1
|
Lawson GM, Azad G. School-Based Mental Health Interventions: Recommendations for Selecting and Reporting Implementation Strategies . THE JOURNAL OF SCHOOL HEALTH 2024; 94:581-585. [PMID: 38627895 DOI: 10.1111/josh.13458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/22/2024] [Accepted: 03/28/2024] [Indexed: 05/14/2024]
Affiliation(s)
- Gwendolyn M Lawson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Gazi Azad
- Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University Irving Medical Center, New York, NY, USA
| |
Collapse
|
2
|
Lionardo A, Nomaini F, Bafadhal OM, Santoso AD, Alfitri. What makes Indonesian government officials believe in and implement evidence-based policy: The mediating role of religion-science compatibility beliefs. Heliyon 2024; 10:e24879. [PMID: 38333784 PMCID: PMC10850408 DOI: 10.1016/j.heliyon.2024.e24879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 12/20/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
This research is aimed at examining the relationship between religion-science compatibility belief (RSCB) and evidence-based policy (EBP) belief and implementation in Indonesia, a country with the biggest Muslim population in the world. A dataset containing responses to a questionnaire completed by 499 government officials in Indonesia was collected for the partial least square structural equation modeling (PLS-SEM). This study finds a relationship between RSCB and EBP belief and implementation. In addition, EBP belief also affected the implementation of EBP. The effect that RSCB has on EBP implementation was partially mediated by EBP belief. Studying how these beliefs relate to the attitude of policy makers toward science in a sociocultural context is important, considering that the focus of previous research is on different contexts pertaining to levels of education, industrialization, wealth, and democratization. This is important to encourage a more comprehensive understanding of the public about science globally. This study responds to the need for the literature to examine factors influencing EBP beliefs and implementation at the individual level in non-health contexts and developing countries.
Collapse
Affiliation(s)
- Andries Lionardo
- Department of Public Administration, Faculty of Social and Political Sciences, Universitas Sriwijaya, Indonesia
| | - Faisal Nomaini
- Department of Communication Science, Faculty of Social and Political Sciences, Universitas Sriwijaya, Indonesia
| | - Oemar Madri Bafadhal
- Department of Communication Science, Faculty of Social and Political Sciences, Universitas Sriwijaya, Indonesia
| | - Anang Dwi Santoso
- Department of Public Administration, Faculty of Social and Political Sciences, Universitas Sriwijaya, Indonesia
| | - Alfitri
- Department of Sociology, Faculty of Social and Political Sciences, Universitas Sriwijaya, Indonesia
| |
Collapse
|
3
|
Hyzak KA, Bunger AC, Bogner J, Davis AK, Corrigan JD. Implementing traumatic brain injury screening in behavioral health treatment settings: results of an explanatory sequential mixed-methods investigation. Implement Sci 2023; 18:35. [PMID: 37587532 PMCID: PMC10428542 DOI: 10.1186/s13012-023-01289-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] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/31/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Traumatic brain injury (TBI) is a complex condition common among individuals treated in behavioral healthcare, but TBI screening has not been adopted in these settings which can affect optimal clinical decision-making. Integrating evidence-based practices that address complex health comorbidities into behavioral healthcare settings remains understudied in implementation science, limited by few studies using theory-driven hypotheses to disentangle relationships between proximal and medial indicators on distal implementation outcomes. Grounded in the Theory of Planned Behavior, we examined providers' attitudes, perceived behavioral control (PBC), subjective norms, and intentions to adopt The Ohio State University TBI Identification Method (OSU TBI-ID) in behavioral healthcare settings. METHODS We used an explanatory sequential mixed-methods design. In Phase I, 215 providers from 25 organizations in the USA completed training introducing the OSU TBI-ID, followed by a survey assessing attitudes, PBC, norms, and intentions to screen for TBI. After 1 month, providers completed another survey assessing the number of TBI screens conducted. Data were analyzed using structural equation modeling (SEM) with logistic regressions. In Phase II, 20 providers were purposively selected for semi-structured interviews to expand on SEM results. Qualitative data were analyzed using thematic analysis, integrated with quantitative results, and combined into joint displays. RESULTS Only 25% (55/215) of providers adopted TBI screening, which was driven by motivations to trial the intervention. Providers who reported more favorable attitudes (OR: 0.67, p < .001) and greater subjective norms (OR: 0.12, p < .001) toward TBI screening demonstrated increased odds of intention to screen, which resulted in greater TBI screening adoption (OR: 0.30; p < .01). PBC did not affect intentions or adoption. Providers explained that although TBI screening can improve diagnostic and clinical decision-making, they discussed that additional training, leadership engagement, and state-level mandates are needed to increase the widespread, systematic uptake of TBI screening. CONCLUSIONS This study advances implementation science by using theory-driven hypothesis testing to disentangle proximal and medial indicators at the provider level on TBI screening adoption. Our mixed-methods approach added in-depth contextualization and illuminated additional multilevel determinants affecting intervention adoption, which guides a more precise selection of implementation strategies.
Collapse
Affiliation(s)
- Kathryn A Hyzak
- Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus, OH, 43210-1234, USA.
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus, OH, 43210-1234, USA
| | - Alan K Davis
- College of Social Work, The Ohio State University, Columbus, OH, USA
- Department of Psychiatry and Behavioral Sciences, Center for Psychedelic and Consciousness Research, Johns Hopkins University Baltimore, Baltimore, MD, USA
- Department of Psychiatry, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - John D Corrigan
- Department of Physical Medicine and Rehabilitation, The Ohio State University College of Medicine, Columbus, OH, 43210-1234, USA
- Ohio Valley Center for Brain Injury Prevention and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
4
|
Lawson GM, Mandell DS, Tomczuk L, Fishman J, Marcus SC, Pellecchia M. Clinician Intentions to use the Components of Parent Coaching Within Community Early Intervention Systems. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:357-365. [PMID: 36525093 PMCID: PMC10191901 DOI: 10.1007/s10488-022-01243-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Parent coaching is a complex, psychosocial intervention with multiple core components. Clinicians' use of these core components may be influenced by distinct factors; no research has examined whether clinician perceptions of parent coaching vary across core coaching components. This study aimed to examine the extent to which clinicians working with families of young autistic children in publicly funded early intervention intend to use core parent coaching components, and to examine how closely psychological factors relate to providers' intentions to use each component. METHODS Using the Theory of Planned Behavior as a framework, this study compared the strength of clinicians' intentions across five core parent coaching components: collaboration with parents, delivering the intervention within daily routines, demonstrating the intervention, providing in-vivo feedback, and reflection and problem solving. We examined the associations between intentions and psychological determinants of intentions (i.e., attitudes, norms, and self-efficacy) for each component. RESULTS Clinicians' average intentions varied by core component, with strongest intentions for demonstrating the intervention strategy for a parent. The associations between intentions and psychological determinants also varied by core component. Attitudes, injunctive norms, and self-efficacy, but not descriptive norms, significantly related to clinicians' intentions to use collaboration and daily routines, whereas attitudes and descriptive norms, but not injunctive norms and self-efficacy, significantly related to clinicians' intentions to use feedback and reflection and problem solving. CONCLUSION These results suggest that implementation strategies should be tailored to the specific intervention component to be most efficient and effective. The results also provide examples of potentially malleable factors that implementation strategies can strategically target.
Collapse
Affiliation(s)
- Gwendolyn M Lawson
- Children's Hospital of Philadelphia, 2716 South St, 8th Floor, Philadelphia, Pennsylvania, 19146, United States.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States.
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Liza Tomczuk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| | - Jessica Fishman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- Annenberg School, University of Pennsylvania, Pennsylvania, United States
| | - Steven C Marcus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
- School of Social Policy and Practice, University of Pennsylvania, Pennsylvania, United States
| | - Melanie Pellecchia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market St, 19104, Pennsylvania, PA, United States
| |
Collapse
|
5
|
Zhang Y, Cook CR, Azad GF, Larson M, Merle JL, Thayer J, Pauls A, Lyon AR. A Pre-Implementation Enhancement Strategy to Increase the Yield of Training and Consultation for School-Based Behavioral Preventive Practices: a Triple-Blind Randomized Controlled Trial. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:552-566. [PMID: 36367633 PMCID: PMC10258873 DOI: 10.1007/s11121-022-01464-3] [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: 10/20/2022] [Indexed: 11/13/2022]
Abstract
As the most common setting where youth access behavioral healthcare, the education sector frequently employs training and follow-up consultation as cornerstone implementation strategies to promote the implementation of evidence-based practices (EBPs). However, these strategies alone are not sufficient to promote desirable implementation (e.g., intervention fidelity) and youth behavioral outcomes (e.g., mitigated externalizing behaviors). Theory-informed pragmatic pre-implementation enhancement strategies (PIES) are needed to prevent the lackluster outcomes of training and consultation. Specifically, social cognitive theory explicates principles that inform the design of PIES content and specify mechanisms of behavior change (e.g., "intentions to implement" (ITI)) to target increasing providers' responsiveness to training and consultation. This triple-blind parallel randomized controlled trial preliminarily examined the efficacy of a pragmatic PIES based on social cognitive theories (SC-PIES) to improve implementation and youth behavioral outcomes from universal preventive EBPs in the education sector. Teachers from a diverse urban district were recruited and randomly assigned to the treatment (SC-PIES; ntreatment = 22) or active control condition (administrative meeting; ncontrol = 21). Based on the condition assigned, teachers received the SC-PIES or met with administrators before their EBP training. We assessed teachers' ITI, intervention fidelity, and youth behavioral outcome (academic engagement as an incompatible behavior to externalizing disorders) at baseline, immediately after training, and 6 weeks afterward. A series of ANCOVAs detected sizeable effects of SC-PIES, where teachers who received SC-PIES demonstrated significantly larger improvement in their ITI, intervention fidelity, and youth behaviors as compared to the control. Conditional analyses indicated that teachers' ITI partially mediated the effect of SC-PIES on intervention fidelity, which in turn led to improved youth behaviors. Findings suggest that theory-informed pragmatic PIES targeting providers' ITI can boost their responsiveness to implementation strategies, as reflected in improved implementation behaviors and youth behavioral outcomes. The results have implications for targeting motivational mechanisms of behavior change and situating preventive implementation strategies at the intersection between the preparation and active implementation stages of an implementation process. Limitations and implications for research and practice are discussed. Clinicaltrials.gov: NCT05240222. Registered on: 2/14/2022. Retrospectively registered. https://clinicaltrials.gov/show/NCT05240222.
Collapse
Affiliation(s)
- Yanchen Zhang
- Department of Psychological & Quantitative Foundations, University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA.
| | - Clayton R Cook
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Gazi F Azad
- Vagelos College of Physicians and Surgeons, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Madeline Larson
- Center for Applied Research and Educational Improvement, University of Minnesota, 1954 Buford Ave, Suite 425, St. Paul, MN, 55108, USA
| | - James L Merle
- Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Jordan Thayer
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Alex Pauls
- Department of Psychological & Quantitative Foundations, University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA
| | - Aaron R Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, Box 354920, 6200 NE 74Th Street, Suite 110, Seattle, WA, 98115, USA
| |
Collapse
|
6
|
Choi SY, Rusch A, Lane A, Liebrecht C, Bilek EL, Eisenberg D, Andrews C, Perry M, Smith SN. Individual and organizational factors as predictors of early evidence-based practice adoption in Michigan high schools: Baseline data from an implementation trial. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895231159429. [PMID: 37091540 PMCID: PMC10052498 DOI: 10.1177/26334895231159429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Background Adolescents increasingly access mental health services in schools. School mental health professionals (SPs; school counselors, social workers, etc.) can offer evidence-based mental health practices (EBPs) in schools, which may address access gaps and improve clinical outcomes. Although some studies have assessed factors associated with EBP adoption in schools, additional research focusing on SP- and school-level factors is warranted to support EBP implementation as SPs' mental health delivery grows. Methods Baseline data were collected from SPs at Michigan high schools participating in a statewide trial to implement SP-delivered cognitive behavioral therapy (CBT) to students. Models examined factors associated with attitudes about EBPs, implementation climate, and implementation leadership, and their associations with CBT knowledge, training attendance, and pre-training CBT delivery. Results One hundred ninety-eight SPs at 107 schools (87%) completed a baseline survey. The mean Evidence-Based Practice Attitude Scale (EBPAS) total score was 2.9, and school-aggregated mean scores of the Implementation Climate Scale (ICS) and Implementation Leadership Scale (ILS) were 1.83 and 1.77, respectively, all on a scale ranging from 0 (low) to 4 (high). ICS and ILS scores were lower than typically reported in clinical settings, while EBPAS scores were higher. School characteristics were not significantly associated with EBPAS, ICS, or ILS scores, but scores did differ by SP role. Higher EBPAS scores were associated with more CBT knowledge (average marginal effect for 1 SD change [AME] = 0.15 points) and a higher probability of training completion (AME = 8 percentage points). Higher ICS scores were associated with a higher probability of pre-training CBT delivery (AME = 6 percentage points), and higher ILS scores were associated with higher probability of training completion (AME = 10 percentage points). Conclusions Our findings suggest that SPs' attitudes toward EBPs and organizational support were positively associated with early signs of implementation success. As schools increasingly fill the adolescent mental healthcare access gap, efforts to strengthen both provider attitudes toward EBP and strategic organizational factors supporting EBP delivery will be key to encouraging EBP uptake in schools. Plain Language Summary Schools are an important setting in which adolescents receive mental healthcare. We need to better understand how to implement evidence-based practices (EBPs) in this setting to improve student mental health. This study examined the attitudes and perceptions of school professionals (SPs) as key contributors to the implementation of a particular EBP, the delivery of cognitive behavioral therapy (CBT) in schools. The study found that implementation climate and leadership scores in participating schools were lower than scores typically reported in clinical settings, while scores for SP attitudes about EBP adoption were higher than typical scores in clinical settings. Results further suggest that SPs with more positive attitudes toward EBPs are more knowledgeable of CBT and more likely to complete a 1-day CBT training. We also found that higher implementation climate scores were associated with SPs reporting pre-training CBT delivery (although this association was not statistically significant), and more implementation leadership was associated with SPs completing the CBT training. These findings suggest that SP attitudes toward EBPs and organizational support in schools are positively associated with early signs of implementation success. Early, low-intensity efforts to (1) improve SP attitudes about mental health EBPs, and (2) increase schools' support for implementation may scaffold more intensive implementation efforts in schools down the road.
Collapse
Affiliation(s)
- Seo Youn Choi
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Amy Rusch
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Annalise Lane
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Celeste Liebrecht
- Department of Learning Health Sciences, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Emily L. Bilek
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Daniel Eisenberg
- Department of Health Policy and Management, Fielding School of Public Health, UCLA, Los Angeles, CA, USA
| | - Carolyn Andrews
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Morgan Perry
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Shawna N. Smith
- Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI, USA
- Department of Psychiatry, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Merle JL, Cook CR, Pullmann MD, Larson MF, Hamlin CM, Hugh ML, Brewer SK, Duong MT, Bose M, Lyon AR. Longitudinal Effects of a Motivationally Focused Strategy to Increase the Yield of Training and Consultation on Teachers' Adoption and Fidelity of a Universal Program. SCHOOL MENTAL HEALTH 2022; 15:105-122. [PMID: 35936515 PMCID: PMC9343567 DOI: 10.1007/s12310-022-09536-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2022] [Indexed: 11/28/2022]
Abstract
Group-based didactic training is a cornerstone implementation strategy used to support the adoption and delivery of evidence-based prevention programs (EBPP) by teachers in schools, but it is often insufficient to drive successful implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theory-based, motivational implementation strategy designed to increase the yield of EBPP training and consultation. The purpose of this study was to examine the longitudinal effects of BASIS-T on hypothesized mechanisms of behavior change (e.g., attitudes toward EBPP, self-efficacy, intentions to implement) and implementation and student outcomes associated with a well-established universal prevention program-the good behavior game (GBG). This pilot trial included 82 elementary school teachers from nine public elementary schools who were randomly assigned at the school-level to the BASIS-T (n = 43) or active comparison (n = 39) condition, with both conditions receiving training and consultation of the good behavior game by a third-party purveyor. Analyses included mixed-effects and multilevel growth modeling of adoption, mechanisms of behavior change, and student behavior outcomes. Meaningful effects were found favoring BASIS-T on immediate adoption of the GBG within the first month of school (74% vs. 40%) and self-efficacy (p < 0.05). These findings advance our understanding of the type of implementation strategies that complement pre-implementation training and post-training consultation in schools by identifying the importance of task self-efficacy as a mechanism of behavior change related to adoption for prevention programming. Supplementary Information The online version contains supplementary material available at 10.1007/s12310-022-09536-z.
Collapse
Affiliation(s)
- James L. Merle
- Department of Population Health Sciences, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108 USA
| | - Clayton R. Cook
- University of Minnesota, 56 E River Pkwy, Minneapolis, MN 55455 USA
| | | | | | | | - Maria L. Hugh
- University of Washington, 6200 NE 74th St, Suite 100, Seattle, WA 98115 USA
| | | | - Mylien T. Duong
- University of Washington, 6200 NE 74th St, Suite 100, Seattle, WA 98115 USA
| | - Mahasweta Bose
- University of Minnesota, 56 E River Pkwy, Minneapolis, MN 55455 USA
| | - Aaron R. Lyon
- University of Washington, 6200 NE 74th St, Suite 100, Seattle, WA 98115 USA
| |
Collapse
|
8
|
Lyon AR, Liu FF, Connors EH, King KM, Coifman JI, Cook H, McRee E, Ludwig K, Law A, Dorsey S, McCauley E. How low can you go? Examining the effects of brief online training and post-training consultation dose on implementation mechanisms and outcomes for measurement-based care. Implement Sci Commun 2022; 3:79. [PMID: 35869500 PMCID: PMC9306246 DOI: 10.1186/s43058-022-00325-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Initial training and ongoing post-training consultation (i.e., ongoing support following training, provided by an expert) are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outcomes. Moreover, the degree to which training and consultation engage theoretical implementation mechanisms-such as provider knowledge, skills, and attitudes-is not well understood. This study examined the effects of a brief online training and varying dosages of post-training consultation (BOLT+PTC) on implementation mechanisms and outcomes for measurement-based care (MBC) practices delivered in the context of education sector mental health services. METHODS A national sample of 75 clinicians who provide mental health interventions to children and adolescents in schools were randomly assigned to BOLT+PTC or control (services as usual). Those in BOLT+PTC were further randomized to 2-, 4-, or 8-week consultation conditions. Self-reported MBC knowledge, skills, attitudes, and use (including standardized assessment, individualized assessment, and assessment-informed treatment modification) were collected for 32 weeks. Multilevel models were used to examine main effects of BOLT+PTC versus control on MBC use at the end of consultation and over time, as well as comparisons among PTC dosage conditions and theorized mechanisms (skills, attitudes, knowledge). RESULTS There was a significant linear effect of BOLT+PTC over time on standardized assessment use (b = .02, p < .01), and a significant quadratic effect of BOLT+PTC over time on individualized assessment use (b = .04, p < .001), but no significant effect on treatment modification. BOLT + any level of PTC resulted in higher MBC knowledge and larger growth in MBC skill over the intervention period as compared to control. PTC dosage levels were inconsistently predictive of outcomes, providing no clear evidence for added benefit of higher PTC dosage. CONCLUSIONS Online training and consultation in MBC had effects on standardized and individualized assessment use among clinicians as compared to services as usual with no consistent benefit detected for increased consultation dosage. Continued research investigating optimal dosages and mechanisms of these established implementation strategies is needed to ensure training and consultation resources are deployed efficiently to impact clinician practices. TRIAL REGISTRATION ClinicalTrials.gov NCT05041517 . Retrospectively registered on 10 September 2021.
Collapse
Affiliation(s)
- Aaron R. Lyon
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Freda F. Liu
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Elizabeth H. Connors
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
| | - Kevin M. King
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Jessica I. Coifman
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Heather Cook
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Erin McRee
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Kristy Ludwig
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Amy Law
- grid.34477.330000000122986657Graduate Medical Education, University of Washington, Learning Gateway, Box 358220, Seattle, WA 98109 USA
| | - Shannon Dorsey
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Elizabeth McCauley
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| |
Collapse
|
9
|
McCall CS, Romero ME, Yang W, Weigand T. A Call for Equity-Focused Social-Emotional Learning. SCHOOL PSYCHOLOGY REVIEW 2022. [DOI: 10.1080/2372966x.2022.2093125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
10
|
Morena AL, Gaias LM, Larkin C. Understanding the Role of Clinical Champions and Their Impact on Clinician Behavior Change: The Need for Causal Pathway Mechanisms. FRONTIERS IN HEALTH SERVICES 2022; 2:896885. [PMID: 36925794 PMCID: PMC10012807 DOI: 10.3389/frhs.2022.896885] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 06/14/2022] [Indexed: 11/13/2022]
Abstract
Background The clinical champion approach is a highly utilized implementation strategy used to mitigate barriers and improve outcomes of implementation efforts. Clinical champions are particularly effective at addressing provider-level barriers and promoting provider-behavior change. Yet, the specific causal pathways that explain how clinical champions impact provider behavior change have not been well-explicated. The current paper applies behavior change models to develop potential causal pathway mechanisms. Methods The proposed mechanisms are informed by previous literature involving clinical champions and empirically supported behavior change models. These models are applied to link specific attributes to different stages of behavior change and barriers for providers. Results Two unique pathway mechanisms were developed, one that explicates how providers develop intention to use EBPs, while the other explicates how providers transition to EBP use and sustainment. Clinical champions may promote intention development through behavioral modeling and peer buy-in. In contrast, champions promote behavioral enactment through skill building and peer mentorship. Conclusion Clinical champions likely play a critical role in reducing provider implementation barriers for providers across various phases of behavior change. The proposed pathways provide potential explanations for how clinical champions promote provider behavior change. Future research should prioritize empirically testing causal pathway mechanisms.
Collapse
Affiliation(s)
- Alexandra L. Morena
- Department of Psychology, University of Massachusetts, Lowell, MA, United States
| | - Larissa M. Gaias
- Department of Psychology, University of Massachusetts, Lowell, MA, United States
| | - Celine Larkin
- University of Massachusetts Chan Medical School, Worcester, MA, United States
| |
Collapse
|
11
|
Evidence Into Practice: Journal Clubs as an Implementation Strategy. J Perianesth Nurs 2022; 37:411-415. [PMID: 35667816 DOI: 10.1016/j.jopan.2021.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/28/2021] [Indexed: 11/21/2022]
|
12
|
Merle JL, Thayer AJ, Larson MF, Pauling S, Cook CR, Rios JA, McGinnis JL, Sullivan MM. Investigating strategies to increase general education teachers' adherence to evidence-based social-emotional behavior practices: A meta-analysis of the single-case literature. J Sch Psychol 2022; 91:1-26. [PMID: 35190070 DOI: 10.1016/j.jsp.2021.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/30/2021] [Accepted: 11/30/2021] [Indexed: 12/17/2022]
Abstract
Educational researchers have produced a variety of evidence-based practices (EBP) to address social, emotional, and behavioral (SEB) needs among students. Yet, these practices are often insufficiently adopted and implemented with fidelity by teachers to produce the beneficial outcomes associated with the EBP, leaving students at risk for developing SEB problems. If ignored, SEB problems can lead to other negative outcomes, such as academic failure. Therefore, implementation strategies (i.e., methods and procedures designed to promote implementation outcomes) are needed to improve teachers' uptake and delivery of EBPs with fidelity. This meta-analysis sought to examine the types and magnitude of effect of implementation strategies that have been designed and tested to improve teacher adherence to SEB EBPs. Included studies (a) used single case experimental designs, (b) employed at least one implementation strategy, (c) targeted general education teachers, and (d) evaluated adherence as a core dimension of fidelity related to the delivery of EBPs. In total, this study included 28 articles and evaluated 122 effect sizes. A total of 15 unique implementation strategies were categorized. Results indicated that, on average, implementation strategies were associated with increases in teacher adherence to EBPs above baseline and group-based pre-implementation trainings alone (g = 2.32, tau = 0.77). Moderator analysis also indicated that larger effects were associated with implementation strategies that used a greater number of unique behavior change techniques (p < .001). Implications and future directions for research and practice regarding use of implementation strategies for general education teachers are discussed.
Collapse
|
13
|
An Examination of Teacher Engagement in Intervention Training and Sustained Intervention Implementation. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09457-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
14
|
Lyon AR, Pullmann MD, Dorsey S, Levin C, Gaias LM, Brewer SK, Larson M, Corbin CM, Davis C, Muse I, Joshi M, Reyes R, Jungbluth NJ, Barrett R, Hong D, Gomez MD, Cook CR. Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy. Implement Sci 2021; 16:3. [PMID: 33413511 PMCID: PMC7788537 DOI: 10.1186/s13012-020-01064-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services-schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes. METHODS Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4-6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness. DISCUSSION This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS-a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation-to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting. TRIAL REGISTRATION ClinicalTrials.gov registration number NCT04451161 . Registered on June 30, 2020.
Collapse
Affiliation(s)
- Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA.
| | - Michael D Pullmann
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Shannon Dorsey
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Carol Levin
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Larissa M Gaias
- Department of Psychology, University of Massachusetts, Lowell, 850 Broadway St, Lowell, MA, 01854, USA
| | - Stephanie K Brewer
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Madeline Larson
- University of Minnesota, 250 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Catherine M Corbin
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Chayna Davis
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Ian Muse
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Mahima Joshi
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Rosemary Reyes
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | | | - Rachel Barrett
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - David Hong
- Washburn Training Institute, 1100 Glenwood Ave, Minneapolis, MN, 55405, USA
| | - Michael D Gomez
- Psychological Sciences, Texas Tech University, 2700 18th Street, Lubbock, TX, 79410, USA
| | - Clayton R Cook
- University of Minnesota, 250 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| |
Collapse
|
15
|
Larson M, Cook CR, Brewer SK, Pullmann MD, Hamlin C, Merle JL, Duong M, Gaias L, Sullivan M, Morrell N, Kulkarni T, Weeks M, Lyon AR. Examining the Effects of a Brief, Group-Based Motivational Implementation Strategy on Mechanisms of Teacher Behavior Change. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 22:722-736. [PMID: 33226575 DOI: 10.1007/s11121-020-01191-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2020] [Indexed: 11/27/2022]
Abstract
Training and consultation are core implementation strategies used to support the adoption and delivery of evidence-based prevention programs (EBPPs), but are often insufficient alone to effect teacher behavior change. Motivational interviewing (MI) and related behavior change techniques (e.g., strategic education, social influence, implementation planning) delivered in a group format offer promising supplements to training and consultation to improve EBPP implementation. Beliefs and Attitudes for Successful Implementation in Schools for Teachers (BASIS-T) is a theoretically informed, motivational implementation strategy delivered in a group format prior to and immediately after EBPP training. The purpose of this study was to examine the proximal effects of BASIS-T on hypothesized mechanisms of behavior change (e.g., attitudes, subjective norms, intentions to implement) in the context of teachers receiving training and consultation to implement the Good Behavior Game. As part of a pilot trial, 83 elementary school teachers from 9 public elementary schools were randomly assigned (at the school-level to reduce contamination across participants) to a BASIS-T (n = 44) or active comparison control (n = 39) condition, with both conditions receiving Good Behavior Game (GBG) training and consultation. A series of mixed effects models revealed meaningful effects favoring BASIS-T on a number of hypothesized mechanisms of behavior change leading to increased motivation to implement GBG. The implications, limitations, and directions for future research on the use of MI with groups of individuals and other behavior change techniques to increase the yield of training and consultation are discussed.
Collapse
Affiliation(s)
- Madeline Larson
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA.
| | - Clayton R Cook
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Stephanie K Brewer
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Michael D Pullmann
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Corinne Hamlin
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - James L Merle
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Mylien Duong
- Committee for Children, 2815 Second Ave., Suite 400, Seattle, WA, 98121, USA
| | - Larissa Gaias
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Margaret Sullivan
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Nicole Morrell
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Tara Kulkarni
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Mollie Weeks
- University of Minnesota, 56 East River Road, Educational Sciences Building, Minneapolis, MN, USA
| | - Aaron R Lyon
- University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| |
Collapse
|
16
|
Davis M, Wolk CB, Jager-Hyman S, Beidas RS, Young JF, Mautone JA, Buttenheim AM, Mandell DS, Volpp KG, Wislocki K, Futterer A, Marx D, Dieckmeyer EL, Becker-Haimes EM. Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol. Pilot Feasibility Stud 2020; 6:143. [PMID: 32995040 PMCID: PMC7519386 DOI: 10.1186/s40814-020-00686-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 09/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background Suicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention in two settings where individuals at risk for suicide are especially likely to present: primary care and specialty mental health care. We will leverage methods from behavioral economics, which involves understanding the many factors that influence human decision making, to inform strategy development. Methods We will identify key mechanisms that limit implementation of evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health through contextual inquiry involving behavioral health and primary care clinicians. Second, we will use contextual inquiry results to systematically design a menu of behavioral economics-informed implementation strategies that cut across settings, in collaboration with an advisory board composed of key stakeholders (i.e., behavioral economists, clinicians, implementation scientists, and suicide prevention experts). Finally, we will conduct rapid-cycle trials to test and refine the menu of implementation strategies. Primary outcomes include clinician-reported feasibility and acceptability of the implementation strategies. Discussion Findings will elucidate ways to address common and unique barriers to evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health care. Results will yield refined, pragmatically tested strategies that can inform larger confirmatory trials to combat the growing public health crisis of suicide.
Collapse
Affiliation(s)
- Molly Davis
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA USA
| | - Courtney Benjamin Wolk
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Shari Jager-Hyman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Jami F Young
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA USA
| | - Jennifer A Mautone
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, and PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA USA
| | - Alison M Buttenheim
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA USA
| | - David S Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA
| | - Kevin G Volpp
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA.,Department of Health Care Management, The Wharton School, University of Pennsylvania, Philadelphia, PA USA.,Penn Medicine Center for Health Care Innovation, University of Pennsylvania, Philadelphia, PA USA
| | - Katherine Wislocki
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Anne Futterer
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - Darby Marx
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| | - E L Dieckmeyer
- Jefferson College of Life Sciences, Thomas Jefferson University, University of Pennsylvania, Philadelphia, PA USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA USA
| |
Collapse
|
17
|
Eliacin J, Matthias MS, Burgess DJ, Patterson S, Damush T, Pratt-Chapman M, McGovern M, Chinman M, Talib T, O'Connor C, Rollins A. Pre-implementation Evaluation of PARTNER-MH: A Mental Healthcare Disparity Intervention for Minority Veterans in the VHA. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:46-60. [PMID: 32399857 DOI: 10.1007/s10488-020-01048-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To design PARTNER-MH, a peer-led, patient navigation program for implementation in Veterans Health Administration (VHA) mental health care settings, we conducted a pre-implementation evaluation during intervention development to assess stakeholders' views of the intervention and to explore implementation factors critical to its future adoption. This is a convergent mixed-methods study that involved qualitative semi-structured interviews and survey data. Data collection was guided by the Consolidated Framework for Implementation Research (CFIR). We interviewed and administered the surveys to 23 peers and 10 supervisors from 12 midwestern VHA facilities. We used deductive and inductive approaches to analyze the qualitative data. We also conducted descriptive analysis and Fisher Exact Test to compare peers and supervisors' survey responses. We triangulated findings to refine the intervention. Overall, participants viewed PARTNER-MH favorably. However, they saw the intervention's focus on minority Veterans and social determinants of health framework as potential barriers, believing this could negatively affect the packaging of the intervention, complicate its delivery process, and impact its adoption. They also viewed clinic structures, available resources, and learning climate as potential barriers. Peers and supervisors' selections and discussions of CFIR items were similar. Our findings informed PARTNER-MH development and helped identify factors that could impact its implementation. This project is responsive to the increasing recognition of the need to incorporate implementation science in healthcare disparities research. Understanding the resistance to the intervention's focus on minority Veterans and the potential barriers presented by contextual factors positions us to adjust the intervention prior to testing, in an effort to maximize implementation success.
Collapse
Affiliation(s)
- Johanne Eliacin
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA.
- Psychology Department, ACT Center of Indiana, IUPUI, Indianapolis, USA.
- Regenstrief Institute, Inc, Indianapolis, IN, USA.
| | - Marianne S Matthias
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- Department of Communication Studies, IUPUI, Indianapolis, USA
| | - Diana J Burgess
- Center for Chronic Disease Outcomes Research (a VA HSR&D Center of Excellence), Veterans Affairs Medical Center, Minneapolis, MN, USA
| | - Scott Patterson
- Department of Psychiatry, Richard L. Roudebush VAMC, Indianapolis, IN, USA
| | - Teresa Damush
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
- General Internal Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Mandi Pratt-Chapman
- Institute for Patient-Centered Initiatives & Health Equity, George Washington University Cancer Center, Washington, DC, USA
| | - Mark McGovern
- Psychiatry & Behavioral Sciences; Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew Chinman
- Veterans Integrated Service Network 4 Mental Illness Research, Education and Clinical Center and the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | | | - Caitlin O'Connor
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
| | - Angela Rollins
- VA HSR&D Center for Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, USA
- Psychology Department, ACT Center of Indiana, IUPUI, Indianapolis, USA
- Regenstrief Institute, Inc, Indianapolis, IN, USA
| |
Collapse
|