Ramsey County Children's Mental Health Collaborative

• There is a limited evidence base for treatments that engage low-income, highly stressed families to support mental health and family resilience

  • Many youth drop out of mental health treatment, with rates ranging from 25-75% (De Haan et al., 2013). Drop-out rates are higher for families with greater trauma and stress (Bornheimer et al., 2018; Skar et al., 2022)

  • Research on evidence-based treatments often fails to include low-income families, and randomized controlled trials with low-income families often have high dropout rates (Jones et al., 2016)

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• The family as a whole is impacted by toxic stress, trauma, and mental health challenges, and yet few evidence-based programs address the whole family.

  • There are many evidence-based treatments for individuals, such as CBT. TF-CBT, and EMDR, as well as a few that include families though focusing on an individual teen, such as Multisystemic Therapy and Functional Family Therapy.

  • “There are few well-developed, standardized and empirically supported family therapies for treating family systems impacted by trauma…. Family treatments that are sensitive to the traumatic context of urban poverty, that include engagement strategies that incorporate alliances with primary and extended family systems, that build family coping skills, and that acknowledge cultural variations in family roles and functions are needed to adequately address the needs of this population.”  (Collins, K., Connors, K., Davis, S., Donohue, A., Gardner, S., Goldblatt, E., Hayward, A., Kiser, L., Strieder, F. Thompson, E., 2010)

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• Adapting Evidence-Based Practices for Under-Resourced Populations (2022 SAMHSA Issue Brief) 

  • Communities and individuals benefit when they receive behavioral health services that are clinically proven effective, equitable, and culturally appropriate. Tailoring care, programs, and services to the cultural, social, gender, and other socio-demographic contexts of individuals served yields positive outcomes.

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• Redefining Evidence-Based Practices: Expanding our View of Evidence is a 2020 issue brief by the Center for Law and Social Policy that highlights the shortcomings of EBPs- in particular, their cultural responsiveness. 

  • This issue brief highlights 3 alternative standards for documenting effective programs and practices: 1) Practice Based Evidence, 2) The Social Innovation Fund, and 3) Community-Centered Evidence-Based Practice. 

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• Limitations to EBPs and Quantitative Program Evaluation: A focus on outcomes, particularly if they are not endorsed by the community, poses the risk of treating people as numbers and of passive recipients of services, rather than as leaders and full partners in creating community health (Landry & Xiong, 2018).  As Landry and Xiong (2018) describe in a related context, such an approach "has the potential to replicate long-standing historical injustices" (Landry & Xiong, 2018).  A community-engaged approach to program design, implementation, and evaluation includes community members as empowered and full partners. Qualitative data collection, collecting stories, and engaging personally with individuals may be more empowering methods of engaging participants as full partners in program evaluation.