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Friedman NR, Watkins L, Barnard-Brak L, Barber A, White SW. De-implementation of Low-Value Practices for Autism Spectrum Disorder. Clin Child Fam Psychol Rev 2023; 26:690-705. [PMID: 37452164 DOI: 10.1007/s10567-023-00447-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 07/18/2023]
Abstract
Due to a variety of factors, Autism Spectrum Disorder (ASD) has long been tethered to use of low-value practice (LVP), arguably moreso than any other psychiatric or neurodevelopmental condition. Although dissemination of empirically supported treatments (EST) for autistic individuals has expanded markedly over the past decade, there has not been concomitant reduction in the use of LVP. It is critical that clinicians and scientists not only promote the implementation of EST, but also facilitate the de-implementation (abandonment and/or divestment) of ineffective or harmful practices. In this review, we describe a data-driven approach that can be used to identify LVP, drawing from established criteria for identification of evidence-based treatments (e.g., APA Division 12, National Clearinghouse on Autism Evidence and Practice; SAMHSA), as well as broader considerations such as social validity, cost, and parsimony. Herein, a data-based approach to LVP identification is proposed with a goal of improving quality of service access. Within an implementation science framework, we identify specific facilitators that sustain LVP use, and recommendations for subsequent de-implementation strategies are offered.
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Affiliation(s)
- Nicole R Friedman
- Center for Youth Development and Intervention, University of Alabama, 101 McMillan Bldg, Box 870348, Tuscaloosa, AL, 35487, USA
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Laci Watkins
- Department of Special Education, University of Alabama, Tuscaloosa, AL, USA
- Department of Educational Psychology, Texas A&M University, College Station, TX, USA
| | - Lucy Barnard-Brak
- Department of Special Education, University of Alabama, Tuscaloosa, AL, USA
| | - Angela Barber
- Department of Communication Sciences and Disorders, Samford University, Birmingham, AL, USA
| | - Susan W White
- Center for Youth Development and Intervention, University of Alabama, 101 McMillan Bldg, Box 870348, Tuscaloosa, AL, 35487, USA.
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA.
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2
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Rabin BA, Cain KL, Watson P, Oswald W, Laurent LC, Meadows AR, Seifert M, Munoz FA, Salgin L, Aldous J, Diaz EA, Villodas M, Vijaykumar S, O'Leary ST, Stadnick NA. Scaling and sustaining COVID-19 vaccination through meaningful community engagement and care coordination for underserved communities: hybrid type 3 effectiveness-implementation sequential multiple assignment randomized trial. Implement Sci 2023; 18:28. [PMID: 37443044 DOI: 10.1186/s13012-023-01283-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND COVID-19 inequities are abundant in low-income communities of color. Addressing COVID-19 vaccine hesitancy to promote equitable and sustained vaccination for underserved communities requires a multi-level, scalable, and sustainable approach. It is also essential that efforts acknowledge the broader healthcare needs of these communities including engagement in preventive services. METHODS This is a hybrid type 3 effectiveness-implementation study that will include a multi-level, longitudinal, mixed-methods data collection approach designed to assess the sustained impact of a co-created multicomponent strategy relying on bidirectional learning, shared decision-making, and expertise by all team members. The study capitalizes on a combination of implementation strategies including mHealth outreach with culturally appropriate messaging, care coordination to increase engagement in high priority preventive services, and the co-design of these strategies using community advisory boards led by Community Weavers. Community Weavers are individuals with lived experience as members of an underserved community serving as cultural brokers between communities, public health systems, and researchers to co-create community-driven, culturally sensitive public health solutions. The study will use an adaptive implementation approach operationalized in a sequential multiple assignment randomized trial design of 300 participants from three sites in a Federally Qualified Health Center in Southern California. This design will allow examining the impact of various implementation strategy components and deliver more intensive support to those who benefit from it most. The primary effectiveness outcomes are COVID-19 vaccine completion, engagement in preventive services, and vaccine confidence. The primary implementation outcomes are reach, adoption, implementation, and maintenance of the multicomponent strategy over a 12-month follow-up period. Mixed-effects logistic regression models will be used to examine program impacts and will be triangulated with qualitative data from participants and implementers. DISCUSSION This study capitalizes on community engagement, implementation science, health equity and communication, infectious disease, and public health perspectives to co-create a multicomponent strategy to promote the uptake of COVID-19 vaccination and preventive services for underserved communities in San Diego. The study design emphasizes broad engagement of our community and clinic partners leading to culturally sensitive and acceptable strategies to produce lasting and sustainable increases in vaccine equity and preventive services engagement. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05841810 May 3, 2023.
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Affiliation(s)
- Borsika A Rabin
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA.
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, La Jolla, CA, USA.
| | - Kelli L Cain
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Paul Watson
- The Global Action Research Center, San Diego, CA, USA
| | | | - Louise C Laurent
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
| | - Audra R Meadows
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, CA, USA
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Marva Seifert
- Department of Medicine, University of California San Diego, La Jolla, CA, USA
| | | | | | | | | | - Miguel Villodas
- Department of Psychology, San Diego State University, CA, San Diego, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Santosh Vijaykumar
- Department of Psychology, Northumbria University, Newcastle Upon Tyne, UK
| | - Sean T O'Leary
- Department of Pediatrics-Infectious Diseases, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Nicole A Stadnick
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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3
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Linsao AW, McKiernan PM, Morgan SM. Mental health providers' perceptions of competency when working with autistic children with co-occurring mental health diagnoses. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:2026-2034. [PMID: 36609698 DOI: 10.1002/jcop.22994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/19/2022] [Accepted: 12/27/2022] [Indexed: 06/14/2023]
Abstract
Psychotherapy research has long focused on provider competence and treatment efficacy. Mental health providers treat diverse client populations with varying, complex needs. Though estimates vary, the rate of children diagnosed with autism and a co-occurring psychiatric disorder is relatively high. While behavioral approaches to treatment have been established as the gold standard, talk-based therapies are increasingly common, and a broader range of providers are treating this population. There are gaps in the literature regarding empirically supported, targeted approaches, and provider sense of competency in addressing complex needs. The aim of this secondary qualitative analysis was to gain further insights into mental health providers' experiences of psychotherapy with autistic children with a cooccurring diagnosis. Eleven licensed clinicians participated in semistructured interviews. The following themes emerged: perception of competency, complex needs, and family involvement. Recommendations for a collaborative approach, increased opportunities for training, and standardized, targeted assessments and treatment protocols were made.
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Affiliation(s)
- Amy W Linsao
- School of Behavioral Sciences, California Southern University, Chandler, Arizona, USA
| | - Patrick M McKiernan
- School of Behavioral Sciences, California Southern University, Chandler, Arizona, USA
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4
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Martinez K, Lane E, Hernandez V, Lugo E, Muñoz FA, Sahms T, Broder-Fingert S, Barnett M, Stadnick NA. Optimizing ATTAIN implementation in a federally qualified health center guided by the FRAME-IS. AMERICAN PSYCHOLOGIST 2023; 78:82-92. [PMID: 37011161 PMCID: PMC10071441 DOI: 10.1037/amp0001077] [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: 04/05/2023]
Abstract
Implementation strategies are methods or techniques used to adopt, implement, and sustain evidence-based practices (EBPs). Implementation strategies are dynamic and may require adaptation to fit implementation contexts, especially in low-resource settings, which are most likely to serve racially and ethnically diverse patients. The framework for reporting adaptations and modifications to evidence-based implementation strategies (FRAME-IS) was used to document adaptations to implementation strategies to inform an optimization pilot of Access to Tailored Autism Integrated Care (ATTAIN; an integrated care model for children with autism and co-occurring mental health needs) in a federally qualified health center (FQHC) near the United States/Mexico border. Quantitative and qualitative data were collected from 36 primary care providers who participated in the initial ATTAIN feasibility pilot to inform adaptations. Adaptations were mapped to the FRAME-IS through an iterative template analysis to inform an optimization pilot at a FQHC 1-year from the start of the COVID-19 pandemic. Four implementation strategies (training and workflow reminders, provider/clinic champions, periodic reflections, and technical assistance) were employed during the feasibility pilot and were adapted for the optimization pilot to fit the needs of the FQHC and service delivery changes prompted by the pandemic. Findings demonstrate the utility of using the FRAME-IS to systematically inform EBP optimization in a FQHC providing care to underserved communities. Findings will inform future research studies implementing integrated mental health models in low-resourced primary care settings. Implementation outcomes and provider perceptions of ATTAIN at the FQHC are also reported. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Kassandra Martinez
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
- Child and Adolescent Services Research Center, San Diego, California
| | - Elizabeth Lane
- Child and Adolescent Services Research Center, San Diego, California
- University of California, San Diego, Department of Psychiatry
| | | | | | | | - Timothy Sahms
- San Ysidro Health, San Diego, California
- University of California, San Diego, Department of Pediatrics
| | | | - Miya Barnett
- University of California, Santa Barbara, Department of Clinical, Counseling, & School Psychology
| | - Nicole A. Stadnick
- San Diego State University/University of California, San Diego Joint Doctoral Program in Clinical Psychology
- Child and Adolescent Services Research Center, San Diego, California
- University of California, San Diego, Department of Psychiatry
- University of California, San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center
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5
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Stadnick NA, Aarons GA, Martinez K, Sklar M, Coleman KJ, Gizzo DP, Lane E, Kuelbs CL, Brookman-Frazee L. Implementation outcomes from a pilot of "Access to Tailored Autism Integrated Care" for children with autism and mental health needs. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1821-1832. [PMID: 35083919 PMCID: PMC9325918 DOI: 10.1177/13623613211065801] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Children with autism frequently experience co-occurring mental health needs. The "Access to Tailored Autism Integrated Care (ATTAIN)" model was co-created with caregivers, pediatric providers, and health care leaders to identify mental health needs and link to mental health care for autistic children. This article describes outcomes from a pilot study of Access to Tailored Autism Integrated Care with 36 pediatric primary care providers from seven clinics within three healthcare systems. Providers participated in an initial Access to Tailored Autism Integrated Care training and received ongoing online support over 4 months with autistic patients ages 4-16 years old. Survey and interview assessments measured provider perceptions of feasibility, acceptability, and intentions to continue using Access to Tailored Autism Integrated Care after the pilot. Providers reported that Access to Tailored Autism Integrated Care was feasible, acceptable, that the initial training was helpful in their implementation but that more specific and tailored implementation support was needed. Results show that Access to Tailored Autism Integrated Care is a promising model to support mental health screening and linkage for children with autism in primary care. Findings provide information on specific areas of the Access to Tailored Autism Integrated Care model that could be benefit from additional refinement to support more widespread use in primary care settings.
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Affiliation(s)
- Nicole A Stadnick
- University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute CA, Dissemination and Implementation Science Center, USA
- Child and Adolescent Services Research Center, USA
| | - Gregory A Aarons
- University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute CA, Dissemination and Implementation Science Center, USA
- Child and Adolescent Services Research Center, USA
| | - Kassandra Martinez
- Child and Adolescent Services Research Center, USA
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, USA
| | - Marisa Sklar
- University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute CA, Dissemination and Implementation Science Center, USA
- Child and Adolescent Services Research Center, USA
| | | | | | - Elizabeth Lane
- University of California San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, USA
| | - Cynthia L Kuelbs
- University of California San Diego, La Jolla, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
| | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, CA, USA
- UC San Diego Altman Clinical and Translational Research Institute CA, Dissemination and Implementation Science Center, USA
- Child and Adolescent Services Research Center, USA
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6
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Ng-Cordell E, Rai A, Peracha H, Garfield T, Lankenau SE, Robins DL, Berkowitz SJ, Newschaffer C, Kerns CM. A Qualitative Study of Self and Caregiver Perspectives on How Autistic Individuals Cope With Trauma. Front Psychiatry 2022; 13:825008. [PMID: 35911211 PMCID: PMC9329569 DOI: 10.3389/fpsyt.2022.825008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 06/15/2022] [Indexed: 11/23/2022] Open
Abstract
Background Coping can moderate the relationship between trauma exposure and trauma symptoms. There are many conceptualisations of coping in the general population, but limited research has considered how autistic individuals cope, despite their above-average rates of traumatic exposure. Objectives To describe the range of coping strategies autistic individuals use following traumatic events. Methods Fourteen autistic adults and 15 caregivers of autistic individuals, recruited via stratified purposive sampling, completed semi-structured interviews. Participants were asked to describe how they/their child attempted to cope with events they perceived as traumatic. Using an existing theoretical framework and reflexive thematic analysis, coping strategies were identified, described, and organized into themes. Results Coping strategies used by autistic individuals could be organized into 3 main themes: (1) Engaging with Trauma, (2) Disengaging from Trauma, and (3) Self-Regulatory Coping. After the three main themes were developed, a fourth integrative theme, Diagnostic Overshadowing, was created to capture participants' reports of the overlap or confusion between coping and autism-related behaviors. Conclusions Autistic individuals use many strategies to cope with trauma, many of which are traditionally recognized as coping, but some of which may be less easily recognized given their overlap with autism-related behaviors. Findings highlight considerations for conceptualizing coping in autism, including factors influencing how individuals cope with trauma, and how aspects of autism may shape or overlap with coping behavior. Research building on these findings may inform a more nuanced understanding of how autistic people respond to adversity, and how to support coping strategies that promote recovery from trauma.
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Affiliation(s)
- Elise Ng-Cordell
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Anika Rai
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Hira Peracha
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Tamara Garfield
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | - Stephen E. Lankenau
- Department of Community Health and Prevention, School of Public Health, Drexel University, Philadelphia, PA, United States
| | - Diana L. Robins
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | | | - Craig Newschaffer
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
| | - Connor M. Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
- A. J. Drexel Autism Institute, Drexel University, Philadelphia, PA, United States
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7
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Han GT, Trevisan DA, Abel EA, Cummings EM, Carlos C, Bagdasarov A, Kala S, Parker T, Canapari C, McPartland JC. Associations between sleep problems and domains relevant to daytime functioning and clinical symptomatology in autism: A meta-analysis. Autism Res 2022; 15:1249-1260. [PMID: 35635067 DOI: 10.1002/aur.2758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/25/2022] [Indexed: 12/16/2022]
Abstract
Autistic individuals experience significantly higher rates of sleep problems compared to the general population, which negatively impacts various aspects of daytime functioning. The strength of associations across domains of functioning has not yet been summarized across studies. The present meta-analysis examined the strength of associations between sleep problems and various domains of daytime functioning in autistic individuals. Searches were conducted in EMBASE, PubMed, Web of Science, and Google Scholar through May 2020. Inclusion criteria were: an index of sleep disturbance in individuals diagnosed with autism spectrum disorder (ASD); data collected prior to any sleep-related intervention; statistical data indicating relations between sleep problems and outcomes relevant to behavior, cognition, and physical or mental health. Exclusion criteria were: statistics characterizing the relationship between sleep disturbance and outcome variables that partialled out covariates; studies examining correlations between different measures of sleep disturbance. Participants totaled 15,074 from 49 published articles and 51 samples, yielding 209 effect sizes. Sleep problems were significantly associated with more clinical symptomatology and worse daytime functioning. Subgroup analyses demonstrated that sleep problems were most strongly associated with internalizing and externalizing symptoms and executive functioning, followed by core autism symptoms, family factors, and adaptive functioning. Findings highlight the far-reaching consequences of sleep problems on daytime functioning for autistic individuals and support the continued prioritization of sleep as a target for intervention through integrated care models to improve wellbeing. LAY SUMMARY: Autistic individuals experience higher rates of sleep problems, such as difficulty falling asleep and staying asleep, compared to the general population. We quantitatively summarized the literature about how sleep problems are related to different aspects of daytime functioning to identify areas that may be most affected by sleep. Sleep problems were related to all areas assessed, with the strongest associations for mood and anxiety symptoms. We recommend prioritizing sleep health in autistic individuals to improve wellbeing and quality of life.
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Affiliation(s)
- Gloria T Han
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA
| | - Dominic A Trevisan
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA
| | - Emily A Abel
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA.,Human Development & Family Studies, Purdue University, West Lafayette, Indiana, USA
| | - Elise M Cummings
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA.,Department of Psychology, Stony Brook University, Stony Brook, New York, USA
| | - Carter Carlos
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA.,Department of Vision Science, Univeristy of California at Berkeley, Berkeley, California, USA
| | - Armen Bagdasarov
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA.,Department of Psychology & Neuroscience, Duke University, Durham, North Carolina, USA
| | - Shashwat Kala
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA
| | - Termara Parker
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA.,Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut, USA
| | - Craig Canapari
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA
| | - James C McPartland
- Yale School of Medicine, Yale Child Study Center, Yale University, New Haven, Connecticut, USA
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8
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Bond L, Farrar J, Borg RC, Keegan K, Journeay K, Hansen N, Mac-Boima E, Rassin A, Betancourt TS. Alternate delivery platforms and implementation models for bringing evidence-based behavioral interventions to scale for youth facing adversity: a case study in West Africa. Implement Sci Commun 2022; 3:16. [PMID: 35168661 PMCID: PMC8848683 DOI: 10.1186/s43058-022-00259-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 01/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Youth Functioning and Organizational Success for West African Regional Development (Youth FORWARD) was launched as an implementation science collaboration focused on scaling out evidence-based mental health interventions for youth exposed to war and other adversities through novel delivery platforms. This implementation science case study examines the use of a collaborative team approach (CTA) as a scale-out strategy to foster the integration of an evidence-based group mental health intervention, the Youth Readiness Intervention, into youth employment programs tied to regional economic development in Sierra Leone. Methods A case study methodology is used to explore the feasibility and acceptability of integrating an evidence-based intervention, the Youth Readiness Intervention (YRI), into youth entrepreneurship programs (ENTR) in Sierra Leone, facilitated by the CTA. The authors analyzed field notes logged during program implementation, 8 weeks of supervision notes, 20 interviews with agency leaders and front-line staff delivering the YRI within this alternate delivery platform. Quantitative dissemination and implementation interviews administered to youth, facilitators, and agency leaders were analyzed using descriptive statistics and mixed linear models. A linked Hybrid Type II effectiveness-implementation cluster randomized trial is evaluating the clinical effectiveness of the YRI within this delivery platform. Results Extant data indicate the strong feasibility and acceptability of integrating the YRI into the ENTR program. Facilitators of integration of the YRI into the ENTR include mission alignment of the organizations with the delivery of psychosocial interventions, shared commitment to serving vulnerable youth, support from local District Youth Councils, and high interest from the youth served. Barriers include perceived competition between frontline organizations seeking funding for psychosocial interventions, and challenges in flexibility between donors and implementation partners operating in a fragile/post-conflict setting. The CTA was a feasible and acceptable strategy to support fidelity and quality improvement while scaling out the YRI. Conclusions Youth entrepreneurship and livelihood programs offer a promising mechanism for expanding the reach of evidence-based interventions to youth in fragile and post-conflict settings. Quality improvement and sustainment of evidence-based interventions are novel concepts in such settings. The CTA strategy institutionalizes the integration of an evidence-based intervention into youth entrepreneurship programs. Trial registration NCT03603613 (phase 1 pilot, registered May 18, 2018) and NCT03542500 (phase 2 scale-out study, registered May 18, 2018).
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Affiliation(s)
- Laura Bond
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Jordan Farrar
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Ryan C Borg
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Katrina Keegan
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Katharine Journeay
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA
| | - Nathan Hansen
- University of Georgia College of Public Health, Health Sciences Campus, Athens, GA, 30602, USA
| | | | - Alimamy Rassin
- Caritas Sierra Leone, 19 Savage Street, Freetown, Sierra Leone
| | - Theresa S Betancourt
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
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9
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Stadnick NA, Martinez K, Coleman KJ, Gizzo DP, Lane E, Lee N, Kuelbs CL, Aarons GA, Brookman-Frazee L. Mental health screening in pediatric primary care for children with autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2022; 26:1305-1311. [PMID: 35105226 DOI: 10.1177/13623613211062963] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT Children with autism experience high rates of co-occurring mental health conditions like challenging behaviors and anxiety. However, these co-occurring mental health needs are often not identified when they first become problematic. Pediatricians and their care staff are in a good position to identify mental health needs early and support families to connect to needed services. This study describes a project focused on mental health screening for children with autism in pediatric primary care clinics. Over half of eligible patients were screened using the Pediatric Symptom Checklist-17. Many children with autism had clinically elevated scores, suggesting the need for mental health assessment or services. In particular, children with positive screens had clinical elevations on the challenging behavior and attention subscales of the Pediatric Symptom Checklist-17. This finding is consistent with typical trends in co-occurring challenging behavior presentations in children with autism. Mental health screening in primary care is feasible and offers a promising opportunity to identify co-occurring mental health needs for children with autism early. Screening rates varied between clinics, suggesting tailored to improve routine screening in pediatric primary care for children with autism.
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Affiliation(s)
- Nicole A Stadnick
- University of California San Diego, USA.,UC San Diego Dissemination and Implementation Science Center, La Jolla, CA, USA.,Child and Adolescent Services Research Center, USA
| | - Kassandra Martinez
- Child and Adolescent Services Research Center, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, USA
| | | | | | - Elizabeth Lane
- University of California San Diego, USA.,Child and Adolescent Services Research Center, USA
| | - Nicholas Lee
- University of California San Diego, USA.,Child and Adolescent Services Research Center, USA
| | - Cynthia L Kuelbs
- University of California San Diego, USA.,Rady Children's Hospital-San Diego, USA
| | - Gregory A Aarons
- University of California San Diego, USA.,UC San Diego Dissemination and Implementation Science Center, La Jolla, CA, USA.,Child and Adolescent Services Research Center, USA
| | - Lauren Brookman-Frazee
- University of California San Diego, USA.,UC San Diego Dissemination and Implementation Science Center, La Jolla, CA, USA.,Child and Adolescent Services Research Center, USA.,Rady Children's Hospital-San Diego, USA
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10
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Stadnick NA, Penalosa MG, Martinez K, Brookman-Frazee L, Gizzo DP, Sahms T, Kuelbs CL, Aarons GA. Pre-Implementation Organizational Environment Associated with Pediatric Integrated Care Readiness in Primary Care. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 7:5-11. [PMID: 35284636 PMCID: PMC8916715 DOI: 10.1080/23794925.2021.1875344] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objective To characterize pre-implementation organizational factors associated with Access To Tailored Autism Integrated Care (ATTAIN), an integrated care model for children with autism and identified or suspected co-occurring mental health needs. Methods Pediatric primary care providers (n=36) completed surveys as part of a pilot study testing ATTAIN feasibility. Measures assessed: background characteristics; implementation climate; organizational readiness; evidence-based practice (EBP) attitudes; knowledge, confidence and comfort caring for children with autism. Results Compared to providers from a network of primary care practices and an integrated healthcare system, providers from a Federally Qualified Health Center (FQHC) reported less positive perceptions of climate supportive of EBP implementation and, specifically, selection for openness and rewards for EBPs. Implementation climate was associated with autism knowledge, comfort with mental health referral and follow up, and organizational change efficacy. Conclusions Findings advance understanding of pre-implementation organizational context factors important to assess for EBP implementation in diverse pediatric care settings.
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Affiliation(s)
- Nicole A. Stadnick
- University of California San Diego, Department of Psychiatry, San Diego, CA,Child and Adolescent Services Research Center, San Diego, CA,UC San Diego Dissemination and Implementation Science Center, San Diego, CA
| | | | - Kassandra Martinez
- Child and Adolescent Services Research Center, San Diego, CA,San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA
| | - Lauren Brookman-Frazee
- University of California San Diego, Department of Psychiatry, San Diego, CA,Child and Adolescent Services Research Center, San Diego, CA,UC San Diego Dissemination and Implementation Science Center, San Diego, CA
| | | | - Timothy Sahms
- University of California San Diego, Department of Pediatrics, San Diego, CA,San Ysidro Health, San Ysidro, CA
| | - Cynthia L. Kuelbs
- University of California San Diego, Department of Pediatrics, San Diego, CA,Rady Children’s Hospital, San Diego, CA
| | - Gregory A. Aarons
- University of California San Diego, Department of Psychiatry, San Diego, CA,Child and Adolescent Services Research Center, San Diego, CA,UC San Diego Dissemination and Implementation Science Center, San Diego, CA
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11
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Maddox BB, Dickson KS, Stadnick NA, Mandell DS, Brookman-Frazee L. Mental Health Services for Autistic Individuals Across the Lifespan: Recent Advances and Current Gaps. Curr Psychiatry Rep 2021; 23:66. [PMID: 34402984 PMCID: PMC8961310 DOI: 10.1007/s11920-021-01278-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE OF REVIEW This synthesis of recent mental health services research with autistic individuals presents significant advances, current gaps, and recommendations for improving mental healthcare for this population. RECENT FINDINGS Recent advances include improved understanding of co-occurring mental health conditions among autistic individuals, a growing evidence base for interventions to address them, the development and implementation of new service models to support mental health for this population, and a substantial increase in mental health services and implementation research focused on autism. Ongoing challenges include a lack of mental health interventions designed for community implementation with autistic individuals, limited workforce capacity, complex and disconnected service systems, and racial, ethnic, and socioeconomic disparities in accessibility and quality of mental health services. Despite the advances in our understanding of mental health needs and mental health services for autistic individuals, several critical gaps remain. We encourage future efforts to develop and test interventions that can be used in community settings, train and incentivize the workforce to provide them, realign policies and funding with best practice, and embrace an equity-focused approach to autism research and care.
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Affiliation(s)
- Brenna B Maddox
- Department of Psychiatry, TEACCH Autism Program, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA.
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Child and Family Development, San Diego State University, San Diego, CA, USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
| | - David S Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren Brookman-Frazee
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Department of Psychiatry, University of California San Diego, San Diego, CA, USA
- Dissemination and Implementation Science Center, University of California San Diego Altman Clinical and Translational Research Institute, San Diego, CA, USA
- Rady Children's Hospital, San Diego, CA, USA
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12
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Ghanouni P, Seaker L. Healthcare Services During the Transitions to Adulthood Among Individuals with ASD Aged 15-25 Years Old: Stakeholders' Perspectives. J Autism Dev Disord 2021; 52:2575-2588. [PMID: 34216328 DOI: 10.1007/s10803-021-05159-6] [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] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Although previous research has shown that the transition to adulthood may be challenging, there exists a lack of research regarding perspectives of stakeholders on the transition of individuals with Autism Spectrum Disorder (ASD). This study aimed to investigate stakeholders' experiences regarding healthcare services for youth with ASD during their transition. We involved 20 stakeholders, including 17 parents of youth with ASD as well as 3 services providers. The study yielded three major themes including: (a) accessibility and quality of care; (b) tensions and conflicts; and (c) navigation and integrated care. The findings can be used to direct change within the healthcare services towards better practices for youth with ASD and increasing the likelihood of positive health outcomes.
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Affiliation(s)
- Parisa Ghanouni
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada.
| | - Liam Seaker
- Department of Occupational Therapy, Dalhousie University, PO Box 15000, Halifax, NS, B3H 4R2, Canada
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13
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Watson DP, Snow-Hill N, Saldana L, Walden AL, Staton M, Kong A, Donenberg G. A Longitudinal Mixed Method Approach for Assessing Implementation Context and Process Factors: Comparison of Three Sites from a Housing First Implementation Strategy Pilot. IMPLEMENTATION RESEARCH AND PRACTICE 2020; 1. [PMID: 33392509 DOI: 10.1177/2633489520974974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Implementation science's focus on establishing implementation strategy effectiveness has overshadowed the need to understand differential performance of such strategies under various conditions. Methods allowing for assessment between implementation context and process can help address this gap. This paper provides a detailed description of a mixed method procedure for assessing factors related to the implementation context and process intersection, which was developed as part of the pilot study of the Housing First Technical Assistance and Training (HFTAT) Program, a multifaceted strategy designed to support Housing First model implementation. Methods The HFTAT was pilot tested among a sample of three organizations. Our mixed method approach combines two tools often used in implementation research-the Stages of Implementation Completion and the Consolidated Framework for Implementation Research-in a novel way. Several stages to analysis were completed, starting with a separate analysis of data pertaining to each measure and then two levels of mixed method analysis. Results The approach provided a better understanding of the issues that impacted the implementation guided by the HFTAT, suggesting: (1) individual determinants seemed to have a bigger impact based on the number of SIC phases they affected, (2) implementation context and process were connected through climate-related factors in the inner setting that made the sites more or less responsive to addressing identified barriers, and (3) there is a need to better assess context factors to identify areas where implementation drivers should be better targeted to facilitate change, and this is supported by prior research. Conclusions Understanding the underlying factors impacting a setting's performance related to a specific implementation strategy has potential to improve decision-making and optimize future implementation efforts. The approach likely be as successful combining the SIC with other determinant frameworks and should be utilized at the onset of an implementation project to maximize its usefulness.
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Affiliation(s)
| | - Nyssa Snow-Hill
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
| | | | | | - Monte Staton
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
| | - Angela Kong
- Department of Pharmacy Systems, Outcomes, & Policy, University of Illinois at Chicago
| | - Geri Donenberg
- Center for Dissemination and Implementation Science, University of Illinois at Chicago
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14
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Zavaleta-Ramírez P, Rosetti MF, Albores-Gallo L, Vargas-Soberanis MA, López ON, Medina-Mora ME. Pathways to a Diagnosis of Autism Spectrum Disorder. Psychiatr Serv 2020; 71:1120-1126. [PMID: 32746716 DOI: 10.1176/appi.ps.201900518] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study aimed to analyze the pathways to obtaining a diagnosis of autism spectrum disorder (ASD) within the Mexican health system. METHODS Parents of children with ASD (N=186) were approached at specialized health centers and interviewed about the sequence of professionals they contacted that led to a diagnosis. The authors established the pathway to diagnosis, time of first parental concerns, time of first consultation, age of the child at diagnosis, and other measures. A Sankey plot was used to illustrate the complexity of the pathway to diagnosis. Diagnostic delays among children with autism were compared with delays among subsamples of children with Asperger's syndrome. Regression analysis was used to evaluate the effect of socioeconomic and clinical variables on diagnostic delays. RESULTS The median diagnostic delay was 27 months (interquartile range [IQR] 8-36), and three professional contacts (IQR 3-6) were needed to achieve a diagnosis. Patients switched between primary and tertiary care even in later stages of the pathway. Patients with Asperger's syndrome had longer delays than patients with autism, and girls and older patients took more time to receive a diagnosis. Parental concerns regarding language, developmental issues, and perceived developmental regression resulted in shorter diagnostic delays. CONCLUSIONS Pathways to diagnosis of ASD are long and involve multiple contacts, with patients alternating between primary and specialized care. This pattern reflects failures in the diagnostic protocols and referral systems of clinical centers in Mexico, and such issues may be experienced in countries with similarly overwhelmed health care systems.
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Affiliation(s)
- Patricia Zavaleta-Ramírez
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Marcos Francisco Rosetti
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Lilia Albores-Gallo
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Manuel Alejandro Vargas-Soberanis
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Omar Nafate López
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
| | - Maria Elena Medina-Mora
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Mexico City (Zavaleta-Ramírez, Rosetti, Medina-Mora); Servicios de Atención Psiquiátrica, Hospital de Psiquiatría Infantil Dr. Juan N. Navarro, Mexico City (Albores-Gallo, Vargas-Soberanis); Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City (Rosetti); Hospital de Especialidades Pediátricas, Tuxtla Gutiérrez, Chiapas, Mexico (Nafate López)
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15
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Moullin JC, Dickson KS, Stadnick NA, Albers B, Nilsen P, Broder-Fingert S, Mukasa B, Aarons GA. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun 2020. [PMID: 32885199 DOI: 10.1186/s43058‐020‐00023‐7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background Recent reviews of the use and application of implementation frameworks in implementation efforts highlight the limited use of frameworks, despite the value in doing so. As such, this article aims to provide recommendations to enhance the application of implementation frameworks, for implementation researchers, intermediaries, and practitioners. Discussion Ideally, an implementation framework, or multiple frameworks should be used prior to and throughout an implementation effort. This includes both in implementation science research studies and in real-world implementation projects. To guide this application, outlined are ten recommendations for using implementation frameworks across the implementation process. The recommendations have been written in the rough chronological order of an implementation effort; however, we understand these may vary depending on the project or context: (1) select a suitable framework(s), (2) establish and maintain community stakeholder engagement and partnerships, (3) define issue and develop research or evaluation questions and hypotheses, (4) develop an implementation mechanistic process model or logic model, (5) select research and evaluation methods (6) determine implementation factors/determinants, (7) select and tailor, or develop, implementation strategy(s), (8) specify implementation outcomes and evaluate implementation, (9) use a framework(s) at micro level to conduct and tailor implementation, and (10) write the proposal and report. Ideally, a framework(s) would be applied to each of the recommendations. For this article, we begin by discussing each recommendation within the context of frameworks broadly, followed by specific examples using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Summary The use of conceptual and theoretical frameworks provides a foundation from which generalizable implementation knowledge can be advanced. On the contrary, superficial use of frameworks hinders being able to use, learn from, and work sequentially to progress the field. Following the provided ten recommendations, we hope to assist researchers, intermediaries, and practitioners to improve the use of implementation science frameworks.
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Affiliation(s)
- Joanna C Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Kent Street, Bentley, Søborg, Western Australia 6102 Australia.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,San Diego State University, 5500 Campanile Drive, San Diego, CA 92182 USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA.,UC San Diego Dissemination and Implementation Science Center, 9452 Medical Center Dr, La Jolla, CA 92037 USA
| | - Bianca Albers
- European Implementation Collaborative, Odense, Denmark.,School of Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC 3053 Australia
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Sarabeth Broder-Fingert
- School of Medicine, Department of Pediatrics, Boston Medical Center and Boston University, 801 Albany Street, Boston, MA 02114 USA
| | - Barbara Mukasa
- Mildmay Uganda, 24985 Lweza, Entebbe Road, Kampala, Uganda
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA.,UC San Diego Dissemination and Implementation Science Center, 9452 Medical Center Dr, La Jolla, CA 92037 USA
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16
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Moullin JC, Dickson KS, Stadnick NA, Albers B, Nilsen P, Broder-Fingert S, Mukasa B, Aarons GA. Ten recommendations for using implementation frameworks in research and practice. Implement Sci Commun 2020; 1:42. [PMID: 32885199 PMCID: PMC7427911 DOI: 10.1186/s43058-020-00023-7] [Citation(s) in RCA: 126] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/26/2020] [Indexed: 01/10/2023] Open
Abstract
Background Recent reviews of the use and application of implementation frameworks in implementation efforts highlight the limited use of frameworks, despite the value in doing so. As such, this article aims to provide recommendations to enhance the application of implementation frameworks, for implementation researchers, intermediaries, and practitioners. Discussion Ideally, an implementation framework, or multiple frameworks should be used prior to and throughout an implementation effort. This includes both in implementation science research studies and in real-world implementation projects. To guide this application, outlined are ten recommendations for using implementation frameworks across the implementation process. The recommendations have been written in the rough chronological order of an implementation effort; however, we understand these may vary depending on the project or context: (1) select a suitable framework(s), (2) establish and maintain community stakeholder engagement and partnerships, (3) define issue and develop research or evaluation questions and hypotheses, (4) develop an implementation mechanistic process model or logic model, (5) select research and evaluation methods (6) determine implementation factors/determinants, (7) select and tailor, or develop, implementation strategy(s), (8) specify implementation outcomes and evaluate implementation, (9) use a framework(s) at micro level to conduct and tailor implementation, and (10) write the proposal and report. Ideally, a framework(s) would be applied to each of the recommendations. For this article, we begin by discussing each recommendation within the context of frameworks broadly, followed by specific examples using the Exploration, Preparation, Implementation, Sustainment (EPIS) framework. Summary The use of conceptual and theoretical frameworks provides a foundation from which generalizable implementation knowledge can be advanced. On the contrary, superficial use of frameworks hinders being able to use, learn from, and work sequentially to progress the field. Following the provided ten recommendations, we hope to assist researchers, intermediaries, and practitioners to improve the use of implementation science frameworks.
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Affiliation(s)
- Joanna C Moullin
- Faculty of Health Sciences, School of Pharmacy and Biomedical Sciences, Curtin University, Kent Street, Bentley, Søborg, Western Australia 6102 Australia.,Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA
| | - Kelsey S Dickson
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,San Diego State University, 5500 Campanile Drive, San Diego, CA 92182 USA
| | - Nicole A Stadnick
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA.,UC San Diego Dissemination and Implementation Science Center, 9452 Medical Center Dr, La Jolla, CA 92037 USA
| | - Bianca Albers
- European Implementation Collaborative, Odense, Denmark.,School of Health Sciences, University of Melbourne, 161 Barry St, Carlton, VIC 3053 Australia
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden
| | - Sarabeth Broder-Fingert
- School of Medicine, Department of Pediatrics, Boston Medical Center and Boston University, 801 Albany Street, Boston, MA 02114 USA
| | - Barbara Mukasa
- Mildmay Uganda, 24985 Lweza, Entebbe Road, Kampala, Uganda
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, 3665 Kearny Villa Rd., Suite 200N, San Diego, CA 92123 USA.,Department of Psychiatry, University of California San Diego, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812 USA.,UC San Diego Dissemination and Implementation Science Center, 9452 Medical Center Dr, La Jolla, CA 92037 USA
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17
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Stadnick NA, Aarons GA, Blake L, Brookman-Frazee LI, Dourgnon P, Engell T, Jusot F, Lau AS, Prieur C, Skar AMS, Barnett ML. Leveraging implementation science to reduce inequities in Children's mental health care: highlights from a multidisciplinary international colloquium. BMC Proc 2020; 14:2. [PMID: 32280371 PMCID: PMC7132860 DOI: 10.1186/s12919-020-00184-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND PURPOSE Access to evidence-based mental health care for children is an international priority. However, there are significant challenges to advancing this public health priority in an efficient and equitable manner. The purpose of this international colloquium was to convene a multidisciplinary group of health researchers to build an agenda for addressing disparities in mental health care access and treatment for children and families through collaboration among scholars from the United States and Europe engaged in innovative implementation science and mental health services research. KEY HIGHLIGHTS Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, presentations related to inner, outer, and bridging context factors that impact the accessibility and quality of mental health evidence-based practices (EBPs) for children and families. Three common topics emerged from the presentations and discussions from colloquium participants, which included: 1) the impact of inner and outer context factors that limit accessibility to EBPs across countries, 2) strategies to adapt EBPs to improve their fit in different settings, 3) the potential for implementation science to address emerging clinical and public health concerns. IMPLICATIONS The common topics discussed underscored that disparities in access to evidence-based mental health care are prevalent across countries. Opportunities for cross-country and cross-discipline learnings and collaborations can help drive solutions to address these inequities, which relate to the availability of a trained and culturally appropriate workforce, insurance reimbursement policies, and designing interventions and implementation strategies to support sustained use of evidence-based practices.
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Affiliation(s)
- Nicole A. Stadnick
- University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
| | - Gregory A. Aarons
- University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
| | - Lucy Blake
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, Lancashire UK
| | - Lauren I. Brookman-Frazee
- University of California San Diego, La Jolla, CA 92093 USA
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California San Diego Dissemination and Implementation Science Center, La Jolla, CA 92093 USA
- Autism Discovery Institute, Rady Children’s Hospital, San Diego, USA
| | - Paul Dourgnon
- Institut de Recherche et Documentation en Economie de la Santé, Paris, France
| | - Thomas Engell
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Florence Jusot
- Institut de Recherche et Documentation en Economie de la Santé, Paris, France
- Université Paris-Dauphine, Paris, France
| | - Anna S. Lau
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California, Los Angeles, Los Angeles, CA 90095 USA
| | | | | | - Miya L. Barnett
- Child and Adolescent Services Research Center, San Diego, CA 92123 USA
- University of California, Santa Barbara, Santa Barbara, CA 93106 USA
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18
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Stadnick NA, Sadler E, Sandall J, Turienzo CF, Bennett IM, Borkan J, Oladeji B, Gureje O, Aarons GA, Sklar M. Comparative case studies in integrated care implementation from across the globe: a quest for action. BMC Health Serv Res 2019; 19:899. [PMID: 31775740 PMCID: PMC6882190 DOI: 10.1186/s12913-019-4661-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Integrated care is the coordination of general and behavioral health and is a highly promising and practical approach to improving healthcare delivery and patient outcomes. While there is growing interest and investment in integrated care implementation internationally, there are no formal guidelines for integrated care implementation applicable to diverse healthcare systems. Furthermore, there is a complex interplay of factors at multiple levels of influence that are necessary for successful implementation of integrated care in health systems. METHODS Guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework (Aarons et al., 2011), a multiple case study design was used to address two research objectives: 1) To highlight current integrated care implementation efforts through seven international case studies that target a range of healthcare systems, patient populations and implementation strategies and outcomes, and 2) To synthesize the shared and unique challenges and successes across studies using the EPIS framework. RESULTS The seven reported case studies represent integrated care implementation efforts from five countries and continents (United States, United Kingdom, Vietnam, Israel, and Nigeria), target a range of clinical populations and care settings, and span all phases of the EPIS framework. Qualitative synthesis of these case studies illuminated common outer context, inner context, bridging and innovation factors that were key drivers of implementation. CONCLUSIONS We propose an agenda that outlines priority goals and related strategies to advance integrated care implementation research. These goals relate to: 1) the role of funding at multiple levels of implementation, 2) meaningful collaboration with stakeholders across phases of implementation and 3) clear communication to stakeholders about integrated care implementation. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Nicole A Stadnick
- Department of Psychiatry, University of California San Diego, La Jolla, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Euan Sadler
- Health Service & Population Research Department, Centre for Implementation Science, King's College London, London, UK
- Department of Nursing, Midwifery and Health, School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK
| | - Jane Sandall
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Cristina Fernandez Turienzo
- Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, London, UK
| | - Ian M Bennett
- Department of Family Medicine, University of Washington, Seattle, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, USA
- Department of Global Health, University of Washington, Seattle, USA
| | - Jeffrey Borkan
- Department of Family Medicine, Brown University, Providence, USA
| | - Bibilola Oladeji
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oye Gureje
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Gregory A Aarons
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
| | - Marisa Sklar
- Department of Psychiatry, University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
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