Qualitative Findings Reflecting Staff Successes and Challenges in Implementing the Child and Family Clinic Plus Initiative

Purpose: In 2006, Governor Pataki allotted $33 million for New York State Office of Mental Health (NYSOMH) to implement the Child and Family Clinic Plus program. Clinic Plus was designed to transform the child mental health system via the provision of universal screenings, comprehensive assessments, and evidence-based treatments in a variety of settings to ensure that interventions work in the child's natural surroundings (NYSOMH, 2008). This presentation aims to present the findings of an examination of Clinic Plus; specifically, to better understand 1) processes related to the enrollment, consenting, screening, assessment, and treatment of youth at clinic sites, including challenges and successes associated with these components, and 2) changes in agency practice and service delivery, including new linkages and agreements with other organizations and the adoption and provision of evidence-based and in-home treatment services since becoming a Clinic Plus provider.

Methods: Ten Clinic Plus provider agencies were targeted across all five New York State regions. Five provider agencies were selected by NYSOMH as exemplars in implementing Clinic Plus, and five provider agencies were randomly selected. From each provider agency, at least two to three clinical staff members, a clinical supervisor and an administrator completed a questionnaire regarding the Clinic-Plus initiative (e.g. issues around the engagement of families, linkages with other community resources, provision of evidence based treatment, and data reporting). Additionally, clinicians and screeners participated in a focus group in order to explore any areas of strength as well as difficulties in implementation of Clinic Plus.

Results: A total of 42 providers completed questionnaires, including administrators, supervisors, outreach workers, social work clinicians, and nurse practitioners, and 29 staff participated in the focus groups. Analysis of the data via NUDIST identified major themes regarding engaging and forming linkages with community partners, securing parental consent, conducting screenings, assessments, and evidence-based therapies, providing in-home services, expanding clinic capacity to accommodate the influx of new clients via screenings, and how sites used and reported data. Strengths of the initiative (e.g. adopting a public health approach to the early identification of mental health difficulties, offering screenings in the child's natural setting, and fostering partnership with existing systems such as school social work services), and barriers (e.g. stigma, difficulty engaging older youth into services, not following through with treatment) were some of the common themes that arose across sites.

Discussion: This study is concordant with a long-term initiative to transform the child mental health service system by facilitating the early detection of and treatment for mental health difficulties among youth. However, given the high rates of unmet need among youth with mental health difficulties across the country, the implications of this study reach beyond New York. Thus it is of great import to understand the factors that impact the implementation of initiatives such as Clinic Plus, which introduces new incentives, opportunities and knowledge in a large state child mental health system, as the ultimate goal of this initiative is to enhance access, utilization of child mental health care and youth mental health outcomes.