a community mental health organization's activities related to the delivery of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT). With values ranging between 1-5. 1 being the lowest with ' Strongly Disagree' and 5 being the highest with 'strongly agree'. The total minimum scores being 19 and the total maximum total scores being 95. The higher values represent a better outcome. Screening given to enrolled providers.

Time frame: baseline, post baseline at 12 month

Population: We encountered several challenges in conducting this study. First, some enrolled participants (enrolled providers) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or no longer working with the agency/clinic

42-item measure to assess parenting practices. 13 questions were pulled to be utilized in these assessments. Scoring ranges are from 1- 5: 1 being 'Never', 2 being 'Almost never', 3 being 'Sometimes, 4 being 'Often', and 5 being 'Always'. Total minimum score being 13 and the highest possible score being 65. The higher score means worse outcome. With Assessment was given to Enrolled Caregivers/parents. Enrolled caregivers had multiple children enrolled meaning that caregivers with multiple children were asked more than once for each time point.

Time frame: Baseline, 3 Month, 6 Month, 9 Month, 12 Month

Population: We encountered several challenges in conducting this study. First, some enrolled participants (caregivers and children) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or children moving to a different foster home.

35-item parent version of the CATS-Youth. CATS are given to enrolled Caregivers. A total symptom score is calculated by summing up the raw scores of items 1-20 (possible range = 0-60). The lowest value score of 0 being 'Never' and the highest value of 3 'Almost Always.' We recommend to use a cut-off ≥ 21 as indication of a clinically relevant level of symptoms. The higher the score means a worse outcome. Screening completed by enrolled caregiver/parents. Enrolled caregivers had multiple children enrolled meaning that caregivers with multiple children were asked more than once for each time point.

Time frame: Baseline, 3 Month, 6 Month, 9 Month, 12 Month

Population: We encountered several challenges in conducting this study. First, some enrolled participants (caregivers and children) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or children moving to a different foster home.

35-item instrument that assesses exposure to traumatic events and all 20 Diagnostic and Statistical Manual of Mental Disorder- Fifth Edition, Symptoms of PTSD. 20 items are scored ranging total value of 0-60; the minimum total score being 0 and the maximum total score being 60. Values ranging between 0-3, with the lowest possible score of 0 being 'Not at All' and 3 being the highest with 'All the time.' The higher values represent a worst outcome. Screenings complete with enrolled children.

Time frame: Baseline, 3 Month, 6 Month, 9 Month, 12 Month

Population: We encountered several challenges in conducting this study. First, some enrolled participants (caregivers and children) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or children moving to a different foster home.

Widely used the Kessler 6 measure of general distress that is well-validated. Assessment was given to Enrolled Caregivers.There are 6 items that are asked and each value scores ranging 0-4, with 0 being 'none of the time' and 4 being 'All of the time. With minimum total score would be 0 and maximum score would be 24. According to the scoring criteria proposed by Kessler 6, persons with a score of 13 or greater are likely to be experiencing severe mental illness. The higher total score represented a worse outcome. Screening was completed by enrolled caregivers/parents. Enrolled caregivers had multiple children enrolled meaning that caregivers with multiple children were asked more than once for each time point.

Time frame: Baseline, 3 Month, 6 Month, 9 Month, 12 Month

Population: We encountered several challenges in conducting this study. First, some enrolled participants (caregivers and children) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or children moving to a different foster home.

The Therapeutic Alliance Score for Children is a 12-item measure of the child's alliance with the therapist using a 4-pt scale. It has good internal consistency and interrupter reliability. Measuring therapeutic alliance is one of the most reliable ways to determine the strength of this bond, and it allows the therapist to identify how comfortable their client might be in sharing their thoughts, experiences, struggles and goals with them throughout care. This scale completed by the adolescent participant aged 12-18, and there is a parallel version for the therapist to complete. Each item is rated on a 4 point scale ranging with 0 being the lowest value 'not at all' to 3 the highest value 'very much'. The lowest possible total score being 0 and the highest possible score (total score) would be 36. The higher the total score represents better outcome showing the strength of the child and therapist bond.

Time frame: 3 Month

Population: At this point of time number of participant analyzed did drop due to participants discontinuing from the study or were missed at this time point.

4-item instrument that assesses feelings of shame following abuse. With a score ranging 0-2, 0 being the lowest value 'Not true' and 2 being the highest value 'Very true'. The lowest possible total score is 0 and the highest possible total score is 8. The higher the score meant a worse outcome. Screening completed by enrolled children.

Time frame: Baseline, 3 Month, 6 Month, 9 Month, 12 Month

Population: We encountered several challenges in conducting this study. First, some enrolled participants (caregivers and children) requested to discontinue their participation. Second, we experienced a high rate of loss to follow-up due to changes in contact information, such as disconnected phone numbers or children moving to a different foster home.

The WAI is a 12-item measure of the parent-therapist alliance using a 7-point scale (never to always). Scoring ranging between 1-7, with 1 being the lowest ('Never') and 7 being the highest with ('Always'). Total scores ranging between 12-84. Screening was completed by enrolled caregivers/parents. Higher score indicate a better therapeutic alliance.

Time frame: 3 Month Timeline