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Haug IM, Neumer SP, Handegård BH, Lisøy C, Rasmussen LMP, Bania EV, Adolfsen F, Patras J. Dose-Response Effects of MittEcho, a Measurement Feedback System, in an Indicated Mental Health Intervention for Children in Municipal and School Services in Norway. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01389-9. [PMID: 38809322 DOI: 10.1007/s10488-024-01389-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
Including routine client feedback can increase the effectiveness of mental health interventions for children, especially when implemented as intended. Rate of implementation, or dose, of such feedback interventions has been shown to moderate results in some studies. Variation in implementation and use of client feedback may also contribute to the mixed results observed within the feedback literature. This study evaluates dose-response associations of client feedback using a novel Measurement Feedback System (MFS) within an indicated group intervention. The primary aim was to determine whether the rate of MFS implementation predicts symptom reduction in anxiety and depression among school-aged children. The secondary aim was to assess whether the rate of MFS implementation influences children's satisfaction with the group intervention or their dropout rates. Data were collected via a randomized factorial study (clinicaltrials.gov NCT04263558) across 58 primary schools in Norway. Children aged 8 to 12 years (N = 701) participated in a group-based, transdiagnostic intervention targeting elevated symptoms of anxiety or depression. Half of the child groups also received the feedback intervention using the MittEcho MFS. Group leaders (N = 83), recruited locally, facilitated the interventions. The MFS dose was measured using the Implementation Index, which combines the use of MFS by both children and providers (group leaders) into a single dose variable. Results showed no significant additional effect of dose of MFS on change in depression or anxiety scores, on user satisfaction with the intervention or on intervention dropout. The discussion addresses potential reasons for these non-significant findings and implications for MFS implementation in preventive, group-based interventions in school settings.
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Affiliation(s)
- Ida Mari Haug
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway.
| | - Simon-Peter Neumer
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Carina Lisøy
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lene-Mari P Rasmussen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Elisabeth Valmyr Bania
- Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frode Adolfsen
- Regional Centre for Child and Adolescent Mental Health and Child Welfare, Northern Norway, UiT The Arctic University of Norway, Sykehusvegen 44, Tromsø, 9019, Norway
| | - Joshua Patras
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
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Juckett LA, Owolabi M, Gustavson AM, Ifejika NL. Implementation Science to Advance Health Equity in Stroke Rehabilitation. J Am Heart Assoc 2024; 13:e031311. [PMID: 38529649 PMCID: PMC11179761 DOI: 10.1161/jaha.123.031311] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 02/02/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Lisa A. Juckett
- School of Health and Rehabilitation Sciences, College of MedicineThe Ohio State UniversityColumbusOHUSA
| | - Mayowa Owolabi
- Center for Genomic and Precision MedicineUniversity of IbadanIbadanNigeria
- University College HospitalIbadanNigeria
- Blossom Specialist Medical CenterIbadanNigeria
| | - Allison M. Gustavson
- Veterans Affairs Health Services Research and Development Center for Care Delivery and Outcomes Research, Veteran Affairs Rehabilitation Research and Development Rehabilitation & Engineering Center for Optimizing Veteran Engagement & ReintegrationMinneapolis Veterans Affairs Health Care SystemMinneapolisMNUSA
- Department of Medicine, Division of General Internal MedicineUniversity of MinnesotaMinneapolisMNUSA
| | - Nneka L. Ifejika
- Department of Physical Medicine and Rehabilitation, Department of NeurologyUT Southwestern Medical CenterDallasTXUSA
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Jensen-Doss A, Casline E, Woodard GS, Phillips DA, Lane E, Palafu T, Waye C, Ramirez V, Cheron DM, Okamura K. Provider Use of, Attitudes Towards, and Self-efficacy with Key Measurement-based Care Practices in Youth Mental Health Treatment: A Multi-site Examination. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01354-6. [PMID: 38334881 DOI: 10.1007/s10488-024-01354-6] [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] [Accepted: 02/02/2024] [Indexed: 02/10/2024]
Abstract
Measurement-based care (MBC) is an underutilized evidence-based practice, and current implementation efforts demonstrate limited success in increasing MBC use. A better understanding of MBC implementation determinants is needed to improve these efforts, particularly from studies examining the full range of MBC practices and that span multiple samples of diverse providers using different MBC systems. This study addressed these limitations by conducting a multi-site survey examining MBC predictors and use in youth treatment. Participants were 159 clinicians and care coordinators working in youth mental health care settings across the United States. Participants were drawn from three program evaluations of MBC implementation. Providers completed measures assessing use of five MBC practices (administering measures, viewing feedback, reviewing feedback in supervision, sharing feedback with clients in session, and using feedback to plan treatment), MBC self-efficacy, and MBC attitudes. Despite expectations that MBC should be standard care for all clients, providers reported only administering measures to 40-60% of clients on average, with practices related to the use of feedback falling in the 1-39% range. Higher MBC self-efficacy and more positive views of MBC practicality predicted higher MBC use, although other attitude measures were not significant predictors. Effects of predictors were not moderated by site, suggesting consistent predictors across implementation settings. Implications of study findings for future research and for the implementation of MBC are discussed.
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Affiliation(s)
| | - Elizabeth Casline
- Center for Dissemination and Implementation Science, Northwestern University Feinberg School of Medicine, Chicago, IL, US
| | - Grace S Woodard
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | | | - Elizabeth Lane
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Tessa Palafu
- The Baker Center for Children and Families, Boston, MA, USA
| | - Catherine Waye
- The Baker Center for Children and Families, Boston, MA, USA
| | | | | | - Kelsie Okamura
- The Baker Center for Children and Families, Boston, MA, USA
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Woodard GS, Casline E, Ehrenreich-May J, Ginsburg GS, Jensen-Doss A. Consultation as an Implementation Strategy to Increase Fidelity of Measurement-Based Care Delivery in Community Mental Health Settings: An Observational Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01321-7. [PMID: 38052929 DOI: 10.1007/s10488-023-01321-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 12/07/2023]
Abstract
Regularly administering outcome measures to clients to inform clinical decision making, referred to as measurement-based care (MBC), has the potential to improve mental health treatment due to its applicability across disorders and treatment settings. Given the utility of MBC, understanding predictors of high-fidelity MBC implementation is important. Training and consultation are widely used implementation strategies to increase the fidelity of evidence-based practice delivery but have rarely been studied with MBC. The current study will examine the relationship between time clinicians spent discussing a case in consultation ("dosage") and MBC fidelity. Thirty clinicians and 56 youth were in the MBC condition of a randomized controlled trial and completed baseline questionnaires. Consultation dosage was extracted from call notes. MBC fidelity was measured using the implementation index, which combines rates of administering and viewing questionnaires, using objective data from the online MBC system. Multi-level modeling was used. Greater consultation dosage significantly predicted a higher implementation index (ß = 0.27, SE = 0.06, p < .001). For every 30 min spent discussing a case in consultation, the case's MBC fidelity increased by 8.1%. Greater consultation dosage significantly predicted higher rates of administration (ß = 0.07, SE = 0.03, p = 0.033) and feedback report viewing (ß = 0.24, SE = 0.06, p < .001). More consultation at the case level predicts greater MBC fidelity using objective measures. The greatest impact was increasing the clinician feedback report viewing rate. The results of this study can help inform future efforts to increase the fidelity with which MBC is delivered and to make consultation as efficient and effective as possible.
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Affiliation(s)
- Grace S Woodard
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA.
| | - Elizabeth Casline
- Northwestern University Feinberg School of Medicine, 420 E. Superior Street, Chicago, IL, 60611, USA
| | - Jill Ehrenreich-May
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA
| | - Golda S Ginsburg
- University of Connecticut School of Medicine, 65 Kane Street Room 3022, West Hartford, CT, 06119, USA
| | - Amanda Jensen-Doss
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33146, USA
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Juckett LA, Bernard KP, Thomas KS. Partnering with social service staff to implement pragmatic clinical trials: an interim analysis of implementation strategies. Trials 2023; 24:739. [PMID: 37978528 PMCID: PMC10656935 DOI: 10.1186/s13063-023-07757-4] [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: 06/29/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND With recent growth in the conduct of pragmatic clinical trials, the reliance on frontline staff to contribute to trial-related activities has grown as well. Active partnerships with staff members are often critical to pragmatic trial implementation, but rarely do research teams track and evaluate the specific "implementation strategies" used to support staff's involvement in trial procedures (e.g., participant recruitment). Accordingly, we adapted implementation science methodologies and conducted an interim analysis of the strategies deployed with social service staff involved in one multi-site pragmatic clinical trial. METHODS We used a naturalistic, observational study design to characterize strategies our research team deployed with staff during monthly, virtual meetings. Data were drawn from meeting notes and recordings from the trial's 4-month Preparation phase and 8-month Implementation phase. Strategies were mapped to the Expert Recommendations for Implementing Change taxonomy and categorized into nine implementation clusters. Survey data were also collected from staff to identify the most useful strategies the research team should deploy when onboarding new staff members in the trial's second year. RESULTS A total of 287 strategies were deployed. Strategies in the develop stakeholder interrelationships cluster predominated in both the Preparation (35%) and Implementation (31%) phases, followed by strategies in the use iterative and evaluative approaches cluster, though these were more prevalent during trial Preparation (24%) as compared to trial Implementation (18%). When surveyed on strategy usefulness, strategies in the provide interactive assistance, use financial approaches, and support staff clusters were most useful, per staff responses. CONCLUSIONS While strategies to develop stakeholder interrelationships were used most frequently during trial Preparation and Implementation, program staff perceived strategies that provided technical assistance, supported clinicians, and used financial approaches to be most useful and should be deployed when onboarding new staff members. Research teams are encouraged to adapt and apply implementation strategy tracking methods when partnering with social service staff and deploy practical strategies that support pragmatic trial success given staff needs and preferences. TRIAL REGISTRATION NCT05357261. May 2, 2022.
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Affiliation(s)
- Lisa A Juckett
- School of Health and Rehabilitation Sciences, The Ohio State University, 453 West 10th Avenue, Columbus, OH, USA.
| | | | - Kali S Thomas
- School of Public Health, Brown University, Providence, RI, USA
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Jensen-Doss A, Woodard G, Patel-Syed Z, Ehrenreich-May J, Rosenfield D, Ginsburg GS. External and Internal Validity Considerations in Youth Effectiveness Trials: Lessons Learned from the COMET Study. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023; 52:735-749. [PMID: 37947431 PMCID: PMC10655847 DOI: 10.1080/15374416.2023.2272958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
OBJECTIVE Effectiveness trials aim to increase the generalizability and public health impact of interventions. However, challenges associated with this design present threats to external and internal validity. This paper illustrates these challenges using data from a two-site randomized effectiveness trial, the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET) and presents recommendations for future research. METHOD COMET was a randomized effectiveness trial conducted in 19 community mental health clinics in two states comparing three interventions: treatment as usual (TAU), TAU with measurement-based care (TAU+), and the Unified Protocol forTransdiagnostic Treatment of Emotional Disorders in Adolescents with MBC (UPA). Participants included 176 clinicians (mean age = 35.5; 85.8% cisgender female; 53.0% racially and/or ethnically minorized) and 196 adolescents (mean age = 14.7; 65.3% cisgender female; 69.4% racially and/or ethnically minorized). Analyses outlined participant flow from recruitment to study completion, described participant characteristics, and examined site differences. RESULTS Analysis of participant flow suggested that recruitment and retention of clinicians and adolescents was challenging, raising questions about whether participants were representative of participating clinics. Both the clinician and adolescent samples were racially and ethnically diverse and adolescents were low income and clinically complex. Significant site differences were observed in clinician and adolescent characteristics. CONCLUSIONS While this study was successful in recruiting a diverse and historically under-represented sample, difficulties in recruitment and retention raise questions about external validity and site differences present challenges to internal validity of study findings. Suggestions for future effectiveness studies, drawing from implementation science approaches, are discussed.
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Affiliation(s)
| | - Grace Woodard
- University of Miami Department of Psychology, Coral Gables, FL, USA
| | - Zabin Patel-Syed
- Northwestern University Fienberg School of Medicine, Center for Dissemination and Implementation Science, Chicago, IL, USA
| | | | | | - Golda S. Ginsburg
- University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT, USA
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Proctor EK, Bunger AC, Lengnick-Hall R, Gerke DR, Martin JK, Phillips RJ, Swanson JC. Ten years of implementation outcomes research: a scoping review. Implement Sci 2023; 18:31. [PMID: 37491242 PMCID: PMC10367273 DOI: 10.1186/s13012-023-01286-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/14/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Proctor and colleagues' 2011 paper proposed a taxonomy of eight implementation outcomes and challenged the field to address a research agenda focused on conceptualization, measurement, and theory building. Ten years later, this paper maps the field's progress in implementation outcomes research. This scoping review describes how each implementation outcome has been studied, research designs and methods used, and the contexts and settings represented in the current literature. We also describe the role of implementation outcomes in relation to implementation strategies and other outcomes. METHODS Arksey and O'Malley's framework for conducting scoping reviews guided our methods. Using forward citation tracing, we identified all literature citing the 2011 paper. We conducted our search in the Web of Science (WOS) database and added citation alerts sent to the first author from the publisher for a 6-month period coinciding with the WOS citation search. This produced 1346 titles and abstracts. Initial abstract screening yielded 480 manuscripts, and full-text review yielded 400 manuscripts that met inclusion criteria (empirical assessment of at least one implementation outcome). RESULTS Slightly more than half (52.1%) of included manuscripts examined acceptability. Fidelity (39.3%), feasibility (38.6%), adoption (26.5%), and appropriateness (21.8%) were also commonly examined. Penetration (16.0%), sustainability (15.8%), and cost (7.8%) were less frequently examined. Thirty-two manuscripts examined implementation outcomes not included in the original taxonomy. Most studies took place in healthcare (45.8%) or behavioral health (22.5%) organizations. Two-thirds used observational designs. We found little evidence of progress in testing the relationships between implementation strategies and implementation outcomes, leaving us ill-prepared to know how to achieve implementation success. Moreover, few studies tested the impact of implementation outcomes on other important outcome types, such as service systems and improved individual or population health. CONCLUSIONS Our review presents a comprehensive snapshot of the research questions being addressed by existing implementation outcomes literature and reveals the need for rigorous, analytic research and tests of strategies for attaining implementation outcomes in the next 10 years of outcomes research.
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Affiliation(s)
- Enola K Proctor
- The Brown School, Shanti Khinduka Distinguished Professor Emerita, Washington University in St. Louis, St. Louis, USA.
| | - Alicia C Bunger
- College of Social Work, The Ohio State University, Columbus, OH, USA
| | | | - Donald R Gerke
- Department of Social Work, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, USA
| | - Jared K Martin
- College of Education & Human Ecology, The Ohio State University, Columbus, OH, USA
| | - Rebecca J Phillips
- College of Liberal Arts & Sciences, Western Oregon University, Monmouth, OR, USA
| | - Julia C Swanson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Triplett NS, Mbwayo A, Kiche S, Liu L, Silva J, AlRasheed R, Johnson C, Amanya C, Munson S, Weiner BJ, Collins PY, Dorsey S. Co-developed implementation guidelines to maximize acceptability, feasibility, and usability of mobile phone supervision in Kenya. Glob Ment Health (Camb) 2023; 10:e31. [PMID: 37854429 PMCID: PMC10579659 DOI: 10.1017/gmh.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/11/2023] [Accepted: 05/16/2023] [Indexed: 10/20/2023] Open
Abstract
Opportunities exist to leverage mobile phones to replace or supplement in-person supervision of lay counselors. However, contextual variables, such as network connectivity and provider preferences, must be considered. Using an iterative and mixed methods approach, we co-developed implementation guidelines to support the implementation of mobile phone supervision with lay counselors and supervisors delivering a culturally adapted trauma-focused cognitive behavioral therapy in Western Kenya. Guidelines were shared and discussed with lay counselors in educational outreach visits led by supervisors. We evaluated the impact of guidelines and outreach on the acceptability, feasibility, and usability of mobile phone supervision. Guidelines were associated with significant improvements in acceptability and usability of mobile phone supervision. There was no evidence of a significant difference in feasibility. Qualitative interviews with lay counselors and supervisors contextualized how guidelines impacted acceptability and feasibility - by setting expectations for mobile phone supervision, emphasizing importance, increasing comfort, and sharing strategies to improve mobile phone supervision. Introducing and discussing co-developed implementation guidelines significantly improved the acceptability and usability of mobile phone supervision. This approach may provide a flexible and scalable model to address challenges with implementing evidence-based practices and implementation strategies in lower-resourced areas.
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Affiliation(s)
- Noah S. Triplett
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Sharon Kiche
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Lucy Liu
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Jacinto Silva
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Rashed AlRasheed
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Clara Johnson
- Department of Psychology, University of Washington, Seattle, WA, USA
| | | | - Sean Munson
- Department of Human Centered Design & Engineering, University of Washington, Seattle, WA, USA
| | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Pamela Y. Collins
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Seattle, WA, USA
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Juckett LA, Oliver HV, Hariharan G, Bunck LE, Devier AL. Strategies for implementing the interRAI home care frailty scale with home-delivered meal clients. Front Public Health 2023; 11:1022735. [PMID: 36755903 PMCID: PMC9900681 DOI: 10.3389/fpubh.2023.1022735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
Introduction Frailty is a complex condition that is highly associated with health decline and the loss of independence. Home-delivered meal programs are designed to provide older adults with health and nutritional support that can attenuate the risk of frailty. However, home-delivered meal agencies do not routinely assess frailty using standardized instruments, leading to uncertainty over the longitudinal impact of home-delivered meals on frailty levels. Considering this knowledge gap, this study aimed to facilitate home-delivered meal staff's implementation of a standardized frailty instrument with meal clients as part of routine programming. This article (a) describes the use of Implementation Mapping principles to develop strategies supporting frailty instrument implementation in one home-delivered meal agency and (b) examines the degree to which a combination of strategies influenced the feasibility of frailty instrument use by home-delivered meal staff at multiple time points. Methods and materials This retrospective observational study evaluated staff's implementation of the interRAI Home Care Frailty Scale (HCFS) with newly enrolled home-delivered meal clients at baseline-, 3-months, and 6-months. The process of implementing the HCFS was supported by five implementation strategies that were developed based on tenets of Implementation Mapping. Rates of implementation and reasons clients were lost to 3- and 6-month follow-up were evaluated using univariate analyses. Client-level data were also examined to identify demographic factors associated with attrition at both follow-up time points. Results Staff implemented the HCFS with 94.8% (n = 561) of eligible home-delivered meal clients at baseline. Of those clients with baseline HCFS data, staff implemented the follow-up HCFS with 43% of clients (n = 241) at 3-months and 18.0% of clients (n = 101) at 6-months. Insufficient client tracking and documentation procedures complicated staff's ability to complete the HCFS at follow-up time points. Discussion While the HCFS assesses important frailty domains that are relevant to home-delivered meal clients, its longitudinal implementation was complicated by several agency- and client-level factors that limited the extent to which the HCFS could be feasibly implemented over multiple time points. Future empirical studies are needed to design and test theoretically derived implementation strategies to support frailty instrument use in the home- and community-based service setting.
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Affiliation(s)
- Lisa A. Juckett
- Occupational Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States,*Correspondence: Lisa A. Juckett ✉
| | - Haley V. Oliver
- Occupational Therapy Division, School of Health and Rehabilitation Sciences, College of Medicine, The Ohio State University, Columbus, OH, United States
| | - Govind Hariharan
- Coles College of Business, Kennesaw State University, Kennesaw, GA, United States
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Juckett LA, Wengerd LR, Banhos M, Darragh AR. Conducting Implementation Research in Stroke Rehabilitation: A Case Example and Considerations for Study Design. Neurorehabil Neural Repair 2022; 36:770-776. [PMID: 36398961 DOI: 10.1177/15459683221138747] [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: 11/19/2022]
Abstract
As neurorehabilitation research continues to grow, the field must ensure its scientific discoveries are implemented into routine clinical care. Without targeted efforts to increase the implementation of evidence into practice, patients may never see the benefits of interventions, assessments, and technologies developed in the confines of empirical studies. This article serves as a response to Lynch et al's 2018 Point of View piece in Neurorehabilitation and Neural Repair that underscored the urgent need for implementation studies to expedite the application of neurorehabilitation evidence in practice. To address this need, we provide the following 4 considerations investigators should contemplate when designing their own studies at the intersection of implementation and neurorehabilitation research: (a) consideration of guiding theories, models, and frameworks, (b) consideration of implementation strategies, (c) considerations of target outcomes, and (d) consideration of hybrid effectiveness-implementation designs. To conclude, we also provide a study exemplar to depict how these considerations can be integrated into the neurorehabilitation research field to narrow the evidence-to-practice gap.
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Affiliation(s)
- Lisa A Juckett
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
| | - Lauren R Wengerd
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
| | - Meredith Banhos
- Wexner Medical Center, The Ohio State University, Columbus, OH, USA
| | - Amy R Darragh
- Division of Occupational Therapy, The Ohio State University, Columbus, OH, USA
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Sichel CE, Connors EH. Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis. Implement Sci Commun 2022; 3:119. [PMID: 36415009 PMCID: PMC9682849 DOI: 10.1186/s43058-022-00356-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prior studies indicate the effectiveness of measurement-based care (MBC), an evidence-based practice, in improving and accelerating positive outcomes for youth receiving behavioral health services. MBC is the routine collection and use of client-reported progress measures to inform shared decision-making and collaborative treatment adjustments and is a relatively feasible and scalable clinical practice, particularly well-suited for under-resourced community mental health settings. However, uptake of MBC remains low, so information on determinants related to MBC practice patterns is needed. METHODS Quantitative and qualitative data from N = 80 clinicians who implemented MBC using a measurement feedback system (MFS) were merged to understand and describe determinants of practice over three study phases. Quantitative, latent class analysis identified clinician groups based on participants' ratings of MFS acceptability, appropriateness, and feasibility and describes similarities/differences between classes in clinician-level characteristics (e.g., age; perceptions of implementation climate; reported MFS use; phase I). Qualitative analyses of clinicians' responses to open-ended questions about their MFS use and feedback about the MFS and implementation supports were conducted separately to understand multi-level barriers and facilitators to MFS implementation (phase II). Mixing occurred during interpretation, examining clinician experiences and opinions across groups to understand the needs of different classes of clinicians, describe class differences, and inform selection of implementation strategies in future research (phase III). RESULTS We identified two classes of clinicians: "Higher MFS" and "Lower MFS," and found similarities and differences in MFS use across groups. Compared to Lower MFS participants, clinicians in the Higher MFS group reported facilitators at a higher rate. Four determinants of practice were associated with the uptake of MBC and MFS in youth-serving community mental health settings for all clinicians: clarity, appropriateness, and feasibility of the MFS and its measures; clinician knowledge and skills; client preferences and behaviors; and incentives and resources (e.g., time; continuing educational support). Findings also highlighted the need for individual-level implementation strategies to target clinician needs, skills, and perceptions for future MBC and MFS implementation efforts. CONCLUSION This study has implications for the adoption of evidence-based practices, such as MBC, in the context of community-based mental health services for youth.
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Affiliation(s)
- Corianna E Sichel
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Mail Unit 78, New York, NY, 10032, USA.
| | - Elizabeth H Connors
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA
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