Brooke Doyle
Commissioner
Children’s Behavioral Health
Knowledge Center
FY 2023 Annual Report
May 2024
MASSACHUSETTS DEPARTMENT
OF MENTAL HEALTH
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Overview
Established in Chapter 321 of the Acts of 2008 the mission of the Children’s Behavioral Health (CBH) Knowledge
Center is to ensure that:
• The workforce of clinicians and direct care staff providing children’s behavioral health services are
highly skilled and well-trained;
• The services provided to children in the Commonwealth are cost-effective and evidence-based; and
• The Commonwealth continues to develop and evaluate new models of service delivery.
The Children’s Behavioral Health Knowledge Center is located at the Department of Mental Health in the Child,
Youth, and Family Services Division. As part of the state’s mental health authority, the Knowledge Center's
purview is the entire children’s behavioral health system, across Executive Office of Health and Human Services
(EOHHS) agencies and public and private payers.
The Knowledge Center fills a gap in the children’s behavioral health system, serving as an information hub
across providers and public and private payers. Through its tools, Center staff members work with colleagues
who are developing, implementing, and advocating for practices, programs, and service delivery models that
are based on the best available evidence about what works to improve outcomes for young people. As an
intermediary organization, the Center’s activities facilitate connection among the rich array of children’s
behavioral health researchers, program developers, providers, practitioners, and consumer advocates in
Massachusetts. The Center’s projects generally focus on the application of research knowledge, not the
production of it.
Strategic Vision
Areas of focus – FY 2023
• Developing the skills of the behavioral health workforce to support youth and families including those
of family members and peer staff
• Supporting the wellbeing of the behavioral health workforce
• Supporting the career development of Black, indigenous, and people of color (BIPOC) behavioral health
professionals
• Enhancing supervisor competency and organizational support for high-quality supervision with specific
attention to working with diverse populations and addressing supervisee secondary traumatic stress
• Supporting the development, evaluation, and dissemination of innovative behavioral health practices
• Using innovative strategies to assist families with navigating the complexities of the behavioral health
system
Key partnerships
Located within the state mental health authority, the Knowledge Center is well positioned to establish
partnerships with other Executive Office of Health and Human Services agencies. This includes co-sponsoring of
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training and other workforce initiatives, braiding funding for shared projects and activities, and better
alignment of workforce priorities and communication across agencies. Collaborations in 2023 included:
• MassHealth - As the largest payer of publicly funded children’s behavioral health services in the
Commonwealth, the Center works closely with colleagues at MassHealth’s Children’s Behavioral
Health Initiative (CBHI) to support the workforce delivering CBHI services.
• Department of Children and Families (DCF) – More than 64% of all referrals made to the LINK-KID
trauma therapy referral service located at the UMass Child Trauma Training Center, were made by
staff members or foster parents from DCF. Additionally, the Center supported training for DCF
contractors who provide services to youth and families on topics such as motivational interviewing,
permanency practice, and reflective supervision.
• Office of the Child Advocate (OCA) -The Office of the Child Advocate (OCA) provides independent
oversight of state services for children to ensure that children receive appropriate, timely and quality
services. The OCA also serves as a resource for families who are receiving, or are eligible to receive,
services from the Commonwealth.
Center Infrastructure
The Knowledge Center has several dissemination vehicles for this work including its website, trainings, listserv,
and webinars. The Center also has established relationships with researchers, skilled trainers in topics such as
early childhood mental health, motivational interviewing, and reflective supervision, e-learning designers, and
consultants with expertise in implementation science and design thinking. In FY 2023:
• The Center’s website had over 13,000 unique visitors.
• The Center provided training and coaching support using evidence-based teaching approaches to
hundreds of behavioral health professionals. The Center does not deliver or support one-time training
events as they have little support for their effectiveness in changing behavior or enhancing skills.
Rather, the Center’s training initiatives tend to be multi-day trainings that are paired with coaching and
organizational consultation to reinforce and support what trainees are learning in the classroom.
• Center staff members provide expert consultation and support to the Commonwealth’s provider
organizations, academic institutions, and EOHHS agencies on the use of implementation science,
meeting design and facilitation, and training curriculum design and development, and design thinking
methodologies.
Major Activities and Accomplishments
Workforce Initiatives
Strengthening Supervision
A key aspect of the Center’s workforce development strategy is to focus on the competency development and
support of supervisors who oversee service delivery in the publicly funded children’s behavioral system.
Supervisors have considerable influence over their staff and play a critical role in teaching, coaching, and
supporting behavioral health staff members that are working directly with youth and families. Many
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supervisors are promoted based on their performance serving as a direct care worker but often do not receive
specialized training on how to be a supervisor. This year the Knowledge Center supported the following
projects designed to support the implementation of high-quality supervision in community behavioral health
centers. The number of applications for supervision training was so great that we have offered the training
series three times during the 2023 CY and have still not met the demand.
Reflective supervision training and coaching
The Knowledge Center worked with Dr. Elizabeth McEnany to train and coach supervisors in Reflective
Supervision (RS). The practice of RS has its roots in infant and early childhood mental health but is applicable
for those working with older youth and families, particularly those who have experienced trauma. RS
strengthens the practice of trauma-informed care through its model of collaboration with and support of
clinicians and other providers. The Knowledge Center has offered RS training yearly since 2015. The five 3-hour
session training is followed by six monthly coaching sessions where participants receive coaching from the
trainers as they apply the skills learned in their work with supervisees.
Addressing Secondary Traumatic Stress in Supervision
In response to the workforce crisis associated with the COVID-19 pandemic and to bolster existing supervision
efforts, the Knowledge Center, in collaboration with Dr. Elizabeth McEnany developed a curriculum focused on
addressing Secondary Traumatic Stress in Supervision (STS). This comprehensive four-part training series was
designed to be facilitated with Reflective Supervision training and delves into supervisory practices at both
individual and organizational levels. STS is characterized by the manifestation of PTSD symptoms in people
working with trauma survivors resulting from at least one indirect exposure to traumatic content.
Learning objectives include enhancing supervisors' abilities to address their supervisees' responses to
secondary stress, with a focus on recognizing and addressing the varying impact based on racial, ethnic, and
cultural identities. Supervisors are trained on STS core competencies for trauma informed support and
supervision. In addition to this comprehensive training, STS incorporates an extra component wherein an
executive sponsor (such as a Senior Leader or HR Manager) is encouraged to attend, fostering actionable
strategies throughout all levels of an organization.
In its first year, STS has been offered three times to over 60 participants spanning across 15 agencies. Ninety-
four percent (94%) of participants reported that they learned a great deal or a lot in the training. Thirty-eight
percent (38%) of participants reported that they would be making many changes in their practice because of
attending the training, while fifty-six percent (56%) said they would made some changes in their practice.
Infant and Early Childhood Mental Health (IECMH) Workforce Development Initiatives
“Despite trending conversations about our emotional well-being, the mental health of our youngest citizens is
largely ignored or misunderstood. Mental health is formed in our earliest days, even before birth. As a baby
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grows through infancy, toddlerhood and the preschool years, each experience—positive or negative—becomes
a building block for their future wellness.”1
There are strong indications that children born during or shortly before the pandemic are experiencing delays
in language and motor development and that many are experiencing outbursts, aggression, and separation
anxiety.2
An estimated 10 to 16 percent of young kids experience mental health issues; kids living in poverty, at a higher
rate of 22%. According to Nancy Kelly, the mental health promotion branch chief at the federal government’s
Substance Abuse and Mental Health Services Administration (SAMHSA) when young children do not live in a
nurturing and a nurturing setting and lack intervention, the impacts of trauma and stress can be immediate and
long-lasting.3
Reflective Supervision Training for Non-Clinical Workforce
Reflective supervision/consultation (RS/C) is widely recognized as best practice in the provision of infant mental
health services including but not limited to early education and care, behavioral health, home visiting,
pediatrics, etc. The primary goal of RS/C is to promote high quality services and positive outcomes in children
and families. And yet, this type of supervision and consultation is not easily available or equitably accessible to
the diverse Infant and Early childhood workforce.
The Knowledge Center continued funding a 12 month-Reflective Consultation Training in FY23 open at no-cost
to any individuals involved in Infant and Early Childhood Mental Health promotion or prevention work with the
goal of diversifying and strengthen the early childhood workforce by creating equitable access to reflective
consultation training and practice. Four groups of 8 people each met for 10 months and a total of 30 hours and
reported an increase in confidence providing Reflective Supervision to employees at their respective agencies.
The offering provides ongoing support to integrate skills learned in training in infant and early childhood mental
health, to support the workforce through ongoing coaching; and to build the capacity of Reflective Supervisors
in the field to continue this coaching in their settings.
Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early
Childhood (DC: 0-5TM)
The Center has continued training the workforce on the DC: 0-5TM. This diagnostic classification approach
recommends a comprehensive, multi-session diagnostic assessment and can provide a deeper understanding of
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(2022). Infant and Early Childhood Mental Health. Zerotothree.org. https://www.zerotothree.org/issue-areas/infant-and-
early-childhood-mental-health/
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Wong, A. (2022, June 9). Pandemic babies are behind after years of stress, isolation affected brain development. USA
Today. https://www.usatoday.com/in-depth/news/education/2022/06/09/pandemic-babies-now-toddlers-delayed-
development-heres-why/9660318002/
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Sullivan, E. T. (2023, February 28). Who’s Looking Out for the Mental Health of Infants and Toddlers? EDSURGE. Retrieved
December 23, 2023, from https://www.edsurge.com/news/2023-02-28-who-s-looking-out-for-the-mental-health-of-
infants-and-toddlers
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the infant/young child’s psychological, emotional, and relational development and experience, all within the
context of family, community, and culture. During FY23 DMH supported three DC: 0-5 Virtual Clinical Trainings
where 68 professionals were trained, as well as six Reflective Consultation Sessions and three Community of
Practice sessions that were open to all DC: 0-5 trained professionals statewide. On average, 45% of participants
reported working for a Children’s Behavioral Health Initiative program and 72% for a Community Behavioral
Health Center.
Early Relational Health Fellowship
With American Rescue Plan Act (ARPA) funding we were able to fund ten slots (from FY23 through FY26) in the Early
Relational Health Fellowship at UMass Chan Medical School for Black, Indigenous, and People of Color (BIPOC)
clinical professionals, looking to gain in-depth knowledge in Infant and Early Childhood Mental Health and become
leaders in the field, hence supporting the dissemination of this much-needed specialty service. This program is a
comprehensive, part-time, hybrid, 18-month training program in early relational health research, theory,
assessment, and relationship-based interventions.
Preview of Investments for FY24
With EOHHS awarding a workforce development grant for FY24 and FY25 that included, among other things,
support for the trainings mentioned above, DMH has focused on other training needs such as training in
intervention modalities with younger children, as well as support of the entire workforce (not just clinical) on
family engagement, observation, and child development, as well as reflective capacity and access to reflective
supervision. To address these needs, we will be providing a 4-day training in Theraplay in April 2024, open to 30
participants, as well as two trainings in Facilitating Attuned Interactions (FAN) in March and May 2024.
Family Therapy Intensive
The DMH CYF Division, the Knowledge Center, and MassHealth’s Children’s Behavioral Health Initiative
supported scholarships for 28 clinicians working in the publicly funded mental health system to attend the
Intensive Certificate Program in Family Systems Therapy provided by Therapy Training Boston. Our publicly
funded treatment systems work to ensure full family engagement in treatment and seek to prepare families to
support their children successfully at home. This course supports beginning and intermediate level clinicians to
become more skilled, self-aware, and confident family-centered clinicians and supervisors. It teaches family
systems ideas and practices, addressing complex family and individual needs through approaches that are
practical, empowering and collaborative for both families and providers. The course provides 81 hours of
training, including approximately one full day of training a month and one two-day-long retreat. Over the past
five years, the program has trained 112 clinicians. Another cohort of 28 clinicians began in July 2023 and is
expected to complete the course in June 2024. The program offers a second year of coaching to anyone who
has taken the training to help clinicians deepen their practice. This project is the result of cross-agency
collaboration and alignment of training approaches across systems.
In-Home Team-Based Practice Profile
In 2017, the Knowledge Center developed a practice profile for the joint DMH/DCF Caring Together Continuum
service. A practice profile is a tool that breaks down large concepts such as “engagement” into discreet skills
and activities that can be taught, learned, and observed. Based on implementation science, practice profiles are
developed through a rigorous stakeholder engagement process and are further informed by the research
literature. The completed profile can be used to develop a range of implementation supports and activities,
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including: staff training and supervision activities, brochures and other educational materials about the service,
and/or quality improvement activities.
In 2021, the Caring Together system was re-procured separately by DCF and DMH which resulted in the end of
the Continuum service. DMH replaced the Continuum with a very similar service called Intensive Home-Based
Therapeutic Care (IHBTC), which together with other home-based treatment services that would benefit from
the use of the practice profile. In total, these services supported over 1100 youth and their families in FY23. The
Knowledge Center brought together a stakeholder group to review and update the Continuum Practice Profile
for use in any of DMH’s home based treatment programs. In Fall 2023 the new In-Home Team-Based Practice
Profile was re-launched with a training in each of DMH’s 5 Areas. The training was attended by 300 providers
across the state.
Young Adult Peer Mentoring Workforce Training
Young Adult Peer Mentors (YAPM) play an emerging and an increasingly vital role in the Commonwealth’s
behavioral healthcare delivery system. YAPMs are professionals who share their personal experience of living
with and overcoming a behavioral health challenge(s) to provide hope and support to youth facing similar
challenges. Additionally, YAPMs serve as guides to other young adults by offering their invaluable experience
with navigating the behavioral healthcare system. Research on the use of peers has found they help promote
engagement in care, reduce utilization of restrictive and costly services such as inpatient hospitals and
emergency departments, and imp