Treatments administered under conditions of usual clinical care (UC) for children have repeatedly been shown to have much smaller effects than evidence-based psychosocial treatments (EBTs) administered within of research studies. These results have led to calls to improve the quality of care for children through dissemination of EBTs to existing service settings. In 2004, the Texas Department of State Health Services (TDSHS) initiated what is likely the largest EBT implementation effort to date. This effort, the Resiliency and Disease Management (RDM) initiative, requires the statewide exclusive use of EBTs in TDSHS mental health services. The proposed study seeks to utilize an existing administrative dataset to assess the impact of RDM on the treatment outcomes of 4,207 children (ages 4-18) treated in the Harris County (Houston, Texas) Mental Health and Mental Retardation Authority (MHMR-A). Specifically, the proposed study will employ an interrupted time-series design to examine changes in child outcomes before and after RDM. This proposal will advance the field by answering a central question of public health importance: Has this large- scale effort to implement EBTs in community mental health settings had an impact on child outcomes (Aim 1)? If, as the state hopes, this policy leads to improved treatment outcomes, this effort may serve as a model for other states interested in making similar improvements. If, on the other hand, this policy is associated with no changes or even worse outcomes, it may provide a cautionary lesson regarding the risks of undertaking such an effort in the absence of funding for intensive implementation methods. The proposed study will also inform future research by determining whether outcomes varied across children or providers and, if so, examining hypothesized child and provider moderators of this variability (Aim 2). Based on the results of the proposed study, future studies will focus on implementation factors related to RDM outcomes.
