Wednesday, June 19, 2013

Creating Systems Change in Mississippi

Volume 2, Number 6 June, 2013

                                                 THEory into ACTion
       A Bulletin of New Developments in Community Psychology Practice
(This article has been cross-posted at APA’s Psychology Benefits Society blog)

Creating Systems Change in Mississippi
Bill Berkowitz, Ph.D., University of Massachusetts Lowell 

         How do you create change?   It’s hard to imagine a more important question for community professionals, or for anyone wanting to improve society. Kien Lee and her colleagues at Community Science, a research and development organization near Washington, D.C., have a distinctive approach to change-making; it focuses on larger community systems.

Systems change in communities is challenging: It aims to change the community as a whole. “When others think about change, it’s often on an individual level, one person at a time,” Kien says. “But we look at the total structure and process. We focus more on how groups and organizations relate to each other – since change there will create change for individuals.”

Kien’s recent work in Mississippi provides an example of how systems change can work.  With support from the W.K. Kellogg Foundation, she and Community Science colleagues have begun evaluating a comprehensive long-term project there, which has three primary goals: increase the reading and math scores of third graders; improve health outcomes, especially of babies; and advance the economic well-being of Mississippi residents. Collectively, the three goals seek to address racial equity.

How does a systems change agent work toward these goals?   Skillfully, slowly, and steadily. It involves working with the interlocking network of key groups, organizations, and institutions in the community, the decision makers who can make changes that will percolate down to individuals.  You’ve got to see both the forest and the individual trees. And that isn’t easy, Kien readily acknowledges; it takes a variety of skills to do the work. Fortunately, Community Science staff, five of whom are community psychologists, have both the research skills and tested practice skills – in assessment, in planning, in implementation, and in evaluation – to do it.

But the work also involves a set of personal qualities. “You have to be assertive in making recommendations,” Kien points out. “But you also have to be sensitive, and to know when to hold back, because it may not be the right time to speak.  We need to be sensitive to the uniqueness of each leader and community with whom we work. When racial inequities exist, for example, a confrontational approach is not usually useful – people aren’t ready for it.  The timing isn’t right. It’s a matter of negotiating between those two poles.”  

         More than that, Kien believes, community system change usually requires some money, even if not huge amounts.  Good collaboration among community stakeholders is needed, and passion is certainly helpful, but some funding is necessary to support and sustain the work over the long haul.  Yet funding itself can create new challenges, for one must then align with the funder’s pace – not too slow, and not too fast. The systems change agent must respond to multiple stakeholders, often in different ways.

There’s an even more fundamental reality: Even under the best circumstances, systems change takes time.  It calls for the gradual development of trusting relationships, and the gradual education of decision makers, so that they feel comfortable getting on board with the work and acting collaboratively.  To its credit, the Kellogg Foundation has been willing to invest the time, as Kien and her colleagues have been engaged now for  1½ years in what is envisioned as a 10-year project. But initial results are promising: There’s evidence that target groups in Mississippi are using their newly-gained evaluation knowledge in practice.

Kien’s work, and the work of Community Science more generally, illustrates that a community psychology and systems-based approach can make a difference in real-world social issues. That’s because all communities have an organizational infrastructure, and “by helping communities take a closer look at their infrastructure, on how they can best serve, we can create change.”  It is more complex work, harder work, work that takes more time; but when done well there’s good reason to believe it will yield greater impact in the long run.

           Kien Lee, who is a co-founder, Principal Associate, and Vice President of Community Science, is the 2013 recipient of the SCRA (American Psychological Association, Division 27) award for Distinguished  Contributions to Community Psychology.

This is one of a series of bulletins highlighting the use of community psychology in practice. Comments, suggestions, and questions are welcome. Please direct them to Bill Berkowitz at

Tuesday, June 11, 2013

How Can We Get Children and Teens Treatment That Works?

By Michael Southam-Gerow, PhD (APA Committee on Children, Youth, and Families)
More than 4 million children and teens have a serious mental disorder, but only 20 percent are getting the help they need. Did you know that it takes more than 15 years for an evidence-based treatment (EBT) to be used consistently in the community? That is about half a generation!
Our society still struggles to meet the mental health needs of our youth despite literally hundreds of studies demonstrating the potency of hundreds of treatments for those problems.
We need to invest time and dollars to disseminate and implement (i.e., effectively spread the use of) EBTs across diverse community practice settings. Whether you’re a researcher, therapist or parent of a child with a mental health problem, you can help EBTs get to the people that need them most.
What do therapists need to know?
  1. EBTs are carefully-tested recipes, not computer code. Think of treatment manuals as a recipe, not strict computer code where one change can wreak havoc. Important ingredients are included, along with an order of assembling those ingredients. The recipes that work become EBTs. However, for individual cases, the proof is in the pudding. Cooks adapt recipes, perhaps shifting ingredients. However, we must measure the desired result, a successful outcome. If varying the recipe worked, great! If not, then perhaps we need to adhere to the recipe more closely.
  2. EBT lists are evolving. These lists initially consisted of cognitive, behavioral, and cognitive-behavioral treatments because that was the nature of what we knew. However, as the field has advanced, more treatments have been tested and the list of EBTs now includes a wider variety of approaches. SAMSHA’s database of evidence-based programs or the Society of Clinical Child and Adolescent Psychology’s registry of Effective Child Therapyare good clearinghouses on the latest therapies.
What do researchers need to know?
  1.  Practice-based evidence is legitimate evidence. As we have learned more through dissemination and implementation efforts, we now know that information must flow both ways between research and practice. Partnering with therapists to learn what is working in usual care and improving what is not has become an important focus for researchers.
  2. We share common goals. Effective partnerships begin with an attitude of respect toward therapists. Both therapists and clinical researchers dedicate their careers to promoting health and optimal functioning for children and teens. Researchers should remind themselves that we are all on the same team given the increasing focus on working with therapists and other stakeholders in partnership-based research efforts.
What do parents need to know?
  1. Psychological treatment is not one-size-fits-all. There is evidence that specific treatments work well for some problems and less well for others. Different child/teen problems may require different treatments. It is important to remember that not all therapists will be equipped to provide all treatments. A frank conversation with a prospective therapist will help you to identify what he/she knows and does not know how to deliver.
  2. Ask your therapist about evidence. Unlike drug treatments, psychological treatments are not developed by for-profit companies. That’s why the public sees very little marketing of psychological treatments and does not learn much about which treatments exist and work (and for which problems). Ask your child’s therapist to describe the treatment options available and what evidence there is to support their use. You can also consult SAMSHA’s database  and the Effective Child Therapy registry BEFORE seeking treatment.

This Blog Post was originally posted in Psychology Benefits Society, a blog from the APA Public Interest Directorate: