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Shanholtz CE, Ridings LE, Espeleta HC, Anton MT, Hanson RF, Saunders B, Ruggiero K, Davidson T. A Comparison of the Readiness of Youth Service Agencies to Implement a Technology-Based Toolkit to Support Treatment Delivery. Community Ment Health J 2023; 59:1163-1171. [PMID: 36918477 DOI: 10.1007/s10597-023-01099-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 02/03/2023] [Indexed: 03/16/2023]
Abstract
Implementation initiatives and technology-based resources aim to address barriers to Evidence-Based Practice (EBP) use by creating generalizable techniques that can be used for a variety of youth-serving agencies. However, research has not carefully examined unique differences between agency types or individual programs in readiness to use such technologies and implementation strategies. The current study explored differences between community mental health clinics and child advocacy centers on organizational cultural factors (e.g., ability to change and commitment for change) to implement a novel technology-based toolkit to support delivery of Trauma Focused Cognitive Behavioral Therapy (TF-CBT). Results indicated that TF-CBT providers from child advocacy centers reported greater commitment to change and more support to use the technology-based system than those from community mental health centers. Findings suggest that implementation initiatives should address the needs of individual agencies and service settings and adaptations should be explored to best meet the needs of these settings.
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Affiliation(s)
- Caroline E Shanholtz
- College of Nursing, The Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA.
- University of California, Los Angeles, 1285 Psychology Building, Los Angeles, CA, 90095, USA.
| | - Leigh E Ridings
- College of Nursing, The Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Hannah C Espeleta
- College of Nursing, The Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Margaret T Anton
- College of Nursing, The Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Rochelle F Hanson
- College of Nursing, The Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Benjamin Saunders
- College of Nursing, The Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Kenneth Ruggiero
- College of Nursing, The Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Tatiana Davidson
- College of Nursing, The Medical University of South Carolina, 99 Jonathan Lucas Street, Charleston, SC, 29425, USA
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2
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Williams NJ, Russo J, Vredevoogd M, Grover T, Green P, Proctor E, Bhat A, Unützer J, Bennett IM. Association of organizational culture and climate with variation in the clinical outcomes of collaborative care for maternal depression in community health centers. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231205891. [PMID: 37936965 PMCID: PMC10576428 DOI: 10.1177/26334895231205891] [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: 11/09/2023] Open
Abstract
Background Organizational factors may help explain variation in the effectiveness of evidence-based clinical innovations through implementation and sustainment. This study tested the relationship between organizational culture and climate and variation in clinical outcomes of the Collaborative Care Model (CoCM) for treatment of maternal depression implemented in community health centers. Method Organizational cultures and climates of 10 community health centers providing CoCM for depression among low-income women pregnant or parenting were assessed using the organizational social context (OSC) measure. Three-level hierarchical linear models tested whether variation in culture and climate predicted variation in improvement in depression symptoms from baseline to 6.5-month post-baseline for N = 468 women with care ±1 year of OSC assessment. Depression symptomology was measured using the Patient Health Questionnaire (PHQ-9). Results After controlling for patient characteristics, case mix, center size, and implementation support, patients served by centers with more proficient cultures improved significantly more from baseline to 6.5-month post-baseline than patients in centers with less proficient cultures (mean improvement = 5.08 vs. 0.14, respectively, p = .020), resulting in a large adjusted effect size of dadj = 0.78. A similar effect was observed for patients served by centers with more functional climates (mean improvement = 5.25 vs. 1.12, p < .044, dadj = 0.65). Growth models indicated that patients from all centers recovered on average after 4 months of care. However, those with more proficient cultures remained stabilized whereas patients served by centers with less proficient cultures deteriorated by 6.5-month post-baseline. A similar pattern was observed for functional climate. Conclusions Variation in clinical outcomes for women from historically underserved populations receiving Collaborative Care for maternal depression was associated with the organizational cultures and climates of community health centers. Implementation strategies targeting culture and climate may improve the implementation and effectiveness of integrated behavioral health care for depression.
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Affiliation(s)
| | - Joan Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Melinda Vredevoogd
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Tess Grover
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Phillip Green
- Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, USA
| | - Enola Proctor
- Brown School of Social Work, Washington University, Saint Louis, MO, USA
| | - Amritha Bhat
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Jürgen Unützer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Ian M. Bennett
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
- Department of Family Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Looi JCL, Allison S, Bastiampillai T, Kisely SR. Mental health services need action on organisational culture and justice. Australas Psychiatry 2022; 30:739-742. [PMID: 35762969 DOI: 10.1177/10398562221111945] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE A commentary on the usefulness of the concepts of organisational culture, organisational climate and justice on the quality and safety of mental health services and how conditions may be improved. CONCLUSIONS Organisational culture, organisational climate and justice impact upon the quality and safety of care, as well as well-being of staff, in mental health services. Psychiatrists and trainees, should consider, act and advocate for improved organisational culture, climate and justice. Improvement in these organisational domains can be achieved, through a coordinated framework that acts across all levels of administration, mid-level management and frontline clinical staff.
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Affiliation(s)
- Jeffrey C L Looi
- Academic Unit of Psychiatry and Addiction Medicine, 104822The Australian National University Medical School, Canberra Hospital, Canberra, ACT, Australia; and Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia
| | - Stephen Allison
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; and College of Medicine and Public Health, 198094Flinders University, Adelaide, SA, Australia
| | - Tarun Bastiampillai
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; College of Medicine and Public Health, 198094Flinders University, Adelaide, SA, Australia; and Department of Psychiatry, 2541Monash University, Clayton, VIC, Australia
| | - Stephen R Kisely
- Consortium of Australian-Academic Psychiatrists for Independent Policy and Research Analysis (CAPIPRA), Canberra, ACT, Australia; School of Medicine, 1974The University of Queensland, Princess Alexandra Hospital, Brisbane, QLD, Australia; and Departments of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
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Beidas RS, Dorsey S, Lewis CC, Lyon AR, Powell BJ, Purtle J, Saldana L, Shelton RC, Stirman SW, Lane-Fall MB. Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem. Implement Sci 2022; 17:55. [PMID: 35964095 PMCID: PMC9375077 DOI: 10.1186/s13012-022-01226-3] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 07/20/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Implementation science is at a sufficiently advanced stage that it is appropriate for the field to reflect on progress thus far in achieving its vision, with a goal of charting a path forward. In this debate, we offer such reflections and report on potential threats that might stymie progress, as well as opportunities to enhance the success and impact of the field, from the perspective of a group of US-based researchers. MAIN BODY Ten mid-career extramurally funded US-based researchers completed a "pre-mortem" or a group brainstorming exercise that leverages prospective hindsight to imagine that an event has already occurred and to generate an explanation for it - to reduce the likelihood of a poor outcome. We came to consensus on six key themes related to threats and opportunities for the field: (1) insufficient impact, (2) too much emphasis on being a "legitimate science," (3) re-creation of the evidence-to-practice gap, (4) difficulty balancing accessibility and field coherence, (5) inability to align timelines and priorities with partners, and (6) overly complex implementation strategies and approaches. CONCLUSION We submit this debate piece to generate further discussion with other implementation partners as our field continues to develop and evolve. We hope the key opportunities identified will enhance the future of implementation research in the USA and spark discussion across international groups. We will continue to learn with humility about how best to implement with the goal of achieving equitable population health impact at scale.
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5
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Geng EH, Nash D, Phanuphak N, Green K, Solomon S, Grimsrud A, Sohn AH, Mayer KH, Bärnighausen T, Bekker LG. The question of the question: impactful implementation science to address the HIV epidemic. J Int AIDS Soc 2022; 25:e25898. [PMID: 35384312 PMCID: PMC8982316 DOI: 10.1002/jia2.25898] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 02/18/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Questions about the implementation of evidence-based intervention to treat and prevent HIV have risen to the top of the field's scientific priorities. Despite the availability of highly efficacious treatment and prevention interventions, impact has fallen short of targets because these interventions are used with insufficient reach, consistency, sustainability and equity in diverse real-world settings. At present, substantial excitement for implementation science - defined as research methods and strategies to improve use of evidence-based interventions - has focused on developing and disseminating methods to conduct rigorous research. Yet, impactful answers depend on a sometimes less visible, but even more important, step: asking good questions about implementation. DISCUSSION In this commentary, we offer several considerations for researchers formulating implementation research questions based on several distinctive features of the field. First, as findings are used not only by other researchers but by implementers, scientific questions must incorporate a range of stakeholder and community perspectives to be most relevant. Second, real-world settings are contextually diverse, and the most relevant scientific questions must position answers to make sense within these contexts (whether geographical, organizational and sociological), rather than apart from them. Third, implementation is complex and dynamic; consequently, research questions must make use of emerging standards in describing implementation strategies and their effects whenever possible. Finally, the field of implementation science continues to evolve, so framing problems with a diverse disciplinary lens will enable researchers to pose insightful and impactful questions. CONCLUSIONS We are now at a juncture marked by both rich evidence-based interventions and a persistent global pandemic. To achieve continued scientific progress against the HIV epidemic, asking the right questions might be part of the answer itself.
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Affiliation(s)
- Elvin H Geng
- Center for Dissemination and Implementation, Institute of Public Health, Division of Infectious Diseases, Department of Medicine, School of Medicine at Washington University in St. Louis, St. Louis, Missouri, USA
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, USA.,Department of Epidemiology and Biostatistics, Graduate School of Public Health, City University of New York, New York, USA
| | | | | | - Sunil Solomon
- Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | | | | | - Kenneth H Mayer
- The Fenway Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Till Bärnighausen
- Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg, Germany
| | - Linda-Gail Bekker
- Institute of Infectious Disease and Molecular Medicine, Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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6
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Dondanville KA, Fina BA, Straud CL, Finley EP, Tyler H, Jacoby V, Blount TH, Moring JC, Pruiksma KE, Blankenship AE, Evans WR, Zaturenskaya M. Launching a Competency-Based Training Program in Evidence-Based Treatments for PTSD: Supporting Veteran-Serving Mental Health Providers in Texas. Community Ment Health J 2021; 57:910-919. [PMID: 32666417 DOI: 10.1007/s10597-020-00676-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/03/2020] [Indexed: 10/23/2022]
Abstract
Community mental health providers play an essential role in delivering services to veterans who either have limited access to U.S. Department of Veterans Affairs (VA) facilities or who prefer to seek care outside of the VA. However, there are limited training opportunities in evidence-based treatments for posttraumatic stress disorder (PTSD) outside of the VA. In 2017, the STRONG STAR Training Initiative was established to develop competency-based training in two evidence-based therapies for PTSD and to provide that training for mental health providers serving veterans and their families in community settings in Texas. This article describes the program's development and implementation, baseline characteristics of participating clinicians, and lessons learned toward the scale-up and extension of this competency-based training effort to include other interventions and locations.
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Affiliation(s)
- Katherine A Dondanville
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.
| | - Brooke A Fina
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Casey L Straud
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, 78249, USA
| | - Erin P Finley
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA.,South Texas Veterans Health Care System, 7400 Merton Minter Blvd, San Antonio, TX, USA
| | - Hannah Tyler
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Vanessa Jacoby
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Tabatha H Blount
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - John C Moring
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Kristi E Pruiksma
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Abby E Blankenship
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, San Antonio, TX, 78229, USA
| | - Wyatt R Evans
- VA North Texas Health Care System, 4500 S Lancaster Rd, Dallas, TX, USA
| | - Mariya Zaturenskaya
- James A. Haley Veterans' Hospital, 13000 Bruce B. Downs Blvd, Tampa, FL, USA
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Garcia D, Blizzard AM, Peskin A, Rothenberg WA, Schmidt E, Piscitello J, Espinosa N, Salem H, Rodriguez GM, Sherman JA, Parlade MV, Landa AL, Davis EM, Weinstein A, Garcia A, Perez C, Rivera JM, Martinez C, Jent JF. Rapid, Full-Scale Change to Virtual PCIT During the COVID-19 Pandemic: Implementation and Clinical Implications. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:269-283. [PMID: 33586056 PMCID: PMC7882248 DOI: 10.1007/s11121-021-01211-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2021] [Indexed: 11/20/2022]
Abstract
Health agencies call for the immediate mobilization of existing interventions in response to numerous child and family mental health concerns that have arisen as result of the COVID-19 pandemic. Answering this call, this pilot study describes the rapid, full-scale change from a primarily clinic-based Parent–Child Interaction Therapy (PCIT) model to a virtual service model (i.e., I-PCIT) in an academic and community-based program in Miami, Florida. First, we describe the virtual service training model our program developed and its implementation with 17 therapists (MAge = 32.35, 88.2% female, 47.1% Hispanic) to enable our clinic to shift from providing virtual services to a small portion of the families served (29.1%) to all of the families served. Second, we examine the effect of I-PCIT on child and caregiver outcomes during the 2-month stay-at-home period between March 16, 2020, and May 16, 2020, in 86 families (MChildAge = 4.75, 71% Hispanic). Due to the rapid nature of the current study, all active participants were transferred to virtual services, and therefore there was no comparison or control group, and outcomes represent the most recently available scores and not treatment completion. Results reveal that I-PCIT reduced child externalizing and internalizing problems and caregiver stress, and increased parenting skills and child compliance with medium to large effects even in the midst of the COVID-19 pandemic. Finally, the study examined components of our virtual service training model associated with the greatest improvements in child and caregiver outcomes. Preliminary findings revealed that locally and collaboratively developed strategies (e.g., online communities of practice, training videos and guides) had the strongest association with child and caregiver outcomes. Implications for virtual service delivery, implementation, and practice in the midst of the COVID-19 pandemic are discussed.
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Affiliation(s)
- Dainelys Garcia
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA.
| | - Angela M Blizzard
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Abigail Peskin
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - W Andrew Rothenberg
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA.,Duke University Center for Child and Family Policy, Coral Gables, 33146, USA
| | - Ellyn Schmidt
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Jennifer Piscitello
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Natalie Espinosa
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Hanan Salem
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Gabriela M Rodriguez
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, 46202, USA
| | - Jamie A Sherman
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Meaghan V Parlade
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Alexis L Landa
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Eileen M Davis
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Allison Weinstein
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Angela Garcia
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Camille Perez
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Jessica M Rivera
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Chary Martinez
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
| | - Jason F Jent
- Mailman Center for Child Development, University of Miami Miller School of Medicine, Miami, 33137, USA
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8
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Lengnick-Hall R, Willging CE, Hurlburt MS, Aarons GA. Incorporators, Early Investors, and Learners: a longitudinal study of organizational adaptation during EBP implementation and sustainment. Implement Sci 2020; 15:74. [PMID: 32912237 PMCID: PMC7488112 DOI: 10.1186/s13012-020-01031-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The majority of literature on evidence-based practice (EBP) adaptation focuses on changes to clinical practices without explicitly addressing how organizations must adapt to accommodate a new EBP. This study explores the process of organizational-rather than EBP-adaptation during implementation and sustainment. To the authors' knowledge, there are no previous implementation studies that focus on organizational adaptation in this way. METHODS This analysis utilizes a case study approach to examine longitudinal qualitative data from 17 community-based organizations (CBOs) in one state and seven county-based child welfare systems. The CBOs had sustained a child-neglect intervention EBP (SafeCare®) for 2 to 10 years. The unit of analysis was the organization, and each CBO represented a case. Organizational-level profiles were created to describe the organizational adaptation process. RESULTS Three organizational-level adaptation profiles were identified as follows: incorporators (n = 7), early investors (n = 6), and learners (n = 4). Incorporators adapted by integrating SafeCare into existing operations to meet contractual or EBP fidelity requirements. Early Investors made substantial organizational adaptations during the early implementation period, then operated relatively consistently as the EBP became embedded in the organization and service system. Learners were characterized by steady and continuous attention to new ways that the organization could adapt to support the EBP. CONCLUSION The profiles demonstrated that there can be multiple effective paths to EBP sustainment. Organizational adaptation was calibrated to fit a CBO's operations (e.g., size of the program) and immediate environmental constraints (e.g., funding levels). Additionally, organizations fulfilled different functional roles in the network of entities involved in EBP implementation. Knowing organizational roles and adaptation profiles can guide implementation planning and help to structure contract designs that bridge the outer (system) and inner (organizational) contexts. Adaptation profiles can also inform the intensity of the implementation strategy tailoring process and the way that strategies are marketed to organizations.
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Affiliation(s)
| | - Cathleen E Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM, USA
| | - Michael S Hurlburt
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
- UC San Diego Dissemination and Implementation Science Center, La Jolla, CA, USA.
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Choy-Brown M, Hamovitch EK, Bornheimer LA, Acri MC, McKay MM. Getting to the table: Agency characteristics and evidence-based intervention adoption in children's mental health care. CHILDREN AND YOUTH SERVICES REVIEW 2020; 110:104774. [PMID: 32189819 PMCID: PMC7079816 DOI: 10.1016/j.childyouth.2020.104774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Scaling evidence-based interventions (EBI) for children and families across healthcare systems can expand public health impact. Research has identified EBI adoption determinants. However, less understood are characteristics of agencies that opt in across the stages of adoption. This study examined the relationship between agency (N=69) characteristics (e.g., revenue) and four adoption stages during a large-scale trial of an EBI for children with significant behavioral difficulties and their families. 48 (70%) of agencies demonstrated interest, 28 (41%) scheduled an informational meeting, 20 (29%) received training, and 16 (22%) demonstrated EBI uptake. Analyses indicated no differences in characteristics and initial interest. However, agencies with small-sized revenue had significantly reduced odds at other adoption stages. Implications for strategies to bring EBI access to scale are discussed.
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Affiliation(s)
| | | | | | - Mary C Acri
- The McSilver Institute for Poverty Policy and Research; Adjunct Assistant Professor at New York University School of Medicine
| | - Mary M McKay
- Brown School at Washington University in St. Louis
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10
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Impact of Stressful Climates on Provider Perceptions of Integrated Behavioral Health Services in Pediatric Primary Care: An Exploratory Study. J Dev Behav Pediatr 2019; 40:686-695. [PMID: 31393319 DOI: 10.1097/dbp.0000000000000712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Pediatric primary care providers (PCPs) work in challenging environments and are increasingly called to implement complex interventions, such as behavioral health (BH) service integration. We explore how perceived stressful practice climates (1) change over time in and (2) influence provider perceptions of collaborative care versus usual care, 2 models of integrated BH care. METHODS Secondary exploratory analysis using hierarchical linear modeling was performed on an 18-month cluster-randomized trial of 8 pediatric primary care practices to Doctor-Office Collaborative Care (DOCC), where an on-site care manager delivered BH services in coordination with PCPs, or Enhanced Usual Care (EUC), where a care manager facilitated referrals to local BH providers. Various indicators of PCP perceptions of BH services, including satisfaction with practice, burdens and beliefs regarding psychosocial problems, and effectiveness in treating behavioral problems, were assessed as outcomes. Moderators were 2 domains of stressful climates, role conflict and role overload. RESULTS Role conflict and role overload stayed stable in both conditions. Role conflict strengthened the positive effect of DOCC on PCP perceived effectiveness in treating behavioral problems (β [SE], 0.04 [0.02]; p = 0.04) and improvement in managing oppositional/aggressive behavior (0.02 [0.01]; p = 0.02). Role overload strengthened the positive effect of DOCC on PCP-perceived improvement in managing attention-deficit hyperactivity disorder (0.03 [0.01]; p = 0.01). Stressful climates did not influence perceptions for EUC providers. CONCLUSIONS Providers experiencing more stressful practice climates developed more positive perceptions of collaborative care. This may encourage stressed providers to make effective practice changes and promote practice integration of BH services.
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Galdikiene N, Asikainen P, Rostila I, Green P, Balčiūnas S, Helminen M, Suominen T. The association of primary healthcare nurses' perceived stress with organizational culture and climate in a team context. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2019. [DOI: 10.15452/cejnm.2019.10.0019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Niimura J, Nakanishi M, Okumura Y, Kawano M, Nishida A. Effectiveness of 1-day trauma-informed care training programme on attitudes in psychiatric hospitals: A pre-post study. Int J Ment Health Nurs 2019; 28:980-988. [PMID: 31081263 DOI: 10.1111/inm.12603] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2019] [Indexed: 11/29/2022]
Abstract
Many patients in mental health settings are likely to have histories of interpersonal traumatic experiences. Mental health providers are recommended to adopt trauma-informed care (TIC) to ensure sensitivity and responsiveness to the impact of trauma on patients. However, few studies have examined the effectiveness of a TIC training programme using standardized measures with follow-up assessments. The aim of the study was to evaluate the effects of a TIC training programme on attitudes towards TIC in mental health professionals. The study involved a pre-post design with 3-month follow-up assessments conducted between March and June 2018. In total, 65 mental health professionals from 29 psychiatric hospitals in Tokyo and its suburban prefectures participated in the study. Mental health professionals participated in a 1-day programme consisting of a 3.5-hour lecture and 1-hour group discussion. Development of favourable attitudes towards TIC was the primary outcome, as assessed by using the Attitude Related Trauma-Informed Care scale. The majority of participants were women (86%), and the mean age was 42.2 years. The mean score of the Attitude Related Trauma-Informed Care scale scores increased significantly from 5.1 during pre-training to 5.5 immediately after training (mean difference: 0.4; 95% confidence interval: 0.3-0.5) and 5.4 after 3 months (mean difference: 0.3; 95% confidence interval: 0.2-0.4). Furthermore, half of the participants claimed to have implemented TIC practice in daily clinical settings at the 3-month follow-up. These results suggested that this brief TIC training programme improved attitudes towards TIC practice significantly.
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Affiliation(s)
- Junko Niimura
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Yasuyuki Okumura
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | | | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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Becker-Haimes EM, Williams NJ, Okamura KH, Beidas RS. Interactions Between Clinician and Organizational Characteristics to Predict Cognitive-Behavioral and Psychodynamic Therapy Use. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 46:701-712. [DOI: 10.1007/s10488-019-00959-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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14
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Williams N, Beidas R. Annual Research Review: The state of implementation science in child psychology and psychiatry: a review and suggestions to advance the field. J Child Psychol Psychiatry 2019; 60:430-450. [PMID: 30144077 PMCID: PMC6389440 DOI: 10.1111/jcpp.12960] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Scientists have developed evidence-based interventions that improve the symptoms and functioning of youth with psychiatric disorders; however, these interventions are rarely used in community settings. Eliminating this research-to-practice gap is the purview of implementation science, the discipline devoted to the study of methods to promote the use of evidence-based practices in routine care. METHODS We review studies that have tested factors associated with implementation in child psychology and psychiatry, explore applications of social science theories to implementation, and conclude with recommendations to advance implementation science through the development and testing of novel, multilevel, causal theories. RESULTS During its brief history, implementation science in child psychology and psychiatry has documented the implementation gap in routine care, tested training approaches and found them to be insufficient for behavior change, explored the relationships between variables and implementation outcomes, and initiated randomized controlled trials to test implementation strategies. This research has identified targets related to implementation (e.g., clinician motivation, organizational culture) and demonstrated the feasibility of activating these targets through implementation strategies. However, the dominant methodological approach has been atheoretical and predictive, relying heavily on a set of variables from heuristic frameworks. CONCLUSIONS Optimizing the implementation of effective treatments in community care for youth with psychiatric disorders is a defining challenge of our time. This review proposes a new direction focused on developing and testing integrated causal theories. We recommend implementation scientists: (a) move from observational studies of implementation barriers and facilitators to trials that include causal theory; (b) identify a core set of implementation determinants; (c) conduct trials of implementation strategies with clear targets, mechanisms, and outcomes; (d) ensure that behaviors that are core to EBPs are clearly defined; and (e) agree upon standard measures. This agenda will help fulfill the promise of evidence-based practice for improving youth behavioral health.
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Affiliation(s)
| | - Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine
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15
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Abstract
OBJECTIVE To assess hospital unit culture and clinician attitudes associated with varying rates of primary cesarean delivery. DATA SOURCES/STUDY SETTING Intrapartum nurses, midwives, and physicians recruited from 79 hospitals in California participating in efforts to reduce cesarean overuse. STUDY DESIGN Labor unit culture and clinician attitudes measured using a survey were linked to the California Maternal Data Center for birth outcomes and hospital covariates. METHODS Association with primary cesarean delivery rates was assessed using multivariate Poisson regression adjusted for hospital covariates. PRINCIPAL FINDINGS 1718 respondents from 70 hospitals responded to the Labor Culture Survey. The "Unit Microculture" subscale was strongly associated with primary cesarean rate; the higher a unit scored on 8-items describing a culture supportive of vaginal birth (eg, nurses are encouraged to spend time in rooms with patients, and doulas are welcomed), the cesarean rate decreased by 41 percent (95% CI = -47 to -35 percent, P < 0.001). Discordant attitudes between nurses and physicians were associated with increased cesarean rates. CONCLUSIONS Hospital unit culture, clinician attitudes, and consistency between professions are strongly associated with primary cesarean rates. Improvement efforts to reduce cesarean overuse must address culture of care as a key part of the change process.
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Affiliation(s)
- Emily White VanGompel
- The University of Chicago Pritzker School of MedicineEvanstonIllinois
- NorthShore University HealthSystemEvanstonIllinois
| | - Susan Perez
- Department of Kinesiology and Health ScienceCalifornia State University, SacramentoSacramentoCalifornia
| | - Avisek Datta
- NorthShore University HealthSystemEvanstonIllinois
| | - Chi Wang
- Biostatistics and ResearchNorthShore University HealthSystemEvanstonIllinois
| | - Valerie Cape
- California Maternal Quality Care CollaborativeStanford UniversityStanfordCalifornia
| | - Elliott Main
- Department of Obstetrics and GynecologyStanford University School of MedicineStanfordCalifornia
- California Maternal Quality Care CollaborativeStanford University School of MedicineStanfordCalifornia
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16
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Jackson CB, Brabson LA, Quetsch LB, Herschell AD. Training transfer: a systematic review of the impact of inner setting factors. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2019; 24:167-183. [PMID: 29922872 DOI: 10.1007/s10459-018-9837-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 06/01/2018] [Indexed: 06/08/2023]
Abstract
Consistent with Baldwin and Ford's model (Pers Psychol 41(1):63-105, 1988), training transfer is defined as the generalization of learning from a training to everyday practice in the workplace. The purpose of this review was to examine the influence of work-environment factors, one component of the model hypothesized to influence training transfer within behavioral health. An electronic literature search guided by the Consolidated Framework for Implementation Research's inner setting domain was conducted was conducted on Medline OVID, Medline EMBASE, and PsycINFO databases. Of 9184 unique articles, 169 full-text versions of articles were screened for eligibility, yielding 26 articles meeting inclusion criteria. Results from the 26 studies revealed that overall, having more positive networks and communication, culture, implementation climate, and readiness for implementation can facilitate training transfer. Although few studies have examined the impact of inner setting factors on training transfer, these results suggest organizational context is important to consider with training efforts. These findings have important implications for individuals in the broader health professions educational field.
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17
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Williams NJ, Frank HE, Frederick L, Beidas RS, Mandell DS, Aarons GA, Green P, Locke J. Organizational culture and climate profiles: relationships with fidelity to three evidence-based practices for autism in elementary schools. Implement Sci 2019; 14:15. [PMID: 30755220 PMCID: PMC6373074 DOI: 10.1186/s13012-019-0863-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Implementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit implementation theory and strategy development to the extent that individual dimensions of culture and climate interact, mutually reinforce or counteract one another, or exhibit non-linear relationships. This study tests whether empirically identifiable culture and climate profiles emerge in a sample of organizations and examines how these profiles relate to EBP fidelity and work attitudes that support EBP sustainment, focusing on three EBPs for youth with autism delivered in schools as an example. METHODS The study included 65 elementary schools in the U.S. that implemented three EBPs-discrete trial training, pivotal response training, and visual schedules-for youth with autism. Organizational culture and climate and work attitudes were assessed using the Organizational Social Context measure at the beginning of the school year. Observations of EBP fidelity occurred mid school-year. We used bias-adjusted stepwise latent profile modeling to (1) identify subpopulations of schools that share similar culture and climate profiles, and (2) test for mean differences across profiles in observed EBP fidelity and teacher and staff work attitudes. RESULTS Controlling for region, four profiles best characterized the organizational cultures and climates of schools. Teachers and staff in schools with a comprehensive profile (high proficiency culture, positive climate) exhibited higher fidelity to two of three EBPs (d's = .95 to 1.64) and reported superior work attitudes (d's = .71 to 1.93) than teachers and staff in all other schools. Teachers and staff in supportive schools (low rigidity culture, positive climate) had better work attitudes, but not better fidelity, than those in schools with indifferent (low culture/climate, elevated stress) and constrained (high rigidity and resistance, high stress) profiles. CONCLUSIONS Organizational culture and climate profiles are a strong predictor of EBP fidelity and work attitudes that support EBP sustainment, highlighting the importance of an organization's overarching social context when developing implementation theory and strategies. Strategies that foster a comprehensive profile may improve EBP implementation.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Drive, Boise, ID, 83625, USA.
| | - Hannah E Frank
- Department of Psychology, Temple University, 1701 N 13th St., Philadelphia, PA, 19122, USA
| | - Lindsay Frederick
- Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St, Seattle, WA, 98105, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Philip Green
- Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, USA
| | - Jill Locke
- Department of Speech and Hearing Sciences, University of Washington, 1417 NE 42nd St, Seattle, WA, 98105, USA
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Bunger AC, Despard M, Lee M, Cao Y. The Cost of Quality: Organizational Financial Health and Program Quality. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2019; 16:18-35. [PMID: 30381019 DOI: 10.1080/23761407.2018.1536575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Purpose: Nonprofit health and human service organizations (NPHSOs) encounter pressure to improve program quality to continue to secure financial resources. Yet, organizations also struggle to innovate, evaluate, and monitor quality absent sufficient resources. This study explores the relationship between NPHSOs' financial health and quality indicators. Methods: Quality indicators were measured in an online survey with leaders from 32 nonprofit children's behavioral health organizations within a Midwestern urban region. Survey responses were matched with financial health metrics extracted from publicly available IRS 990 forms from 2010 to 2014. Results: Organizations struggled to maintain adequate reserve levels, although those with more quality capacities had greater assets and growth in those assets. Discussion: Although financial health appeared to be related to quality, it is unclear whether quality attracts financial resources, or if financial reserves support quality. Conclusion: Continuing research and dialogue are needed to understand the financial implications of an increasing emphasis on quality.
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Affiliation(s)
- Alicia C Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH, USA
| | - Mathieu Despard
- Center for Community Capital, University of North Carolina, Chapel Hill, USA
| | - Madeline Lee
- Department of Social Work, California State University, San Marcos, USA
| | - Yiwen Cao
- Department of Family Medicine and Public Health, University of California, San Diego, USA
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19
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Trus M, Galdikiene N, Balciunas S, Green P, Helminen M, Suominen T. Connection between organizational culture and climate and empowerment: The perspective of nurse managers. Nurs Health Sci 2018; 21:54-62. [PMID: 30091283 DOI: 10.1111/nhs.12549] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 11/28/2022]
Abstract
Health-care organizations differ from other institutions due to their unique structure and management. Organizational culture and climate are the key constructs that compose the organizational social context, and might have an impact on employees, such as nurse managers, and the organization itself. The aim of this study was to analyze the connections between organizational culture and climate and work-related empowerment, and also to present culture and climate profiles at team and organization levels. The research was carried out in Lithuania among 193 nurse managers in seven hospitals using a questionnaire that measured organizational culture and climate (Organizational Social Context instrument), and work-related empowerment (Conditions for Work Effectiveness Questionnaire-II and Work Empowerment Questionnaire). The findings showed that nurse managers were both structurally and psychologically empowered when the organizational culture was proficient and resistant, and the climate was engaged and functional. These results suggest that nurse managers are more likely to be empowered when there is an appropriate organizational culture and climate in the workplace. Creating an empowering work environment might have a positive impact on individual and organizational outcomes.
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Affiliation(s)
- Marija Trus
- Faculty of Social Sciences, Programme of Nursing Science, University of Tampere, Tampere, Finland.,Department of Nursing, Klaipeda University, Klaipeda, Lithuania
| | - Nijole Galdikiene
- Department of Nursing, Klaipeda State University of Applied Sciences, Klaipeda, Lithuania
| | - Sigitas Balciunas
- Department of Public Administration, Social Research Center, Šiauliai University, Šiauliai, Lithuania
| | - Philip Green
- Children's Mental Health Services Research Center, University of Tennessee, Knoxville, Tennessee, USA
| | - Mika Helminen
- Faculty of Social Sciences, Programme of Nursing Science, University of Tampere, Tampere, Finland.,Pirkanmaa Hospital District, Science Centre, Tampere, Finland
| | - Tarja Suominen
- Faculty of Social Sciences, Programme of Nursing Science, University of Tampere, Tampere, Finland
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20
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Lucock M, Barkham M, Donohoe G, Kellett S, McMillan D, Mullaney S, Sainty A, Saxon D, Thwaites R, Delgadillo J. The Role of Practice Research Networks (PRN) in the Development and Implementation of Evidence: The Northern Improving Access to Psychological Therapies PRN Case Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:919-931. [PMID: 28667572 PMCID: PMC5640744 DOI: 10.1007/s10488-017-0810-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Practice research networks (PRNs) can support the implementation of evidence based practice in routine services and generate practice based evidence. This paper describes the structure, processes and learning from a new PRN in the Improving Access to Psychological Therapies programme in England, in relation to an implementation framework and using one study as a case example. Challenges related to: ethics and governance processes; communications with multiple stakeholders; competing time pressures and linking outcome data. Enablers included: early tangible outputs and impact; a collaborative approach; engaging with local research leads; clarity of processes; effective dissemination; and committed leadership.
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Affiliation(s)
- Mike Lucock
- University of Huddersfield, Harold Wilson Building, Queensgate, Huddersfield, HD1 3DH, UK. .,South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK.
| | - Michael Barkham
- Clinical Psychology Unit, Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
| | - Gillian Donohoe
- Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK
| | - Stephen Kellett
- Department of Psychology, University of Sheffield and Sheffield Health & Social Care NHS Foundation Trust, Sheffield, UK
| | - Dean McMillan
- Department of Health Sciences, University of York, York, UK
| | - Sarah Mullaney
- South West Yorkshire Partnership NHS Foundation Trust, Wakefield, UK
| | | | - David Saxon
- Centre for Psychological Services Research, University of Sheffield, Sheffield, UK
| | | | - Jaime Delgadillo
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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21
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Brookman-Frazee L, Stahmer AC. Effectiveness of a multi-level implementation strategy for ASD interventions: study protocol for two linked cluster randomized trials. Implement Sci 2018; 13:66. [PMID: 29743090 PMCID: PMC5944167 DOI: 10.1186/s13012-018-0757-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Centers for Disease Control (2018) estimates that 1 in 59 children has autism spectrum disorder, and the annual cost of ASD in the U.S. is estimated to be $236 billion. Evidence-based interventions have been developed and demonstrate effectiveness in improving child outcomes. However, research on generalizable methods to scale up these practices in the multiple service systems caring for these children has been limited and is critical to meet this growing public health need. This project includes two, coordinated studies testing the effectiveness of the Translating Evidence-based Interventions (EBI) for ASD: Multi-Level Implementation Strategy (TEAMS) model. TEAMS focuses on improving implementation leadership, organizational climate, and provider attitudes and motivation in order to improve two key implementation outcomes-provider training completion and intervention fidelity and subsequent child outcomes. The TEAMS Leadership Institute applies implementation leadership strategies and TEAMS Individualized Provider Strategies for training applies motivational interviewing strategies to facilitate provider and organizational behavior change. METHODS A cluster randomized implementation/effectiveness Hybrid, type 3, trial with a dismantling design will be used to understand the effectiveness of TEAMS and the mechanisms of change across settings and participants. Study #1 will test the TEAMS model with AIM HI (An Individualized Mental Health Intervention for ASD) in publicly funded mental health services. Study #2 will test TEAMS with CPRT (Classroom Pivotal Response Teaching) in education settings. Thirty-seven mental health programs and 37 school districts will be randomized, stratified by county and study, to one of four groups (Standard Provider Training Only, Standard Provider Training + Leader Training, Enhanced Provider Training, Enhanced Provider Training + Leader Training) to test the effectiveness of combining standard, EBI-specific training with the two TEAMS modules individually and together on multiple implementation outcomes. Implementation outcomes including provider training completion, fidelity (coded by observers blind to group assignment) and child behavior change will be examined for 295 mental health providers, 295 teachers, and 590 children. DISCUSSION This implementation intervention has the potential to increase quality of care for ASD in publicly funded settings by improving effectiveness of intervention implementation. The process and modules will be generalizable to multiple service systems, providers, and interventions, providing broad impact in community services. TRIAL REGISTRATION This study is registered with Clinicaltrials.gov ( NCT03380078 ). Registered 20 December 2017, retrospectively registered.
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0812 USA
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
| | - Aubyn C. Stahmer
- Child and Adolescent Services Research Center, 3020 Children’s Way MC 5033, San Diego, CA 92123 USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, UC Davis MIND Institute, 2825 50th Street, Sacramento, CA 95817 USA
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22
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Powell BJ, Beidas RS. Advancing Implementation Research and Practice in Behavioral Health Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:825-833. [PMID: 27591772 DOI: 10.1007/s10488-016-0762-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA.
| | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA, 19104, USA
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23
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Powell BJ, Beidas RS, Rubin RM, Stewart RE, Wolk CB, Matlin SL, Weaver S, Hurford MO, Evans AC, Hadley TR, Mandell DS. Applying the Policy Ecology Framework to Philadelphia's Behavioral Health Transformation Efforts. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:909-926. [PMID: 27032411 DOI: 10.1007/s10488-016-0733-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Raghavan et al. (Implement Sci 3(26):1-9, 2008) proposed that effective implementation of evidence-based practices requires implementation strategies deployed at multiple levels of the "policy ecology," including the organizational, regulatory or purchaser agency, political, and social levels. However, much of implementation research and practice targets providers without accounting for contextual factors that may influence provider behavior. This paper examines Philadelphia's efforts to work toward an evidence-based and recovery-oriented behavioral health system, and uses the policy ecology framework to illustrate how multifaceted, multilevel implementation strategies can facilitate the widespread implementation of evidence-based practices. Ongoing challenges and implications for research and practice are discussed.
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Affiliation(s)
- Byron J Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, 135 Dauer Drive, Campus Box 7411, Chapel Hill, NC, 27599-7411, USA. .,Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ronnie M Rubin
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Rebecca E Stewart
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Samantha L Matlin
- Thomas Scattergood Behavioral Health Foundation, Philadelphia, PA, USA
| | - Shawna Weaver
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Matthew O Hurford
- Community Care Behavioral Health Organization, Philadelphia, PA, USA
| | - Arthur C Evans
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA, USA
| | - Trevor R Hadley
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services Research, University of Pennsylvania, Philadelphia, PA, 19104, USA
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24
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Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:783-798. [PMID: 26474761 DOI: 10.1007/s10488-015-0693-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health.
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Stahmer AC, Suhrheinrich J, Schetter PL, McGee Hassrick E. Exploring multi-level system factors facilitating educator training and implementation of evidence-based practices (EBP): a study protocol. Implement Sci 2018; 13:3. [PMID: 29310683 PMCID: PMC5759305 DOI: 10.1186/s13012-017-0698-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/11/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study examines how system-wide (i.e., region, district, and school) mechanisms such as leadership support, training requirements, structure, collaboration, and education affect the use of evidence-based practices (EBPs) in schools and how this affects the outcomes for students with autism spectrum disorder (ASD). Despite growing evidence for the positive effects of EBPs for ASD, these practices are not consistently or effectively used in schools. Although special education programs are mandated to use EBPs, there are very few evidence-based methods for selecting, implementing, and sustaining EBPs. Research focuses primarily on teacher training, without attention to contextual factors (e.g., implementation climate, attitudes toward EBPs, resource allocation, and social networks) that may impact outcomes. Using an implementation science framework, this project will prospectively examine relations between system-wide factors and teachers' use of EBPs and student education outcomes. METHODS/DESIGN Survey data will be collected from approximately 85 regional special education directors, 170 regional program specialists, 265 district special education directors, 265 behavior specialists, 925 school principals, 3538 special education teachers, and 2700 paraprofessionals. Administrative data for the students with ASD served by participating teachers will be examined. A total of 79 regional-, district-, and school-level personnel will also participate in social network interviews. Mixed methods, including surveys, administrative data, and observational checklists, will be used to gather in-depth information about system-wide malleable factors that relate to positive teacher implementation of EBPs and student outcomes. Multi-level modeling will be used to assess system-wide malleable factors related to EBP implementation which will be linked to the trainer, teacher, and student outcomes and examined based on moderators (e.g., district size, Special Education Local Plan Area structure, teachers' ASD experience). Finally, a dynamic social network approach will be used to map EBP-related connectivity across all levels of the system for selected regions. Dynamic network analysis will be used to gauge the degree to which and ways that EBP trainings, resources, and interventions are shared (or not shared) among school staff. DISCUSSION Results are expected to inform the development of system-wide interventions to improve the school-based implementation of EBPs for students with ASD.
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Affiliation(s)
- Aubyn C. Stahmer
- University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA 95819 USA
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, USA
- Center of Excellence in Developmental Disabilities, University of California, Davis, Sacramento, USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Jessica Suhrheinrich
- College of Education, San Diego State University, 5500 Campanile Dr., San Diego, CA 92182 USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Patricia L. Schetter
- University of California, Davis MIND Institute, 2825 50th St, Sacramento, CA 95819 USA
- Center of Excellence in Developmental Disabilities, University of California, Davis, Sacramento, USA
| | - Elizabeth McGee Hassrick
- Life Course Outcomes Research Program at AJ Drexel Autism Institute, Drexel University, 3020 Market St, St 560, Philadelphia, PA19104 USA
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Powell BJ, Mandell DS, Hadley TR, Rubin RM, Evans AC, Hurford MO, Beidas RS. Are general and strategic measures of organizational context and leadership associated with knowledge and attitudes toward evidence-based practices in public behavioral health settings? A cross-sectional observational study. Implement Sci 2017; 12:64. [PMID: 28499401 PMCID: PMC5429548 DOI: 10.1186/s13012-017-0593-9] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 05/04/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Examining the role of modifiable barriers and facilitators is a necessary step toward developing effective implementation strategies. This study examines whether both general (organizational culture, organizational climate, and transformational leadership) and strategic (implementation climate and implementation leadership) organizational-level factors predict therapist-level determinants of implementation (knowledge of and attitudes toward evidence-based practices). METHODS Within the context of a system-wide effort to increase the use of evidence-based practices (EBPs) and recovery-oriented care, we conducted an observational, cross-sectional study of 19 child-serving agencies in the City of Philadelphia, including 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Organizational variables included characteristics such as EBP initiative participation, program size, and proportion of independent contractor therapists; general factors such as organizational culture and climate (Organizational Social Context Measurement System) and transformational leadership (Multifactor Leadership Questionnaire); and strategic factors such as implementation climate (Implementation Climate Scale) and implementation leadership (Implementation Leadership Scale). Therapist-level variables included demographics, attitudes toward EBPs (Evidence-Based Practice Attitudes Scale), and knowledge of EBPs (Knowledge of Evidence-Based Services Questionnaire). We used linear mixed-effects regression models to estimate the associations between the predictor (organizational characteristics, general and strategic factors) and dependent (knowledge of and attitudes toward EBPs) variables. RESULTS Several variables were associated with therapists' knowledge of EBPs. Clinicians in organizations with more proficient cultures or higher levels of transformational leadership (idealized influence) had greater knowledge of EBPs; conversely, clinicians in organizations with more resistant cultures, more functional organizational climates, and implementation climates characterized by higher levels of financial reward for EBPs had less knowledge of EBPs. A number of organizational factors were associated with the therapists' attitudes toward EBPs. For example, more engaged organizational cultures, implementation climates characterized by higher levels of educational support, and more proactive implementation leadership were all associated with more positive attitudes toward EBPs. CONCLUSIONS This study provides evidence for the importance of both general and strategic organizational determinants as predictors of knowledge of and attitudes toward EBPs. The findings highlight the need for longitudinal and mixed-methods studies that examine the influence of organizational factors on implementation.
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Affiliation(s)
- Byron J. Powell
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1105C McGavran-Greenberg Hall, Campus Box 7411, Chapel Hill, NC 27599 USA
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - David S. Mandell
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | - Trevor R. Hadley
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
| | | | - Arthur C. Evans
- Department of Behavioral Health and Intellectual disAbility Services, Philadelphia, PA 19107 USA
- American Psychological Association, Washington, DC USA
| | | | - Rinad S. Beidas
- Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104 USA
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Bitanihirwe BKY. Curbing the epidemic of fatal opioid abuse. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1217091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stirman SW, Gutner CA, Langdon K, Graham JR. Bridging the Gap Between Research and Practice in Mental Health Service Settings: An Overview of Developments in Implementation Theory and Research. Behav Ther 2016; 47:920-936. [PMID: 27993341 DOI: 10.1016/j.beth.2015.12.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 12/09/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
Abstract
Twenty years after Sobell's (1996) influential call to integrate advances in behavior therapy into clinical settings, significant progress has been made in implementation science. In this narrative review, we provide an overview of implementation research findings and highlight recent findings that can inform efforts to bridge the gap between research and practice in mental health service settings. Key findings are summarized, organized according to levels of influence described in two implementation frameworks: The Exploration, Planning, Implementation, and Sustainment Framework (EPIS; Aarons et al., 2011) and the Consolidated Framework for Implementation Research (CFIR; Damschroder et al., 2009). Important levels of influence to consider when implementing new treatments include the outer context, inner context, characteristics of the individual, and characteristics of the innovation. Research on strategies to prepare clinicians to deliver evidence-based psychosocial treatments (EBPTs) and to address contextual barriers to implementation at each level is described, with discussion of implications for the implementation of EBPTs and next steps for research.
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Affiliation(s)
| | - Cassidy A Gutner
- National Center for PTSD, VA Boston Healthcare System; Boston University
| | - Kirsten Langdon
- Department of Psychiatry, Rhode Island Hospital, Providence, RI
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Williams NJ. Assessing mental health clinicians' intentions to adopt evidence-based treatments: reliability and validity testing of the evidence-based treatment intentions scale. Implement Sci 2016; 11:60. [PMID: 27150798 PMCID: PMC4857292 DOI: 10.1186/s13012-016-0417-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 04/05/2016] [Indexed: 12/02/2022] Open
Abstract
Background Intentions play a central role in numerous empirically supported theories of behavior and behavior change and have been identified as a potentially important antecedent to successful evidence-based treatment (EBT) implementation. Despite this, few measures of mental health clinicians’ EBT intentions exist and available measures have not been subject to thorough psychometric evaluation or testing. This paper evaluates the psychometric properties of the evidence-based treatment intentions (EBTI) scale, a new measure of mental health clinicians’ intentions to adopt EBTs. Methods The study evaluates the reliability and validity of inferences made with the EBTI using multi-method, multi-informant criterion variables collected over 12 months from a sample of 197 mental health clinicians delivering services in 13 mental health agencies. Structural, predictive, and discriminant validity evidence is assessed. Results Findings support the EBTI’s factor structure (χ2 = 3.96, df = 5, p = .556) and internal consistency reliability (α = .80). Predictive validity evidence was provided by robust and significant associations between EBTI scores and clinicians’ observer-reported attendance at a voluntary EBT workshop at a 1-month follow-up (OR = 1.92, p < .05), self-reported EBT adoption at a 12-month follow-up (R2 = .17, p < .001), and self-reported use of EBTs with clients at a 12-month follow-up (R2 = .25, p < .001). Discriminant validity evidence was provided by small associations with clinicians’ concurrently measured psychological work climate perceptions of functionality (R2 = .06, p < .05), engagement (R2 = .06, p < .05), and stress (R2 = .00, ns). Conclusions The EBTI is a practical and theoretically grounded measure of mental health clinicians’ EBT intentions. Scores on the EBTI provide a basis for valid inferences regarding mental health clinicians’ intentions to adopt EBTs. Discussion focuses on research and practice applications. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0417-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Dr., Boise, ID, 83725-1940, USA.
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Acri MC, Bornheimer LA, O’Brien K, Sezer S, Little V, Cleek AF, McKay MM. A model of integrated health care in a poverty-impacted community in New York City: Importance of early detection and addressing potential barriers to intervention implementation. SOCIAL WORK IN HEALTH CARE 2016; 55:314-27. [PMID: 27070372 PMCID: PMC5545980 DOI: 10.1080/00981389.2015.1137256] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention.
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Affiliation(s)
- Mary C. Acri
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
| | - Lindsay A. Bornheimer
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
| | - Kyle O’Brien
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
| | - Sara Sezer
- The Institute for Family Health, New York, New York, USA
| | - Virna Little
- The Institute for Family Health, New York, New York, USA
| | - Andrew F. Cleek
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
| | - Mary M. McKay
- McSilver Institute for Poverty Policy & Research, New York University Medical Center, New York, New York, USA
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Glisson C, Williams NJ, Hemmelgarn A, Proctor E, Green P. Increasing clinicians' EBT exploration and preparation behavior in youth mental health services by changing organizational culture with ARC. Behav Res Ther 2016; 76:40-6. [PMID: 26649464 PMCID: PMC4706472 DOI: 10.1016/j.brat.2015.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 11/16/2015] [Accepted: 11/17/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Clinician EBT exploration and preparation behavior is essential to the ongoing implementation of new EBTs. This study examined the effect of the ARC organizational intervention on clinician EBT exploration and preparation behavior and assessed the mediating role of organizational culture as a linking mechanism. METHOD Fourteen community mental health agencies that serve youth in a major Midwestern metropolis along with 475 clinicians who worked in those agencies, were randomly assigned to either the three-year ARC intervention or control condition. Organizational culture was assessed with the Organizational Social Context (OSC) measure at baseline and follow-up. EBT exploration and preparation behavior was measured as clinician participation in nine separate community EBT workshops held over a three-year period. RESULTS There was 69 percent greater odds (OR = 1.69, p < .003) of clinicians in the ARC condition (versus control) attending each subsequent workshop. Workshop attendance in the control group remained under two percent and declined over three years while attendance in the ARC condition grew from 3.6 percent in the first workshop to 12 percent in the ninth and final workshop. Improvement in proficient organizational culture mediated the positive effect of the ARC intervention on clinicians' workshop attendance (a × b = .21; 95% CI:LL = .05, UL = .40). CONCLUSIONS Organizational interventions that create proficient mental health agency cultures can increase clinician EBT exploration and preparation behavior that is essential to the ongoing implementation of new EBTs in community youth mental health settings.
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Williams NJ. Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH 2015. [PMID: 26474761 DOI: 10.1007/s10488‐015‐0693‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
A step toward the development of optimally effective, efficient, and feasible implementation strategies that increase evidence-based treatment integration in mental health services involves identification of the multilevel mechanisms through which these strategies influence implementation outcomes. This article (a) provides an orientation to, and rationale for, consideration of multilevel mediating mechanisms in implementation trials, and (b) systematically reviews randomized controlled trials that examined mediators of implementation strategies in mental health. Nine trials were located. Mediation-related methodological deficiencies were prevalent and no trials supported a hypothesized mediator. The most common reason was failure to engage the mediation target. Discussion focuses on directions to accelerate implementation strategy development in mental health.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, 1910 University Dr., Boise, ID, 83725-1940, USA.
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Glisson C. The Role of Organizational Culture and Climate in Innovation and Effectiveness. HUMAN SERVICE ORGANIZATIONS, MANAGEMENT, LEADERSHIP & GOVERNANCE 2015; 39:245-250. [PMID: 27595124 PMCID: PMC5008450 DOI: 10.1080/23303131.2015.1087770] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- Charles Glisson
- Children's Mental Health Services Research Center, University of Tennessee, Knoxville, Tennessee, USA
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