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McGuier EA, Kolko DJ, Aarons GA, Schachter A, Klem ML, Diabes MA, Weingart LR, Salas E, Wolk CB. Teamwork and implementation of innovations in healthcare and human service settings: a systematic review. Implement Sci 2024; 19:49. [PMID: 39010100 PMCID: PMC11247800 DOI: 10.1186/s13012-024-01381-9] [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] [Received: 01/18/2024] [Accepted: 07/07/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Implementation of new practices in team-based settings requires teams to work together to respond to new demands and changing expectations. However, team constructs and team-based implementation approaches have received little attention in the implementation science literature. This systematic review summarizes empirical research examining associations between teamwork and implementation outcomes when evidence-based practices and other innovations are implemented in healthcare and human service settings. METHODS We searched MEDLINE, CINAHL, APA PsycINFO and ERIC for peer-reviewed empirical articles published from January 2000 to March 2022. Additional articles were identified by searches of reference lists and a cited reference search for included articles (completed in February 2023). We selected studies using quantitative, qualitative, or mixed methods to examine associations between team constructs and implementation outcomes in healthcare and human service settings. We used the Mixed Methods Appraisal Tool to assess methodological quality/risk of bias and conducted a narrative synthesis of included studies. GRADE and GRADE-CERQual were used to assess the strength of the body of evidence. RESULTS Searches identified 10,489 results. After review, 58 articles representing 55 studies were included. Relevant studies increased over time; 71% of articles were published after 2016. We were unable to generate estimates of effects for any quantitative associations because of very limited overlap in the reported associations between team variables and implementation outcomes. Qualitative findings with high confidence were: 1) Staffing shortages and turnover hinder implementation; 2) Adaptive team functioning (i.e., positive affective states, effective behavior processes, shared cognitive states) facilitates implementation and is associated with better implementation outcomes; Problems in team functioning (i.e., negative affective states, problematic behavioral processes, lack of shared cognitive states) act as barriers to implementation and are associated with poor implementation outcomes; and 3) Open, ongoing, and effective communication within teams facilitates implementation of new practices; poor communication is a barrier. CONCLUSIONS Teamwork matters for implementation. However, both team constructs and implementation outcomes were often poorly specified, and there was little overlap of team constructs and implementation outcomes studied in quantitative studies. Greater specificity and rigor are needed to understand how teamwork influences implementation processes and outcomes. We provide recommendations for improving the conceptualization, description, assessment, analysis, and interpretation of research on teams implementing innovations. TRIAL REGISTRATION This systematic review was registered in PROSPERO, the international prospective register of systematic reviews. REGISTRATION NUMBER CRD42020220168.
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Affiliation(s)
- Elizabeth A McGuier
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA.
| | - David J Kolko
- Department of Psychiatry, School of Medicine, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA, 15213, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
- ACTRI Dissemination and Implementation Science Center, UC San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Allison Schachter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Mary Lou Klem
- Health Sciences Library System, University of Pittsburgh, Pittsburgh, PA, USA
| | - Matthew A Diabes
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Laurie R Weingart
- Tepper School of Business, Carnegie Mellon University, Pittsburgh, PA, USA
| | - Eduardo Salas
- Department of Psychological Sciences, Rice University, Houston, TX, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
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Brown FL, Lee C, Servili C, Willhoite A, Van Ommeren M, Hijazi Z, Kieselbach B, Skeen S. Psychological interventions for children with emotional and behavioral difficulties aged 5-12 years: An evidence review. Glob Ment Health (Camb) 2024; 11:e75. [PMID: 39314997 PMCID: PMC11418085 DOI: 10.1017/gmh.2024.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/18/2024] [Accepted: 04/29/2024] [Indexed: 09/25/2024] Open
Abstract
In low- and middle-income countries (LMICs), children and families face a multitude of risk factors for mental health and well-being. These risks are even further exacerbated in humanitarian emergencies. However, access to effective mental health services in such settings is severely limited, leading to a large mental health treatment gap. Middle childhood (5-12 years) is a crucial period for human development during which symptoms of emotional distress often emerge, with one in three mental disorders developing prior to age 14. However, there is little evidence of effective psychological interventions for children in this developmental stage, and suitable for implementation within LMICs and humanitarian emergencies. We conducted this evidence review to inform the development of a new intervention package based on existing best practice for this age group, drawing insights from both global and LMIC resources. Our review synthesizes the findings of 52 intervention studies from LMICs and humanitarian settings; 53 existing systematic reviews and meta-analyses covering both LMICs and high-income countries, and 15 technical guidelines. Overall, there is limited high-quality evidence from which to draw recommendations for this age group; however, some promising intervention approaches were identified for children experiencing externalizing and internalizing symptoms, traumatic stress and a combination of difficulties. Several effective interventions utilize cognitive-behavioral techniques for children, in either group or individual format, and incorporate caregiver skills training into treatment, although the findings are mixed. Most evaluated interventions use specialists as delivery agents and are lengthy, which poses challenges for scale-up in settings where financial and human resources are scarce. These findings will inform the development of new psychological interventions for children in this age group with emotional and behavioral difficulties.
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Affiliation(s)
| | - Catherine Lee
- Child Protection, United Nations Children’s Fund, New York, NY, USA
| | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Ann Willhoite
- Child Protection, United Nations Children’s Fund, New York, NY, USA
| | - Mark Van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Zeinab Hijazi
- Programme Division Director’s Office, United Nations Children’s Fund, New York, NY, USA
| | - Berit Kieselbach
- Department of Social Determinants of Health, World Health Organization, Geneva, Switzerland
| | - Sarah Skeen
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Johnson C, AlRasheed R, Gray C, Triplett N, Mbwayo A, Weinhold A, Whetten K, Dorsey S. Uncovering determinants of perceived feasibility of TF-CBT through coincidence analysis. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895231220277. [PMID: 38322800 PMCID: PMC10775737 DOI: 10.1177/26334895231220277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Introduction A mental health provider's perception of how well an intervention can be carried out in their context (i.e., feasibility) is an important implementation outcome. This article aims to identify determinants of feasibility of trauma-focused cognitive behavioral therapy (TF-CBT) through a case-based causal approach. Method Data come from an implementation-effectiveness study in which lay counselors (teachers and community health volunteers) implemented a culturally adapted manualized mental health intervention, TF-CBT, delivered to teens who were previously orphaned and were experiencing posttraumatic stress symptoms and prolonged grief in Western Kenya. The intervention team identified combinations of determinants that led to feasibility among teacher- and community health volunteer-counselors through coincidence analysis. Results Among teacher-counselors, organizational-level factors (implementation climate, implementation leadership) determined moderate and high levels of feasibility. Among community health volunteer-counselors, a strong relationship between a clinical supervisor and the supervisee was the most influential determinant of feasibility. Conclusion Methodology and findings from this article can guide the assessment of determinants of feasibility and the development of implementation strategies for manualized mental health interventions in contexts like Western Kenya. Plain Language Summary A mental health provider's perception of how easy a therapy is to use in their work setting (i.e., feasibility) can impact whether the provider uses the therapy in their setting. Implementation researchers have recommended finding practices and constructs that lead to important indicators that a therapy will be used. However, limited research to our knowledge has searched and found practices and constructs that might determine feasibility of a therapy. This article uses existing data from a large trial looking at the continued use of a trauma-focused therapy to find practices and constructs that lead to moderate and high levels of feasibility. We found that in settings with a strong organizational structure that organization and leadership support for the therapy led to teachers in Kenya to perceive the therapy as easy to use. On the other hand, in settings with a weaker organizational structure, outside support from a clinical supervisor led to community health volunteers in Kenya perceiving the therapy as easy to use. The findings from this article can guide context-specific recommendations for increasing perceived therapy feasibility at the provider-, organization-, and policy levels.
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Affiliation(s)
- Clara Johnson
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Christine Gray
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Noah Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Andrew Weinhold
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Kathryn Whetten
- Center for Health Policy and Inequities Research, Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Martinez RG, Weiner BJ, Meza RD, Dorsey S, Palazzo LG, Matson A, Bain C, Mettert KD, Pullmann MD, Lewis CC. Study protocol: Novel Methods for Implementing Measurement-Based Care with youth in Low-Resource Environments (NIMBLE). Implement Sci Commun 2023; 4:152. [PMID: 38017522 PMCID: PMC10683142 DOI: 10.1186/s43058-023-00526-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/02/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND For youth receiving care in community mental health centers, comorbidities are the rule rather than the exception. Using measurement-based care (MBC), or the routine evaluation of symptoms to inform care decisions, as the foundation of treatment for youth with comorbid problems significantly improves the impact of psychotherapy by focusing care and building engagement and alliance. MBC increases the rate of symptom improvement, detects clients who would otherwise deteriorate, and alerts clinicians to non-responders. Despite its demonstrated utility, MBC is rarely implemented with fidelity; less than 15% of providers report using MBC per recommendations. Previous efforts to support MBC implementation have yielded suboptimal outcomes, in part, due to organizations' challenges with identifying and prioritizing barriers and selecting and developing strategies to overcome them. New methods are needed for identifying and prioritizing barriers, and matching strategies to barriers to optimize MBC implementation and treatment quality to improve youth mental health outcomes in community settings. METHODS Pragmatic implementation methods will be piloted in four diverse community mental health centers. Methods include (a) rapid evidence synthesis; (b) rapid ethnography; (c) design kits (e.g., kits with disposable cameras, journals, maps); (d) barrier prioritization, and (e) causal pathway diagramming. These activities will generate actionable barriers; subsequently, we will use facilitated group processes to prioritize barriers and develop causal pathway diagrams to match strategies to barriers to create implementation plans that optimize MBC fidelity (Aim 1). We will track strategy deployment for 6 months, then compare MBC fidelity for another 6 months post-implementation with data from 2 years of historical controls (Aim 2). Finally, we will co-design a toolkit for design kit methods with youth and the practice and scientific communities (Aim 3). DISCUSSION Optimizing MBC implementation in community mental health centers could transform youth mental health care by ensuring the most pressing symptoms are targeted early in treatment. The discussion section highlights expected challenges and limits to using the five methods, including recruitment and engagement given the high pressure on community mental health settings. TRIAL REGISTRATION Clinicaltrials.gov. NCT05644756 . Registered on 18 November 2022. This trial was retrospectively registered.
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Affiliation(s)
- Ruben G Martinez
- The Warren Alpert Medical School of Brown University, Providence, RI, USA.
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Rosemary D Meza
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Lorella G Palazzo
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Abigail Matson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Carolyn Bain
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kayne D Mettert
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Michael D Pullmann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Tsheole P, Makhado L, Maphula A. Childhood Trauma and Exposure to Violence Interventions: The Need for Effective and Feasible Evidence-Based Interventions. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1760. [PMID: 38002851 PMCID: PMC10670457 DOI: 10.3390/children10111760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/11/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
Several crimes in South Africa cause physical, economic, and mental problems. Xenophobic attacks, mob justice, and other violent conduct directly traumatise children. Service delivery riots and physical and sexual abuse are examples. This evaluation evaluates childhood trauma and exposure to violence interventions. The review describes the therapeutic methods for traumatised children exposed to violence, the healthcare professionals administering them, and the strategies used to tailor the interventions. The researcher systematically searched PsycINFO, Google Scholar, PubMed, Science Direct, and EBSCOhost. Literature from 2011 to 31 July 2023 was searched, and 19 papers were chosen for further review after the systematic search. The authors conducted an eligibility evaluation according to PRISMA guidelines. A thorough review of article texts identified 19 papers that met eligibility standards. Only nineteen studies have validated trauma and violence therapies for children. An effective multi-phased intervention that is feasible and adaptable to varied socioeconomic backgrounds is needed. Further studies on the mental health benefits of brief trauma intervention treatment are needed.
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Affiliation(s)
- Petunia Tsheole
- Department of Psychology, Faculty of Health Sciences, University of Venda, Thohoyandou 0950, South Africa
| | - Lufuno Makhado
- Public Health, Faculty of Health Care Sciences, University of Venda, Thohoyandou 0950, South Africa; (L.M.); (A.M.)
| | - Angelina Maphula
- Public Health, Faculty of Health Care Sciences, University of Venda, Thohoyandou 0950, South Africa; (L.M.); (A.M.)
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Calvert HG, McQuilkin M, Havlicak A, Lewis T, Turner L. Acceptability, appropriateness, and feasibility of Rural School Support Strategies for behavioral interventions: a mixed methods evaluation over two years of a hybrid type 3 implementation-effectiveness trial. Implement Sci Commun 2023; 4:92. [PMID: 37568206 PMCID: PMC10416374 DOI: 10.1186/s43058-023-00478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 07/28/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Positive Behavioral Interventions and Supports (PBIS) is a framework for implementing evidence-based interventions for preventing behavioral issues and improving climate in schools. The implementation of school-wide PBIS with fidelity is complex, requiring leadership commitment, teaming, and coordination of systems for tracking behaviors and consequences. Putting these components in place while ensuring alignment with the values and needs of the school community can be difficult for schools with fewer resources, such as rural schools. Implementation supports are needed, including strategies such as technical assistance, but it is unclear whether lower-cost modalities such as virtual support are acceptable, appropriate, and feasible and whether perceptions vary throughout the implementation process. METHODS A type 3 hybrid implementation-effectiveness trial is taking place in 40 Idaho schools, testing a bundle of implementation supports selected to meet the needs of schools in rural areas. Supports include technical assistance from an implementation support practitioner (ISP), didactic trainings, virtual learning sessions, and an online resource portal. Surveys and interviews in the first 2 years of implementation (fall 2019 to spring 2021) explored outcomes of acceptability, appropriateness, and feasibility regarding the implementation supports among more than 150 school stakeholders. RESULTS Evaluations showed high acceptability and appropriateness of the PBIS concepts and training. The 20 schools receiving additional implementation support rated the technical assistance and support from the project's ISPs as the most acceptable and appropriate resource. Reasons for acceptability were the relationship built with the ISP, the ISP's expertise, and being a "neutral party." Although in-person support from the ISP was preferred, remote support was acceptable and increased feasibility of attendance. Virtual learning sessions were acceptable for learning and collaboration, particularly in the second year of implementation, once ISPs had developed closer relationships with school teams. CONCLUSIONS School staff found training, technical assistance, and virtual learning sessions to be acceptable and appropriate. Virtual formats of training and technical assistance decreased in acceptability but increased feasibility of attendance. In-person support was preferred during initial implementation, and virtual support was more acceptable thereafter. TRIAL REGISTRATION This trial was prospectively registered on ClinicalTrials.gov ( NCT03736395 ), on November 9, 2018.
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Affiliation(s)
- Hannah G Calvert
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA.
| | - Michaela McQuilkin
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
| | - Ashley Havlicak
- School of Public and Population Health, College of Health Sciences, Boise State University, 1910 W University Dr, Boise, ID, 83725-1742, USA
| | - Teri Lewis
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
| | - Lindsey Turner
- Center for School and Community Partnerships, College of Education, Boise State University, 1910 W University Drive, Boise, ID, 83725-1742, USA
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Spencer L, Alderson H, Scott S, Kaner E, Ling J. 'The Addiction Was Making Things Harder for My Mental Health': A Qualitative Exploration of the Views of Adults and Adolescents Accessing a Substance Misuse Treatment Service. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5967. [PMID: 37297571 PMCID: PMC10253073 DOI: 10.3390/ijerph20115967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023]
Abstract
The relationship between substance use and mental health is complex, and both constitute a global public health burden. In the UK, the estimated annual financial costs of alcohol-related harm and illicit drug use are GBP 21.5 billion and GBP 10.7 billion, respectively. This issue is magnified in the North East of England, where treatment access is low and a large proportion of individuals experience socioeconomic deprivation. The present study aimed to explore the experiences of adults and adolescents accessing a substance misuse treatment service in the North East, in order to inform policy makers, commissioners, and providers of substance misuse treatment and prevention. Semi-structured qualitative interviews were conducted with an opportunistic sample of n = 15 adult participants (aged 18 years and over) and n = 10 adolescent participants (aged between 13 and 17 years). Interviews were audio-recorded, transcribed, anonymised, and analysed thematically. Five key themes were identified: (1) initiation of substance use, (2) early life experiences, (3) the bi-directional relationship of mental health and substance use, (4) cessation of substance use, and (5) accessing treatment. Future preventative interventions should focus on providing support to individuals who have been exposed to adverse childhood experiences, with treatment provision for individuals experiencing co-occurring mental health and substance use issues taking a more holistic approach.
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Affiliation(s)
- Liam Spencer
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (S.S.)
| | - Hayley Alderson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (S.S.)
| | - Steph Scott
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (S.S.)
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne NE2 4AX, UK (S.S.)
| | - Jonathan Ling
- Faculty of Health Sciences and Wellbeing, University of Sunderland, Sunderland SR1 3SD, UK
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Becker-Haimes EM, Klein CC, Frank HE, Oquendo MA, Jager-Hyman S, Brown GK, Brady M, Barnett ML. Clinician Maladaptive Anxious Avoidance in the Context of Implementation of Evidence-Based Interventions: A Commentary. FRONTIERS IN HEALTH SERVICES 2022; 2:833214. [PMID: 36382152 PMCID: PMC9648711 DOI: 10.3389/frhs.2022.833214] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
This paper posits that a clinician's own anxious reaction to delivering specific evidence-based interventions (EBIs) should be better accounted for within implementation science frameworks. A key next step for implementation science is to delineate the causal processes most likely to influence successful implementation of evidence-based interventions (EBIs). This is critical for being able to develop tailored implementation strategies that specifically target mechanisms by which implementation succeeds or fails. First, we review the literature on specific EBIs that may act as negatively valenced stimuli for clinicians, leading to a process of clinician maladaptive anxious avoidance that can negatively impact EBI delivery. In the following sections, we argue that there are certain EBIs that can cause emotional distress or discomfort in a clinician, related to either: (1) a clinicians' fear of the real or predicted short-term distress the EBI can cause patients, or (2) fears that the clinician will inadvertently cause the patient harm and/or face liability. This distress experienced by the clinician can perpetuate a cycle of maladaptive anxious avoidance by the clinician, contributing to lack of or suboptimal EBI implementation. We illustrate how this cycle of maladaptive anxious avoidance can influence implementation by providing several examples from leading EBIs in the psychosocial literature. To conclude, we discuss how leveraging decades of treatment literature aimed at mitigating maladaptive anxious avoidance can inform the design of more tailored and effective implementation strategies for EBIs that are negatively valenced.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, United States
| | - Corinna C. Klein
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, United States
| | - Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, RI, United States
- Bradley Hospital, Lifespan Health System, Riverside, RI, United States
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Gregory K. Brown
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Megan Brady
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Miya L. Barnett
- Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, Santa Barbara, CA, United States
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Becker-Haimes EM, Wislocki K, DiDonato S, Jensen-Doss A. Predictors of Clinician-Reported Self-Efficacy in Treating Trauma-Exposed Youth. J Trauma Stress 2022; 35:109-119. [PMID: 34048094 PMCID: PMC10676627 DOI: 10.1002/jts.22688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022]
Abstract
Clinicians' self-efficacy with regard to delivering evidence-based interventions (EBIs) to youth is an important target for both improving EBI use in the community and mitigating the risk of clinician burnout and turnover. Examining predictors of clinician self-efficacy to treat trauma-exposed youth is, therefore, an important step for informing the design of implementation strategies to enhance the mental health workforce's capacity to deliver EBIs in this population. We examined predictors of clinician self-efficacy in working with trauma-exposed youth in a sample of practicing mental health clinicians (N = 258, M age = 34.4 years, 85.0% female). Clinicians were recruited and surveyed as part of a larger study examining how clients' exposure to potentially traumatic events influences clinician decision-making. Results of regression models indicated that training in any trauma treatment model, being trained via a variety of formats (e.g., in-person training, online, supervision), and training in a variety of treatment models were all associated with higher perceived self-efficacy regarding effectively treating trauma-exposed youth. Of the treatment models and training formats examined, receiving in-person training, R2 = .10, and training in trauma-focused cognitive behavioral therapy, R2 = .10, were the strongest predictors of higher self-efficacy ratings. Clinician discipline, R2 = .04, and clinical practice factors, R2 = .20, were also related to self-efficacy. Collectively, the R2 indicated a large effect, with the predictors explaining 25.4% of the variance in self-efficacy ratings. Implications for designing implementation strategies targeting clinician self-efficacy and future research are discussed.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
- Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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Dumornay NM, Finegold KE, Chablani A, Elkins L, Krouch S, Baldwin M, Youn SJ, Marques L, Ressler KJ, Moreland-Capuia A. Improved emotion regulation following a trauma-informed CBT-based intervention associates with reduced risk for recidivism in justice-involved emerging adults. Front Psychiatry 2022; 13:951429. [PMID: 36276328 PMCID: PMC9579430 DOI: 10.3389/fpsyt.2022.951429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 09/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Male youth who have been involved in the juvenile legal system have disproportionate rates of trauma and violence exposure. Many justice-involved youth have untreated mental illness, with an estimated 66% of young men who are incarcerated meeting criteria for at least one mental health disorder, including posttraumatic stress disorder (PTSD), depression, and substance abuse. While Cognitive Behavioral Therapy (CBT) approaches are considered among effective evidence-based treatments for addressing and treating behavioral and emotional difficulties, male youth with a history of incarceration and youth who are at risk for (re)incarceration, violence, emotion dysregulation, and trauma face significant barriers in accessing these services. METHODS Roca, Inc. (Roca), an internationally recognized organization moving the needle on urban violence by working relentlessly with young people at the center of violence in Massachusetts and Maryland, employs a trauma-informed CBT-based skills curriculum and approach in their intervention model, to improve youths' educational, employment, parenting, and life skills opportunities, while decreasing risk for recidivism, addressing trauma and increasing skills for emotion regulation. The aim of this analysis was to assess the effectiveness of Roca's trauma-informed CBT skills curriculum on youths' emotional and behavioral outcomes. We analyzed data from over 300 participating emerging adult men from four sites in Massachusetts and one site in Baltimore, Maryland who had at least three series of data collection across multiple skills-based sessions. RESULTS We found improvements in outcomes in overall mean scores related to decreased distress about employment and education, as are expected with standard intervention approaches for justice-involved youth. Participants who show improvement in emotion regulation across engagement (approximately half the cohort), were found to have significant improvements in distress related to relationship and family functioning and self-care, and decreased substance use, along with other outcomes compared to those participants with less improvement in emotion regulation. Furthermore, improvement in different aspects of emotion regulation were associated with improved relationships, life distress, substance use, and improved prosocial thinking. CONCLUSIONS Together, these data suggest that adding mental health support and skills training, such as with trauma-informed CBT models, to programs for justice-involved youth may lead to significant improvements in functioning, quality of life, and mental health outcomes.
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Affiliation(s)
- Nathalie M Dumornay
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Institute of Child Development, University of Minnesota, Minneapolis, MN, United States
| | - Katherine E Finegold
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,School and Child Clinical Psychology, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | - Soo Jeong Youn
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Luana Marques
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Kerry J Ressler
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Alisha Moreland-Capuia
- Division of Depression & Anxiety Disorders, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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11
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Shim RS, Tierney M, Rosenzweig MH, Goldman HH. Improving Behavioral Health Services in the Time of COVID-19 and Racial Inequities. NAM Perspect 2021; 2021:202110c. [PMID: 34901776 DOI: 10.31478/202110c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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12
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Frank HE, Last BS, AlRabiah R, Fishman J, Rudd BN, Kratz HE, Harker C, Fernandez-Marcote S, Jackson K, Comeau C, Shoyinka S, Beidas RS. Understanding therapists' perceived determinants of trauma narrative use. Implement Sci Commun 2021; 2:131. [PMID: 34852850 PMCID: PMC8638192 DOI: 10.1186/s43058-021-00231-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 10/23/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Trauma narratives are a critical, exposure-based component of trauma-focused cognitive-behavioral therapy, yet community therapists rarely use them. Given evidence that intentions to deliver elements of cognitive behavioral therapy vary by component, and that intentions to deliver exposure are the weakest, this study focused specifically on trauma narratives. We drew on a social psychology causal theory (Theory of Planned Behavior (TPB)) and an implementation science framework (the Consolidated Framework for Implementation Research (CFIR)) to glean insight into multilevel influences on trauma narrative use. While the CFIR offers a broad list of factors potentially affecting implementation, the TPB offers causal pathways between individual-level constructs that predict behavior, including the uptake of an evidence-based intervention. The integration of these approaches may provide a more complete understanding of factors affecting therapists' use of TNs. METHODS Therapists (n=65) trained in trauma-focused cognitive behavioral therapy completed a survey about their use of and beliefs about trauma narratives. Content analysis was used to identify common beliefs about trauma narratives. A subset of participants (n=17) completed follow-up qualitative interviews, which were analyzed using an integrated approach informed by the CFIR. RESULTS While most participants reported high intentions to use TNs, nearly half reported that they did not use TNs in the last 6 months. Survey data indicate a number of TPB-related determinants related to using trauma narratives. Qualitative interviews identified CFIR-relevant contextual factors that may influence constructs central to TPB. CONCLUSIONS These results highlight the importance of integrating approaches that address multiple theoretical determinants of therapist behavior, including therapist, organizational, and client factors with causal explanations to explain implementation behavior.
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Affiliation(s)
- Hannah E Frank
- Department of Psychology, Temple University, Philadelphia, PA, USA.
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
| | - Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Reem AlRabiah
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N Rudd
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychiatry, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Hilary E Kratz
- Department of Psychology, La Salle University, Philadelphia, PA, USA
| | - Colleen Harker
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Kamilah Jackson
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
- PerformCare New Jersey, Robbinsville, NJ, USA
| | | | - Sosunmolu Shoyinka
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, USA
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13
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Moore SA, Arnold KT, Beidas RS, Mendelson T. Specifying and Reporting Implementation Strategies Used in a School-Based Prevention Efficacy Trial. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2. [PMID: 34761223 DOI: 10.1177/26334895211047841] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Implementation strategies used to enhance the implementation of interventions during efficacy and effectiveness studies are rarely reported. Tracking and reporting implementation strategies during these phases has potential to improve future research studies and real-world implementation. We present an exemplar of how this might be executed by specifying and reporting the implementation strategies that were used during a school-based efficacy trial, Project POWER, which tested a trauma-informed prevention program delivered by a university research team, community members, and school staff facilitators in 29 schools. Methods Following the conclusion of the 4-year trial, core Project POWER research team members identified the implementation strategies that supported intervention delivery during the trial using an established taxonomy of school-based implementation strategies. The actors, actions, action targets, temporality, dose, and implementation outcomes were specified using established implementation strategies reporting guidelines. Results The research team identified 37 implementation strategies that were used during the Project POWER trial. Most strategies fell within the categories of Train and Educate Stakeholders, Use Evaluative and Iterative Strategies, and Develop Stakeholder Interrelationships. Actors included members of the research team and partner schools. Strategies were used multiple times during the preparation and implementation phases. Action targets were most often characteristics of individuals, implementation process, and characteristics of the inner setting. Strategies predominantly targeted the implementation outcomes of fidelity, acceptability, feasibility, and adoption. Conclusions This study provided evidence that implementation strategies are used and can be identified in efficacy research using a retrospective approach. Identifying and specifying implementation strategies used during the initial phases of the translational research pipeline can inform the implementation strategies that are carried forward, adapted, or discontinued in future trials and routine practice to improve implementation and effectiveness outcomes.
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Affiliation(s)
| | - Kimberly T Arnold
- Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania.,Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania.,Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Tamar Mendelson
- Department of Mental Health and Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health
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14
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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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15
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A Qualitative Examination of a School-Based Implementation of Computer-Assisted Cognitive-Behavioral Therapy for Child Anxiety. SCHOOL MENTAL HEALTH 2021; 13:347-361. [PMID: 34178162 DOI: 10.1007/s12310-021-09424-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Mental health treatment in schools has the potential to improve youth treatment access. However, school-specific barriers can make implementing evidence-based interventions difficult. Task-shifting (i.e., training lay staff to implement interventions) and computer-assisted interventions may mitigate these barriers. This paper reports on a qualitative examination of facilitators and barriers of a school-based implementation of a computer-assisted intervention for anxious youth (Camp Cope-A-Lot; CCAL). Participants (N = 45) included school staff in first through fourth grades. Providers attended a training in CCAL and received weekly, hour-long group consultation calls for three months. In the second year, the sustainability of CCAL use was assessed. Qualitative interviews were conducted after the first year (initial implementation) and second year (sustainability). Interviews were analyzed using the Consolidated Framework for Implementation Research domains to classify themes. Although participants reported that CCAL included useful skills, they expressed concerns about recommended session length (45 minutes) and frequency (weekly). Time burden of consultation calls was also a barrier. School staff facilitated implementation by enabling flexible scheduling for youth to be able to participate in the CCAL program. However, the sustainability of the program was limited due to competing school/time demands. Results suggest that even with computer assisted programs, there is a need to tailor interventions and implementation efforts to account for the time restrictions experienced by school-based service providers. Optimal fit between the intervention and specific school is important to maintain the potential benefits of computer-assisted treatments delivered by lay service providers in schools.
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16
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Chafouleas SM, Pickens I, Gherardi SA. Adverse Childhood Experiences (ACEs): Translation into Action in K12 Education Settings. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09427-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Arnold KT, Porter KMP, Frattaroli S, Durham RE, Clary LK, Mendelson T. Multilevel Barriers and Facilitators to Sustainability of a Universal Trauma-Informed School-Based Mental Health Intervention Following an Efficacy Trial: A Qualitative Study. SCHOOL MENTAL HEALTH 2021; 13:174-185. [PMID: 33628336 DOI: 10.1007/s12310-020-09402-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Limited research exists about factors that influence the sustainability of preventive school mental health interventions when research support ends. This study assessed barriers and facilitators to sustaining RAP (Relax, be Aware, do a Personal rating) Club, a trauma-informed universal mental health intervention, in urban schools following efficacy trial implementation. Between 2016-2018, 13 Baltimore City schools implemented RAP Club. We evaluated RAP Club sustainability using semi-structured interviews with administrators (n=10) and school staff trained to deliver the intervention (n=11), as well as review of intervention fidelity logs (n=137) and notes from supervision calls (n=10) with school staff and research team members who implemented the program. Although most school staff described RAP Club as acceptable and beneficial, none of the 13 schools sustained the intervention. Barriers to sustainability included low self-efficacy among school staff trained to deliver the intervention, school staff turnover, logistical challenges with space and time in the regular school calendar to deliver the program, insufficient funding to sustain the program outside of the research context, and limited planning and ongoing communication between school personnel and researchers about sustainability. Recommendations for increasing post-trial program sustainability include developing sustainability plans with schools during the pre-implementation phase, enhancing ongoing support for school staff during the implementation phase, and using academic-community partnerships to facilitate sustainability and intervention scale-up during the post-implementation phase. Increasing sustainability of beneficial school-based mental health programs has the potential to reduce mental health disparities and promote health equity.
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Affiliation(s)
- Kimberly T Arnold
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA.,University of Pennsylvania, Perelman School of Medicine, Department of Psychiatry, Philadelphia, PA, USA.,University of Pennsylvania, Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Keshia M Pollack Porter
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Shannon Frattaroli
- Johns Hopkins Bloomberg School of Public Health, Department of Health Policy and Management, Baltimore, MD, USA
| | - Rachel E Durham
- Notre Dame of Maryland University, School of Education, Baltimore, MD, USA
| | - Laura K Clary
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA
| | - Tamar Mendelson
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, MD, USA.,Johns Hopkins Bloomberg School of Public Health, Department of Population, Family and Reproductive Health, Baltimore, MD, USA
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18
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Gossmann K, Eilers R, Rosner R, Barke A. How do licensed psychotherapists in Germany feel about treating patients with posttraumatic stress symptoms? - an experimental study based on case vignettes. Eur J Psychotraumatol 2021; 12:1995265. [PMID: 34868487 PMCID: PMC8635540 DOI: 10.1080/20008198.2021.1995265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Previous research indicates that not all children, adolescents and adults suffering from PTSD receive psychotherapy and if they do, trauma is not always considered during therapy. One reason for this undertreatment might be a limited readiness of licenced psychotherapists (LPTs) to treat patients who have experienced a trauma and thus suffer from PTSD symptoms. OBJECTIVE The aim of this study is to explore the association between the readiness of LPTs to treat patients with PTSD symptoms and different patients' and therapists' characteristics. METHOD We used case vignettes to assess the readiness of LPTs in Germany in a nationwide online survey (N = 768). The vignettes described patients with PTSD and were adapted to the age group mainly treated by the therapists (children/adolescents vs. adults). The patients' characteristics in the otherwise identical vignettes were randomized for patient gender (female vs. male) and symptom cluster (internalizing vs. externalizing). Rating scales were used to assess readiness. Additionally, therapists' characteristics (age, trauma-specific training, perceived fears/doubts, and objective barriers to treating the vignette patient) were assessed. RESULTS The patients' characteristics did not influence the treatment readiness of the LPTs. Regarding therapists' characteristics, LPTs working mainly with children and adolescents, and those who had completed trauma-specific training reported a higher readiness to treat the vignette patient. CONCLUSIONS Regarding the treatment of patients suffering from PTSD symptoms of different ages, our study indicated that the assessed therapists' characteristics were more relevant for the treatment readiness of LPTs than the patients' characteristics of age or symptom type.
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Affiliation(s)
- Katharina Gossmann
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rebekka Eilers
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
| | - Antonia Barke
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstaett, Germany
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19
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Fenwick KM, Palinkas LA, Hurlburt MS, Lengnick-Hall RD, Horwitz SM, Hoagwood KE. Acquisition of Information About Innovative Practices in Outpatient Mental Health Clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:752-763. [PMID: 32157474 PMCID: PMC7222893 DOI: 10.1007/s10488-020-01029-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study uses qualitative interviews with leaders of 34 mental health clinics in the context of a statewide rollout of clinical and business innovations to explore how clinics first learn about innovations and which external sources of information they access. Clinic leaders reported accessing information about innovations mainly from government agencies, professional associations, peer organizations, and research literature. Leaders mentioned an average of two external sources of information. There was evidence of variation in how leaders accessed information and how information about innovations was communicated within clinics. Findings have implications for improving dissemination of information about innovations in mental health systems.
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Affiliation(s)
- Karissa M Fenwick
- Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (206), Los Angeles, USA.
| | - Lawrence A Palinkas
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Michael S Hurlburt
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | | | - Sarah M Horwitz
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
| | - Kimberly E Hoagwood
- Department of Child and Adolescent Psychiatry, New York University, New York, NY, USA
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20
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Establishing cross-systems collaborations for implementation: protocol for a longitudinal mixed methods study. Implement Sci 2020; 15:55. [PMID: 32677987 PMCID: PMC7364639 DOI: 10.1186/s13012-020-01016-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background Cross-system interventions can help integrate services across different service delivery systems but require organizations to establish strong collaborative relationships for implementation. Contingency theory suggests that the effectiveness of different collaborative strategies (i.e. specific ways organizations align operations and services) varies by context. This paper describes a study of different strategies for fostering collaboration between child welfare and substance abuse treatment agencies and the conditions under which they are effective for implementation. We also describe the development and piloting of the Collaborating Across Systems for Program Implementation (CASPI) tool—a decision-making guide intended to help researchers and organizational leaders identify and use appropriate collaborative strategies for their context. Methods/design This multisite longitudinal, mixed methods study, leverages a naturally occurring implementation initiative -- in up to 17 Ohio counties -- to implement Ohio START (Sobriety Treatment and Reducing Trauma). START is a child welfare model that requires strong collaboration with local substance use treatment organizations to promote integrated services. During the first two years, we will identify collaborative strategies associated with improved START implementation (penetration and fidelity) and service delivery outcomes (timeliness), given system, and organizational features. We will conduct a convergent mixed methods study drawing on worker surveys, agency documents, administrative data, formal partner agreements, and group interviews. Data will be integrated and analyzed using Qualitative Comparative Analysis (QCA). To develop the CASPI, an expert panel comprised of implementation experts, and community stakeholders will convene to synthesize our findings and develop contents (including a decision tree). During the final year of the study, we will assess the acceptability, appropriateness, and feasibility of the CASPI in a randomized vignette experiment, and a pilot-test with 3 child welfare agencies that have not yet implemented START. Discussion Our results will lay the groundwork for a larger controlled trial that will test the CASPI’s effectiveness for supporting effective and efficient implementation of cross-system interventions like START. The CASPI is expected to help leaders and researchers select and use collaboration strategies tailored to their context and be applicable in a wide range of settings including rural communities. Our work also advances system-level implementation strategies. Trial registration NCT03931005, Registered April 29, 2019.
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21
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Powell BJ, Haley AD, Patel SV, Amaya-Jackson L, Glienke B, Blythe M, Lengnick-Hall R, McCrary S, Beidas RS, Lewis CC, Aarons GA, Wells KB, Saldana L, McKay MM, Weinberger M. Improving the implementation and sustainment of evidence-based practices in community mental health organizations: a study protocol for a matched-pair cluster randomized pilot study of the Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS). Implement Sci Commun 2020; 1. [PMID: 32391524 PMCID: PMC7207049 DOI: 10.1186/s43058-020-00009-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Implementing and sustaining evidence-based programs with fidelity may require multiple implementation strategies tailored to address multi-level, context-specific barriers and facilitators. Ideally, selecting and tailoring implementation strategies should be guided by theory, evidence, and input from relevant stakeholders; however, methods to guide the selection and tailoring of strategies are not well-developed. There is a need for more rigorous methods for assessing and prioritizing implementation determinants (barriers and facilitators) and linking implementation strategies to determinants. The Collaborative Organizational Approach to Selecting and Tailoring Implementation Strategies (COAST-IS) is an intervention designed to increase the effectiveness of evidence-based practice implementation and sustainment. COAST-IS will enable organizational leaders and clinicians to use Intervention Mapping to select and tailor implementation strategies to address their site-specific needs. Intervention Mapping is a multi-step process that incorporates theory, evidence, and stakeholder perspectives to ensure that implementation strategies effectively address key determinants of change. Methods COAST-IS will be piloted with community mental health organizations that are working to address the needs of children and youth who experience trauma-related emotional or behavioral difficulties by engaging in a learning collaborative to implement an evidence-based psychosocial intervention (trauma-focused cognitive behavioral therapy). Organizations will be matched and then randomized to participate in the learning collaborative only (control) or to receive additional support through COAST-IS. The primary aims of this study are to (1) assess the acceptability, appropriateness, feasibility, and perceived utility of COAST-IS; (2) evaluate the organizational stakeholders' fidelity to the core elements of COAST-IS; and (3) demonstrate the feasibility of testing COAST-IS in a larger effectiveness trial. Discussion COAST-IS is a systematic method that integrates theory, evidence, and stakeholder perspectives to improve the effectiveness and precision of implementation strategies. If effective, COAST-IS has the potential to improve the implementation and sustainment of a wide range of evidence-based practices in mental health and other sectors. Trial registration This study was registered in ClinicalTrials.gov (NCT03799432) on January 10, 2019 (last updated August 5, 2019).
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Affiliation(s)
- Byron J Powell
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA.,Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amber D Haley
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sheila V Patel
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa Amaya-Jackson
- Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA.,National Center for Child Traumatic Stress, Durham, NC, USA.,North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
| | - Beverly Glienke
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA
| | - Mellicent Blythe
- North Carolina Child Treatment Program, Center for Child and Family Health, Durham, NC, USA.,School of Social Work, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Lengnick-Hall
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Stacey McCrary
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Cara C Lewis
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Gregory A Aarons
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Kenneth B Wells
- Department of Psychiatry and Behavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.,The Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | | | - Mary M McKay
- Brown School, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO 63130, USA
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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