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Olson JR, Walker ER, Chwastiak L, Druss BG, Molfenter T, Benson F, Cerrato A, Gotham HJ. Supporting Implementation Through Online Learning Communities: Lessons Learned From a National Training and Technical Assistance Network. Eval Health Prof 2024; 47:178-191. [PMID: 38790111 DOI: 10.1177/01632787241237246] [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] [Indexed: 05/26/2024]
Abstract
Recent implementation science frameworks highlight the role of training and technical assistance (TTA) in building workforce capacity to implement evidence-based practices (EBPs). However, evaluation of TTA is limited. We describe three case examples that highlight TTA by three regional centers in the national Mental Health Technology Transfer Center (MHTTC) network. Each MHTTC formed Learning Communities (LCs) to facilitate connections among behavioral health professionals with the goals of sharing implementation strategies, discussing best-practices, and developing problem solving techniques. Data on outcomes were collected through a combination of self-report surveys and qualitative interviews. LC participants reported strong connectedness, gains in knowledge and skills, improvements in implementation capacity, and intentions to advocate for organizational and systems-level change. Furthermore, across the case examples, we identified LC characteristics that are associated with participant perceptions of outcomes, including tailoring LC content to workforce needs, providing culturally relevant information, engaging leaders, forming connections among participants and trainers, and challenging participants' current workplace practices. These findings are interpreted through the lens of the Interactive Systems Framework, which focuses on how TTA, such as LCs, can facilitate connections between the theoretical and empirical foundations of interventions and the practices of implementing interventions in real-world settings to advance workforce capacity.
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Affiliation(s)
| | | | - Lydia Chwastiak
- Northwest Mental Health Technology Transfer Center (MHTTC), USA
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Agley J, Gassman R, Reho K, Roberts J, Heil SKR, Castillo G, Golzarri-Arroyo L. Continuous Quality Improvement in the Substance Abuse and Mental Health Services Administration's Technology Transfer Center Network: A Process Evaluation. Eval Health Prof 2024; 47:154-166. [PMID: 38790107 PMCID: PMC11157976 DOI: 10.1177/01632787241234882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
In healthcare and related fields, there is often a gap between research and practice. Scholars have developed frameworks to support dissemination and implementation of best practices, such as the Interactive Systems Framework for Dissemination and Implementation, which shows how scientific innovations are conveyed to practitioners through tools, training, and technical assistance (TA). Underpinning those aspects of the model are evaluation and continuous quality improvement (CQI). However, a recent meta-analysis suggests that the approaches to and outcomes from CQI in healthcare vary considerably, and that more evaluative work is needed. Therefore, this paper describes an assessment of CQI processes within the Substance Abuse and Mental Health Services Administration's (SAMHSA) Technology Transfer Center (TTC) Network, a large TA/TTC system in the United States comprised of 39 distinct centers. We conducted key informant interviews (n = 71 representing 28 centers in the Network) and three surveys (100% center response rates) focused on CQI, time/effort allocation, and Government Performance and Results Act (GPRA) measures. We used data from each of these study components to provide a robust picture of CQI within a TA/TTC system, identifying Network-specific concepts, concerns about conflation of the GPRA data with CQI, and principles that might be studied more generally.
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McGinty EE, Alegria M, Beidas RS, Braithwaite J, Kola L, Leslie DL, Moise N, Mueller B, Pincus HA, Shidhaye R, Simon K, Singer SJ, Stuart EA, Eisenberg MD. The Lancet Psychiatry Commission: transforming mental health implementation research. Lancet Psychiatry 2024; 11:368-396. [PMID: 38552663 DOI: 10.1016/s2215-0366(24)00040-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 04/19/2024]
Affiliation(s)
| | - Margarita Alegria
- Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Lola Kola
- College of Medicine, University of Ibadan, Ibadan, Nigeria; Kings College London, London, UK
| | | | | | | | | | - Rahul Shidhaye
- Pravara Institute of Medical Sciences University, Loni, India; Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | | | - Sara J Singer
- Stanford University School of Medicine, Stanford, CA, USA
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Agley J, Gassman R, Reho K, Roberts J, Heil SKR, Golzarri-Arroyo L, Eddens K. Organizational Network Analysis of SAMHSA's Technology Transfer Center (TTC) Network. J Behav Health Serv Res 2024; 51:123-131. [PMID: 37872261 PMCID: PMC10733212 DOI: 10.1007/s11414-023-09867-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] [Accepted: 10/10/2023] [Indexed: 10/25/2023]
Abstract
Technology transfer centers (TTCs) facilitate the movement of evidence-based practices in behavioral healthcare from theory to practice. One of the largest such networks is the Substance Abuse and Mental Health Services Administration's (SAMHSA) TTC Network. This brief report shares findings from an organizational network analysis (ONA) of the network conducted as part of an external evaluation. For non-supervisory TTCs (n = 36) across three focus areas (addiction, prevention, and mental health), the authors computed network density, harmonic closeness, and non-null dyadic reciprocity for five types of interactions (e.g., "collaborated in workgroups"), then, for each interaction type, used Welch's T-test to compare mean harmonic closeness of standalone TTC grantees versus multiple-TTC grantees. ONA identified potentially isolated regional TTCs as well as mismatches between some centers' desired scope and their network centrality and enabled investigation of broader questions around behavioral health support systems. The approach appears useful for evaluating TTCs and similar support networks.
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Affiliation(s)
- Jon Agley
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA.
| | - Ruth Gassman
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Kaitlyn Reho
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Jeffrey Roberts
- Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St, Bloomington, IN, 47405, USA
| | - Susan K R Heil
- American Institutes for Research (AIR), Arlington, VA, USA
| | - Lilian Golzarri-Arroyo
- Biostatistics Consulting Center, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
| | - Kate Eddens
- Department of Epidemiology and Biostatistics, School of Public Health Bloomington, Indiana University Bloomington, Bloomington, IN, USA
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Davidson TM, Espeleta HC, Ridings LE, Witcraft S, Bravoco O, Higgins K, Houchins R, Kitchens D, Manning B, Jones S, Crookes B, Hanson R, Ruggiero KJ. Implementation of a Stepped Care Program to Address Emotional Recovery among Traumatic Injury Patients. J Am Coll Surg 2023; 237:810-825. [PMID: 37815166 PMCID: PMC10914157 DOI: 10.1097/xcs.0000000000000862] [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] [Indexed: 10/11/2023]
Abstract
BACKGROUND Annually, over 600,000 adults served in US trauma centers (≥20%) develop posttraumatic stress disorder (PTSD) and/or depression in the first year after injury. American College of Surgeons guidelines include screening and addressing mental health recovery in trauma centers. Yet, many trauma centers do not monitor and address mental health recovery, and it is a priority to learn how to implement evidence-informed mental health programs in trauma centers. STUDY DESIGN This report describes our application of the Exploration, Preparation, Implementation, Sustainment model to implement the Trauma Resilience and Recovery Program (TRRP) in 3 Level I and II trauma centers to address patients' mental health needs. TRRP is a scalable and sustainable stepped model of care-one of the few in the US-that provides early intervention and direct services after traumatic injury. RESULTS Trauma centers are well positioned to accelerate patients' mental health recovery via early identification, education, screening, and referrals to mental health agencies that provide best-practice care. We found that TRRP was acceptable to the 3 partnering trauma centers we studied. Early engagement of patient, provider, and hospital administration stakeholders enhanced buy-in during the early stages of the implementation process and promoted sustainability. Active processes to support monitoring, evaluation, and adaptation were critical. CONCLUSIONS Our work demonstrates the feasibility of implementing and adapting TRRP, a cost-efficient and sustainable stepped care intervention, in Level I and II trauma centers. Several factors should be carefully considered by trauma centers seeking to integrate behavioral health interventions into their trauma program.
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Affiliation(s)
- Tatiana M Davidson
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Hannah C Espeleta
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Leigh E Ridings
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Sara Witcraft
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Olivia Bravoco
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Kristen Higgins
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Rachel Houchins
- Prisma Health Midlands, Level I Trauma Center, Columbia, SC (Houchins)
| | - Debra Kitchens
- Prisma Health Upstate, Level I Trauma Center, Greeneville, SC (Kitchens, Manning)
| | - Benjamin Manning
- Prisma Health Upstate, Level I Trauma Center, Greeneville, SC (Kitchens, Manning)
| | - Seon Jones
- Trident Medical Center, Level II Trauma Center, Charleston, SC (Jones)
| | - Bruce Crookes
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
| | - Rochelle Hanson
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
| | - Kenneth J Ruggiero
- From the College of Nursing (Davidson, Espeleta, Ridings, Witcraft, Bravoco, Higgins, Crookes, Ruggiero), Medical University of South Carolina, Charleston, SC
- Department of Psychiatry, Medical University of South Carolina, Charleston, SC (Davidson, Espeleta, Ridings, Hanson, Ruggiero)
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Donohue JF, Elborn JS, Lansberg P, Javed A, Tesfaye S, Rugo H, Duddi SRD, Jithoo N, Huang PH, Subramaniam K, Ramanjinappa N, Koltun A, Melamed S, Chan JCN. Bridging the "Know-Do" Gaps in Five Non-Communicable Diseases Using a Common Framework Driven by Implementation Science. J Healthc Leadersh 2023; 15:103-119. [PMID: 37416849 PMCID: PMC10320809 DOI: 10.2147/jhl.s394088] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 04/12/2023] [Indexed: 07/08/2023] Open
Abstract
According to the United Nations High-Level Meeting 2018, five non-communicable diseases (NCDs) including cardiovascular diseases, chronic respiratory diseases, diabetes mellitus, cancer, and mental health conditions accounted for two-thirds of global deaths. These five NCDs share five common risk factors including tobacco use, unhealthy diets, physical inactivity, alcohol use, and air pollution. Low- and middle-income countries (LMICs) face larger burden of NCDs than high-income countries (HICs), due to differences in ecological, technological, socioeconomic and health system development. Based on high-level evidence albeit mainly from HICs, the burden caused by NCDs can be reduced by affordable medicines and best practices. However, "know-do" gaps, ie, gaps between what we know in science and what we do in practice, has limited the impact of these strategies, especially in LMICs. Implementation science advocates the use of robust methodologies to evaluate sustainable solutions in health, education and social care aimed at informing practice and policies. In this article, physician researchers with expertise in NCDs reviewed the common challenges shared by these five NCDs with different clinical courses. They explained the principles of implementation science and advocated the use of an evidence-based framework to implement solutions focusing on early detection, prevention and empowerment, supplemented by best practices in HICs and LMICs. These successful stories can be used to motivate policymakers, payors, providers, patients and public to co-design frameworks and implement context-relevant, multi-component, evidence-based practices. In pursuit of this goal, we propose partnership, leadership, and access to continuing care as the three pillars in developing roadmaps for addressing the multiple needs during the journey of a person with or at risk of these five NCDs. By transforming the ecosystem, raising awareness and aligning context-relevant practices and policies with ongoing evaluation, it is possible to make healthcare accessible, affordable and sustainable to reduce the burden of these five NCDs.
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Affiliation(s)
| | | | | | - Afzal Javed
- Warwick Medical School, University of Warwick, Warwick, UK & Pakistan Psychiatric Research Centre, Coventry, UK
| | - Solomon Tesfaye
- Sheffield Teaching Hospitals and the University of Sheffield, Sheffield, UK
| | - Hope Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sita Ratna Devi Duddi
- International Alliance of Patients’ Organisations, London, United Kingdom
- DakshamA Health and Education, Delhi, India
| | | | | | | | | | | | | | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity, Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, Special Administrative Regions of the People’s Republic of China
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Ogunsola OO, Olawepo JO, Ajayi O, Osayi E, Akinro YT, Ifechelobi C, Chigbu C, Okonkwo P, Ezeanolue EE. AVIVA: a telehealth tool to improve cervical cancer screening in resource-constrained settings. BMJ Glob Health 2023; 8:e012311. [PMID: 37433694 DOI: 10.1136/bmjgh-2023-012311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/17/2023] [Indexed: 07/13/2023] Open
Abstract
Cervical cancer accounts for 21.7% of all cancer deaths in the sub-Saharan Africa with a case fatality rate of 68%. Nigeria's Federal Ministry of Health has adopted cervical cancer screening (CCS) using visual inspection with acetic acid or Lugol's iodine (VIA/VILI) and cryotherapy treatment for precancerous lesions as the preferred screening and treatment strategy. Using the Exploration, Preparation, Implementation and Sustainment Framework, our study documents our experience during the development, piloting and roll-out of the APIN Public Health Initiatives (APIN)-developed VIA Visual Application (AVIVA) for CCS using the VIA method in 86 APIN-supported health facilities across 7 states in Nigeria. Between December 2019 and June 2022, with the aid of 9 gynaecologists and 133 case finders, a total of 29 262 women living with HIV received VIA-based CCS and 1609 of them were VIA-positive, corresponding to VIA positivity rate of 5.5%. Over the 30 months duration and the 5 phases of CCS scale-up, AVIVA development and expansion, a total of 1247 cases were shared via the AVIVA App (3741 pictures), with 1058 of such cases undergoing expert review, corresponding to a reviewer rate of 84.8%. Overall, the use of the AVIVA App improved both the VIA-positive and VIA-negative concordance rates by 16 percentage points each (26%-42% and 80%-96%, respectively) from baseline to the end of the study. We concluded that the AVIVA App is an innovative tool to improve CCS rates and diagnostic precision by connecting health facility staff and expert reviewers in resource-limited settings.
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Affiliation(s)
| | - John Olajide Olawepo
- Center For Translation and Implementation Research, University of Nigeria, Nsukka, Nigeria
- Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Oluseye Ajayi
- Prevention and Community Services, APIN Public Health Initiatives, Abuja, Nigeria
| | - Emmanuel Osayi
- Clinical Services, APIN Public Health Initiatives, Abuja, Nigeria
| | | | | | - Chibuike Chigbu
- Center For Translation and Implementation Research, University of Nigeria, Nsukka, Nigeria
- Department of Obstetrics and Gynecology, University of Nigeria, Nsukka, Nigeria
| | | | - Echezona Edozie Ezeanolue
- Center For Translation and Implementation Research, University of Nigeria, Nsukka, Nigeria
- Healthy Sunrise Foundation, Las Vegas, Nevada, USA
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Moise N, Bauer AM. Current and future directions in the application of implementation science to accelerate the adoption of evidence-based practices in behavioral health. Gen Hosp Psychiatry 2022; 77:88-91. [PMID: 35576715 DOI: 10.1016/j.genhosppsych.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Nathalie Moise
- Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Amy M Bauer
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
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