1
|
Lyons MJ, J Whitaker D, Self-Brown S, A Weeks E. A Longitudinal Analysis of Trajectories and Predictors of Fidelity Using the SafeCare Parenting Model. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:240-253. [PMID: 38183521 DOI: 10.1007/s10488-023-01336-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/08/2024]
Abstract
Evidence-based practice (EBP) fidelity, understood as the extent to which a program is implemented as the developers intended, is a key implementation variable which likely relates to consumer outcomes. However, studies that track fidelity longitudinally and at large scale are uncommon, and finding reliable predictors of fidelity has proven to be a complex challenge. Further, attitudes toward EBP are a potentially important predictor of fidelity, but results across the literature have been mixed. The purpose of the present study is to use data from the ongoing implementation and dissemination of the SafeCare model to better understand (1) the characteristics of SafeCare implementation fidelity trajectories, and (2) whether individual level factors predict differences in fidelity and fidelity trajectories, especially provider attitudes toward EBP. The analyses reported here include 14,778 observed fidelity sessions by 868 providers in 172 agencies. We use multilevel modeling to examine fidelity, fidelity trajectories over time, and several potential individual-level predictors of fidelity, including demographics, work history, and attitudes toward EBP. We found: (1) that SafeCare fidelity begins high at baseline (93.85% on average); (2) that SafeCare fidelity displays a statistically significant trend of positive linear growth, even among those with less positive attitudes; and (3) that positive attitudes are associated with slightly higher fidelity on average and at baseline, while negative attitudes are associated with slightly lower fidelity on average and at baseline. To our knowledge, this is the largest longitudinal analysis of EBP fidelity in a child welfare program to date, and our findings support the notion that intensive coaching supports which are titrated over time can be sufficient to ensure sustained high fidelity, at least in some cases. Further, these findings indicate that robust training and coaching processes can ensure high fidelity and fidelity growth even among providers with less positive attitudes toward EBP.
Collapse
Affiliation(s)
- Matthew Jay Lyons
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, USA.
| | | | | | - Erin A Weeks
- School of Public Health, Georgia State University, Atlanta, USA
| |
Collapse
|
2
|
Smith JD, Li DH, Merle JL, Keiser B, Mustanski B, Benbow ND. Adjunctive interventions: change methods directed at recipients that support uptake and use of health innovations. Implement Sci 2024; 19:10. [PMID: 38331832 PMCID: PMC10854146 DOI: 10.1186/s13012-024-01345-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 01/24/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Implementation science groups change methods into two categories: (1) clinical, behavioral, or biomedical intervention targeting recipient's health outcomes and (2) implementation strategies targeting the delivery system. Differentiating interventions from strategies based on their intended functions is critical to accurately attributing their effects to health or implementation outcomes. However, in coordinating 200+ HIV implementation research projects and conducting systematic reviews, we identified change methods that had characteristics of both interventions and strategies that were inconsistently categorized. To alleviate confusion and improve change method specification, we propose that implementation science should adopt an extant but rarely used term-adjunctive interventions-to classify change methods that are distinct from the common intervention/strategy taxonomy. MAIN TEXT Adjunctive interventions as change methods that target recipients (e.g., patients, participants) of a health intervention but are designed to increase recipients' motivation, self-efficacy, or capacity for initiating, adhering to, complying with, or engaging with the health intervention over time. In two of our published reviews on implementation of HIV interventions, 25 out of 45 coded change methods fell into this gray area between strategy and intervention. We also noted instances in which the same change method was labelled as the intervention ("the thing"), as an adjunctive intervention, or an implementation strategy in different studies-further muddying the waters. Adjunctive interventions are distinguished from other change methods by their intended targets, desired outcomes, and theory of action and causal processes. Whereas health interventions target recipients and have a direct, causal effect on the health outcome, adjunctive interventions enhance recipients' attitudes and behaviors to engage with the intervention and have an indirect causal link to the health outcome via increasing the probability of recipients' utilization and adherence to the intervention. Adjunctive interventions are incapable of directly producing the health outcome and will themselves require implementation strategies to effectively impact sustained uptake, utilization, and adherence. Case examples, logic modeling, and considerations (e.g., relationship to consumer engagement strategies) for adjunctive intervention research are provided. CONCLUSION Conceptualizing adjunctive interventions as a separate type of change method will advance implementation research by improving tests of effectiveness, and the specification of mechanisms and outcomes.
Collapse
Affiliation(s)
- Justin D Smith
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA.
| | - Dennis H Li
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - James L Merle
- Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Brennan Keiser
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Third Coast Center for AIDS Research, Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nanette D Benbow
- Department of Psychiatry and Behavioral Sciences and Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| |
Collapse
|
3
|
Lyon AR, Cook CR, Larson M, Hugh ML, Dopp A, Hamlin C, Reinke P, Bose M, Law A, Goosey R, Goerdt A, Morrell N, Wackerle-Hollman A, Pullmann MD. Protocol for a hybrid type 3 effectiveness-implementation trial of a pragmatic individual-level implementation strategy for supporting school-based prevention programming. Implement Sci 2024; 19:2. [PMID: 38167046 PMCID: PMC10763475 DOI: 10.1186/s13012-023-01330-y] [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: 10/27/2023] [Accepted: 12/12/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND For approximately one in five children who have social, emotional, and behavioral (SEB) challenges, accessible evidence-based prevention practices (EBPPs) are critical. In the USA, schools are the primary setting for children's SEB service delivery. Still, EBPPs are rarely adopted and implemented by front-line educators (e.g., teachers) with sufficient fidelity to see effects. Given that individual behavior change is ultimately required for successful implementation, focusing on individual-level processes holds promise as a parsimonious approach to enhance impact. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a pragmatic, multifaceted pre-implementation strategy targeting volitional and motivational mechanisms of educators' behavior change to enhance implementation and student SEB outcomes. This study protocol describes a hybrid type 3 effectiveness-implementation trial designed to evaluate the main effects, mediators, and moderators of the BASIS-T implementation strategy as applied to Positive Greetings at the Door, a universal school-based EBPP previously demonstrated to reduce student disruptive behavior and increase academic engagement. METHODS This project uses a blocked randomized cohort design with an active comparison control (ACC) condition. We will recruit and include approximately 276 teachers from 46 schools randomly assigned to BASIS-T or ACC conditions. Aim 1 will evaluate the main effects of BASIS-T on proximal implementation mechanisms (attitudes, subjective norms, self-efficacy, intentions to implement, and maintenance self-efficacy), implementation outcomes (adoption, reach, fidelity, and sustainment), and child outcomes (SEB, attendance, discipline, achievement). Aim 2 will examine how, for whom, under what conditions, and how efficiently BASIS-T works, specifically by testing whether the effects of BASIS-T on child outcomes are (a) mediated via its putative mechanisms of behavior change, (b) moderated by teacher factors or school contextual factors, and (c) cost-effective. DISCUSSION This study will provide a rigorous test of BASIS-T-a pragmatic, theory-driven, and generalizable implementation strategy designed to target theoretically-derived motivational mechanisms-to increase the yield of standard EBPP training and support strategies. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT05989568. Registered on May 30, 2023.
Collapse
Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Clayton R Cook
- Character Strong, 4227 S Meridian, Puyallup, WA, 98373, USA
| | | | - Maria L Hugh
- University of Kansas, 1122 W Campus Rd, Lawrence, KS, 66045, USA
| | - Alex Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 91604, USA
| | - Corinne Hamlin
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Peter Reinke
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Mahasweta Bose
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Amy Law
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Roger Goosey
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| | - Annie Goerdt
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | - Nicole Morrell
- University of Minnesota, 1954 Buford Avenue, Suite 425, St. Paul, MN, 55108, USA
| | | | - Michael D Pullmann
- University of Washington, 6200 NE 74Th Street, Suite 100, Seattle, WA, 98115, USA
| |
Collapse
|