Costs of Preparing to Implement a Family-Based Intervention to Prevent Pediatric Obesity in Primary Care: a Budget Impact Analysis

Implementation Preparation Costs of Virtual Interview Training in Pre-Employment Transition Services: A Budget Impact Analysis

Virtual Reality Job Interview Training (VR-JIT) and Virtual Interview Training for Transition Age Youth (VIT-TAY) demonstrated initial effectiveness at increasing employment among transition-age youth with disabilities engaged in pre-employment transition services. We characterized activities and estimated the labor and non-labor costs required to prepare schools to implement VR-JIT or VIT-TAY. Implementation preparation and support teams reported labor hours throughout the implementation preparation process. Implementation preparation labor hours at 43 schools cost approximately $1,427 per school, while non-labor costs were $100 per trainee (student). We estimated the replication of implementation preparation labor activities would cost $1,024 per school (range: $841-$1,208). Most costs were spent in delivery planning and teacher training. Given that implementation preparation costs can be barriers to intervention adoption, our results provide critical information for contemplating future implementation of VR-JIT or VIT-TAY.

Family-based pediatric weight management interventions in US primary care settings targeting children ages 6-12 years old: A systematic review guided by the RE-AIM framework

Obesity is a pandemic that disproportionately affects children from vulnerable populations in the USA. Current treatment approaches in primary care settings in the USA have been reported to be insufficient at managing pediatric obesity, primarily due to implementation challenges for healthcare systems and barriers for families. While the literature has examined the efficacy of pediatric obesity interventions focused on internal validity, it lacks sufficient reporting and analysis of external validity necessary for successful translation to primary care settings. We conducted a systematic review of the primary-care-setting literature from January 2007 to March 2020 on family-based pediatric weight management interventions in both English and/or Spanish for children ages 6-12 years in the USA using the Reach, Efficacy/Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. A literature search, using PRISMA guidelines, was conducted in January 2022 using the following electronic databases: Medline Ovid, Embase, and Cochrane Library. 22 270 records were screened, and 376 articles were reviewed in full. 184 studies were included. The most commonly reported dimensions of the RE-AIM framework were Reach (65%), Efficacy/Effectiveness (64%), and Adoption (64%), while Implementation (47%) and Maintenance (42%) were less often reported. The prevalence of reporting RE-AIM construct indicators ranged greatly, from 1% to 100%. This systematic review underscores the need for more focus on external validity to guide the development, implementation, and dissemination of future pediatric obesity interventions based in primary care settings. It also suggests conducting additional research on sustainable financing for pediatric obesity interventions.

Costs to Implement a Pediatric Weight Management Program Across 3 Distinct Contexts

BACKGROUND

The Connect for Health program is an evidence-based program that aligns with national recommendations for pediatric weight management and includes clinical decision support, educational handouts, and community resources. As implementation costs are a major driver of program adoption and maintenance decisions, we assessed the costs to implement the Connect for Health program across 3 health systems that primarily serve low-income communities with a high prevalence of childhood obesity.

METHODS

We used time-driven activity-based costing methods. Each health system (site) developed a process map and a detailed report of all implementation actions taken, aligned with major implementation requirements (eg, electronic health record integration) or strategies (eg, providing clinician training). For each action, sites identified the personnel involved and estimated the time they spent, allowing us to estimate the total costs of implementation and breakdown costs by major implementation activities.

RESULTS

Process maps indicated that the program integrated easily into well-child visits. Overall implementation costs ranged from $77,103 (Prisma Health) to $84,954 (Denver Health) to $142,721 (Massachusetts General Hospital). Across implementation activities, setting up the technological aspects of the program was a major driver of costs. Other cost drivers included training, engaging stakeholders, and audit and feedback activities, though there was variability across systems based on organizational context and implementation choices.

CONCLUSIONS

Our work highlights the major cost drivers of implementing the Connect for Health program. Accounting for context-specific considerations when assessing the costs of implementation is crucial, especially to facilitate accurate projections of implementation costs in future settings.

A Cost Analysis of Rethink the Strip: De-implementing a Low-value Practice in Primary Care

BACKGROUND

Routine self-monitoring of blood glucose is a low-value practice that provides limited benefit for patients with non-insulin-treated type 2 diabetes mellitus.

OBJECTIVES

We estimated the costs of Rethink the Strip (RTS), a multistrategy approach to the de-implementation of self-monitoring of blood glucose in primary care.

RESEARCH DESIGN

RTS was conducted among 20 primary care clinics in North Carolina. We estimated the non-site-based and site-based costs of the 5 RTS strategies (practice facilitation, audit and feedback, provider champions, educational meetings, and educational materials) from the analytic perspective of an integrated health care system for 12 and 27-month time horizons. Material costs were tracked through project records, and personnel costs were assessed using activity-based costing. We used nationally based wage estimates.

RESULTS

Total RTS costs equaled $68,941 for 12 months. Specifically, non-site-based costs comprised $16,560. Most non-site-based costs ($11,822) were from the foundational programming and coding updates to the electronic health record data to develop the audit and feedback reports. The non-site-based costs of educational meetings, practice facilitation, and educational materials were substantially lower, ranging between ~$400 and $1000. Total 12-month site-based costs equaled $2569 for a single clinic (or $52,381 for 20 clinics). Educational meetings were the most expensive strategy, averaging $1401 per clinic. The site-based costs for the 4 other implementation strategies were markedly lower, ranging between $51 for educational materials and $555 for practice facilitation per clinic.

CONCLUSIONS

This study provides detailed cost information for implementation strategies used to support evidence-based programs in primary care clinics.

Enhancing pre-employment transition services: A type 1 hybrid randomized controlled trial protocol for evaluating WorkChat: A Virtual Workday among autistic transition-age youth

Autistic transition-age youth experience high rates of unemployment and underemployment, in part due to the social challenges they may face when having conversations in the workplace. In an effort to help enhance conversational abilities in the workplace, our collaborative team partnered to develop WorkChat: A Virtual Workday. Specifically, our team of scientists, community partners, and diversity and inclusion experts participated in a community-engaged process to develop WorkChat using iterative feedback from autistic transition-age youth and their teachers. With initial development complete, this study reports on the protocol that our collaborative team developed, reviewed, and approved to conduct a randomized controlled trial (RCT) to evaluate the real-world effectiveness and initial implementation process outcomes of WorkChat when integrated into post-secondary pre-employment transition services (Pre-ETS). Our aims are to: 1) evaluate whether services-as-usual in combination with WorkChat, compared to services-as-usual with an attention control, enhances social cognition and work-based social ability (between pre- and post-test); reduces anxiety about work-based social encounters (between pre- and post-test), and increases sustained employment by 9-month follow-up; 2) evaluate whether social cognitive ability and work-based social ability mediate the effect of WorkChat on sustained employment; and 3) conduct a multilevel, mixed-method process evaluation of WorkChat implementation.

A budget impact analysis of cost to implement a whole child health focused, family-based intervention in primary care for children with elevated BMI

BACKGROUND

Although the cost of implementing evidence-based interventions (EBIs) is a key determinant of adoption, lack of cost information is widespread. We previously evaluated the cost of preparing to implement Family Check-Up 4 Health (FCU4Health), an individually tailored, evidence-based parenting program that takes a whole child approach, with effects on both behavioral health and health behavior outcomes, in primary care settings. This study estimates the cost of implementation, including preparation.

METHODS

We assessed the cost of FCU4Health across the preparation and implementation phases spanning 32 months and 1 week (October 1, 2016-June 13, 2019) in a type 2 hybrid effectiveness-implementation study. This family-level randomized controlled trial took place in Arizona with n = 113 predominantly low-income, Latino families with children ages > 5.5 to < 13 years. Using electronic cost capture and time-based activity-driven methods, budget impact analysis from the perspective of a future FCU4Health adopting entity-namely, ambulatory pediatric care clinicians-was used to estimate the cost of implementation. Labor costs were based on 2021 Bureau of Labor Statistics Occupational Employment Statistics, NIH-directed salary cap levels or known salaries, plus fringe benefits at a standard rate of 30%. Non-labor costs were based on actual amounts spent from receipts and invoices.

RESULTS

The cost of FCU4Health implementation to 113 families was $268,886 ($2380 per family). Actual per family cost varied widely, as individual tailoring resulted in families receiving a range of 1-15 sessions. The estimated cost of replicating implementation for future sites ranged from $37,636-$72,372 ($333-$641 per family). Using our previously reported preparation costs (i.e., $174,489; $1544 per family), with estimated replication costs of $18,524-$21,836 ($164-$193 per family), the total cost of delivering FCU4Health was $443,375 ($3924 per family), with total estimated replication costs of $56,160-$94,208 ($497-$834 per family).

CONCLUSIONS

This study provides a baseline for costs associated with implementation of an individually tailored parenting program. Results provide critical information for decision makers and a model for future economic analysis and can be used to inform optimization thresholds for implementation and, when necessary, benchmarks for program adaptation to promote scale-up.

TRIAL REGISTRATION

This trial was prospectively registered on January 6, 2017, at ClinicalTrials.gov (NCT03013309).

Scoping review of costs of implementation strategies in community, public health and healthcare settings

OBJECTIVES

To identify existing evidence concerning the cost of dissemination and implementation (D&I) strategies in community, public health and health service research, mapped with the 'Expert Recommendations for Implementing Change' (ERIC) taxonomy.

DESIGN

Scoping review.

DATA SOURCES

MEDLINE, EMBASE, CINAHL, PsycINFO, Scopus and the Cochrane Library were searched to identify any English language reports that had been published between January 2008 and December 2019 concerning the cost of D&I strategies.

DATA EXTRACTION

We matched the strategies identified in each article using ERIC taxonomies; further classified them into five areas (eg, dissemination, implementation, integration, capacity building and scale-up); and extracted the corresponding costs (total costs and cots per action target and per evidence-based programme (EBP) participant). We also recorded the reported level of costing methodology used for cost assessment of D&I strategies.

RESULTS

Of the 6445 articles identified, 52 studies were eligible for data extraction. Lack of D&I strategy cost data was the predominant reason (55% of the excluded studies) for study exclusion. Predominant topic, setting, country and research design in the included studies were mental health (19%), primary care settings (44%), the US (35%) and observational (42%). Thirty-five (67%) studies used multicomponent D&I strategies (ranging from two to five discrete strategies). The most frequently applied strategies were Conduct ongoing training (50%) and Conduct educational meetings (23%). Adoption (42%) and reach (27%) were the two most frequently assessed outcomes. The overall costs of Conduct ongoing training ranged from $199 to $105 772 ($1-$13 973 per action target and $0.02-$412 per EBP participant); whereas the cost of Conduct educational meetings ranged from $987 to $1.1-$2.9 million/year ($33-$54 869 per action target and $0.2-$146 per EBP participant). The wide range of costs was due to the varying scales of the studies, intended audiences/diseases and the complexities of the strategy components. Most studies presented limited information on costing methodology, making interpretation difficult.

CONCLUSIONS

The quantity of published D&I strategy cost analyses is increasing, yet guidance on conducting and reporting of D&I strategy cost analysis is necessary to facilitate and promote the application of comparative economic evaluation in the field of D&I research.

Pragmatic considerations and approaches for measuring staff time as an implementation cost in health systems and clinics: key issues and applied examples

Background

As the field of implementation science wrestles with the need for system decision-makers to anticipate the budget impact of implementing new programs, there has been a push to report implementation costs more transparently. For this purpose, the method of time-driven activity-based costing (TDABC) has been heralded as a pragmatic advance. However, a recent TDABC review found that conventional methods for estimating staff time remain resource-intensive and called for simpler alternatives. Our objective was to conceptually compare conventional and emerging TDABC approaches to measuring staff time.

Methods

Our environmental scan of TDABC methods identified several categories of approaches for staff time estimation; across these categories, staff time was converted to cost as a pro-rated fraction of salary/benefits. Conventional approaches used a process map to identify each step of program delivery and estimated the staff time used at each step in one of 3 ways: (a) uniform estimates of time needed for commonly occurring tasks (self-report), (b) retrospective “time diary” (self-report), or (c) periodic direct observation. In contrast, novel semi-automated electronic health record (EHR) approaches “nudge” staff to self-report time for specific process map step(s)—serving as a contemporaneous time diary. Also, novel EHR-based automated approaches include timestamps to track specific steps in a process map. We compared the utility of these TDABC approach categories according to the 5 R’s model that measures domains of interest to system decision-makers: relevance, rapidity, rigor, resources, and replicability, and include two illustrative case examples.

Results

The 3 conventional TDABC staff time estimation methods are highly relevant to settings but have limited rapidity, variable rigor, are rather resource-intensive, and have varying replicability. In contrast to conventional TDABC methods, the semi-automated and automated EHR-based approaches have high rapidity, similar rigor, similar replicability, and are less resource-intensive, but have varying relevance to settings.

Conclusions

This synthesis and evaluation of conventional and emerging methods for staff time estimation by TDABC provides the field of implementation science with options beyond the current approaches. The field remains pressed to innovatively and pragmatically measure costs of program delivery that rate favorably across all of the 5 R’s domains.

Understanding implementation costs of a pediatric weight management intervention: an economic evaluation protocol

Background

Understanding the cost and/or cost-effectiveness of implementation strategies is crucial for organizations to make informed decisions about the resources needed to implement and sustain evidence-based interventions (EBIs). This economic evaluation protocol describes the methods and processes that will be used to assess costs and cost-effectiveness across implementation strategies used to improve the reach, adoption, implementation, and organizational maintenance of an evidence-based pediatric weight management intervention- Building Health Families (BHF).

Methods

A within-trial cost and cost-effectiveness analysis (CEA) will be completed as part of a hybrid type III effectiveness-implementation trial (HEI) designed to examine the impact of an action Learning Collaborative (LC) strategy consisting of network weaving, consultee-centered training, goal-setting and feedback, and sustainability action planning to improve the adoption, implementation, organizational maintenance, and program reach of BHF in micropolitan and surrounding rural communities in the USA, over a 12-month period. We discuss key features of implementation strategy components and the associated cost collection and outcome measures and present brief examples on what will be included in the CEA for each discrete implementation strategy and how the results will be interpreted. The cost data will be collected by identifying implementation activities associated with each strategy and using a digital-based time tracking tool to capture the time associated with each activity. Costs will be assessed relative to the BHF program implementation and the multicomponent implementation strategy, included within and external to a LC designed to improve reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) of BHF. The CEA results will be reported by RE-AIM outcomes, using the average cost-effectiveness ratio or incremental cost-effectiveness ratio. All the CEAs will be performed from the community perspective.

Discussion

The proposed costing approach and economic evaluation framework for dissemination and implementation strategies and EBI implementation will contribute to the evolving but still scant literature on economic evaluation of implementation and strategies used and facilitate the comparative economic analysis.

Trial registration

ClinicalTrials.gov NCT04719442. Registered on January 22, 2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43058-022-00287-1.

Costing a population health management approach for participant recruitment to a diabetes prevention study

Limited research has reported the economic feasibility-from both a research and practice perspective-of efforts to recruit and enroll an intended audience in evidence-based approaches for disease prevention. We aimed to retrospectively assess and estimate the costs of a population health management (PHM) approach to identify, engage, and enroll patients in a Type 1 Hybrid Effectiveness-Implementation (HEI), diabetes-prevention trial. We used activity-based costing to estimate the recruitment costs of a PHM approach integrated within an HEI trial. We took the perspective of a healthcare system that may adopt, and possibly sustain, the strategy in the typical practice. We also estimated replication costs based on how the strategy could be applied in healthcare systems interested in referring patients to a local diabetes prevention program from a payer perspective. The total recruitment and enrollment costs were $360,424 to accrue 599 participants over approximately 15 months. The average cost per screened and enrolled participant was $263 and $620, respectively. Translating to the typical settings, total recruitment costs for replication were estimated as $193,971 (range: $43,827-$210,721). Sensitivity and scenario analysis results indicated replication costs would be approximately $283-$444 per patient enrolled if glucose testing was necessary, based on the Medicare-covered services. From a private payer perspective, and without glucose testing, per-participant assessed costs were estimated at $31. A PHM approach can be used to accrue a large number of participants in a short period of time for an HEI trial, at a comparable cost per participant.

Family-based nutrition interventions for obesity prevention among school-aged children: a systematic review

Effective evidence-informed family-based nutrition interventions for childhood obesity management are needed. (a) To assess the number and quality of published randomized controlled trials incorporating family-based nutrition interventions for childhood obesity (ages 5-18 years) management and (b) to identify intervention attributes (e.g., contact time, nutrition curricula, and behavior change strategies) used in successful interventions. Studies that met eligibility criteria were randomized controlled trials and family-based childhood obesity management interventions for children and adolescents ages 5-18 years old that included a healthy eating component and measured child dietary behaviors and/or parent dietary feeding practices. Six databases were searched: CINAHL complete, Cochrane Central Register of Controlled Trials, Health Source: Nursing/Academic Edition, MEDLINE with full text (PubMed), PsycINFO, SPORTDiscus, and ERIC (EBSCO Host). The validated Quality Assessment Tool for Quantitative Studies was used to assess study quality. Eight studies met eligibility criteria. Study quality analysis showed that blinding of the research teams (e.g., analysts, and those focused on data collection) and the use of age appropriate, valid, and reliable instruments were areas of concern. Successful nutrition interventions targeting children 5-18 years old, appear to include setting family-based goals, modifying home food environment, hands-on approaches to teaching nutrition (games, group-based activities), and fruit and vegetable vouchers. This review highlighted a limited amount of moderate to high quality evidence to suggest that family-based nutrition interventions can be successful in improving dietary behaviors and that interventions with positive outcomes had some components of nutrition curricula and strategies in common.

Cost analysis of a remote patient monitoring programme for post-discharge patients with type 2 diabetes

INTRODUCTION

Assessing costs of an evidence-based health promotion programme is crucial to understand the economic feasibility of adopting or sustaining the programme. This study conducted a cost analysis of a remote patient monitoring (RPM) programme to enhance the post-discharge management of type 2 diabetes.

METHODS

Using retrospective data collected during RPM implementation from September 2014 to February 2018, we estimated the costs of implementing an RPM in the primary care setting. Measures included total and average annual costs, costs per participant who was enrolled or completed the programme, and costs per person-day. We further conducted sensitivity and scenario analyses to examine variations in estimated programme costs associated with varying programme efficiencies and alternative personnel compositions of the RPM team.

RESULTS

The total RPM implementation costs were estimated at US$4,374,544 with an average annual programme costs of US$1,249,870, which translated to US$3207 per participant (n = 1364) completing the three-month programme. The per person-day cost was averaged at US$24 (182,932 person-days). Sensitivity and scenario analyses results indicate that the sustainment costs were approximately US$1.6 million annually and the per-person-day costs were between US$21 and US$29 with each nurse coach on average serving a panel of 62-93 patients.

CONCLUSION

The implementation and sustainment costs of an RPM programme, estimated under various assumptions of programme efficiency and care team compositions, as exemplified in this study, will help healthcare organizations make informed decisions in budgeting for and sustaining telehealth programmes to enhance diabetes management.

Cost comparison of five Australasian obesity prevention interventions for children aged from birth to two years

BACKGROUND

In the absence of rigorous evidence of cost-effectiveness for early childhood obesity prevention interventions, the next-best option may be for decision-makers to consider the relevant costs of interventions when allocating resources.

OBJECTIVES

This study aimed to estimate systematically the cost of five obesity prevention interventions in children aged 0-2 years, undertaken in research settings in Australia and New Zealand.

METHODS

A standardised costing protocol informed the costing methodology, ensuring comparability of results across interventions. Micro-costing was undertaken, with intervention costs defined from the funder perspective and valued in 2018 Australian dollars using unit costs from the trials or market rates.

RESULTS

Interventions varied widely in their resource use. The total cost per participant ranged from $80 for the CHAT SMS intervention arm (95% UI $77-$82) to $1135 for the Healthy Beginnings intervention (95% UI $1059-$1189). Time costs of personnel delivering interventions contributed >50% of total intervention costs for all included studies.

CONCLUSIONS

An understanding of the costs associated with intervention delivery modes is important, alongside effectiveness. Telephone delivery may include unexpected costs associated with connection to intervention participants at convenient times. A SMS-based intervention had the lowest delivery cost in this study.

Implementation strategies for digital mental health interventions in health care settings

U.S. health care systems are tasked with alleviating the burden of mental health, but are frequently underprepared and lack workforce and resource capacity to deliver services to all in need. Digital mental health interventions (DMHIs) can increase access to evidence-based mental health care. However, DMHIs commonly do not fit into the day-to-day activities of the people who engage with them, resulting in a research-to-practice gap for DMHI implementation. For health care settings, differences between digital and traditional mental health services make alignment and integration challenging. Specialized attention is needed to improve the implementation of DMHIs in health care settings so that these services yield high uptake, engagement, and sustainment. The purpose of this article is to enhance efforts to integrate DMHIs in health care settings by proposing implementation strategies, selected and operationalized based on the discrete strategies established in the Expert Recommendations for Implementing Change project, that align to DMHI-specific barriers in these settings. Guidance is offered in how these strategies can be applied to DMHI implementation across four phases commonly distinguished in implementation science using the Exploration, Preparation, Implementation, Sustainment Framework. Next steps to advance research in this area and improve the research-to-practice gap for implementing DMHIs are recommended. Applying implementation strategies to DMHI implementation will enable psychologists to systematically evaluate this process, which can yield an enhanced understanding of the factors that facilitate implementation success and improve the translation of DMHIs from controlled trials to real-world settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Family Check-Up 4 Health: Study protocol of a randomized type II hybrid effectiveness-implementation trial in integrated primary care (the healthy communities 4 healthy students study)

BACKGROUND

Parenting interventions like the Family Check-Up have demonstrated effects on child physical and behavioral health outcomes. However, access to these programs is limited, particularly for populations experiencing health disparities. Primary care settings have become recognized as a potential delivery system in which these programs may be implemented at scale. The purpose of this trial is to test the effectiveness of the Family Check-Up 4 Health (FCU4Health) program, an adaptation of the FCU for primary care, and assess program implementation in an integrated primary care setting.

METHODS

We will conduct a hybrid type 2 effectiveness-implementation trial in partnership with a primary care clinic in a low-income, majority Latino community. Families with 2- to 5-year-old children will be eligible to participate. Families will be randomized to receive the intervention (n = 130) or services as usual (n = 70) and will be assessed annually over three years. Outcomes are informed by the RE-AIM framework (i.e., reach, effectiveness, adoption, implementation, and maintenance). Effectiveness outcomes include child health behaviors (e.g., Dietary Screener Questionnaire), behavioral health (e.g., Strengths and Difficulties Questionnaire), and parenting (e.g., Proactive Parenting). Early stage implementation outcomes are also included (e.g., cost, acceptability, appropriateness, and feasibility). Effectiveness outcomes will be assessed via intent-to-treat (ITT) analyses. Implementation outcomes will be primarily descriptive with comparisons to prior trials of FCU4Health and the original FCU.

PROJECTED OUTCOMES

This trial will provide evidence related to the potential of integrated primary care settings to deliver evidence-based preventive interventions with a dual focus on behavioral and physical health.

Costs of preparing to implement a virtual reality job interview training programme in a community mental health agency: A budget impact analysis

RATIONAL, AIMS AND OBJECTIVES

Individual Placement and Support (IPS) is an evidence based strategy for facilitating employment among adults with severe mental illness (SMI) where staff may lead mock job interviews to prepare clients for real-world interviews (a method with limited scalability and cost effectiveness). A virtual reality job interview training program (VR-JIT)-delivered via the internet-has demonstrated efficacy for increasing employment among adults with SMI. Now, VR-JIT is being implemented with a community mental health agency (CMHA) and evaluated for its effectiveness within IPS. This study is a budget impact analysis, evaluating the costs of preparing a CMHA to implement VR-JIT.

METHOD

Implementation preparation occurred over 7 months from October 1, 2016 to April 30, 2017. CMHA staff (n = 15) and external research partners (n = 3) tracked their hours completing implementation preparation activities. Salaries plus a 28% fringe benefit rate were used to derive a per-hour salary amount for each individual and applied to each activity. Non-labor equipment costs were obtained from purchase receipts. A budget impact analysis evaluated the expenditures associated with preparing the CMHA to implement VRJIT.

RESULTS

The total implementation preparation costs equaled $25,482. Labor costs equaled $22,882 and non-labor costs equaled $2,600. In total, 655 person-hours were spent preparing for VR-JIT implementation (e.g., preparing lab space, training, and supervising operations).

CONCLUSIONS

This study presents an initial evaluation of the budget impact of preparing to implement VR-JIT in a CMHA. Cost considerations for future implementation preparation will be discussed. Given that the cost to prepare to implement an intervention can hinder its adoption, results provide an important analysis for decision-makers that may enhance uptake. Future work will determine the cost-effectiveness of VR-JIT implemented within IPS. This study is registered at http://clinicaltrials.gov, NCT = 03049813, "Virtual Reality Job Interview Training: An Enhancement to Supported Employment in Severe Mental Illness."

Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities

Childhood obesity has become a global pandemic in developed countries, leading to a host of medical conditions that contribute to increased morbidity and premature death. The causes of obesity in childhood and adolescence are complex and multifaceted, presenting researchers and clinicians with myriad challenges in preventing and managing the problem. This article reviews the state of the science for understanding the etiology of childhood obesity, the preventive interventions and treatment options for overweight and obesity, and the medical complications and co-occurring psychological conditions that result from excess adiposity, such as hypertension, nonalcoholic fatty liver disease, and depression. Interventions across the developmental span, varying risk levels, and service contexts (e.g.,community, school, home, health care systems) are reviewed. Future directions for research are offered with an emphasis on translational issues for taking evidence-based interventions to scale in a manner that will reduce the public health burden of the childhood obesity pandemic.

Quantitative approaches for the evaluation of implementation research studies

Implementation research necessitates a shift from clinical trial methods in both the conduct of the study and in the way that it is evaluated given the focus on the impact of implementation strategies. That is, the methods or techniques to support the adoption and delivery of a clinical or preventive intervention, program, or policy. As strategies target one or more levels within the service delivery system, evaluating their impact needs to follow suit. This article discusses the methods and practices involved in quantitative evaluations of implementation research studies. We focus on evaluation methods that characterize and quantify the overall impacts of an implementation strategy on various outcomes. This article discusses available measurement methods for common quantitative implementation outcomes involved in such an evaluation-adoption, fidelity, implementation cost, reach, and sustainment-and the sources of such data for these metrics using established taxonomies and frameworks. Last, we present an example of a quantitative evaluation from an ongoing randomized rollout implementation trial of the Collaborative Care Model for depression management in a large primary healthcare system.