This paper describes the application of mixed method designs in implementation research in 22 mental health services research studies published in peer-reviewed journals over the last 5 years. Our analyses revealed 7 different structural arrangements of qualitative and quantitative methods, 5 different functions of mixed methods, and 3 different ways of linking quantitative and qualitative data together. Complexity of design was associated with number of aims or objectives, study context, and phase of implementation examined. The findings provide suggestions for the use of mixed method designs in implementation research.

/pdf/mixed-method-designs-in-implementation-research-7pgcll46j5.pdf

Mixed Method Designs in Implementation Research

Pricing the Priceless Child: The Changing Social Value of Children

Little is known about the effects of placing children who are abused or neglected into foster care. This paper uses the placement tendency of child protection investigators as an instrumental variable to identify causal effects of foster care on long-term outcomes--including juvenile delinquency, teen motherhood, and employment--among children in Illinois where a rotational assignment process effectively randomizes families to investigators. Large marginal treatment effect estimates suggest caution in the interpretation, but the results suggest that children on the margin of placement tend to have better outcomes when they remain at home, especially older children.

/pdf/child-protection-and-child-outcomes-measuring-the-effects-of-1d1f3xo7xd.pdf

Child Protection and Child Outcomes: Measuring the Effects of Foster Care.

https://digitalcommons.unl.edu/cgi/viewcontent.cgi?article=1516&context=publichealthresources

Adverse childhood experiences and life opportunities: shifting the narrative

Nursing home care is currently a two-tiered system. The lower tier consists of facilities housing mainly Medicaid residents and, as a result, has very limited resources. The nearly 15 percent of U.S. nonhospital-based nursing homes that serve predominantly Medicaid residents have fewer nurses, lower occupancy rates, and more health-related deficiencies. They are more likely to be terminated from the Medicaid/Medicare program, are disproportionately located in the poorest counties, and are more likely to serve African-American residents than are other facilities. The public reporting of quality indicators, intended to improve quality through market mechanisms, may result in driving poor homes out of business and will disproportionately affect nonwhite residents living in poor communities. This article recommends a proactive policy stance to mitigate these consequences of quality competition.

Driven to Tiers: Socioeconomic and Racial Disparities in the Quality of Nursing Home Care

Purpose: The goals of this study are to describe the current state of residential care/assisted living (RC/ AL) care and residents in comparison with nursing home (NH) care and residents, identify different types of RC/AL care and residents, and consider how variation in RC/AL case-mix reflects differences in care provision and/or consumer preference. Design and Methods: Data were derived from the Collaborative Studies of Long-Term Care, a four-state study of 193 RC/AL facilities and 40 NHs. Multivariate analyses examined differences in ten process of care measures between RC/AL facilities with less than 16 beds; traditional RC/AL with 16 or more beds; newmodel RC/AL; and NHs. Generalized estimating equation models determined differences in resident case-mix across RC/AL facilities using data for 2,078 residents. Results: NHs report provision of significantly more health services and have significantly more lenient admission policies than RC/AL facilities, but provide less privacy. They do not differ from larger RC/AL facilities in policy clarity or resident control. Differences within RC/AL types are evident, with smaller and for-profit facilities scoring lower than other facilities across multiple process measures, including those related to individual freedom and institutional order. Resident impairment is substantial in both NHs and RC/AL settings, but differs by RC/AL facility characteristics. Implications: Differences in process of care and resident characteristics by facility type highlight the importance of considering: (1) the adequacy of existing process measures for evaluating smaller facilities; (2) resident case-mix when comparing facility types and outcomes; and (3) the complexity

Assisted Living and Nursing Homes: Apples and Oranges?

Outcomes for Young Adults Who Experienced Foster Care

Article history:Received 17 March 2008Received in revised form 30 May 2008Accepted 25 June 2008Available online 10 July 2008Keywords:Team DecisionmakingFoster careFamily involvementImplementation Prior to pursuing a full outcome evaluation, studies of implementation ﬁdelity are often conducted todetermine the extent to which practice-level implementation conforms to a program's speciﬁed conceptualframework and practice guidelines. This purpose of this study is to measure indicators of the implementationof Team Decisionmaking (TDM), an approach to making child welfare placement decisions sponsored by theAnnie E. Casey Foundation, in which birth parents, relatives and community members play a central role inthe decision-making process. Researchers review literature pertaining to implementation ﬁdelity, especiallyin the ﬁeld of child welfare, and outline the key components of TDM practice. Quantitative analyses of TDMimplementation indicators across three sites reveal a large degree of consistency in adherence to practiceguidelines, although key discrepancies point to the need for closer examinations of cross-site differences.Researchers conclude with implications for practice and research.© 2008 Elsevier Ltd. All rights reserved.

Children and Youth Services Review

Length of service for foster parents: Using administrative data to understand retention

Child welfare policy and practice have increased their focus on adoption for those children who cannot rapidly be reunified from foster care. The burgeoning numbers of children receiving adoption subsidies have led some states to be concerned about or even to curtail adoption subsidy levels. Yet, little is known about how the cost of foster care compares to that of adoption. This study uses longitudinal adoption subsidy and foster care placement data to estimate the relative costs of foster care and adoption for a statistically matched group of children. The data show that a sizable proportion of children who are not adopted will leave foster care but that an offsetting proportion of the children who remain will be transitioned to substantially more expensive placements than those used by adopted children. On balance, adoption achieves substantial governmental savings.

https://www.jstor.org/stable/10.1086/499339

Judith Wildfire

Papers

Assisted Living and Nursing Homes: Apples and Oranges?

Outcomes for Young Adults Who Experienced Foster Care

Children and Youth Services Review

Length of service for foster parents: Using administrative data to understand retention

A Comparison of the Governmental Costs of Long‐Term Foster Care and Adoption