Expanding Access to Mental Health Services for Maltreated Youth in Child Advocacy Centers: Implementation Determinants and Strategies to Improve Screening and Referral

/ABSTRACT Child maltreatment is a pervasive public health issue, with long-term consequences for children’s mental health and development. Maltreated children are at heightened risk for psychiatric disorders, yet many do not receive timely or appropriate care. Child Advocacy Centers (CACs) are uniquely positioned to identify and address mental health concerns early in the trajectory of trauma exposure. As frontline responders for child maltreatment cases, CACs utilize multidisciplinary teams (MDTs) to conduct forensic interviews, provide medical evaluations, and coordinate referrals for mental health services. Despite this critical role, significant gaps remain in the consistent implementation of evidence-based mental health screening and referral practices within CACs, leaving many children lost to care. This project leverages the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to systematically examine and strengthen mental health screening and referral practices in CACs. The study has three aims: (1) Identify barriers and facilitators of mental health screening and referral practices in CACs and similar settings through a scoping review; (2) Generate a detailed understanding of workflows in two CACs and primary determinants influencing consistent implementation of screening and referral using rapid ethnographic assessments (i.e., workflow observations and semi-structured interviews); (3) Collaboratively create practical roadmaps with CAC partners for improving screening and referral practices guided by causal pathway diagram (CPD) workshops. The scoping review will provide a comprehensive understanding of the factors that impact mental health screening and referral, creating a foundation for ethnographic exploration. Rapid ethnographic assessments will document detailed workflows and decision-making processes within CACs, identifying points where mental health screening and referral protocols can be strengthened. CPD workshops will use this contextual ethnographic knowledge to detail specific implementation strategies aligned with the determinants most significant to each CAC. Overall, this project will provide practical recommendations to enhance mental health screening and referral practices in CACs and will advance implementation science by applying novel partner-driven methods to multidisciplinary settings. Ultimately, this work aims to expand access to evidence- based mental health care for maltreated youth by addressing gaps in the early stages of the care cascade. Project Number: 1F31MH141936-01A1 | Fiscal Year: 2026 | NIH Institute/Center: National Institute of Mental Health (NIMH) | Principal Investigator: PRIYA DAHIYA | Institution: UNIVERSITY OF WASHINGTON, SEATTLE, WA | Award Amount: $50,114 | Activity Code: F31 | Study Section: Special Emphasis Panel[ZRG1 F16-S (20)] View on NIH RePORTER: https://reporter.nih.gov/project-details/11383733