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Dopp AR, Hindmarch G, Osilla KC, Meredith LS, Manuel JK, Becker K, Tarhuni L, Schoenbaum M, Komaromy M, Cassells A, Watkins KE. Mis-implementation of evidence-based behavioural health practices in primary care: lessons from randomised trials in Federally Qualified Health Centers. EVIDENCE & POLICY : A JOURNAL OF RESEARCH, DEBATE AND PRACTICE 2024; 20:15-35. [PMID: 38911233 PMCID: PMC11192460 DOI: 10.1332/17442648y2023d000000016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Background Implementing evidence-based practices (EBPs) within service systems is critical to population-level health improvements - but also challenging, especially for complex behavioral health interventions in low-resource settings. "Mis-implementation" refers to poor outcomes from an EBP implementation effort; mis-implementation outcomes are an important, but largely untapped, source of information about how to improve knowledge exchange. Aims and objectives We present mis-implementation cases from three pragmatic trials of behavioral health EBPs in U.S. Federally Qualified Health Centers (FQHCs). Methods We adapted the Consolidated Framework for Implementation Research and its Outcomes Addendum into a framework for mis-implementation and used it to structure the case summaries with information about the EBP and trial, mis-implementation outcomes, and associated determinants (barriers and facilitators). We compared the three cases to identify shared and unique mis-implementation factors. Findings Across cases, there was limited adoption and fidelity to the interventions, which led to eventual discontinuation. Barriers contributing to mis-implementation included intervention complexity, low buy-in from overburdened providers, lack of alignment between providers and leadership, and COVID-19-related stressors. Mis-implementation occurred earlier in cases that experienced both patient- and provider-level barriers, and that were conducted during the COVID-19 pandemic. Discussion and conclusion Multi-level determinants contributed to EBP mis-implementation in FQHCs, limiting the ability of these health systems to benefit from knowledge exchange. To minimize mis-implementation, knowledge exchange strategies should be designed around common, core barriers but also flexible enough to address a variety of site-specific contextual factors and should be tailored to relevant audiences such as providers, patients, and/or leadership.
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Cooper C, Watson K, Alvarado F, Carroll AJ, Carson SL, Donenberg G, Ferdinand KC, Islam N, Johnson R, Laurent J, Matthews P, McFarlane A, Mills SD, Vu MB, Washington IS, Yuan CT, Davis P. Community Engagement in Implementation Science: the Impact of Community Engagement Activities in the DECIPHeR Alliance. Ethn Dis 2023; DECIPHeR:52-59. [PMID: 38846725 PMCID: PMC11099526 DOI: 10.18865/ed.decipher.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2024] Open
Abstract
Background The translation of evidence-based interventions into practice settings remains challenging. Implementation science aims to bridge the evidence-to-practice gap by understanding multilevel contexts and tailoring evidence-based interventions accordingly. Engaging community partners who possess timely, local knowledge is crucial for this process to be successful. The Disparities Elimination through Coordinated Interventions to Prevent and Control Heart and Lung Disease Risk (DECIPHeR) Alliance aims to address cardiopulmonary health disparities by engaging diverse community partners to improve the implementation of evidence-based interventions. The goal of the Community Engagement Subcommittee is to strengthen community engagement practice across DECIPHeR. This paper presents the subcommittee's "Why We Engage Communities" statement that outlines why community engagement is critical for implementation science. The paper also provides case examples of DECIPHeR community engagement activities. Methods To develop the "Why We Engage Communities" statement, we conducted a literature review, surveyed subcommittee members to assess the importance of community engagement in their work, and integrated community partner feedback. We synthesize the findings into three key themes and present examples of community engagement activities and their impact across DECIPHeR projects. Results The statement presents three themes that illustrate why community engagement increases the impact of implementation and health equity research. Community engagement (1) engages local knowledge and expertise, (2) promotes authentic relationships, and (3) builds community and researcher capacity. The statement provides a guiding framework for strengthening DECIPHeR research and enhancing community partnerships. Conclusion Community engagement can improve the implementation of evidence-based interventions across diverse settings, improving intervention effectiveness in underserved communities and furthering health equity.
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Affiliation(s)
- Claire Cooper
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY
| | | | | | - Allison J. Carroll
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Savanna L. Carson
- Department of General Internal Medicine and Health Services Research, University of California, Los Angeles, Los Angeles, CA
| | - Geri Donenberg
- Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois, Chicago, Chicago, IL
| | | | - Nadia Islam
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY
| | - Rebecca Johnson
- Northwestern University and Total Resource Community Development Organization, Chicago, IL
| | | | | | | | - Sarah D. Mills
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Maihan B. Vu
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - India S. Washington
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christina T. Yuan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Paris Davis
- Total Resource Community Development Organization and Triedstone Church of Chicago, Chicago, IL
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Bunger AC, Yoon S, Maguire-Jack K, Phillips R, West KY, Clark-Hammond G, Kranich C. Implementation and Mental Health Outcomes of a Service Cascade Linking Child Welfare and Children's Mental Health Systems: A Case Study of the Gateway CALL Demonstration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:327-341. [PMID: 36449108 PMCID: PMC9931844 DOI: 10.1007/s10488-022-01238-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/05/2022]
Abstract
The mental health needs of children and youth involved in the child welfare system remain largely unmet. Service cascades are an emerging approach to systematizing mental health screening, assessment, and treatment referral processes. However, evidence is minimal and inconsistent regarding the effectiveness of such approaches for improving mental health service access and outcomes. In an effort to address this gap, this study presents a case-study of the implementation fidelity and treatment outcomes of the Gateway CALL service cascade. Study analyses involved longitudinal data collected as part of a larger evaluation of Gateway CALL. Specifically, descriptive and linear mixed model analyses were conducted to assess the implementation of service cascade components, and changes in mental health outcomes (behavior problems) among 175 children placed out-of-home during the study. Study analyses found that although fidelity was strong early in the service cascade, implementation began to break down once components involved more than one service system (child welfare, mental health). However, results also indicated that parent-reported child behavior problems decreased significantly over time, despite later cascade components being implemented with poor fidelity to the Gateway CALL service model. For children and youth involved in child welfare systems, service cascades like Gateway CALL have the potential to significantly improve both mental health service receipt and outcomes. To maximize the effectiveness of such approaches, later phases of implementation may require increased attention and support, particularly regarding processes and outcomes that cross child welfare and mental health service systems.
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Affiliation(s)
- Alicia C. Bunger
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | - Susan Yoon
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | | | - Rebecca Phillips
- College of Social Work, The Ohio State University, Columbus, OH 43210 USA
| | | | | | - Christiana Kranich
- Government Resource Center, Ohio Colleges of Medicine, Columbus, OH 43210 USA
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Schlechter CR, Del Fiol G, Lam CY, Fernandez ME, Greene T, Yack M, Schulthies S, Nelson M, Bohner C, Pruhs A, Siaperas T, Kawamoto K, Gibson B, Nahum-Shani I, Walker TJ, Wetter DW. Application of community - engaged dissemination and implementation science to improve health equity. Prev Med Rep 2022; 24:101620. [PMID: 34976676 PMCID: PMC8684008 DOI: 10.1016/j.pmedr.2021.101620] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022] Open
Abstract
Community engagement is critical to accelerate and improve implementation of evidence-based interventions to reduce health inequities. Community-engaged dissemination and implementation research (CEDI) emphasizes engaging stakeholders (e.g., community members, practitioners, community organizations, etc.) with diverse perspectives, experience, and expertise to provide tacit community knowledge regarding the local context, priorities, needs, and assets. Importantly, CEDI can help improve health inequities through incorporating unique perspectives from communities experiencing health inequities that have historically been left out of the research process. The community-engagement process that exists in practice can be highly variable, and characteristics of the process are often underreported, making it difficult to discern how engagement of community partners was used to improve implementation. This paper describes the community-engagement process for a multilevel, pragmatic randomized trial to increase the reach and impact of evidence-based tobacco cessation treatment among Community Health Center patients; describes how engagement activities and the resulting partnership informed the development of implementation strategies and improved the research process; and presents lessons learned to inform future CEDI research.
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Affiliation(s)
- Chelsey R. Schlechter
- Center for Health Outcomes and Population Equity, University of Utah and Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112, United States
- Department of Population Health Sciences, University of Utah, Address: 295 Chipeta Way, Salt Lake City, UT 84108, United States
- Corresponding author.
| | - Guilherme Del Fiol
- Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way #140, Salt Lake City, UT 84108, United States
| | - Cho Y. Lam
- Center for Health Outcomes and Population Equity, University of Utah and Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112, United States
- Department of Population Health Sciences, University of Utah, Address: 295 Chipeta Way, Salt Lake City, UT 84108, United States
| | - Maria E. Fernandez
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, 7000 Fannin St, Houston, TX 77030, United States
| | - Tom Greene
- Department of Population Health Sciences, University of Utah, Address: 295 Chipeta Way, Salt Lake City, UT 84108, United States
| | - Melissa Yack
- Center for Health Outcomes and Population Equity, University of Utah and Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112, United States
| | - Sandra Schulthies
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT 84116, United States
| | - Marci Nelson
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT 84116, United States
| | - Claudia Bohner
- Utah Department of Health, 288 N 1460 W, Salt Lake City, UT 84116, United States
| | - Alan Pruhs
- Association for Utah Community Health, 860 E 4500 S, Murray, UT 84107, United States
| | - Tracey Siaperas
- Association for Utah Community Health, 860 E 4500 S, Murray, UT 84107, United States
| | - Kensaku Kawamoto
- Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way #140, Salt Lake City, UT 84108, United States
| | - Bryan Gibson
- Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way #140, Salt Lake City, UT 84108, United States
| | - Inbal Nahum-Shani
- Institute for Social Research, University of Michigan, 426 Thompson St, Ann Arbor, MI 48104, United States
| | - Timothy J. Walker
- University of Texas Health Science Center at Houston School of Public Health, Department of Health Promotion & Behavioral Sciences, Center for Health Promotion and Prevention Research, 7000 Fannin St, Houston, TX 77030, United States
| | - David W. Wetter
- Center for Health Outcomes and Population Equity, University of Utah and Huntsman Cancer Institute, 2000 Circle of Hope Dr, Salt Lake City, UT 84112, United States
- Department of Population Health Sciences, University of Utah, Address: 295 Chipeta Way, Salt Lake City, UT 84108, United States
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Bunger AC, Maguire-Jack K, Yoon S, Mooney D, West KY, Hammond GC, Kranich C. Does mental health screening and assessment in child welfare improve mental health service receipt, child safety, and permanence for children in out-of-home care? An evaluation of the Gateway CALL demonstration. CHILD ABUSE & NEGLECT 2021; 122:105351. [PMID: 34628151 DOI: 10.1016/j.chiabu.2021.105351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Unmet mental health service needs among children in out-of-home care are sometimes attributed to poor assessments and referrals in child welfare. The Gateway CALL project implemented mental health screening, diagnostic assessment, and referral to treatment practices. OBJECTIVE We examined the effectiveness of Gateway CALL for improving children's mental health service receipt, safety, and permanency outcomes. PARTICIPANTS AND SETTING Participants included 538 children (birth to 18 years) in out-of-home placements through a county-based child welfare agency over a 17-month period. METHODS We compared the mental health service receipt, safety, and permanency outcomes for 175 children who received Gateway CALL with 175 children who received "services as usual" identified through propensity score matching. Participant demographics, safety, and permanency outcomes were drawn from child welfare administrative records, and mental health service visits and diagnoses were drawn from Medicaid billing records. RESULTS Gateway CALL appeared to increase the number of mental health service visits children received (z = 2.14, p = 0.032), although not the likelihood of receiving services. In terms of child safety, children in Gateway CALL had a greater number of screened-in calls after the intervention than those in the comparison group [t(348) = -1.92, p = 0.03]; there were no differences in substantiations. There were also no observed effects on permanency. CONCLUSIONS Despite systematic efforts to identify, assess, and refer children to mental health services through the Gateway CALL intervention, substantial unmet mental health service needs among children persisted. Results have implications for designing interventions that promote cross-system service access.
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Affiliation(s)
- Alicia C Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA.
| | - Kathryn Maguire-Jack
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI 48109, USA
| | - Susan Yoon
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA
| | | | - Kristopher Y West
- Nationwide Children's Hospital, 495 East Main Street, Columbus, OH 43215, USA
| | | | - Christiana Kranich
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA
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Schoenwald SK, Bradshaw CP, Hoagwood KE, Atkins MS, Ialongo N, Douglas SR. Festschrift for Leonard Bickman: Introduction to The Future of Children's Mental Health Services Special Issue. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:649-654. [PMID: 32715428 PMCID: PMC7382702 DOI: 10.1007/s10488-020-01070-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This introductory article describes the genesis of the Festschrift for Leonard Bickman and of this Festschrift special issue entitled, The Future of Children’s Mental Health Services. The special issue includes a collection of 11 original children’s mental health services research articles, broadly organized in accordance with three themes (i.e., Improving Precision and Use of Service Data to Guide Policy and Practice, Implementation and Dissemination, and Preparing for Innovation), followed by an interview-style article with Bickman. Then follows a featured manuscript by Bickman himself, three invited commentaries, and a compilation of letters and notes in which colleagues reflect on his career and on their experiences of him. The introduction concludes with a few thoughts about the future of children’s mental health services portended by the extraordinary scholarly contributions of Bickman and those who have been inspired by him.
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Affiliation(s)
- Sonja K Schoenwald
- Oregon Social Learning Center, 10 Shelton McMurphy Blvd., Eugene, OR, 97401, USA.
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Landsverk J, Proctor EK. From Research Training to Scientific Advancement-Contributions from the Implementation Research Institute: An Introduction to the Special Issue. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:169-175. [PMID: 31970568 DOI: 10.1007/s10488-020-01015-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The special series is designed to provide examples of funded implementation research conducted by alumni of the first four cohorts of the Implementation Research Institute (IRI). The introduction links the six substantive papers to the conceptual and methodological challenges laid out in a 2009 publication in this journal which led to the IRI training program in the emerging science of implementation with a special focus on behavior health settings. The 7th paper in the series illustrates an innovative evaluative approach to design and measurement of IRI fellow publications and grants informed by the training program such as bibliometrics. The introduction also notes some elements identified in the 2009 foundational paper not represented in these papers such as costs as well as important developments and foci in the decade since 2009 such as de-implementation, sustainability, dynamic adaptation processes, and hybrid designs that need to be an integral part of training programs in implementation research.
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Affiliation(s)
- John Landsverk
- Oregon Social Learning Center, 10 Shelton McMurphy Blvd., Eugene, OR, 97401, USA.
| | - Enola K Proctor
- Brown School of Social Work, Washington University in St. Louis, 1 Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
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Pintello D. Commentary: Establishing Scientific Rigor and Excellence in Implementation Science Training to Improve the Deployment of Evidence-Based Mental Health Services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:265-271. [PMID: 32026141 DOI: 10.1007/s10488-020-01014-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Real-world challenges continue to impede the dissemination, implementation and sustainment of high-quality, evidence-based practices, resulting in too many individuals not receiving the effective mental health care that they urgently need. The field of implementation science is poised to generate new solutions to address this important public health problem. Training a new generation of researchers in implementation science is one solution. The Implementation Research Institute (IRI) offers one approach to such training. The papers in this series, authored by some of the IRI graduates, illustrate the depth and breadth of the intellectual scope of IRI graduates' contributions to the implementation science field, chronicles important lessons learned, and underscores the IRI's training capacity. This commentary reflects upon the series in terms of a framework and themes that relate to core implementation science principles and to future research that corresponds to the National Institute of Mental Health research priorities and strategic plan.
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Affiliation(s)
- Denise Pintello
- Division of Services and Intervention Research, National Institute of Mental Health, 6001 Executive Boulevard, Rm 7142, Bethesda, MD, 20892-9631, USA.
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Bunger AC, Birken SA, Hoffman JA, MacDowell H, Choy-Brown M, Magier E. Elucidating the influence of supervisors' roles on implementation climate. Implement Sci 2019; 14:93. [PMID: 31653254 PMCID: PMC6815002 DOI: 10.1186/s13012-019-0939-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/11/2019] [Indexed: 11/20/2022] Open
Abstract
Background Supervisors play an essential role in implementation by diffusing and synthesizing information, selling implementation, and translating top management’s project plans to frontline workers. Theory and emerging evidence suggest that through these roles, supervisors shape implementation climate—i.e., the degree to which innovations are expected, supported, and rewarded. However, it is unclear exactly how supervisors carry out each of these roles in ways that contribute to implementation climate—this represents a gap in the understanding of the causal mechanisms that link supervisors’ behavior with implementation climate. This study examined how supervisors’ performance of each of these roles influences three core implementation climate domains (expectations, supports, and rewards). Materials and methods A sequenced behavioral health screening, assessment, and referral intervention was implemented within a county-based child welfare agency. We conducted 6 focus groups with supervisors and frontline workers from implementing work units 6 months post-implementation (n = 51) and 1 year later (n = 40) (12 groups total). Participants were asked about implementation determinants, including supervision and implementation context. We audio-recorded, transcribed, and analyzed focus groups using an open coding process during which the importance of the supervisors’ roles emerged as a major theme. We further analyzed this code using concepts and definitions related to middle managers’ roles and implementation climate. Results In this work setting, supervisors (1) diffused information about the intervention proactively, and in response to workers’ questions, (2) synthesized information by tailoring it to workers’ individual needs, (3) translated top managements’ project plans into day-to-day tasks through close monitoring and reminders, and (4) justified implementation. All four of these roles appeared to shape the implementation climate by conveying strong expectations for implementation. Three roles (diffusing, synthesizing, and mediating) influenced climate by supporting workers during implementation. Only one role (diffusing) influenced climate by conveying rewards. Conclusions Supervisors shaped implementation climate by carrying out four roles (diffusing, synthesizing, mediating, and selling). Findings suggest that the interaction of these roles convey expectations and support for implementation (two implementation climate domains). Our study advances the causal theory explaining how supervisors’ behavior shapes the implementation climate, which can inform implementation practice.
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Affiliation(s)
- Alicia C Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH, 43210, USA.
| | - Sarah A Birken
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC, 27599, USA
| | - Jill A Hoffman
- School of Social Work, Portland State University, 1800 SW 6th Avenue, Suite 600, Portland, OR, 97201, USA
| | - Hannah MacDowell
- Bureau of Maternal, Child and Family Health, Ohio Department of Health, 246 North High Street, Columbus, OH, 43215, USA
| | - Mimi Choy-Brown
- School of Social Work, University of Minnesota, Peters Hall, 1404 Gortner Ave, Saint Paul, MN, 55108, USA
| | - Erica Magier
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH, 43210, USA
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