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Conigrave JH, Lee KSK, Dobbins T, Wilson S, Padarian J, Ivers R, Morley K, Haber PS, Vnuk J, Marshall K, Conigrave K. No improvement in AUDIT-C screening and brief intervention rates among wait-list controls following support of Aboriginal Community Controlled Health Services: evidence from a cluster randomised trial. BMC Health Serv Res 2024; 24:813. [PMID: 39010081 PMCID: PMC11247787 DOI: 10.1186/s12913-024-11214-6] [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: 01/12/2024] [Accepted: 06/18/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND While Aboriginal and Torres Strait Islander Australians are less likely to drink any alcohol than other Australians, those who drink are more likely to experience adverse alcohol-related health consequences. In a previous study, providing Aboriginal Community Controlled Health Services (ACCHSs) with training and support increased the odds of clients receiving AUDIT-C alcohol screening. A follow-up study found that these results were maintained for at least two years, but there was large variability in the effectiveness of the intervention between services. In this study, we use services that previously received support as a comparison group to test whether training and support can improve alcohol screening and brief intervention rates among wait-list control ACCHSs. METHODS Design: Cluster randomised trial using routinely collected health data. SETTING Australia. CASES Twenty-two ACCHSs that see at least 1000 clients a year and use Communicare as their practice management software. Intervention and comparator: After initiating support, we compare changes in screening and brief intervention between wait-list control services and services that had previously received support. MEASUREMENT Records of AUDIT-C screening and brief intervention activity in routinely collected data. RESULTS During the reference period we observed 357,257 instances where one of 74,568 clients attended services at least once during a two-monthly data extraction period. Following the start of support, the odds of screening (OR = 0.94 [95% CI 0.67, 1.32], p = 0.74, [Formula: see text]≈ 0.002) and brief intervention (OR = 1.43 [95% CI 0.69, 2.95], p = 0.34, [Formula: see text]≈ 0.002) did not improve for the wait-list control group, relative to comparison services. CONCLUSIONS We did not replicate the finding that support and training improves AUDIT-C screening rates with wait-list control data. The benefits of support are likely context dependent. Coincidental policy changes may have sensitised services to the effects of support in the earlier phase of the study. Then the COVID-19 pandemic may have made services less open to change in this latest phase. Future efforts could include practice software prompts to alcohol screening and brief intervention, which are less reliant on individual staff time or resources. TRIAL REGISTRATION Retrospectively registered on 2018-11-21: ACTRN12618001892202.
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Affiliation(s)
- James H Conigrave
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia.
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia.
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia.
- Institute for Positive Psychology and Education, Australian Catholic University, Sydney, NSW, Australia.
| | - K S Kylie Lee
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Faculty of Health Sciences, National Drug Research Institute, Curtin University, Perth, WA, Australia
- Burnet Institute, Melbourne, VIC, Australia
| | - Timothy Dobbins
- School of Population Health, UNSW Sydney, Sydney, NSW, Australia
| | - Scott Wilson
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- Centre for Alcohol Policy Research, La Trobe University, Melbourne, VIC, Australia
- Aboriginal Drug and Alcohol Council of South Australia, Adelaide, South Australia, Australia
| | - José Padarian
- Sydney Institute of Agriculture and School of Life and Environmental Sciences, The University of Sydney, Sydney, NSW, Australia
| | - Rowena Ivers
- Graduate School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Kirsten Morley
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
| | - Paul S Haber
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Julia Vnuk
- Aboriginal Health Council of South Australia, Adelaide, South Australia, Australia
- Adelaide Rural Clinical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Kushani Marshall
- School of Medicine, The University of Notre Dame, Sydney, NSW, Australia
| | - Kate Conigrave
- Faculty of Medicine and Health, Central Clinical School, University of Sydney, Sydney, NSW, Australia
- Centre of Research Excellence in Indigenous Health and Alcohol, University of Sydney, Sydney, NSW, Australia
- The Edith Collins Centre (Translational Research in Alcohol, Drugs and Toxicology), Sydney Local Health District, Sydney, NSW, Australia
- Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Mirzania M, Shakibazadeh E, Bohren MA, Hantoushzadeh S, Khajavi A, Foroushani AR. Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research. Reprod Health 2024; 21:70. [PMID: 38802923 PMCID: PMC11131232 DOI: 10.1186/s12978-024-01813-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). METHODS An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. RESULTS The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). CONCLUSIONS This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges.
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Affiliation(s)
- Marjan Mirzania
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Sedigheh Hantoushzadeh
- Department of Obstetrics and Gynecology, School of Medicine, Vali-E-Asr Reproductive Health research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdoljavad Khajavi
- Department of Social Medicine, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Abbas Rahimi Foroushani
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Hoagwood KE, Richards-Rachlin S, Baier M, Vilgorin B, Horwitz SM, Narcisse I, Diedrich N, Cleek A. Implementation Feasibility and Hidden Costs of Statewide Scaling of Evidence-Based Therapies for Children and Adolescents. Psychiatr Serv 2024; 75:461-469. [PMID: 38268465 PMCID: PMC11099614 DOI: 10.1176/appi.ps.20230183] [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] [Indexed: 01/26/2024]
Abstract
OBJECTIVE State mental health systems are retraining their workforces to deliver services supported by research. Knowledge about evidence-based therapies (EBTs) for child and adolescent disorders is robust, but the feasibility of their statewide scaling has not been examined. The authors reviewed implementation feasibility for 12 commonly used EBTs, defining feasibility for statewide scaling as an EBT having at least one study documenting acceptability, facilitators and barriers, or fidelity; at least one study with a racially and ethnically diverse sample; an entity for training, certification, or licensing; and fiscal data reflecting the costs of implementation. METHODS The authors reviewed materials for 12 EBTs being scaled in New York State and conducted a literature review with search terms relevant to their implementation. Costs and certification information were supplemented by discussions with treatment developers and implementers. RESULTS All 12 EBTs had been examined for implementation feasibility, but only three had been examined for statewide scaling. Eleven had been studied in populations reflecting racial-ethnic diversity, but few had sufficient power for subgroup analyses to demonstrate effectiveness with these samples. All had certifying or licensing entities. The per-clinician costs of implementation ranged from $500 to $3,500, with overall ongoing costs ranging from $100 to $6,000. A fiscal analysis of three EBTs revealed hidden costs ranging from $5,000 to $24,000 per clinician, potentially limiting sustainability. CONCLUSIONS The evidence necessary for embedding EBTs in state systems has notable gaps that may hinder sustainability. Research-funding agencies should prioritize studies that focus on the practical aspects of scaling to assist states as they retrain their workforces.
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Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Shira Richards-Rachlin
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Meaghan Baier
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Boris Vilgorin
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Iriane Narcisse
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Nadege Diedrich
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
| | - Andrew Cleek
- Department of Child and Adolescent Psychiatry, New York University (NYU) Grossman School of Medicine, New York City (Hoagwood, Richards-Rachlin, Horwitz, Narcisse); Department of Psychology, St. John's University, New York City (Richards-Rachlin); McSilver Institute for Poverty Policy and Research, NYU Silver School of Social Work, New York City (Baier, Vilgorin, Diedrich, Cleek)
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Huybrechts I, Declercq A, Verté E, Raeymaeckers P, Anthierens S. How does the external context affect an implementation processes? A qualitative study investigating the impact of macro-level variables on the implementation of goal-oriented primary care. Implement Sci 2024; 19:32. [PMID: 38627741 PMCID: PMC11020613 DOI: 10.1186/s13012-024-01360-0] [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: 01/03/2024] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Although the importance of context in implementation science is not disputed, knowledge about the actual impact of external context variables on implementation processes remains rather fragmented. Current frameworks, models, and studies merely describe macro-level barriers and facilitators, without acknowledging their dynamic character and how they impact and steer implementation. Including organizational theories in implementation frameworks could be a way of tackling this problem. In this study, we therefore investigate how organizational theories can contribute to our understanding of the ways in which external context variables shape implementation processes. We use the implementation process of goal-oriented primary care in Belgium as a case. METHODS A qualitative study using in-depth semi-structured interviews was conducted with actors from a variety of primary care organizations. Data was collected and analyzed with an iterative approach. We assessed the potential of four organizational theories to enrich our understanding of the impact of external context variables on implementation processes. The organizational theories assessed are as follows: institutional theory, resource dependency theory, network theory, and contingency theory. Data analysis was based on a combination of inductive and deductive thematic analysis techniques using NVivo 12. RESULTS Institutional theory helps to understand mechanisms that steer and facilitate the implementation of goal-oriented care through regulatory and policy measures. For example, the Flemish government issued policy for facilitating more integrated, person-centered care by means of newly created institutions, incentives, expectations, and other regulatory factors. The three other organizational theories describe both counteracting or reinforcing mechanisms. The financial system hampers interprofessional collaboration, which is key for GOC. Networks between primary care providers and health and/or social care organizations on the one hand facilitate GOC, while on the other hand, technology to support interprofessional collaboration is lacking. Contingent variables such as the aging population and increasing workload and complexity within primary care create circumstances in which GOC is presented as a possible answer. CONCLUSIONS Insights and propositions that derive from organizational theories can be utilized to expand our knowledge on how external context variables affect implementation processes. These insights can be combined with or integrated into existing implementation frameworks and models to increase their explanatory power.
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Affiliation(s)
- Ine Huybrechts
- Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium.
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette/Brussels, Belgium.
| | - Anja Declercq
- LUCAS - Centre for Care Research and Consultancy, KU Leuven, Minderbroedersstraat 8/5310, 3000, Leuven, Belgium
- Center for Sociological Research, Faculty of Social Sciences, KU Leuven, Parkstraat 45/3601, 3000, Leuven, Belgium
| | - Emily Verté
- Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090, Jette/Brussels, Belgium
| | - Peter Raeymaeckers
- Department of Social Work, University of Antwerp, St-Jacobstraat 2, 2000, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610, Antwerp, Belgium
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Southam-Gerow MA, Sale R, Robinson A, Sanborn V, Wu J, Boggs B, Riso A, Scalone M, Sandman A. Science for behavioral health systems change: evolving research-policy-public partnerships. Front Public Health 2024; 12:1359143. [PMID: 38544730 PMCID: PMC10965690 DOI: 10.3389/fpubh.2024.1359143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/28/2024] [Indexed: 05/15/2024] Open
Abstract
Potent partnerships among researchers, policymakers, and community members have potential to produce positive changes in communities on a range of topics, including behavioral health. The paper provides a brief illustrative review of such partnerships and then describes the development and evolution of one partnership in particular in Virginia. The origin of the partnership is traced, along with its founding vision, mission, and values. Some of its several projects are described, including (a) needs assessment for implementation of evidence-based programs (EBPs) pursuant to the Family First Prevention Services Act; (b) statewide fidelity monitoring of key EBPs; and (c) projects to synergize state investments in specific EBPs, like multisystemic therapy, functional family therapy, and high fidelity wraparound. The paper concludes with some themes around which the center has evolved to serve the state and its citizens more effectively.
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Affiliation(s)
- Michael A. Southam-Gerow
- Center for Evidence-based Partnerships in Virginia, Department of Psychology, Virginia Commonwealth University, Richmond, VA, United States
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Shattuck D, Willging CE, Peterson J, Ramos MM. Outer-context determinants on the implementation of school-based interventions for LGBTQ+ adolescents. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241249417. [PMID: 38666140 PMCID: PMC11044576 DOI: 10.1177/26334895241249417] [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: 04/28/2024] Open
Abstract
Background Schools are critical venues for supporting LGBTQ+ youth well-being. Implementing LGBTQ-supportive practices can decrease experiences of stigmatization, discrimination, and victimization that lead to adverse mental health outcomes like anxiety, depression, and suicidality. However, schools are also subject to a wide range of outer-context pressures that may influence their priorities and implementation of LGBTQ-supportive practices. We assessed the role of emergent outer-context determinants in the context of a 5-year cluster randomized controlled trial to study the implementation of LGBTQ-supportive evidence-informed practices (EIPs) in New Mexico high schools. Method Using an iterative coding approach, we analyzed qualitative data from annual interviews with school professionals involved in EIP implementation efforts. Results The analysis yielded three categories of outer-context determinants that created challenges and opportunities for implementation: (a) social barriers related to heterocentrism, cisgenderism, and religious conservatism; (b) local, state, and national policy and political discourse; and (c) crisis events. Conclusions By exploring the implications of outer-context determinants for the uptake of LGBTQ-supportive practices, we demonstrate that these elements are dynamic-not simply reducible to barriers or facilitators-and that assessing outer-context determinants shaping implementation environments is crucial for addressing LGBTQ health equity.
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Affiliation(s)
- Daniel Shattuck
- Pacific Institute for Research and Evaluation (PIRE)—Southwest Center, Albuquerque, NM, USA
| | - Cathleen E. Willging
- Pacific Institute for Research and Evaluation (PIRE)—Southwest Center, Albuquerque, NM, USA
| | - Jeffery Peterson
- School of Public and Community Health Services, University of Montana, Missoula, Montana, USA
| | - Mary M. Ramos
- Department of Pediatrics, University of New Mexico School of Medicine, Albuquerque, NM, USA
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Wortham WK, Rodwin AH, Purtle J, Munson MR, Raghavan R. Revisiting the policy ecology framework for implementation of evidence-based practices in mental health settings. Implement Sci 2023; 18:58. [PMID: 37936123 PMCID: PMC10629012 DOI: 10.1186/s13012-023-01309-9] [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: 03/03/2023] [Accepted: 10/01/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Over the past three decades, policy actors and actions have been highly influential in supporting the implementation of evidence-based practices (EBPs) in mental health settings. An early examination of these actions resulted in the Policy Ecology Framework (PEF), which was originally developed as a tactical primer for state and local mental health regulators in the field of child mental health. However, the policy landscape for implementation has evolved significantly since the original PEF was published. An interrogation of the strategies originally proposed in the PEF is necessary to provide an updated menu of strategies to improve our understanding of the mechanisms of policy action and promote system improvement. OBJECTIVES This paper builds upon the original PEF to address changes in the policy landscape for the implementation of mental health EBPs between 2009 and 2022. We review the current state of policy strategies that support the implementation of EBPs in mental health care and outline key areas for policy-oriented implementation research. Our review identifies policy strategies at federal, state, agency, and organizational levels, and highlights developments in the social context in which EBPs are implemented. Furthermore, our review is organized around some key changes that occurred across each PEF domain that span organizational, agency, political, and social contexts along with subdomains within each area. DISCUSSION We present an updated menu of policy strategies to support the implementation of EBPs in mental health settings. This updated menu of strategies considers the broad range of conceptual developments and changes in the policy landscape. These developments have occurred across the organizational, agency, political, and social contexts and are important for policymakers to consider in the context of supporting the implementation of EBPs. The updated PEF expands and enhances the specification of policy levers currently available, and identifies policy targets that are underdeveloped (e.g., de-implementation and sustainment) but are becoming visible opportunities for policy to support system improvement. The updated PEF clarifies current policy efforts within the field of implementation science in health to conceptualize and better operationalize the role of policy in the implementation of EBPs.
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Affiliation(s)
- Whitney K Wortham
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA.
| | - Aaron H Rodwin
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
| | - Michelle R Munson
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Ramesh Raghavan
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
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Hahlweg P, Lindig A, Frerichs W, Zill J, Hanken H, Müller V, Peters MC, Scholl I. Major influencing factors on routine implementation of shared decision-making in cancer care: qualitative process evaluation of a stepped-wedge cluster randomized trial. BMC Health Serv Res 2023; 23:840. [PMID: 37553560 PMCID: PMC10408234 DOI: 10.1186/s12913-023-09778-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: 10/20/2022] [Accepted: 06/30/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Shared decision-making (SDM) is highly relevant in oncology but rarely implemented in routine care. In a stepped-wedge cluster randomized implementation trial, the outcome evaluation of a theoretically and empirically based multi-component SDM implementation program did not show a statistically significant effect on patient-reported SDM uptake. Within this SDM implementation trial, a thorough a priori planned process evaluation was conducted. Thus, the aim of this study was to investigate factors influencing SDM implementation in the context of a multi-component SDM implementation program. METHODS We conducted qualitative process evaluation of a stepped-wedge SDM implementation trial. Qualitative data included interviews with nurses and physicians of participating departments, field notes by the study team, and meeting minutes. Data were analyzed via deductive and inductive qualitative content analysis on basis of the Consolidated Framework for Implementation Research (CFIR). RESULTS Transcripts of 107 interviews with 126 nurses and physicians, 304 pages of field note documentation, and 125 pages of meeting minutes were analyzed. Major factors influencing SDM implementation were found for all domains of the CFIR: a) four regarding characteristics of the individuals involved (e.g., perceived personal relevance, individual motivation to change), b) eleven regarding the inner setting (e.g., leadership engagement, networks and communication, available resources, compatibility with clinical practice), c) two regarding the outer setting (e.g., culture of health care delivery), d) eight regarding characteristics of the intervention (e.g., relative advantage, adaptability), and e) three regarding the implementation process (e.g., integration into existing structures). Furthermore, we found strong interrelations between several of the influencing factors within and between domains. CONCLUSIONS This comprehensive process evaluation complements the outcome evaluation of the SDM implementation trial and adds to its interpretation. The identified influencing factors can be used for planning, conducting, and evaluating SDM implementation in the future. TRIAL REGISTRATION clinicaltrials.gov, NCT03393351, registered 8 January 2018, https://clinicaltrials.gov/ct2/show/NCT03393351.
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Affiliation(s)
- Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Anja Lindig
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Wiebke Frerichs
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jördis Zill
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Henning Hanken
- Department of Oral, Maxillofacial and Plastic Surgery, Asklepios Klinik Nord - Heidberg, Tangstedter Landstr. 400, 22417, Hamburg, Germany
| | - Volkmar Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Mia-Carlotta Peters
- II. Department of Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Center of Health Care Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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Escoffery C, Sekar S, Allen CG, Madrigal L, Haardoerfer R, Mertens A. A scoping review of outer context constructs in dissemination and implementation science theories, models, and frameworks. Transl Behav Med 2023; 13:327-337. [PMID: 36694938 PMCID: PMC10182421 DOI: 10.1093/tbm/ibac115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Many studies have explored organizational factors that facilitate implementation. However, there is still a limited understanding of determinants external to the implementing organization and their effects on evidence-based intervention (EBI) adoption, implementation, and outcomes. The purpose of this scoping review was to assess definitions of context and identify salient determinants of outer context found in dissemination and implementation theories, models, and frameworks. We employed a compilation of dissemination and implementation frameworks from two reviews as the data source. We abstracted the following information: type of article, outcomes of the framework, presence of a context definition, presence of any outer setting definition and the definition, number and domains of outer setting mentioned, definitions of outer context constructs, and any quantitative measures of outer setting. We identified 19 definitions of outer context. Forty-seven (49%) frameworks reported one or more specific constructs of the outer setting. While the outer context domains described in the frameworks varied, the most common domains were policy (n = 24), community (n = 20), partnerships (n = 13), and communications (n = 12). Based on our review of the frameworks, more conceptualization and measurement development for outer context domains are needed. Few measures were found and definitions of domains varied across frameworks. Expanding outer context construct definitions would advance measure development for important factors external to the organizations related to EBI implementation.
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Affiliation(s)
- Cam Escoffery
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Atlanta, GA, USA
| | - Swathi Sekar
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Atlanta, GA, USA
| | - Caitlin G Allen
- Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Lillian Madrigal
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Atlanta, GA, USA
| | - Regine Haardoerfer
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Atlanta, GA, USA
| | - Ann Mertens
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA, USA
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10
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Eiroa-Orosa FJ, MacIntyre G. Editorial: From individual to collective: bridging the gap between clinical practice and public policies. Front Psychol 2023; 14:1169159. [PMID: 37235099 PMCID: PMC10208267 DOI: 10.3389/fpsyg.2023.1169159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Affiliation(s)
- Francisco José Eiroa-Orosa
- Section of Personality, Evaluation and Psychological Treatment, Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Barcelona, Catalonia, Spain
| | - Gillian MacIntyre
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, United Kingdom
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11
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Purtle J, Stadnick NA, Wynecoop M, Bruns EJ, Crane ME, Aarons G. A policy implementation study of earmarked taxes for mental health services: study protocol. Implement Sci Commun 2023; 4:37. [PMID: 37004117 PMCID: PMC10067193 DOI: 10.1186/s43058-023-00408-4] [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] [Received: 02/27/2023] [Accepted: 03/05/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Insufficient funding is frequently identified as a critical barrier to the implementation and sustainment of evidence-based practices (EBPs). Thus, increasing access to funding is recognized as an implementation strategy. Policies that create earmarked taxes-defined as taxes for which revenue can only be spent on specific activities-are an increasingly common mental health financing strategy that could improve the reach of EBPs. This project's specific aims are to (1) identify all jurisdictions in the USA that have implemented earmarked taxes for mental health and catalogue information about tax design; (2) characterize experiences implementing earmarked taxes among local (e.g., county, city) mental health agency leaders and other government and community organization officials and assess their perceptions of the acceptability and feasibility of different types of policy implementation strategies; and (3) develop a framework to guide effect earmarked tax designs, inform the selection of implementation strategies, and disseminate the framework to policy audiences. METHODS The project uses the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to inform data collection about the determinants and processes of tax implementation and Leeman's typology of implementation strategies to examine the acceptability and feasibility strategies which could support earmarked tax policy implementation. A legal mapping will be conducted to achieve aim 1. To achieve aim 2, a survey will be conducted of 300 local mental health agency leaders and other government and community organization officials involved with the implementation of earmarked taxes for mental health. The survey will be followed by approximately 50 interviews with these officials. To achieve aim 3, quantitative and qualitative data will be integrated through a systematic framework development and dissemination process. DISCUSSION This exploratory policy implementation process study will build the evidence base for outer-context implementation determinants and strategies by focusing on policies that earmarked taxes for mental health services.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708, Broadway, New York, NY, 10003, USA.
| | - Nicole A Stadnick
- Department of Psychiatry, Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Megan Wynecoop
- Department of Public Health Policy & Management, Global Center for Implementation Science, New York University School of Global Public Health, 708, Broadway, New York, NY, 10003, USA
| | - Eric J Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 6200 NE 74Th St, Building 29, Suite 110, Seattle, WA, 98115, USA
| | - Margaret E Crane
- Department of Psychology, Temple University, Weiss Hall, 1701 N 13Th St, Philadelphia, PA, 19122, USA
- Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, 425 E 61St St, New York, NY, 10065, USA
| | - Gregory Aarons
- Department of Psychiatry, Dissemination and Implementation Science Center, Altman Clinical and Translational Research Institute, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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12
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Kokole D, Mercken L, Anderson P, Mejía-Trujillo J, Perez-Gomez A, Bustamante I, Piazza M, Natera Rey G, Arroyo M, Pérez De León A, Bautista Aguilar N, Medina Aguilar PS, Schulte B, O'Donnell A, de Vries H, Jané-Llopis E. Country and policy factors influencing the implementation of primary care-based alcohol screening: A comparison of Colombia, Mexico and Peru. Glob Public Health 2023; 18:2207410. [PMID: 37156224 DOI: 10.1080/17441692.2023.2207410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Researchers and practitioners recognise the importance of context when implementing healthcare interventions, but the influence of wider environment is rarely mapped. This paper identifies the country and policy-related factors potentially explaining the country differences in outcomes of an intervention focused on improving detection and management of heavy alcohol use in primary care in Colombia, Mexico and Peru. Qualitative data obtained through interviews, logbooks and document analysis are used to explain quantitative data on number of alcohol screenings and screening providers in each of the countries. Existing alcohol screening standards in Mexico, and policy prioritisation of primary care and consideration of alcohol as a public health issue in Colombia and Mexico positively contributed to the outcome, while the COVID-19 pandemic had a negative impact. In Peru, the context was unsupportive due to a combination of: political instability amongst regional health authorities; lack of focus on strengthening primary care due to the expansion of community mental health centres; alcohol considered as an addiction rather than a public health issue; and the impact of COVID-19 on healthcare. We found that wider environment-related factors interacted with the intervention implemented and can help explain country differences in outcomes.
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Affiliation(s)
- Daša Kokole
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Liesbeth Mercken
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Department of Health Psychology, Open University, Heerlen, Netherlands
| | - Peter Anderson
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Ines Bustamante
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Marina Piazza
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Miriam Arroyo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, Mexico
| | | | | | | | - Bernd Schulte
- Department of Psychiatry and Psychotherapy, Centre for Interdisciplinary Addiction Research (ZIS), University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hein de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Eva Jané-Llopis
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
- ESADE, Universitat Ramon Llull, Barcelona, Spain
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13
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Mielke J, Brunkert T, Zúñiga F, Simon M, Zullig LL, De Geest S. Methodological approaches to study context in intervention implementation studies: an evidence gap map. BMC Med Res Methodol 2022; 22:320. [PMID: 36517765 PMCID: PMC9749183 DOI: 10.1186/s12874-022-01772-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Within implementation science studies, contextual analysis is increasingly recognized as foundational to interventions' successful and sustainable implementation. However, inconsistencies between methodological approaches currently limit progress in studying context and guidance to standardize the use of those approaches is scant. Therefore, this study's objective was to systematically review and map current methodological approaches to contextual analysis in intervention implementation studies. The results would help us both to systematize the process of contextual analysis and identify gaps in the current evidence. METHODS We conducted an evidence gap map (EGM) based on literature data via a stepwise approach. First, using an empirically developed search string, we randomly sampled 20% of all intervention implementation studies available from PubMed per year (2015-2020). Second, we assessed included studies that conducted a contextual analysis. Data extraction and evaluation followed the Basel Approach for CoNtextual ANAlysis (BANANA), using a color-coded rating scheme. Also based on BANANA and on the Context and Implementation of Complex Interventions (CICI) framework-an implementation framework that pays ample attention to context- we created visual maps of various approaches to contextual analysis. RESULTS Of 15, 286 identified intervention implementation studies and study protocols, 3017 were screened for inclusion. Of those, 110 warranted close examination, revealing 22% that reported on contextual analysis. Only one study explicitly applied a framework for contextual analysis. Data were most commonly collected via surveys (n = 15) and individual interviews (n = 13). Ten studies reported mixed-methods analyses. Twenty-two assessed meso-level contextual and setting factors, with socio-cultural aspects most commonly studied. Eighteen described the use of contextual information for subsequent project phases (e.g., intervention development/adaption, selecting implementation strategies). Nine reported contextual factors' influences on implementation and/or effectiveness outcomes. CONCLUSIONS This study describes current approaches to contextual analysis in implementation science and provides a novel framework for evaluating and mapping it. By synthesizing our findings graphically in figures, we provide an initial evidence base framework that can incorporate new findings as necessary. We strongly recommend further development of methodological approaches both to conduct contextual analysis and to systematize the reporting of it. These actions will increase the quality and consistency of implementation science research.
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Affiliation(s)
- Juliane Mielke
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Thekla Brunkert
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Franziska Zúñiga
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
| | - Leah L. Zullig
- Center for Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System and Department of Population Health Sciences, Duke University Medical Center, Durham, NC USA
| | - Sabina De Geest
- Institute of Nursing Science, Department Public Health, University of Basel, Bernoullistrasse 28, CH-4056 Basel, Switzerland
- Department of Public Health and Primary Care, KU Leuven, Academic Center for Nursing and Midwifery, Louvain, Belgium
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14
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Nelson KL, Powell BJ, Langellier B, Lê-Scherban F, Shattuck P, Hoagwood K, Purtle J. State Policies that Impact the Design of Children's Mental Health Services: A Modified Delphi Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:834-847. [PMID: 35737191 PMCID: PMC9219374 DOI: 10.1007/s10488-022-01201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2022] [Indexed: 12/22/2022]
Abstract
To identify the state-level policies and policy domains that state policymakers and advocates perceive as most important for positively impacting the use of children's mental health services (CMHS). We used a modified Delphi technique (i.e., two rounds of questionnaires and an interview) during Spring 2021 to elicit perceptions among state mental health agency officials and advocates (n = 28) from twelve states on state policies that impact the use of CMHS. Participants rated a list of pre-specified policies on a 7-point Likert scale (1 = not important, 7 = extremely important) in the following policy domains: insurance coverage and limits, mental health services, school and social. Participants added nine policies to the initial list of 24 policies. The "school" policy domain was perceived as the most important, while the "social" policy domain was perceived as the least important after the first questionnaire and the second most important policy domain after the second questionnaire. The individual policies perceived as most important were school-based mental health services, state mental health parity, and Medicaid reimbursement rates. Key stakeholders in CMHS should leverage this group of policies to understand the current policy landscape in their state and to identify gaps in policy domains and potential policy opportunities to create a more comprehensive system to address children's mental health from a holistic, evidence-based policymaking perspective.
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Affiliation(s)
- Katherine L Nelson
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA.
| | - Byron J Powell
- Brown School and School of Medicine, Washington University in St. Louis, St. Louis, MO, USA
| | - Brent Langellier
- Department of Health Management and Policy, Drexel University Dornsife School of Public Health, 3215 Market St, Philadelphia, PA, 19104, USA
| | - Félice Lê-Scherban
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | | | - Kimberly Hoagwood
- Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York, USA
| | - Jonathan Purtle
- Department of Public Health Policy and Management, New York University School of Global Public Health, New York, USA
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15
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Alvarez K, Cervantes PE, Nelson KL, Seag DEM, Horwitz SM, Hoagwood KE. Review: Structural Racism, Children's Mental Health Service Systems, and Recommendations for Policy and Practice Change. J Am Acad Child Adolesc Psychiatry 2022; 61:1087-1105. [PMID: 34971730 PMCID: PMC9237180 DOI: 10.1016/j.jaac.2021.12.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 11/26/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Racism is a public health crisis that impacts on children's mental health, yet mental health service systems are insufficiently focused on addressing racism. Moreover, a focus on interpersonal racism and on individual coping with the impacts of racism has been prioritized over addressing structural racism at the level of the service system and associated institutions. In this paper, we examine strategies to address structural racism via policies affecting children's mental health services. METHOD First, we identify and analyze federal and state policies focused on racism and mental health equity. Second, we evaluate areas of focus in these policies and discuss the evidence base informing their implementation. Finally, we provide recommendations for what states, counties, cities, and mental health systems can do to promote antiracist evidence-based practices in children's mental health. RESULTS Our analysis highlights gaps and opportunities in the evidence base for policy implementation strategies, including the following: mental health services for youth of color, interventions addressing interpersonal racism and bias in the mental health service system, interventions addressing structural racism, changes to provider licensure and license renewal, and development of the community health workforce. CONCLUSION Recommendations are provided both within and across systems to catalyze broader systems transformation.
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Affiliation(s)
- Kiara Alvarez
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | - Katherine L Nelson
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania; Merck & Co., Inc., Kenilworth, New Jersey
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16
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Purtle J, Nelson KL, Lengnick‐Hall R, Horwitz SMC, Palinkas LA, McKay MM, Hoagwood KE. Inter-agency collaboration is associated with increased frequency of research use in children's mental health policy making. Health Serv Res 2022; 57:842-852. [PMID: 35285023 PMCID: PMC9264471 DOI: 10.1111/1475-6773.13955] [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: 07/12/2021] [Revised: 02/08/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine whether the self-report frequency of inter-agency collaboration about children's mental health issues is associated with the self-report frequency of using research evidence in children's mental health policy and program decision making in mental health agencies (MHAs). DATA SOURCES Primary data were collected through web-based surveys of state (N = 221) and county (N = 117) MHA officials. DESIGN The primary independent variable was a composite score quantifying the frequency of collaboration about children's mental health issues between officials in MHAs and six other state agencies. The dependent variables were composite scores quantifying the frequency of research use in children's mental health policy and program decision making in general and for specific purposes (i.e., conceptual, instrumental, tactical, imposed). Covariates were composite scores quantifying well-established determinants of research use (e.g., agency leadership, research use skills) in agency policy and program decision making. DATA METHODS Separate multiple linear regression models estimated associations between frequency of inter-agency collaboration and research use scores, adjusting for other determinants of research use, respondent state, and other covariates. Data from state and county officials were analyzed separately. PRINCIPAL FINDINGS The frequency of inter-agency collaboration was positively and independently associated with the frequency of research use in children's mental health policy making among state (β = 0.22, p = 0.004) and county (β = 0.39, p < 0.0001) MHA officials. Inter-agency collaboration was also the only variable significantly associated with the frequency of research use for all four specific purposes among state MHA officials, and similar findings we observed among county MHA officials. The magnitudes of associations between inter-agency collaboration and frequency of research use were generally stronger than for more well-established determinants of research use in policy making. CONCLUSIONS Strategies that promote collaboration between MHA officials and external agencies could increase the use of research evidence in children's mental health policy and program decision making in MHAs.
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Affiliation(s)
- Jonathan Purtle
- Department of Public Health Policy & ManagementSchool of Global Public Health, Global Center for Implementation Science, New York UniversityNew YorkNew YorkUSA
| | - Katherine L. Nelson
- Department of Health Management and PolicyDrexel University Dornsife School of Public HealthPhiladelphiaPennsylvaniaUSA
| | | | - Sarah Mc Cue Horwitz
- Department of Child and Adolescent PsychiatryNew York University School of MedicineNew YorkNew YorkUSA
| | - Lawrence A. Palinkas
- Suzanne Dworak‐Peck School of Social WorkUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Mary M. McKay
- Washington University in St. Louis, Brown SchoolSt. LouisMissouriUSA
| | - Kimberly E. Hoagwood
- Department of Child and Adolescent PsychiatryNew York University School of MedicineNew YorkNew YorkUSA
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17
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O'Dell SM, Gormley MJ, Schlieder V, Klinger T, DeHart K, Kettlewell PW, Kulchak Rahm A. Perspectives of Rural Primary Care Clinicians on Pediatric Attention-Deficit/Hyperactivity Disorder Care. J Dev Behav Pediatr 2022; 43:273-282. [PMID: 35353792 DOI: 10.1097/dbp.0000000000001056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Despite efficacious treatments, evidence-based guidelines, and increased availability of integrated behavioral health care, youth coping with attention-deficit/hyperactivity disorder (ADHD) receive suboptimal care. More research is needed to understand and address care gaps, particularly within rural health systems that face unique challenges. We conducted a qualitative study within a predominantly rural health system with a pediatric-integrated behavioral health care program to address research gaps and prepare for quality improvement initiatives, including primary care clinician (PCC) trainings and clinical decision support tools in the electronic health record (EHR). METHOD Semistructured interviews were conducted with 26 PCCs representing clinics within the health system. Interview guides were based on the Practical Robust Implementation and Sustainability Model to elicit PCC views regarding determinants of current practices and suggestions to guide quality improvement efforts. We used thematic analysis to identify patterns of responding that were common across participants. RESULTS PCCs identified several internal and external contextual factors as determinants of current practices. Of note, PCCs recommended increased access to continuing education trainings held in clinic over lunch and delivered in less than 30 minutes. Suggested improvements to the EHR included incorporating parent and teacher versions of the Vanderbilt Rating Scale into the EHR, documentation templates aligned with evidence-based guidelines, and alerts and suggestions to aid medication management during appointments. CONCLUSION Future research to identify implementation strategies to help rural PCCs adopt innovations are needed given the increased responsibility for managing ADHD care and intractable gaps in access to behavioral health care in rural regions.
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Affiliation(s)
- Sean M O'Dell
- Departments of Population Health Sciences
- Psychiatry and Behavioral Health, Geisinger, Danville, PA
| | - Matthew J Gormley
- Psychiatry and Behavioral Health, Geisinger, Danville, PA
- Department of Educational Psychology, University of Nebraska-Lincoln, Lincoln, NE
| | | | - Tracey Klinger
- Investigator Initiated Research Operations, Geisinger, Danville, PA
| | - Kathy DeHart
- Department of Pediatrics, Geisinger, Danville, PA
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18
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Cooper HLF, Gross S, Klein E, Fadanelli M, Ballard A, Lockard S, Batty E, Young A, Ibragimov U. Capacity for sustainment of recently established syringe service programs in Appalachian Kentucky: The central role of staff champions. Drug Alcohol Rev 2022; 41:863-872. [PMID: 35112747 PMCID: PMC11107953 DOI: 10.1111/dar.13436] [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: 04/10/2021] [Revised: 10/30/2021] [Accepted: 12/28/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ensuring adequate harm reduction infrastructure in rural areas is imperative, as drug-related epidemics expand into them. Here, we explore the capacity for sustainment of syringe service programs (SSP) in Appalachian Kentucky. METHODS We interviewed all staff (n = 16) of all SSPs (n = 7) in two Kentucky health districts in 2018-2019 using semi-structured one-on-one qualitative interviews; local departments of health (DOH) operated the SSPs. Interview domains encompassed: (i) SSP establishment; (ii) day-to-day operations, participation and health impacts; (iii) perceived prospects for sustainment; and (iv) perceived influences on #i-#iii. We analysed verbatim transcripts using thematic analytic methods; Schell's 'capacity for sustainment' constructs were treated as sensitising concepts during the analysis. RESULTS Most community members, law enforcement and DOH staff opposed SSPs before they opened, because of stigma and concerns about enabling and needlestick injuries; DOH staff also opposed SSPs because they believed they lacked the capacity to operate them. Training, technical assistance, visible evidence of the programs' public health impact and contact with SSP participants transformed DOH staff into program champions. As champions, SSP staff developed programs that had strong capacity for sustainment, as defined by Schell (e.g. visible public health impact, stable funding, political support). Staff reported that the SSPs had high prospects for sustainment. DISCUSSION AND CONCLUSION As in SSPs that opened in cities decades ago, staff in emerging SSPs in these rural areas appear to have become crucial champions for these controversial programs, and may serve as vital resources for expanding harm reduction programming more broadly in these underserved areas.
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Affiliation(s)
- Hannah L. F. Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, USA
| | - Skylar Gross
- Department of Epidemiology, The Ohio State University College of Public Health, Columbus, USA
| | - Emma Klein
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, USA
| | - Monica Fadanelli
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, USA
| | - April Ballard
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, USA
| | - Scott Lockard
- Kentucky River District Health Department, Hazard, USA
| | - Evan Batty
- Department of Epidemiology, University of Kentucky’s College of Public Health, Lexington, USA
| | - April Young
- Department of Epidemiology, University of Kentucky’s College of Public Health, Lexington, USA
| | - Umed Ibragimov
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, USA
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19
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Starks TJ, Skeen SJ, Scott Jones S, Gurung S, Millar BM, Ferraris C, Ventuneac A, Parsons JT, Sparks MA. Effectiveness of a Combined Motivational Interviewing and Cognitive Behavioral Intervention to Reduce Substance Use and Improve HIV-Related Immune Functioning. AIDS Behav 2022; 26:1138-1152. [PMID: 34537912 DOI: 10.1007/s10461-021-03467-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2021] [Indexed: 12/01/2022]
Abstract
This study evaluated the effectiveness of Project PLUS, a 6-session Motivational Interviewing and Cognitive Behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence among PLWH. In a quasi-experimental design, 84 participants from a network of three comprehensive care clinics in New York City received the intervention immediately post-baseline (the Immediate condition) and 90 were assigned to a Waitlist control. Viral load and CD4 data were extracted from electronic medical records (EMR) for a No-Intervention comparison cohort (n = 120). Latent growth curve analyses did not show a consistent pattern of significant between-group differences post-intervention or across time in ART adherence or substance use severity between Immediate and Waitlist participants. Additionally, Immediate intervention participants did not differ significantly from the Waitlist or No-Treatment groups on viral load or CD4 post-intervention or across time. The potential to detect intervention effects may have been limited by the use of a quasi-experimental design, the high quality of standard care at these clinics, or inadequate intervention dose.Trial Registration: ClinicalTrials.gov (NIH U.S. National Library of Medicine) Identifier: NCT02390908; https://clinicaltrials.gov/ct2/show/NCT02390908.
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Affiliation(s)
- Tyrel J Starks
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA.
- Doctoral Program in Health Psychology and Clinical Science, Graduate Center of CUNY, New York, NY, USA.
| | - Simone J Skeen
- PRIDE Health Research Consortium, Hunter College of CUNY, New York, NY, USA
| | - S Scott Jones
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Sitaji Gurung
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Brett M Millar
- Department of Psychology, Hunter College of the City University of New York (CUNY), 695 Park Ave. 611 Hunter North, New York, NY, 10065, USA
| | - Christopher Ferraris
- HIV Center for Clinical and Behavioral Studies at the New York State Psychiatric Institute and Columbia University, New York, NY, USA
| | - Ana Ventuneac
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Martha A Sparks
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Stanton MC, Ali SB, the SUSTAIN Center Team. A typology of power in implementation: Building on the exploration, preparation, implementation, sustainment (EPIS) framework to advance mental health and HIV health equity. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895211064250. [PMID: 37091105 PMCID: PMC9978699 DOI: 10.1177/26334895211064250] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Persistent inequities in HIV health are due, in part, to barriers to successful HIV-related mental health intervention implementation with marginalized groups. Implementation Science (IS) has begun to examine how the field can promote health equity. Lacking is a clear method to analyze how power is generated and distributed through practical implementation processes and how this power can dismantle and/or reproduce health inequity through intervention implementation. The aims of this paper are to (1) propose a typology of power generated through implementation processes, (2) apply this power typology to expand on the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to advance HIV and mental health equity and (3) articulate questions to guide the explicit examination and distribution of power throughout implementation. Methods This paper draws on the work of an Intermediary Purveyor organization implementing trauma-informed care and harm reduction organizational change with HIV service organizations. The expanded framework was developed through analyzing implementation coaching field notes, grant reporting, and evaluation documents, training feedback, partner evaluation interviews, and existing implementation literature. Results The authors identify three types of power working through implementation; (1) discursive power is enacted through defining health-related problems to be targeted by intervention implementation, as well as through health narratives that emerge through implementation; (2) epistemic power influences whose knowledge is valued in decision-making and is recreated through knowledge generation; and (3) material power is created through resource distribution and patterns of access to health resources and acquisition of health benefits provided by the intervention. Decisions across all phases and related to all factors of EPIS influence how these forms of power striate through intervention implementation and ultimately affect health equity outcomes. Conclusions The authors conclude with a set of concrete questions for researchers and practitioners to interrogate power throughout the implementation process. Plain language summary Over the past few years, Implementation Science researchers have committed increased attention to the ways in which the field can more effectively address health inequity. Lacking is a clear method to analyze how implementation processes themselves generate power that has the potential to contribute to health inequity. In this paper, the authors describe and define three types of power that are created and distributed through intervention implementation; discursive power, epistemic power, and material power. The authors then explain how these forms of power shape factors and phases of implementation, using the well-known EPIS (exploration, preparation, implementation, sustainment) framework. The authors draw from their experience working with and Intermediary Purveyor supporting HIV service organizations implementing trauma-informed care and harm reduction organizational change projects. This paper concludes with a set of critical questions that can be used by researchers and practitioners as a concrete tool to analyze the role of power in intervention implementation processes.
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Affiliation(s)
- Megan C. Stanton
- Department of Sociology, Anthropology, Criminology and Social Work, Eastern Connecticut State University, Willimantic, CT, USA
| | - Samira B. Ali
- Graduate College of Social Work, University of Houston, Houston, TX, USA
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Pilar M, Jost E, Walsh-Bailey C, Powell BJ, Mazzucca S, Eyler A, Purtle J, Allen P, Brownson RC. Quantitative measures used in empirical evaluations of mental health policy implementation: A systematic review. IMPLEMENTATION RESEARCH AND PRACTICE 2022; 3:26334895221141116. [PMID: 37091091 PMCID: PMC9924289 DOI: 10.1177/26334895221141116] [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: 12/11/2022] Open
Abstract
Background Mental health is a critical component of wellness. Public policies present an opportunity for large-scale mental health impact, but policy implementation is complex and can vary significantly across contexts, making it crucial to evaluate implementation. The objective of this study was to (1) identify quantitative measurement tools used to evaluate the implementation of public mental health policies; (2) describe implementation determinants and outcomes assessed in the measures; and (3) assess the pragmatic and psychometric quality of identified measures. Method Guided by the Consolidated Framework for Implementation Research, Policy Implementation Determinants Framework, and Implementation Outcomes Framework, we conducted a systematic review of peer-reviewed journal articles published in 1995-2020. Data extracted included study characteristics, measure development and testing, implementation determinants and outcomes, and measure quality using the Psychometric and Pragmatic Evidence Rating Scale. Results We identified 34 tools from 25 articles, which were designed for mental health policies or used to evaluate constructs that impact implementation. Many measures lacked information regarding measurement development and testing. The most assessed implementation determinants were readiness for implementation, which encompassed training (n = 20, 57%) and other resources (n = 12, 34%), actor relationships/networks (n = 15, 43%), and organizational culture and climate (n = 11, 31%). Fidelity was the most prevalent implementation outcome (n = 9, 26%), followed by penetration (n = 8, 23%) and acceptability (n = 7, 20%). Apart from internal consistency and sample norms, psychometric properties were frequently unreported. Most measures were accessible and brief, though minimal information was provided regarding interpreting scores, handling missing data, or training needed to administer tools. Conclusions This work contributes to the nascent field of policy-focused implementation science by providing an overview of existing measurement tools used to evaluate mental health policy implementation and recommendations for measure development and refinement. To advance this field, more valid, reliable, and pragmatic measures are needed to evaluate policy implementation and close the policy-to-practice gap. Plain Language Summary Mental health is a critical component of wellness, and public policies present an opportunity to improve mental health on a large scale. Policy implementation is complex because it involves action by multiple entities at several levels of society. Policy implementation is also challenging because it can be impacted by many factors, such as political will, stakeholder relationships, and resources available for implementation. Because of these factors, implementation can vary between locations, such as states or countries. It is crucial to evaluate policy implementation, thus we conducted a systematic review to identify and evaluate the quality of measurement tools used in mental health policy implementation studies. Our search and screening procedures resulted in 34 measurement tools. We rated their quality to determine if these tools were practical to use and would yield consistent (i.e., reliable) and accurate (i.e., valid) data. These tools most frequently assessed whether implementing organizations complied with policy mandates and whether organizations had the training and other resources required to implement a policy. Though many were relatively brief and available at little-to-no cost, these findings highlight that more reliable, valid, and practical measurement tools are needed to assess and inform mental health policy implementation. Findings from this review can guide future efforts to select or develop policy implementation measures.
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Affiliation(s)
- Meagan Pilar
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Infectious Diseases, Washington University School of Medicine,
Washington University in St. Louis, St. Louis, MO, USA
| | - Eliot Jost
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Callie Walsh-Bailey
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Byron J. Powell
- Center for Mental Health Services Research, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Division of Infectious Diseases, John T. Milliken Department of
Medicine, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
| | - Stephanie Mazzucca
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Amy Eyler
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management, New York
University School of Global Public Health, Global Center for Implementation Science, New York University, New York, NY, USA
| | - Peg Allen
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
| | - Ross C. Brownson
- Prevention Research Center, Brown School, Washington University in St.
Louis, St. Louis, MO, USA
- Department of Surgery (Division of Public Health Sciences) and Alvin
J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St.
Louis, St. Louis, MO, USA
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Vinson SY, Dennis AL. Systemic, Racial Justice-Informed Solutions to Shift "Care" From the Criminal Legal System to the Mental Health Care System. Psychiatr Serv 2021; 72:1428-1433. [PMID: 33979203 DOI: 10.1176/appi.ps.202000735] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The current configuration and function of U.S. societal structures drives the overrepresentation of people with serious mental illness in the criminal legal system. Although the causes are multifactorial, the mental health system poorly serves those at highest risk of criminal legal system involvement. The growth of the mental health evidence base regarding the social determinants of mental health has ushered in greater understanding of their central role in the promotion and maintenance of mental illness and health. These academic strides, however, have failed to translate into widespread care and payment policy changes. Additionally, as is the case in the criminal legal system, structural racism shapes people's experiences in the mental health care system, contributing to inequitable mental health outcomes for persons with severe mental illness from racial and ethnic minority groups. This is a critical consideration for the population involved in the criminal legal system: Black and Brown people make up more than half of those incarcerated in the United States (despite comprising just 32% of the total population). In the absence of an intersectional, antiracist, structurally informed approach, any attempt by the mental health care system to stem the overrepresentation of people with serious mental illness in the criminal legal system will fail. This article provides an overview of the current mental health care system's shortcomings in serving this population. It proposes concrete steps to address these shortcomings, with a special focus on race and social determinants of health.
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Affiliation(s)
- Sarah Y Vinson
- Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, and Lorio Forensics, Atlanta (Vinson); University of Georgia School of Law, Athens (Dennis)
| | - Andrea L Dennis
- Department of Psychiatry and Behavioral Sciences, Morehouse School of Medicine, and Lorio Forensics, Atlanta (Vinson); University of Georgia School of Law, Athens (Dennis)
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Piat M, Wainwright M, Cherkas D, Leblanc S, Sofouli E, Rivest MP, Albert H, Casey R, O'Rourke JJ, Labonté L. Identifying and understanding the contextual factors that shaped mid-implementation outcomes during the COVID-19 pandemic in organizations implementing mental health recovery innovations into services. Implement Sci Commun 2021; 2:101. [PMID: 34526136 PMCID: PMC8441235 DOI: 10.1186/s43058-021-00206-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 08/25/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Seven housing and health services organizations were guided through a process of translating Chapter Six of the Canadian Guidelines for Recovery-Oriented Practice into a recovery-oriented innovation and plan for its implementation. At the time of the COVID-19 outbreak and lockdown measures, six of the seven organizations had begun implementing their chosen innovation (peer workers, wellness recovery action planning facilitator training, staff training and a family support group). This mid-implementation study used the Consolidated Framework for Implementation Research (CFIR) to identify contextual factors that influenced organizations to continue or postpone implementation of recovery-oriented innovations in the early months of the COVID-19 pandemic. METHODS Twenty-seven semi-structured 45-min interviews were conducted between May and June 2020 (21 implementation team members and six providers of the innovation (trainers, facilitators, peer workers). Interview guides and analysis were based on the CFIR. Content analysis combined deductive and inductive approaches. Summaries of coded data were given ratings based on strength and valence of the construct's impact on implementation. Ratings were visualized by mid-implementation outcome and recovery innovation to identify constructs which appear to distinguish between sites with a more or less favorable mid-implementation outcomes. RESULTS Four mid-implementation outcomes were observed at this snapshot in time (from most to least positive): continued implementation with adaptation (one site), postponement with adaptation and estimated relaunch date (four sites), indefinite postponement with no decision on relaunch date (one site), and no implementation of innovation yet (one site). Two constructs had either a negative influence (external policies and incentives-renamed COVID-19-related external policy for this study) or a positive influence (leadership engagement), regardless of implementation outcome. Four factors appeared to distinguish between more or less positive mid-implementation outcome: adaptability, implementation climate and relative priority, available resources, and formally appointed internal implementation leaders (renamed "engaging implementation teams during the COVID-19 pandemic" for this study). CONCLUSIONS The COVID-19 pandemic is an unprecedented outer setting factor. Studies that use the CFIR at the mid-implementation stage are rare, as are studies focusing on the outer setting. Through robust qualitative analysis, we identify the key factors that shaped the course of implementation of recovery innovations over this turbulent time.
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Affiliation(s)
- Myra Piat
- Department of Psychiatry, McGill University and Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada.
| | - Megan Wainwright
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK
| | - Danielle Cherkas
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, Ontario, M5S 1V4, Canada
| | - Sébastien Leblanc
- École de travail social, Université de Moncton, 18, avenue Antonine-Maillet, Moncton, Nouveau-Brunswick, E1A 3E9, Canada
| | - Eleni Sofouli
- Department of Psychiatry, McGill University, Ludmer Research & Training Building, 1033 Avenue des Pins, Montréal, QC, H3A 1A1, Canada
| | - Marie-Pier Rivest
- École de travail social, Université de Moncton, 18, avenue Antonine-Maillet, Moncton, Nouveau-Brunswick, E1A 3E9, Canada
| | - Hélène Albert
- École de travail social, Université de Moncton, 18, avenue Antonine-Maillet, Moncton, Nouveau-Brunswick, E1A 3E9, Canada
| | - Regina Casey
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, T-325, 2211 Westbrook Mall, Vancouver, British Columbia, V6T 2B5I, Canada
| | - Joseph J O'Rourke
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, The University of British Columbia, T-325, 2211 Westbrook Mall, Vancouver, British Columbia, V6T 2B5I, Canada
| | - Lise Labonté
- Douglas Mental Health University Institute, 6875, boul. LaSalle, Montréal, Québec, H4H 1R3, Canada
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Zurynski Y, Ellis LA, Tong HL, Laranjo L, Clay-Williams R, Testa L, Meulenbroeks I, Turton C, Sara G. Implementation of Electronic Medical Records in Mental Health Settings: Scoping Review. JMIR Ment Health 2021; 8:e30564. [PMID: 34491208 PMCID: PMC8456340 DOI: 10.2196/30564] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The success of electronic medical records (EMRs) is dependent on implementation features, such as usability and fit with clinical processes. The use of EMRs in mental health settings brings additional and specific challenges owing to the personal, detailed, narrative, and exploratory nature of the assessment, diagnosis, and treatment in this field. Understanding the determinants of successful EMR implementation is imperative to guide the future design, implementation, and investment of EMRs in the mental health field. OBJECTIVE We intended to explore evidence on effective EMR implementation for mental health settings and provide recommendations to support the design, adoption, usability, and outcomes. METHODS The scoping review combined two search strategies that focused on clinician-facing EMRs, one for primary studies in mental health settings and one for reviews of peer-reviewed literature in any health setting. Three databases (Medline, EMBASE, and PsycINFO) were searched from January 2010 to June 2020 using keywords to describe EMRs, settings, and impacts. The Proctor framework for implementation outcomes was used to guide data extraction and synthesis. Constructs in this framework include adoption, acceptability, appropriateness, feasibility, fidelity, cost, penetration, and sustainability. Quality assessment was conducted using a modified Hawker appraisal tool and the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. RESULTS This review included 23 studies, namely 12 primary studies in mental health settings and 11 reviews. Overall, the results suggested that adoption of EMRs was impacted by financial, technical, and organizational factors, as well as clinician perceptions of appropriateness and acceptability. EMRs were perceived as acceptable and appropriate by clinicians if the system did not interrupt workflow and improved documentation completeness and accuracy. Clinicians were more likely to value EMRs if they supported quality of care, were fit for purpose, did not interfere with the clinician-patient relationship, and were operated with readily available technical support. Evidence on the feasibility of the implemented EMRs was mixed; the primary studies and reviews found mixed impacts on documentation quality and time; one primary study found downward trends in adverse events, whereas a review found improvements in care quality. Five papers provided information on implementation outcomes such as cost and fidelity, and none reported on the penetration and sustainability of EMRs. CONCLUSIONS The body of evidence relating to EMR implementation in mental health settings is limited. Implementation of EMRs could benefit from methods used in general health settings such as co-designing the software and tailoring EMRs to clinical needs and workflows to improve usability and acceptance. Studies in mental health and general health settings rarely focused on long-term implementation outcomes such as penetration and sustainability. Future evaluations of EMRs in all settings should consider long-term impacts to address current knowledge gaps.
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Affiliation(s)
- Yvonne Zurynski
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Huong Ly Tong
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Luke Testa
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Isabelle Meulenbroeks
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.,National Health and Medical Research Council Partnership Centre for Health System Sustainability, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Charmaine Turton
- Information for Mental Health, System Information and Analytics Branch, New South Wales Ministry of Health, St Leonards, Australia
| | - Grant Sara
- Information for Mental Health, System Information and Analytics Branch, New South Wales Ministry of Health, St Leonards, Australia.,Northern Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
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Cervantes PE, Seag DE, Nelson KL, Purtle J, Hoagwood KE, Horwitz SM. Academic-Policy Partnerships in Evidence-Based Practice Implementation and Policy Maker Use of Child Mental Health Research. Psychiatr Serv 2021; 72:1076-1079. [PMID: 34139883 PMCID: PMC8410622 DOI: 10.1176/appi.ps.202000582] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Strategies are needed to improve policy makers' evidence-informed decision making and the availability of evidence-based, state-supported services. This study examined whether academic-policy partnerships could promote these outcomes. METHODS Data from two national surveys of state mental health agency representatives were used to compare barriers to implementation of evidence-based practices (EBPs) and policy makers' use of child mental health research in states with strong academic-policy partnerships in workforce training or in program implementation/evaluation (IE) with barriers in states with no or limited partnerships in these areas. RESULTS Strong IE partnerships were associated with more confidence in research use and fewer issues with provider readiness and capacity but with more issues with EBP fidelity. Strong training partnerships were associated with fewer endorsements of lack of time as a barrier to research use. CONCLUSIONS Academic-policy partnerships had some benefit for states' research use and EBP implementation. Because these partnerships may reduce barriers, further research should explore characteristics of effective collaborations.
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Affiliation(s)
- Paige E. Cervantes
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY
| | - Dana E.M. Seag
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY
| | - Katherine L. Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | | | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, NYU Langone Health, New York, NY
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Lui JHL, Brookman-Frazee L, Lind T, Le K, Roesch S, Aarons GA, Innes-Gomberg D, Pesanti K, Lau AS. Outer-context determinants in the sustainment phase of a reimbursement-driven implementation of evidence-based practices in children's mental health services. Implement Sci 2021; 16:82. [PMID: 34412666 PMCID: PMC8375074 DOI: 10.1186/s13012-021-01149-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although there is increasing investment to implement evidence-based practices (EBPs) in public systems across the USA, continued or sustained use of EBPs after initial implementation remains a challenge. The low integration of EBPs in routine practice severely limits their public health impact, highlighting the need to understand factors that affect the return on costly investments in EBP implementation. This study aims to (1) characterize trajectories of EBP delivery volume through a reimbursement-driven implementation and (2) examine impacts of system-level policy regulatory activity and state-level mental health services funding on the implementation reimbursement strategy. METHODS This study involved secondary data analyses. Psychotherapy administrative claims and regulatory site visit data from the Los Angeles County Department of Mental Health and California state mental health expenditures were extracted from 2010 to 2017. Multilevel regression examined EBP claims volume over time with state expenditures and regulatory compliance as predictors. RESULTS EBP claims volume trajectories demonstrated a rapid initial increase, followed by a period of decrease, and a small increase in the final year. State mental health expenditures increased across time reflecting increased funding availability. State mental health expenditures and system regulatory compliance were inversely related to EBP claims volume. CONCLUSIONS The impact of reimbursement-driven EBP implementation strategy is sensitive to multiple outer-context determinants. At the system level, commitment to fidelity of implementation regulations resulted in reduced use of the reimbursement strategy. Alternative reimbursement streams not tied to EBPs coupled with an expanded array of reimbursable services also impacted the use of the reimbursement strategy to implement EBPs.
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Affiliation(s)
- Joyce H L Lui
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA.
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Teresa Lind
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Kenny Le
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Scott Roesch
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychology, San Diego State University, San Diego, CA, USA
| | - Gregory A Aarons
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | | | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, CA, USA
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Snell-Rood C, Jaramillo ET, Hamilton AB, Raskin SE, Nicosia FM, Willging C. Advancing health equity through a theoretically critical implementation science. Transl Behav Med 2021; 11:1617-1625. [PMID: 33904908 PMCID: PMC8367016 DOI: 10.1093/tbm/ibab008] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
While implementation science is driven by theory, most implementation science theories, models, and frameworks (TMF) do not address issues of power, inequality, and reflexivity that are pivotal to achieving health equity. Theories used in anthropology address these issues effectively and could complement prevailing implementation science theories and constructs. We propose three broad areas of theory that complement and extend existing TMF in implementation science to advance health equity. First, theories of postcoloniality and reflexivity foreground attention to the role of power in knowledge production and to the ways that researchers and interventionists may perpetuate the inequalities shaping health. Second, theories of structural violence and intersectionality can help us to better understand the unequal burden of health disparities in the population, thereby encouraging researchers to think beyond single interventions to initiate partnerships that can impact overlapping health vulnerabilities and influence the upstream causes of vulnerability. Finally, theories of policy and governance encourage us to examine the social-political forces of the "outer context" crucial for implementation and sustainability. The incorporation of critical theories could enhance implementation science and foster necessary reflexivity among implementation scientists. We contend that a theoretically critical implementation science will promote better science and, more importantly, support progress toward health equity.
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Affiliation(s)
- Claire Snell-Rood
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Elise Trott Jaramillo
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, Albuquerque, NM, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah E Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesca M Nicosia
- Institute for Health & Aging, University of California, Integrative Health, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, Albuquerque, NM, USA
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A more practical guide to incorporating health equity domains in implementation determinant frameworks. Implement Sci Commun 2021; 2:61. [PMID: 34090524 PMCID: PMC8178842 DOI: 10.1186/s43058-021-00146-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 04/07/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Due to striking disparities in the implementation of healthcare innovations, it is imperative that researchers and practitioners can meaningfully use implementation determinant frameworks to understand why disparities exist in access, receipt, use, quality, or outcomes of healthcare. Our prior work documented and piloted the first published adaptation of an existing implementation determinant framework with health equity domains to create the Health Equity Implementation Framework. We recommended integrating these three health equity domains to existing implementation determinant frameworks: (1) culturally relevant factors of recipients, (2) clinical encounter or patient-provider interaction, and (3) societal context (including but not limited to social determinants of health). This framework was developed for healthcare and clinical practice settings. Some implementation teams have begun using the Health Equity Implementation Framework in their evaluations and asked for more guidance. METHODS We completed a consensus process with our authorship team to clarify steps to incorporate a health equity lens into an implementation determinant framework. RESULTS We describe steps to integrate health equity domains into implementation determinant frameworks for implementation research and practice. For each step, we compiled examples or practical tools to assist implementation researchers and practitioners in applying those steps. For each domain, we compiled definitions with supporting literature, showcased an illustrative example, and suggested sample quantitative and qualitative measures. CONCLUSION Incorporating health equity domains within implementation determinant frameworks may optimize the scientific yield and equity of implementation efforts by assessing and ideally addressing implementation and equity barriers simultaneously. These practical guidance and tools provided can assist implementation researchers and practitioners to concretely capture and understand barriers and facilitators to implementation disparities.
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Lengnick-Hall R, Stadnick NA, Dickson KS, Moullin JC, Aarons GA. Forms and functions of bridging factors: specifying the dynamic links between outer and inner contexts during implementation and sustainment. Implement Sci 2021; 16:34. [PMID: 33794956 PMCID: PMC8015179 DOI: 10.1186/s13012-021-01099-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 03/15/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Bridging factors are relational ties, formal arrangements, and processes that connect outer system and inner organizational contexts. They may be critical drivers of evidence-based practice (EBP) implementation and sustainment. Yet, the complex interplay between outer and inner contexts is often not considered. Bridging factors were recently defined in the updated Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Further identification and specification of this construct will advance implementation models, measures, and methods. Our goal is to advance bridging factor research by identifying relevant dimensions and exemplifying these dimensions through illustrative case studies. METHODS We used a multiple case study design. Each case (n = 10) represented different contexts, EBPs, and bridging factor types. Inclusion criteria were the presence of clearly distinguishable outer and inner contexts, identifiable bridging factor, sufficient information to describe how the bridging factor affected implementation, and variation from other cases. We used an iterative qualitative inquiry process to develop and refine a list of dimensions. Case data were entered into a matrix. Dimensions comprised the rows and case details comprised the columns. After a review of all cases, we collectively considered and independently coded each dimension as function or form. RESULTS We drew upon the concepts of functions and forms, a distinction originally proposed in the complex health intervention literature. Function dimensions help define the bridging factor and illustrate its purpose as it relates to EBP implementation. Form dimensions describe the specific structures and activities that illustrate why and how the bridging factor has been customized to a local implementation experience. Function dimensions can help researchers and practitioners identify the presence and purpose of bridging factors, whereas form dimensions can help us understand how the bridging factor may be designed or modified to support EBP implementation in a specific context. We propose five function and three form bridging factor dimensions. CONCLUSIONS Bridging factors are described in many implementation models and studies, but without explicit reference or investigation. Bridging factors are an understudied and critical construct that requires further attention to facilitate implementation research and practice. We present specific recommendations for a bridging factors research agenda.
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Affiliation(s)
| | - Nicole A. Stadnick
- Department of Psychiatry, University of California-San Diego, La Jolla, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
| | - Kelsey S. Dickson
- Child and Adolescent Services Research Center, San Diego, CA USA
- College of Education, San Diego State University, San Diego, CA USA
| | - Joanna C. Moullin
- Child and Adolescent Services Research Center, San Diego, CA USA
- Curtin Medical School, Curtin University, Perth, Western Australia
| | - Gregory A. Aarons
- Department of Psychiatry, University of California-San Diego, La Jolla, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA USA
- Child and Adolescent Services Research Center, San Diego, CA USA
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Hoagwood KE, Kelleher K, Counts NZ, Brundage S, Peth-Pierce R. Preventing Risk and Promoting Young Children's Mental, Emotional, and Behavioral Health in State Mental Health Systems. Psychiatr Serv 2021; 72:311-316. [PMID: 33167817 DOI: 10.1176/appi.ps.202000147] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early neural development and maternal health have critical long-term effects on children's mental health and outcomes later in life. As child mental disorders continue to rise nationwide, a number of states are considering new ways of investing in the critical early childhood period to prevent later poor outcomes and reduce the burden on the mental health system. Because most state mental health authorities (SMHAs) have no dedicated mental health dollars to devote to this early, crucial period of child development, building coalitions is key to implementing prevention and promotion programming. The authors describe two issues-coalition building and contractual considerations-that should be considered as SMHAs develop these types of policies or plan new prevention and promotion initiatives. Coalition building includes establishing the structural conditions for implementing a prevention or promotion initiative, resolving workforce issues (i.e., who will carry the program out), and engaging communities and families in the effort. Contractual considerations include establishing agreed-upon measures and metrics to monitor outcomes, assigning accountability for those outcomes, and delineating realistic time frames for these investments before expecting improved outcomes. The promise of moving services upstream to support early childhood development, to prevent mental health issues from derailing children's development, and to promote children's well-being are goals that are within reach.
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Affiliation(s)
- Kimberly Eaton Hoagwood
- Department of Child and Adolescent Psychiatry, New York University, New York (Hoagwood); Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Kelleher); Behavioral Health Innovation, Mental Health America, Alexandria, Virginia (Counts); Children's Health Initiative, United Hospital Fund, New York (Brundage); Public Health Communications Consulting, LLC, North Royalton, Ohio (Peth-Pierce)
| | - Kelly Kelleher
- Department of Child and Adolescent Psychiatry, New York University, New York (Hoagwood); Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Kelleher); Behavioral Health Innovation, Mental Health America, Alexandria, Virginia (Counts); Children's Health Initiative, United Hospital Fund, New York (Brundage); Public Health Communications Consulting, LLC, North Royalton, Ohio (Peth-Pierce)
| | - Nathaniel Z Counts
- Department of Child and Adolescent Psychiatry, New York University, New York (Hoagwood); Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Kelleher); Behavioral Health Innovation, Mental Health America, Alexandria, Virginia (Counts); Children's Health Initiative, United Hospital Fund, New York (Brundage); Public Health Communications Consulting, LLC, North Royalton, Ohio (Peth-Pierce)
| | - Suzanne Brundage
- Department of Child and Adolescent Psychiatry, New York University, New York (Hoagwood); Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Kelleher); Behavioral Health Innovation, Mental Health America, Alexandria, Virginia (Counts); Children's Health Initiative, United Hospital Fund, New York (Brundage); Public Health Communications Consulting, LLC, North Royalton, Ohio (Peth-Pierce)
| | - Robin Peth-Pierce
- Department of Child and Adolescent Psychiatry, New York University, New York (Hoagwood); Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio (Kelleher); Behavioral Health Innovation, Mental Health America, Alexandria, Virginia (Counts); Children's Health Initiative, United Hospital Fund, New York (Brundage); Public Health Communications Consulting, LLC, North Royalton, Ohio (Peth-Pierce)
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Determinants of using children's mental health research in policymaking: variation by type of research use and phase of policy process. Implement Sci 2021; 16:13. [PMID: 33468166 PMCID: PMC7815190 DOI: 10.1186/s13012-021-01081-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/07/2021] [Indexed: 01/24/2023] Open
Abstract
Background Research use in policymaking is multi-faceted and has been the focus of extensive study. However, virtually no quantitative studies have examined whether the determinants of research use vary according to the type of research use or phase of policy process. Understanding such variation is important for selecting the targets of implementation strategies that aim to increase the frequency of research use in policymaking. Methods A web-based survey of US state agency officials involved with children’s mental health policymaking was conducted between December 2019 and February 2020 (n = 224, response rate = 33.7%, 49 states responding (98%), median respondents per state = 4). The dependent variables were composite scores of the frequency of using children’s mental health research in general, specific types of research use (i.e., conceptual, instrumental, tactical, imposed), and during different phases of the policy process (i.e., agenda setting, policy development, policy implementation). The independent variables were four composite scores of determinants of research use: agency leadership for research use, agency barriers to research use, research use skills, and dissemination barriers (e.g., lack of actionable messages/recommendations in research summaries, lack of interaction/collaboration with researchers). Separate multiple linear regression models estimated associations between determinant and frequency of research use scores. Results Determinants of research use varied significantly by type of research use and phase of policy process. For example, agency leadership for research use was the only determinant significantly associated with imposed research use (β = 0.31, p < 0.001). Skills for research use were the only determinant associated with tactical research use (β = 0.17, p = 0.03) and were only associated with research use in the agenda-setting phase (β = 0.16, p = 0.04). Dissemination barriers were the most universal determinants of research use, as they were significantly and inversely associated with frequency of conceptual (β = −0.21, p = 0.01) and instrumental (β = −0.22, p = 0.01) research use and during all three phases of policy process. Conclusions Decisions about the determinants to target with policy-focused implementation strategies—and the strategies that are selected to affect these targets—should reflect the specific types of research use that these strategies aim to influence. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01081-8.
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Last BS, Schriger SH, Timon CE, Frank HE, Buttenheim AM, Rudd BN, Fernandez-Marcote S, Comeau C, Shoyinka S, Beidas RS. Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making. Implement Sci Commun 2021; 2:6. [PMID: 33431032 PMCID: PMC7802291 DOI: 10.1186/s43058-020-00105-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that TF-CBT clinicians complete TNs with only half of their clients, yet little is known about what determines TF-CBT clinicians' use of TNs. The behavioral insights literature-an interdisciplinary field studying judgment and decision-making-offers theoretical and empirical tools to conceptualize what drives complex human behaviors and decisions. Drawing from the behavioral insights literature, the present study seeks to understand what determines clinician use of TNs and to generate strategies that target these determinants. METHODS Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (N = 17) to understand their decisions to use TNs with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the "Easy Attractive Social Timely" framework, a behavioral insights design approach. RESULTS We generated and validated three broad themes about what determines clinician implementation of TNs: decision complexity, clinician affective experience, and agency norms. We hypothesized behavioral insights that underlie these implementation determinants and designed a list of nine corresponding behavioral insights strategies that may facilitate TN implementation. CONCLUSIONS Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.
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Affiliation(s)
- Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carter E Timon
- College of Liberal and Professional Studies, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah E Frank
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N Rudd
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Carrie Comeau
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Sosunmolu Shoyinka
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Rinad S Beidas
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, 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 Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Koriakin TA, McKee SL, Schwartz MB, Chafouleas SM. Development of a Comprehensive Tool for School Health Policy Evaluation: The WellSAT WSCC. THE JOURNAL OF SCHOOL HEALTH 2020; 90:923-939. [PMID: 33184889 DOI: 10.1111/josh.12956] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Stakeholders increasingly recognize the role of policy in implementing Whole School, Whole Community, Whole Child (WSCC) frameworks in schools; however, few tools are currently available to assess alignment between district policies and WSCC concepts. The purpose of this study was to expand the Wellness School Assessment Tool (WellSAT) for evaluation of policies related to all 10 domains of the WSCC model. METHODS Developing the WellSAT WSCC was an iterative process that involved (1) identifying items for each domain based on key concepts and best practice recommendations; (2) expert review of the draft measure; (3) cognitive pre-testing; (4) developing scoring criteria; and (5) pilot-testing the measure. RESULTS Ratings from expert reviewers indicated that the tool included items that were both relevant and important to each of the 10 WSCC domains. Results of cognitive pre-testing indicated that the items were understood as intended. Feedback from expert reviews, cognitive pre-testing, and pilot-testing was used to further revise and refine the measure and develop a final version of the tool. Acceptable interrater reliability was established for the final selection of items. CONCLUSIONS The WellSAT WSCC provides a reliable means for assessing integration and alignment between WSCC model concepts and district policies.
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Affiliation(s)
- Taylor A Koriakin
- Neag School of Education, University of Connecticut, 249 Glenbrook Road, Unit 3064, Storrs, CT, 06269
| | - Sarah L McKee
- Rudd Center for Obesity and Food Policy, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT, 06103
| | - Marlene B Schwartz
- Rudd Center for Obesity and Food Policy, University of Connecticut, 1 Constitution Plaza, Suite 600, Hartford, CT, 06103
| | - Sandra M Chafouleas
- Neag School of Education, University of Connecticut, 249 Glenbrook Road, Unit 3064, Storrs, CT, 06269
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Caton L, Yuan M, Louie D, Gallo C, Abram K, Palinkas L, Brown CH, McGovern M. The prospects for sustaining evidence-based responses to the US opioid epidemic: state leadership perspectives. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:84. [PMID: 33148283 PMCID: PMC7640430 DOI: 10.1186/s13011-020-00326-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The US 21st Century Cures Act provided $7.5 billion in grant funding to states and territories for evidence-based responses to the opioid epidemic. Currently, little is known about optimal strategies for sustaining these programs beyond this start-up funding. METHODS Using an inductive, conventional content analysis, we conducted key informant interviews with former and current state leaders (n = 16) about barriers/facilitators to sustainment and strategies for sustaining time-limited grants. RESULTS Financing and reimbursement, service integration, and workforce capacity were the most cited barriers to sustainment. Status in state government structure, public support, and spending flexibility were noted as key facilitators. Effective levers to increase chances for sustainment included strong partnerships with other state agencies, workforce and credentialing changes, and marshalling advocacy through public awareness campaigns. CONCLUSIONS Understanding the strategies that leaders have successfully used to sustain programs in the past can inform how to continue future time-limited, grant-funded initiatives.
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Affiliation(s)
- Lauren Caton
- Center for Behavioral Health Services and Implementation Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mina Yuan
- Center for Behavioral Health Services and Implementation Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Dexter Louie
- Center for Behavioral Health Services and Implementation Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Carlos Gallo
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Karen Abram
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lawrence Palinkas
- Department of Children, Youth and Families, Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
| | - C Hendricks Brown
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Mark McGovern
- Center for Behavioral Health Services and Implementation Research, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Palo Alto, CA, USA. .,Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA.
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Hoagwood KE, Purtle J, Spandorfer J, Peth-Pierce R, Horwitz SM. Aligning dissemination and implementation science with health policies to improve children's mental health. AMERICAN PSYCHOLOGIST 2020; 75:1130-1145. [PMID: 33252950 PMCID: PMC8034490 DOI: 10.1037/amp0000706] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The prevalence of mental health problems among children (ages 0-21) in the United States remains unacceptably high and, post-COVID-19, is expected to increase dramatically. Decades of psychological knowledge about effective treatments should inform the delivery of better services. Dissemination and implementation (D&I) science has been heralded as a solution to the persistent problem of poor quality services and has, to some extent, improved our understanding of the contexts of delivery systems that implement effective practices. However, there are few studies demonstrating clear, population-level impacts of psychological interventions on children. Momentum is growing among communities, cities, states, and some federal agencies to build "health in all policies" to address broad familial, social, and economic factors known to affect children's healthy development and mental health. These health policy initiatives offer a rare opportunity to repurpose D&I science, shifting it from a primary focus on evidence-based practice implementation, to a focus on policy development and implementation to support child and family health and well-being. This shift is critical as states develop policy responses to address the health and mental health impacts of the COVID-19 pandemic on already-vulnerable families. We provide a typology for building research on D&I and children's mental health policy. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University
| | - Julia Spandorfer
- Department of Child and Adolescent Psychiatry, New York University Langone Health
| | | | - Sarah McCue Horwitz
- Department of Child and Adolescent Psychiatry, New York University Langone Health
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Cooper HL, Cloud DH, Freeman PR, Fadanelli M, Green T, Van Meter C, Beane S, Ibragimov U, Young AM. Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102701. [PMID: 32223985 PMCID: PMC7529684 DOI: 10.1016/j.drugpo.2020.102701] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/24/2020] [Accepted: 02/16/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Buprenorphine is a cornerstone to curbing opioid epidemics, but emerging data suggest that rural pharmacists in the US sometimes refuse to dispense this medication. We conducted a case study to explore buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, and analyze whether and how they were shaped by features of the rural risk environment. METHODS In this case study, we conducted one-on-one semi-structured interviews with 14 pharmacists operating 15 pharmacies in these counties to explore buprenorphine dispensing practices and perceived influences on these practices. Thematic analyses of the resulting transcripts revealed three features of the rural risk environment that shaped dispensing. To explore these three risk environment features, we analyzed policy documents (e.g., Attorney General lawsuits) and administrative databases (e.g., incarceration data). Textual documents were analyzed using thematic analyses and administrative data were analyzed using descriptive statistics; memoes explored relationships among risk environment features and dispensing practices. RESULTS Twelve of the 15 pharmacies limited dispensing, by refusing to serve new patients; limiting dispensing to known patients or prescribers; or refusing to dispense buprenorphine altogether. Concerns about exceeding a "Drug Enforcement Administration (DEA) cap" on opioid dispensing stifled dispensing. A legacy of aggressive and fraudulent marketing of opioid analgesics (OAs) by pharmaceutical companies and physician OA overprescribing undermined pharmacist trust in buprenorphine and in its prescribers. The escalating local war on drugs may have undermined dispensing by reinforcing stigma against people who use drugs. CONCLUSIONS Initiatives to increase buprenorphine prescribing must be accompanied by policy changes to increase dispensing. Specifically, buprenorphine should be removed from opioid monitoring systems; efforts to de-escalate the war on drugs should be extended to encompass rural areas; initiatives to dismantle aggressive OA marketing should be strengthened; and efforts to re-build pharmacist trust in physicians are needed.
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Affiliation(s)
| | - David H Cloud
- Emory University Rollins School of Public Health, Atlanta GA
| | | | | | - Travis Green
- University of Kentucky College of Public Health, Lexington KY
| | | | - Stephanie Beane
- Emory University Rollins School of Public Health, Atlanta GA
| | | | - April M Young
- University of Kentucky College of Public Health, Lexington KY
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Purtle J, Nelson KL, Bruns EJ, Hoagwood KE. Dissemination Strategies to Accelerate the Policy Impact of Children's Mental Health Services Research. Psychiatr Serv 2020; 71:1170-1178. [PMID: 32517640 PMCID: PMC9721469 DOI: 10.1176/appi.ps.201900527] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The United States is in the midst of a children's mental health crisis, with rates of depression, anxiety, and suicide increasing precipitously. Evidence produced by children's mental health services research can help address this crisis by informing public policy decisions about service delivery, system design, and investments in the social determinants of mental health. Unfortunately, the policy impact of children's mental health services research is limited because evidence often fails to reach policy makers, be responsive to their needs, resonate with their worldview, or reflect the contexts in which they make decisions. Dissemination strategies-defined as the development and targeted distribution of messages and materials about research evidence pertaining to a specific issue or intervention-can help address these challenges. Yet, limited integrated guidance exists to inform the design of such strategies. This article addresses this need by synthesizing the results of empirical studies to provide guidance about how to enhance the dissemination of children's mental health services research to policy makers. The article provides four recommendations about the content of policy maker-focused dissemination materials, discusses how strategic framing and message tailoring can increase the chances that evidence is persuasive to policy makers, and highlights strategies to ensure that evidence reaches policy makers.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Bruns); Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York (Hoagwood)
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Bruns); Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York (Hoagwood)
| | - Eric J Bruns
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Bruns); Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York (Hoagwood)
| | - Kimberly E Hoagwood
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia (Purtle, Nelson); Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle (Bruns); Department of Child and Adolescent Psychiatry, New York University Langone School of Medicine, New York (Hoagwood)
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Ibragimov U, Young AM, Cooper HLF. Understanding rural risk environments for drug-related harms: Progress, challenges, and steps forward. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 85:102926. [PMID: 32912825 PMCID: PMC8215764 DOI: 10.1016/j.drugpo.2020.102926] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Umedjon Ibragimov
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States.
| | - April M Young
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Hannah L F Cooper
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Bond GR, Johnson-Kwochka AV, Pogue JA, Langfitt Reese S, Becker DR, Drake RE. A Tale of Four States: Factors Influencing the Statewide Adoption of IPS. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:528-538. [PMID: 32978711 DOI: 10.1007/s10488-020-01087-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2020] [Indexed: 11/30/2022]
Abstract
Evidence-based supported employment has become a core community mental health service in much of the U.S. Although a national learning community has facilitated progress in about half of the states, other states have tried to implement evidence-based supported employment on their own. Many studies have examined site-level factors influencing implementation of supported employment, but few have focused on the role of state agency policies and actions. This study examined four states that have not joined the learning community, comparing two that have implemented with success (adopting states) and two that have faced challenges (non-adopting states). This comparative case study approach compared barriers, facilitators, and strategies in two states adopting IPS to two states that did not. The authors examined quantitative data from public records and conducted content analysis of qualitative and quantitative data from key informant interviews. The two non-adopting states lacked model clarity, funding, focus on people with serious mental illness, and collaboration between state mental health and vocational rehabilitation agencies. The two successful states experienced similar barriers but overcame them following lawsuit settlements that required implementation of evidence-based supported employment. Key strategies for successful implementation were funding, fidelity monitoring, technical assistance, and collaboration between state mental health and vocational rehabilitation agencies. With legal settlements serving as the catalyst, states facing challenges to implementing evidence-based supported employment can achieve success using standard implementation strategies to fund and ensure the quality of services.
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Affiliation(s)
- Gary R Bond
- IPS Employment Center and Westat, Lebanon, NH, USA.
- Westat, Rivermill Commercial Center, 85 Mechanic Street, Suite C-3, Lebanon, NH, 03766, USA.
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Scholl I, Kobrin S, Elwyn G. "All about the money?" A qualitative interview study examining organizational- and system-level characteristics that promote or hinder shared decision-making in cancer care in the United States. Implement Sci 2020; 15:81. [PMID: 32957962 PMCID: PMC7507661 DOI: 10.1186/s13012-020-01042-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 09/07/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Despite decades of ethical, empirical, and policy support, shared decision-making (SDM) has failed to become standard practice in US cancer care. Organizational and health system characteristics appear to contribute to the difficulties in implementing SDM in routine care. However, little is known about the relevance of the different characteristics in specific healthcare settings. The aim of the study was to explore how organizational and health system characteristics affect SDM implementation in US cancer care. METHODS We conducted semi-structured interviews with diverse cancer care stakeholders in the USA. Of the 36 invited, 30 (83%) participants consented to interview. We used conventional content analysis to analyze transcript content. RESULTS The dominant theme in the data obtained was that concerns regarding a lack of revenue generation, or indeed, the likely loss of revenue, were a major barrier preventing implementation of SDM. Many other factors were prominent as well, but the view that SDM might impair organizational or individual profit margins and reduce the income of some health professionals was widespread. On the organizational level, having leadership support for SDM and multidisciplinary teams were viewed as critical to implementation. On the health system level, views diverged on whether embedding tools into electronic health records (EHRs), making SDM a criterion for accreditation and certification, and enacting legislation could promote SDM implementation. CONCLUSION Cancer care in the USA has currently limited room for SDM and is prone to paying lip service to the idea. Implementation efforts in US cancer care need to go further than interventions that target only the clinician-patient level. On a policy level, SDM could be included in alternative payment models. However, its implementation would need to be thoroughly assessed in order to prevent further misdirected incentivization through box ticking.
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Affiliation(s)
- Isabelle Scholl
- Dartmouth College, The Dartmouth Institute for Health Policy & Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA.
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, W26, 20246, Hamburg, Germany.
| | - Sarah Kobrin
- Healthcare Delivery Research Program, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA
| | - Glyn Elwyn
- Dartmouth College, The Dartmouth Institute for Health Policy & Clinical Practice, Level 5, Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH, 03756, USA
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Cooper HLF. Prescription Drug Monitoring Programs and Overdoses: Advancing the Next Generation of Research. Am J Public Health 2020; 110:1450-1451. [PMID: 32903090 DOI: 10.2105/ajph.2020.305860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Hannah L F Cooper
- The author is with the Rollins School of Public Health, Emory University, Atlanta, GA
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Establishing cross-systems collaborations for implementation: protocol for a longitudinal mixed methods study. Implement Sci 2020; 15:55. [PMID: 32677987 PMCID: PMC7364639 DOI: 10.1186/s13012-020-01016-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Background Cross-system interventions can help integrate services across different service delivery systems but require organizations to establish strong collaborative relationships for implementation. Contingency theory suggests that the effectiveness of different collaborative strategies (i.e. specific ways organizations align operations and services) varies by context. This paper describes a study of different strategies for fostering collaboration between child welfare and substance abuse treatment agencies and the conditions under which they are effective for implementation. We also describe the development and piloting of the Collaborating Across Systems for Program Implementation (CASPI) tool—a decision-making guide intended to help researchers and organizational leaders identify and use appropriate collaborative strategies for their context. Methods/design This multisite longitudinal, mixed methods study, leverages a naturally occurring implementation initiative -- in up to 17 Ohio counties -- to implement Ohio START (Sobriety Treatment and Reducing Trauma). START is a child welfare model that requires strong collaboration with local substance use treatment organizations to promote integrated services. During the first two years, we will identify collaborative strategies associated with improved START implementation (penetration and fidelity) and service delivery outcomes (timeliness), given system, and organizational features. We will conduct a convergent mixed methods study drawing on worker surveys, agency documents, administrative data, formal partner agreements, and group interviews. Data will be integrated and analyzed using Qualitative Comparative Analysis (QCA). To develop the CASPI, an expert panel comprised of implementation experts, and community stakeholders will convene to synthesize our findings and develop contents (including a decision tree). During the final year of the study, we will assess the acceptability, appropriateness, and feasibility of the CASPI in a randomized vignette experiment, and a pilot-test with 3 child welfare agencies that have not yet implemented START. Discussion Our results will lay the groundwork for a larger controlled trial that will test the CASPI’s effectiveness for supporting effective and efficient implementation of cross-system interventions like START. The CASPI is expected to help leaders and researchers select and use collaboration strategies tailored to their context and be applicable in a wide range of settings including rural communities. Our work also advances system-level implementation strategies. Trial registration NCT03931005, Registered April 29, 2019.
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Connors EH, Douglas S, Jensen-Doss A, Landes SJ, Lewis CC, McLeod BD, Stanick C, Lyon AR. What Gets Measured Gets Done: How Mental Health Agencies can Leverage Measurement-Based Care for Better Patient Care, Clinician Supports, and Organizational Goals. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:250-265. [PMID: 32656631 DOI: 10.1007/s10488-020-01063-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mental health clinicians and administrators are increasingly asked to collect and report treatment outcome data despite numerous challenges to select and use instruments in routine practice. Measurement-based care (MBC) is an evidence-based practice for improving patient care. We propose that data collected from MBC processes with patients can be strategically leveraged by agencies to also support clinicians and respond to accountability requirements. MBC data elements are outlined using the Precision Mental Health Framework (Bickman et al. in Adm Policy Mental Health Mental Health Serv Res 43:271-276, 2016), practical guidance is provided for agency administrators, and conceptual examples illustrate strategic applications of one or more instruments to meet various needs throughout the organization.
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Affiliation(s)
- Elizabeth H Connors
- Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT, 06511, USA.
| | - Susan Douglas
- Department of Leadership, Policy and Organizations, Vanderbilt University, 230 Appleton Place, Nashville, TN, 37203, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124, USA
| | - Sara J Landes
- VISN 16 Mental Illness Research, Education, and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114, USA
- Department of Psychiatry, University of Arkansas for Medical Sciences, 4301 W. Markham St, Little Rock, AR, 72205, USA
| | - Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
| | - Bryce D McLeod
- Department of Psychology, Virginia Commonwealth University, 806 W. Franklin Street, PO Box 842018, Richmond, VA, 23284, USA
| | - Cameo Stanick
- Clinical Practice, Training, and Research and Evaluation, Hathaway-Sycamores Child and Family Services, 100 W. Walnut Street, Ste #375, Pasadena, CA, 91124, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, 6200 NE 74th Street, Suite 100, Seattle, WA, 98115, USA
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Graaf G, Snowden L. State Strategies for Enhancing Access and Quality in Systems of Care for Youth with Complex Behavioral Health Needs. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:185-200. [PMID: 32638137 DOI: 10.1007/s10488-020-01061-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The investigators conducted a qualitative study with state administrators and policymakers about the financing and policies that structure public systems of care for children with complex behavioral healthcare needs. The objective was to characterize diverse strategies states employed to enhance funding for, access to, and quality and effectiveness of home and community-based services (HCBS) for these youth. States report using a wide variety of creative solutions while navigating the unique needs and constraints of their political and economic environments. Findings can benefit public officials, researchers, and advocates by advancing knowledge-sharing of public policy-making and resourceful problem-solving.
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Affiliation(s)
- Genevieve Graaf
- School of Social Work, University of Texas At Arlington, Social Work Complex - A, 112D, 211 South Cooper Street, Box 19129, Arlington, TX, 76019, USA.
| | - Lonnie Snowden
- School of Public Health, University of California, Berkeley, USA
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Lengnick-Hall R, Willging C, Hurlburt M, Fenwick K, Aarons GA. Contracting as a bridging factor linking outer and inner contexts during EBP implementation and sustainment: a prospective study across multiple U.S. public sector service systems. Implement Sci 2020; 15:43. [PMID: 32527274 PMCID: PMC7288508 DOI: 10.1186/s13012-020-00999-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 05/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bridging factors are relational ties (e.g. partnerships), formal arrangements (e.g. contracts or polices) and processes (e.g. data sharing agreements) linking outer and inner contexts and are a recent evolution of the Exploration-Preparation-Implementation-Sustainment (EPIS) framework. Bridging factor research can elucidate ways that service systems may influence and/or be influenced by organizations providing health services. This study used the EPIS framework and open systems and resource dependence theoretical approaches to examine contracting arrangements in U.S. public sector systems. Contracting arrangements function as bridging factors through which systems communicate, interact, and exchange resources with the organizations operating within them. METHODS The sample included 17 community-based organizations in eight service systems. Longitudinal data is derived from 113 contract documents and 88 qualitative interviews and focus groups involving system and organizational stakeholders. Analyses consisted of a document review using content analysis and focused coding of transcripts from the interviews and focus groups. A multiple case study analysis was conducted to identify patterns across service systems and organizations. The dataset represented service systems that had sustained the same EBP for between 2 and 10 years, which allowed for observation of bridging factors and outer-inner context interactions over time. RESULTS Service systems and organizations influenced each other in a number of ways through contracting arrangements. Service systems influenced organizations when contracting arrangements resulted in changes to organizational functioning, required organizational responses to insufficient funding, and altered interorganizational network relationships. Organizations influenced service systems when contract arrangements prompted organization-driven contract negotiation/tailoring, changes to system-level processes, and interorganizational collaboration. Service systems and organizations were dependent on each other as implementation progressed. Resources beyond funding emerged, including adequate numbers of eligible clients, expertise in the evidence-based practice, and training and coaching capacity. CONCLUSION This study advances implementation science by expanding the range and definition of bridging factors and illustrating specific bi-directional influences between outer context service systems and inner context organizations. This study also identifies bi-directional dependencies over the course of implementation and sustainment. An analysis of influence, dependencies, and resources exchanged through bridging factors has direct implications for selecting and tailoring implementation strategies, especially those that require system-level coordination and change.
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Affiliation(s)
| | | | - Michael Hurlburt
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Karissa Fenwick
- VA Greater Los Angeles Healthcare System, 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 (UC San Diego-DISC), La Jolla, CA USA
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