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Last modified: Tuesday, November 30, 2010

$3.8 million grant to fund mental health service study by IU School of Education and Vanderbilt University

Center for Adolescent and Family Studies to be partner in five-year project

Nov. 30, 2010

BLOOMINGTON, Ind. -- The National Institute for Mental Health has awarded a $3.8 million grant to the Indiana University Center for Adolescent and Family Studies (CAFS) and Vanderbilt University to study methods to improve mental health services.

The five-year project will examine how to improve mental health services for youth and families in community mental health settings. The study will integrate an evidence-based treatment co-developed by Tom Sexton, director of CAFS and professor of counseling and psychology in the IU School of Education, with a computer-based method of measurement and feedback about treatment from Vanderbilt.

"This study is an attempt to see if -- with the system we've developed -- we can provide ongoing and regular real-time feedback to clinicians to see if it results in improved outcomes for children and adolescents in the mental health system," Sexton said.

The project will apply functional family therapy, a type of clinical treatment of violent, criminal, behavioral, school, and conduct problems with youth and their families with Vanderbilt's "Contextualized Feedback System" or CFS. Sexton is a recognized international expert on evidence-based functional family therapy, delivering more than 300 workshops on the subject, and he has written the book The Handbook of Family Therapy, and Functional Family Therapy in Clinical Practice.

Vanderbilt's CFS system is the work of the Center for Evaluation and Program Improvement in the Peabody College of Education and Human Development. The center is directed by Leonard Bickman, Betts Chair and professor of psychology, psychiatry, and public policy.

During the project, Western Youth Services in Orange County, Calif., will use functional family therapy and continuously evaluate its effectiveness with the CFS. The feedback will come to service providers immediately so that they can adapt ongoing treatment in an evidence-based manner to better serve the needs of the youth and families in treatment.

Sexton said the project represents a potential positive change in how all mental health services are provided. "We never do what physicians do," Sexton said. "We don't measure our progress." Sexton said for mental health providers, there hasn't generally been something akin to checking a patient's cholesterol level, for example. "Vanderbilt's got a terrific system of psychometrically-sound measures to actually measure change as it's going on," he said.

CAFS has worked with Western Youth Services on implementing functional family therapy in recent years. Sexton said that he and his partners selected the agency because it serves a large number of clients (around 5,000), providing a sizable population for the study. IU staff will conduct most of the functional family therapy training, monitoring, and developing adjustments in service based on the feedback. Vanderbilt staff will gather most of the data and producing tracking information.

"Together, we form this computer-based system -- the functional family therapy and CFS system -- that if it's successful here certainly will have applications many other places," Sexton said.

The need for a change in practice is evident, Sexton said. "Almost all the services provided around the country have no evidence they work," he said. "We've developed a handful of treatments that seem to work really well, but the bad news is that once you put it into a community setting, it's not as easy to do, in part because community settings are really complicated."

Sexton said CAFS began working with Bickman's center at Vanderbilt more than three years ago to apply functional family therapy to the computerized feedback system. "It's help for people that are working with kids and adolescents to keep on track, keep their treatment focused on the right thing so they're more efficient, more cost effective, more accountable, and have better outcomes."

Sexton said the effect on community mental health services can be analogized to the control panels of new hybrid cars. "A Prius has a big screen and the screen tells you every five minutes what your gas mileage is," he said. "If you're around many Prius owners, they get addicted to this screen, caught in the game of getting better gas mileage." Sexton said he imagines a similar effect on mental health services, with providers receiving feedback based on reliable and valid information from the client, outside observers, supervisors and others.

"You could adjust the course of what you were doing," Sexton said. "You could adjust it during treatment, thereby making it fit people better and produce better outcomes."