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Baral A, Hanna F, Chimoriya R, Rana K. Cannabis Use and Its Impact on Mental Health in Youth in Australia and the United States: A Scoping Review. EPIDEMIOLOGIA 2024; 5:106-121. [PMID: 38534804 DOI: 10.3390/epidemiologia5010007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/28/2024] Open
Abstract
Cannabis is a widely used substance among the youth population, with an estimated 2.8% currently smoking cannabis. Its popularity is growing due to the perception of its harmless nature and lack of dependence. However, this increase in use has been linked to mental health issues, especially since its partial decriminalisation in some part of the United States and Australia. The objective of this scoping review was to investigate the mental health impact of cannabis use among young people in Australia and the United States. A scoping review was conducted according to the Joanna Briggs Institute (JBI) protocol, and articles were searched from ProQuest Central and EBSCO Host (MEDLINE and CINAHL databases). A total of 24 articles were analysed, including systematic reviews, meta-analyses, and cohort, longitudinal, and cross-sectional studies. The findings indicate that cannabis use is associated with depression, psychosis, suicide, cannabis use disorder, dependence, decline in cognitive function, and the development of externalising behaviour, particularly attention deficit hyperactivity disorder. However, the relationship between cannabis use and anxiety is equivocal. Mental health issues were more prevalent with increased frequency, duration, intensity, and type of use. Female, minority, LGBTQI, African American, Aboriginal, and Torres Strait Islander youth and the age of onset of cannabis use were significant factors for the development of mental health problems. The increasing prevalence of cannabis use among high school and college students suggests the need for intervention by teachers, parents, and community health professionals to make them aware of its potential negative mental health outcomes. Moreover, policy-level interventions by the government are required to discourage young people from using cannabis.
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Affiliation(s)
- Aayush Baral
- Public Health Program, Department of Health and Education, Torrens University Australia, Melbourne, VIC 3000, Australia
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
| | - Fahad Hanna
- Public Health Program, Department of Health and Education, Torrens University Australia, Melbourne, VIC 3000, Australia
| | - Ritesh Chimoriya
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
- School of Medicine, Western Sydney University, Campbelltown, NSW 2560, Australia
- Concord Institute of Academic Surgery, Concord Repatriation General Hospital, Concord, NSW 2139, Australia
| | - Kritika Rana
- Philanthropy Nepal (Paropakari Nepal) Research Collaboration, Auburn, NSW 2144, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW 2560, Australia
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Rodríguez-Nogueira Ó, Leirós-Rodríguez R, Pinto-Carral A, Álvarez-Álvarez MJ, Morera-Balaguer J, Moreno-Poyato AR. Relationship between competency for evidence-based practice and level of burnout of physical therapists with the establishment of the therapeutic relationship. Physiother Theory Pract 2024; 40:357-365. [PMID: 35972934 DOI: 10.1080/09593985.2022.2112638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND Evidence-based practice (EBP) interventions and effective therapeutic alliance (TA) are associated with greater treatment success. Furthermore, burnout syndrome could be detrimental to the development of such TA. OBJECTIVE To examine the association between EBP competencies and burnout level with the quality of TA among Spanish physiotherapists. METHODS Cross-sectional research with an electronic survey including the EBP Questionnaire-19, Maslach Burnout Inventory and Working Alliance Inventory-Short (WAI-S) and administered to 471 physiotherapists. RESULTS Regarding the EBP Questionnaire-19, physiotherapists scored highest on attitude and lowest on knowledge. For WAIS which achieved appropriate results of internal consistency and validity in the sample analyzed, bond scored the highest and goals the lowest. Years of experience was significantly associated with the task (r = 0.5; p = .003) and bond (r = 0.7; p = .002) and the WAIS total score (r = 0.8; p < .001), and all burnout subscales (-0.7 < r > 0.7; p < .001 for all). CONCLUSION Lower levels of burnout and improved EBP competencies are associated with a TA of greater quality. The association between attitudes toward EBP, a higher level of self-confidence and a lower perception of depersonalization appear to be determinant factors for improving TA.
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Affiliation(s)
- Óscar Rodríguez-Nogueira
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Raquel Leirós-Rodríguez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Arrate Pinto-Carral
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - María José Álvarez-Álvarez
- SALBIS Research Group, Department of Nursing and Physiotherapy, Faculty of Health Sciences, Universidad de León, Leon, Spain
| | - Jaume Morera-Balaguer
- Physical Therapy Department, CEU Universities, Universidad Cardenal Herrera-CEU, Elche, Spain
| | - Antonio R Moreno-Poyato
- Department of Public Health, Mental Health and Maternal and Child Health Nursing, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Feixa Llarga, Hospitalet del Llobregat, Spain
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Eiraldi R, Lawson GM, Glick HA, Khanna MS, Beidas R, Fishman J, Rabenau-McDonnell Q, Wilson T, Comly R, Schwartz BS, Jawad AF. Implementation fidelity, student outcomes, and cost-effectiveness of train-the-trainer strategies for Masters-level therapists in urban schools: results from a cluster randomized trial. Implement Sci 2024; 19:4. [PMID: 38273369 PMCID: PMC10809609 DOI: 10.1186/s13012-023-01333-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Little is known about the effectiveness and cost-effectiveness of train-the-trainer implementation strategies in supporting mental health evidence-based practices in schools, and about the optimal level of support needed for TT strategies. METHODS The current study is part of a larger type 2 hybrid cluster randomized controlled trial. It compares two train-the-trainer strategies, Train-the-Trainer (TT) and Train-the-Trainer plus ongoing consultation for trainers (TT +) on the delivery of a group cognitive behavioral treatment protocol for anxiety disorders. Participants were 33 therapists, 29 supervisors, and 125 students who were at risk for anxiety disorders from 22 urban schools. Implementation outcomes were implementation fidelity and treatment dosage. Student outcomes were child- and parent-reported symptoms of anxiety, child-reported symptoms of depression, and teacher-reported academic engagement. We estimated the cost of implementing the intervention in each condition and examined the probability that a support strategy for supervisors (TT vs TT +) is a good value for varying values of willingness to pay. RESULTS Therapists in the TT and TT + conditions obtained similarly high implementation fidelity and students in the conditions received similar treatment dosages. A mixed effects modeling approach for student outcomes revealed time effects for symptoms of anxiety and depression reported by students, and emotional disaffection reported by teachers. There were no condition or condition × times effects. For both conditions, the time effects indicated an improvement from pre-treatment to post-treatment in symptoms of anxiety and depression and academic emotional engagement. The average cost of therapist, supervisor, and consultant time required to implement the intervention in each condition was $1002 for TT and $1431 for TT + (p = 0.01). There was a greater than 80% chance that TT was a good value compared to TT + for all values of willingness to pay per one-point improvement in anxiety scores. CONCLUSIONS A TT implementation approach consisting of a thorough initial training workshop for therapists and supervisors as well as ongoing supervision for therapists resulted in adequate levels of fidelity and student outcomes but at a lower cost, compared to the TT + condition that also included ongoing external expert consultation for supervisors. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02651402.
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Affiliation(s)
- Ricardo Eiraldi
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA.
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA.
| | - Gwendolyn M Lawson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA
| | - Henry A Glick
- Department of Biostatistics and Epidemiology, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
- Wharton School, University of Pennsylvania, 3620 Locust Walk, Philadelphia, PA, 19104, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locus Walk # 210, Philadelphia, PA, 19104, USA
| | - Muniya S Khanna
- OCD and Anxiety Institute, 3138 Butler Pike # 200, Plymouth Meeting, PA, 19462, USA
| | - Rinad Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 North Michigan Avenue, Chicago, IL, 60611, USA
| | - Jessica Fishman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market St, Philadelphia, PA, 19104, USA
- Message Effects Lab, Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA, 19104, USA
| | - Quinn Rabenau-McDonnell
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Tara Wilson
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Rachel Comly
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Billie S Schwartz
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
| | - Abbas F Jawad
- Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 8293, Philadelphia, PA, 19146-2305, USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA
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Flanagan EH, Wyatt JP, Pavlo AJ, Kang S, Blackman KD, Ocasio L, Guy K, O'Connell MJ, Bellamy CD. Care integration goes Beyond Co-Location: Creating a Medical Home. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:123-133. [PMID: 38015324 DOI: 10.1007/s10488-023-01317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/29/2023]
Abstract
How to successfully integrate mental health and primary care remains a critically important question given the continued morbidity and early mortality of people with serious mental illness. This study investigated integration in a community mental health center (MHC) primarily treating people with SMI in a large, urban northeastern city where an on-site primary care center (PCC) was opened resulting in co-located mental health and primary care services being provided. Using focus groups and online surveys this study asked participants about their thoughts and interactions with the on-site PCC. Participants included staff from clinical, non-clinical, and leadership roles in the mental health center (MHC; PCC staff; and MHC clients who did not use the on-site PCC). MHC staff also offered their thoughts about and experiences with the on-site PCC one year and two years after the on-site PCC opened through an on-line survey. In both methods, staff reported limited awareness and expectations of the PCC in the first year. Staff indicated that successful care integration goes beyond co-location and peer health navigation can enhance integration. Finally, staff discussed desires for enhancing care integration and co-located services into a medical home that included communicating across medical records and providers at different agencies. Our results suggest that, in addition to the previously researched three C's of care integration (consultation, coordination, and collaboration), two more C's were essential to successful care integration: co-location and communication. Communication across medical records and providers at different agencies was an essential component of care integration, and co-location added increased ability to communicate across providers.
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Affiliation(s)
- Elizabeth H Flanagan
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Janan P Wyatt
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
- Yale University School of Medicine, 319 Peck Street Building 1, New Haven, CT, 06513, USA.
| | - Anthony J Pavlo
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Sylvia Kang
- New York University Grossman School of Medicine, One Park Ave, New York, NY, 10016, USA
| | - Kimberly D Blackman
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Luz Ocasio
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Kimberly Guy
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Maria J O'Connell
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, USA
| | - Chyrell D Bellamy
- Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, 06511, 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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Motamedi M, Lau AS, Byeon YV, Yu SH, Brookman-Frazee L. Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents. J Behav Health Serv Res 2023; 50:468-485. [PMID: 37430134 DOI: 10.1007/s11414-023-09844-5] [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: 06/15/2023] [Indexed: 07/12/2023]
Abstract
Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.
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Affiliation(s)
- Mojdeh Motamedi
- University of California San Diego, La Jolla, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Anna S Lau
- University of California Los Angeles, Los Angeles, USA
| | | | | | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
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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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Cidav Z, Mandell D, Ingersoll B, Pellecchia M. Programmatic Costs of Project ImPACT for Children with Autism: A Time-Driven Activity Based Costing Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:402-416. [PMID: 36637638 PMCID: PMC9838366 DOI: 10.1007/s10488-022-01247-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 01/14/2023]
Abstract
Programmatic cost assessment of clinical interventions can inform future dissemination and implementation efforts. We conducted a randomized trial of Project ImPACT (Improving Parents As Communication Teachers) in which community early intervention (EI) providers coached caregivers in techniques to improve young children's social communication skills. We estimated implementation and intervention costs while demonstrating an application of Time-Driven Activity-Based Costing (TDABC). We defined Project ImPACT implementation and intervention as processes that can be broken down successively into a set of procedures. We created process maps for both implementation and intervention delivery. We determined resource use and costs, per unit procedure in the first year of the program, from a payer perspective. We estimated total implementation cost per clinician and per site, intervention cost per child, and provided estimates of total hours spent and associated costs for implementation strategies, intervention activities and their detailed procedures. Total implementation cost was $43,509 per clinic and $14,503 per clinician. Clinician time (60%) and coach time (12%) were the most expensive personnel resources. Implementation coordination and monitoring (47%), ongoing consultation (26%) and clinician training (19%) comprised most of the implementation cost, followed by fidelity assessment (7%), and stakeholder engagement (1%). Per-child intervention costs were $2619 and $9650, respectively, at a dose of one hour per week and four hours per week Project ImPACT. Clinician and clinic leader time accounted for 98% of per child intervention costs. Highest cost intervention activity was ImPACT delivery to parents (89%) followed by assessment for child's ImPACT eligibility (10%). The findings can be used to inform funding and policy decision-making to enhance early intervention options for young children with autism. Uncompensated time costs of clinicians are large which raises practical and ethical concerns and should be considered in planning of implementation initiatives. In program budgeting, decisionmakers should anticipate resource needs for coordination and monitoring activities. TDABC may encourage researchers to assess costs more systematically, relying on process mapping and gathering prospective data on resource use and costs concurrently with their collection of other trial data.
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Affiliation(s)
- Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - David Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Brooke Ingersoll
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Melanie Pellecchia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Newlon JL, Murphy EM, Ahmed R, Illingworth KS. Determining and regulating scope of practice for health care professionals: A participatory, multiple stakeholder approach. Res Social Adm Pharm 2023; 19:457-467. [PMID: 36517405 DOI: 10.1016/j.sapharm.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/07/2022] [Accepted: 11/13/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Scope of practice varies between health professions and states. OBJECTIVE To explore stakeholders' preferences for determining and regulating health care professionals' scopes of practice. METHODS Stakeholders in medicine, nursing, and pharmacy, including practitioners, leaders of professional associations, regulatory board members, and healthcare executives, were recruited via professional organizations, social media, and snowball sampling. Stakeholder preferences were collected using concept mapping, an integrated mixed methods approach which includes 1) brainstorming of statements and 2) sorting and rating of statements. Multidimensional scaling, hierarchical cluster analysis, and Mann Whitney-U tests were used for analysis. RESULTS Thirty participants generated and sorted statements regarding preferences for scope of practice, creating eight clusters: 1) accountability to prioritize patient safety, 2) standardization, 3) collaborative regulation, 4) intra-professional regulation, 5) federal versus state, 6) role of non-health care professionals, 7) prioritization of patient outcomes, and 8) health care professional training and education. Fifty-seven participants rated statements in terms of importance and feasibility. Physicians and non-physicians held similar views on 68.5% (n = 37) and 81.5% (n = 44) of statements, respectively for importance and feasibility. The statements in the standardization and health care professional training and education clusters were perceived as the most important and feasible across stakeholder types.
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Affiliation(s)
- Jenny L Newlon
- Birth Control Pharmacist, USA; Purdue University - College of Pharmacy, USA
| | | | - Rami Ahmed
- Indiana University - School of Medicine, USA
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Fitzgeraldson E, Triandafilidis Z, Franklin Y, Palazzi K, Kay-Lambkin F, Fitzpatrick S. Feasibility and Acceptability of a Novel Online Program for Mental Health Carers. Int J Psychol Res (Medellin) 2023; 16:41-55. [PMID: 37547866 PMCID: PMC10402641 DOI: 10.21500/20112084.5733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 07/11/2022] [Accepted: 09/21/2022] [Indexed: 08/08/2023] Open
Abstract
Objective To evaluate the feasibility and acceptability of a new online program (Minds Together ) for carers of a person with depressive or anxiety symptoms. Methods Using a two-arm randomised controlled trial design, 108 carers of a person with depressive or anxiety symptomology aged 16 years or over (89% female; mean age 50 years) received immediate or delayed access to the Minds Together program. Feasibility was measured using program activation and survey completion rates. Acceptability was measured using a project-specific satisfaction scale, semi-structured interviews, and program completion metadata. The study used intention-to-treat (ITT) analysis for participant-reported outcomes (carer burden, coping self-efficacy) across groups. Results Feasibility and acceptability thresholds were consistent with similar studies: 59% activated their program account, 47% met the program completion threshold, and almost all reported satisfaction with the program. The ITT indicated trends in increased coping self-efficacy and reduced carer burden for the Intervention group, compared to the Waitlist control. Conclusions The Minds Together program is a feasible and acceptable program for carers supporting a person with depressive or anxiety symptomology. Results support exploration of the program's efficacy in a full-scale RCT.
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Affiliation(s)
- E Fitzgeraldson
- Everymind, Newcastle, Australia. University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
| | - Z Triandafilidis
- School of Medicine and Public, University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
| | - Y Franklin
- Everymind, Newcastle, Australia. Australia
| | - K Palazzi
- Everymind, Newcastle, Australia. Australia
| | - F Kay-Lambkin
- Hunter Medical Research Institute, New Lambton Heights, Australia. Hunter Medical Research InstituteAustralia
| | - S Fitzpatrick
- University of Newcastle, Newcastle, Australia. University of NewcastleUniversity of NewcastleAustralia
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Brown LA, AlRabiah R, Terasse M, Aksianiuk V, Sisti D. Knowledge of evidence-based practices for PTSD among mental health court judges. MEDICINE, SCIENCE, AND THE LAW 2023; 63:42-52. [PMID: 35473423 DOI: 10.1177/00258024221096250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Mental health courts offer access to community-based care for defendants with psychiatric disorders, including posttraumatic stress disorder (PTSD). However, limited information is available on how judges make treatment decisions about evidence-based practices. In this qualitative study, we interviewed mental health court judges to evaluate: (1) perspectives toward the role of PTSD in criminal behavior; (2) knowledge about evidence-based practice for PTSD; (3) treatment decisions for defendants with PTSD; and (4) treatment decisions for defendants at risk for suicide, a common comorbidity with PTSD. We hypothesized that mental health court judges would report low familiarity with evidence-based practices for PTSD despite wide recognition of the impact of trauma on criminal behavior. Methods: Mental health court judges (N = 11, 60% women, 60% between 50-59 years) were recruited from 7 states in the US and completed a demographics questionnaire and semi-structured qualitative interview that was transcribed and double-coded. Results: Judges in mental health court unanimously agreed that PTSD is highly prevalent among their defendants, but that they had not having received formal education about evidence-based practices for PTSD. They reported relying on their team members to provide recommendations for treatment planning and viewed their role as the enforcer of the treatment teams' suggestions. Finally, judges also reported that suicide prevention is an important consideration and that there is a need for universal suicide risk assessments. Conclusions: These findings have implications for continuing education among judges in mental health court, and we recommend mandated training to increase awareness of evidence-based practices for PTSD and suicide prevention.
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Affiliation(s)
- Lily A Brown
- Department of Psychiatry, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Reem AlRabiah
- Department of Psychiatry, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Melanie Terasse
- Department of Sociology, Princeton University, Princeton, NJ, USA
- Scattergood Program for Applied Ethics in Behavioral Health Care, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Valeryia Aksianiuk
- Scattergood Program for Applied Ethics in Behavioral Health Care, 6572University of Pennsylvania, Philadelphia, PA, USA
| | - Dominic Sisti
- Department of Psychiatry, 6572University of Pennsylvania, Philadelphia, PA, USA
- Scattergood Program for Applied Ethics in Behavioral Health Care, 6572University of Pennsylvania, Philadelphia, PA, USA
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12
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Candon M, Williams N, Zentgraf K, Buttenheim A, Bewtra M, Beidas RS, Stewart RE. Variation in Stakeholder Preferences for Implementing Evidence-Based Practices in Behavioral Health Care. Psychiatr Serv 2022; 73:1270-1273. [PMID: 35319915 PMCID: PMC9500117 DOI: 10.1176/appi.ps.202100453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Objective The authors examined whether stakeholders in behavioral health care differ in their preferences for strategies that support the implementation of evidence-based practices (EBPs). Methods Using data collected in March and April 2019 in a survey of stakeholders in Philadelphia Medicaid’s behavioral health care system, the authors compared empirical Bayes preference weights for implementation strategies across clinicians, supervisors, agency executives, and payers. Results Preferences for implementation strategies overlapped among the stakeholders (N=357 survey respondents). Financial incentives were consistently ranked as most useful and performance feedback as the least useful for implementing EBPs. However, areas of divergence were identified. For example, payers preferred compensation for EBP delivery, whereas clinicians considered compensation for time spent on preparing for EBPs as equally useful. Conclusions The observed variation in stakeholder preferences for strategies to implement EBPs may shed light on why the ongoing shift from volume to value in behavioral health care has had mixed results.
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Affiliation(s)
- Molly Candon
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | | | - Kelly Zentgraf
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alison Buttenheim
- Center for Health Incentives and Behavioral Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Family and Community Health, School of Nursing, University of Pennsylvania
| | - Meenakshi Bewtra
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rinad S. Beidas
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Penn Implementation Science Center (PISCE@LDI), Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
| | - Rebecca E. Stewart
- Center for Mental Health, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA
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13
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Costa N, Blyth FM, Amorim AB, Parambath S, Shanmuganathan S, Schneider CH. Implementation initiatives to improve low back pain care in Australia: a scoping review. PAIN MEDICINE 2022; 23:1979-2009. [PMID: 35758625 DOI: 10.1093/pm/pnac102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This scoping review aimed to comprehensively review strategies for implementation of low back pain (LBP) guidelines, policies and models of care in the Australian healthcare system. METHODS A literature search was conducted in MEDLINE, EMBASE, CINAHL, Amed and Web of Science to identify studies that aimed to implement or integrate evidence-based interventions/practices to improve LBP care within Australian settings. RESULTS Twenty-five studies met the inclusion criteria. Most studies targeted primary care settings (n = 13). Other settings included tertiary care (n = 4), community (n = 4), pharmacies (n = 3). One study targeted both primary and tertiary care settings (n = 1). Only 40% of the included studies reported an underpinning framework, model or theory. Implementation strategies most frequently used were evaluative and iterative strategies (n = 14, 56%) and train and educate stakeholders (n = 13, 52%), followed by engage consumers (n = 6, 24%), develop stakeholder relationships (n = 4, 16%), change in infrastructure (n = 4, 16%) and support clinicians (n = 3, 12%). The most common implementation outcomes considered were acceptability (n = 11, 44%) and adoption (n = 10, 40%), followed by appropriateness (n = 7, 28%), cost (n = 3, 12%), feasibility (n = 1, 4%) and fidelity (n = 1, 4%). Barriers included time constraints, funding, and teamwork availability. Facilitators included funding and collaboration between stakeholders. CONCLUSIONS Implementation research targeting LBP appears to be a young field, mostly focusing on training and educating stakeholders in primary care. Outcomes on sustainability and penetration of evidence-based interventions are lacking. There is a need for implementation research guided by established frameworks that consider interrelationships between organisational and system contexts beyond the clinician-patient dyad.
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Affiliation(s)
- Nathalia Costa
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia.,The University of Queensland, School of Health and Rehabilitation Sciences, Brisbane, Queensland, Australia
| | - Fiona M Blyth
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Anita B Amorim
- The University of Sydney, School of Health Sciences, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Sarika Parambath
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Selvanaayagam Shanmuganathan
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Carmen Huckel Schneider
- The University of Sydney, Sydney School of Public Health, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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14
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Bartakova J, Zúñiga F, Guerbaai RA, Basinska K, Brunkert T, Simon M, Denhaerynck K, De Geest S, Wellens NIH, Serdaly C, Kressig RW, Zeller A, Popejoy LL, Nicca D, Desmedt M, De Pietro C. Health economic evaluation of a nurse-led care model from the nursing home perspective focusing on residents' hospitalisations. BMC Geriatr 2022; 22:496. [PMID: 35681157 PMCID: PMC9185955 DOI: 10.1186/s12877-022-03182-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/31/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health economic evaluations of the implementation of evidence-based interventions (EBIs) into practice provide vital information but are rarely conducted. We evaluated the health economic impact associated with implementation and intervention of the INTERCARE model-an EBI to reduce hospitalisations of nursing home (NH) residents-compared to usual NH care. METHODS The INTERCARE model was conducted in 11 NHs in Switzerland. It was implemented as a hybrid type 2 effectiveness-implementation study with a multi-centre non-randomised stepped-wedge design. To isolate the implementation strategies' costs, time and other resources from the NHs' perspective, we applied time-driven activity-based costing. To define its intervention costs, time and other resources, we considered intervention-relevant expenditures, particularly the work of the INTERCARE nurse-a core INTERCARE element. Further, the costs and revenues from the hotel and nursing services were analysed to calculate the NHs' losses and savings per resident hospitalisation. Finally, alongside our cost-effectiveness analysis (CEA), a sensitivity analysis focused on the intervention's effectiveness-i.e., regarding reduction of the hospitalisation rate-relative to the INTERCARE costs. All economic variables and CEA were assessed from the NHs' perspective. RESULTS Implementation strategy costs and time consumption per bed averaged 685CHF and 9.35 h respectively, with possibilities to adjust material and human resources to each NH's needs. Average yearly intervention costs for the INTERCARE nurse salary per bed were 939CHF with an average of 1.4 INTERCARE nurses per 100 beds and an average employment rate of 76% of full-time equivalent per nurse. Resident hospitalisation represented a total average loss of 52% of NH revenues, but negligible cost savings. The incremental cost-effectiveness ratio of the INTERCARE model compared to usual care was 22'595CHF per avoided hospitalisation. As expected, the most influential sensitivity analysis variable regarding the CEA was the pre- to post-INTERCARE change in hospitalisation rate. CONCLUSIONS As initial health-economic evidence, these results indicate that the INTERCARE model was more costly but also more effective compared to usual care in participating Swiss German NHs. Further implementation and evaluation of this model in randomised controlled studies are planned to build stronger evidential support for its clinical and economic effectiveness. TRIAL REGISTRATION clinicaltrials.gov ( NCT03590470 ).
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Affiliation(s)
- Jana Bartakova
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.,Institute of Biophysics and Informatics, 1St Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Franziska Zúñiga
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.
| | - Raphaëlle-Ashley Guerbaai
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Kornelia Basinska
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Thekla Brunkert
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.,University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland
| | - Michael Simon
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Kris Denhaerynck
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Sabina De Geest
- Department Public Health, Institute of Nursing Science, Faculty of Medicine, University of Basel, Basel, Switzerland.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Louvain, Belgium
| | - Nathalie I H Wellens
- Department of Public Health and Social Affairs, Directorate General of Health, Canton of Vaud, Lausanne, Switzerland.,La Source School of Nursing, HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | - Reto W Kressig
- University Department of Geriatric Medicine FELIX PLATTER, Basel, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Lori L Popejoy
- The University of Missouri, Sinclair School of Nursing, Columbia, US
| | - Dunja Nicca
- Institute of Epidemiology, Biostatistics and Prevention, University of Zürich, Conches, Switzerland
| | - Mario Desmedt
- Foundation Asile Des Aveugles, Lausanne, Switzerland
| | - Carlo De Pietro
- Department of Business Economics, Health and Social Care, University of Applied Sciences and Arts of Southern Switzerland, Lugano, Switzerland
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15
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Vroom EB, Massey OT, Akbari Z, Bristol SC, Cook B, Green AL, Levin BL, Tyson DM, Johnson ME. Exploring perceptions of implementation practice capacity in community-based behavioral health organizations. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1700-1716. [PMID: 34797922 PMCID: PMC8917074 DOI: 10.1002/jcop.22749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/03/2021] [Accepted: 11/06/2021] [Indexed: 06/13/2023]
Abstract
Community-based organizations (CBOs) must have the capacity to adopt, implement, and sustain evidence-based practices (EBPs). However, limited research exists examining CBOs' ability/capacity to implement EBPs. The purpose of this preliminary study was to investigate how staff of CBOs perceive implementation practice capacity, determine factors needed for adequate capacity for implementing EBPs, and examine which perspectives of capacity are shared across organizational levels. Ninety-seven administrators and practitioners of CBOs were surveyed using the Implementation Capacity Survey, which examines perceived importance, presence, and organizational capacity of the CBO in nine implementation practice areas (IPAs) (e.g., leadership). Results revealed participants rated IPAs on the importance scale higher than IPAs on the present scale. Presence and organizational capacity scales were strongly correlated, and results showed significant differences between administrators and practitioners on ratings of presence and organizational capacity. Implications for future research aimed at examining/building implementation practice capacity in community settings will be discussed.
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Affiliation(s)
- Enya B Vroom
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Oliver T Massey
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Zahra Akbari
- Department of Economics, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Skye C Bristol
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Brandi Cook
- Department of Chemistry, Cell Biology, Microbiology, and Molecular Biology, College of Arts and Sciences, University of South Florida, Tampa, Florida, USA
| | - Amy L Green
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
| | - Bruce L Levin
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Dinorah M Tyson
- College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Micah E Johnson
- Department of Mental Health Law and Policy, College of Behavioral and Community Sciences, University of South Florida, Tampa, Florida, USA
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16
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Schriger SH, Klein MR, Last BS, Fernandez-Marcote S, Dallard N, Jones B, Beidas RS. Community Mental Health Clinicians' Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study. JMIR Pediatr Parent 2022; 5:e29250. [PMID: 35023839 PMCID: PMC8989386 DOI: 10.2196/29250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 12/19/2021] [Accepted: 01/04/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians' experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. OBJECTIVE We examined community mental health clinicians' perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. METHODS We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists' responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. RESULTS Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. CONCLUSIONS First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services.
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Affiliation(s)
- Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | - Melanie R Klein
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States
| | - Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Natalie Dallard
- Community Behavioral Health, Philadelphia, PA, United States
| | - Bryanna Jones
- Community Behavioral Health, Philadelphia, PA, United States
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States.,Penn Medicine Nudge Unit, University of Pennsylvania Health System, Philadelphia, PA, United States.,Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA, United States
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17
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Kuhn M, Gonzalez E, Weil L, Izguttinov A, Walker S. Effectiveness of Child-Focused Interventions for Externalizing Behavior: a Rapid Evidence Review. Res Child Adolesc Psychopathol 2022; 50:987-1009. [PMID: 35212851 DOI: 10.1007/s10802-022-00904-6] [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: 01/31/2022] [Indexed: 10/19/2022]
Abstract
Parent behavior management training (BMT) is well established as an effective, evidence-based treatment for children with externalizing behavior. Despite the wealth of data supporting BMT, many community providers use a variety of child-focused and non-directive interventions to target behavior problems. There is lack of clarity as to whether the evidence supporting child-focused externalizing treatments is sufficiently compelling to support offering these treatments rather than or in addition to BMT. This rapid evidence review compares the effectiveness of BMT with several common child-focused interventions for externalizing behavior including cognitive behavioral (CBT), social skill (SS), and play/dynamic (PT) approaches. PubMed, PsychINFO, and Web of Science were searched for English-language articles from year 2000 onwards for each intervention type. Inclusion criteria were child age (12 and under), presence of a child-focused behavioral treatment condition, and externalizing behavior as an outcome variable. A total of 30 studies met inclusion criteria and were coded (13 CBT, 10 SS, 7 PT). Results supported social skills interventions with accompanying BMT as effective in improving externalizing problems, with generally moderate effect sizes. Individual social skills interventions were promising but needing further evaluation compared to treatment as usual. CBT treatments with and without accompanying BMT showed moderate effects over waitlist but produced less consistently significant effects compared to more robust controls. Play therapy approaches showed inconsistent effects and require further evaluation. This review supports social skills plus BMT treatments as a child-focused intervention with probable efficacy for child externalizing problems. Implications for policy and community practice are discussed.
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Affiliation(s)
- M Kuhn
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA. .,University of Washington Child and Adolescent Psychiatry, Seattle, WA, USA.
| | - E Gonzalez
- Seattle Children's Hospital and Research Institute, Seattle, WA, USA.,University of Washington Child and Adolescent Psychiatry, Seattle, WA, USA
| | - L Weil
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
| | - A Izguttinov
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
| | - S Walker
- University of Washington Evidence Based Practice Institute, Seattle, WA, USA
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18
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Vroom EB, Massey OT. Moving from Implementation Science to Implementation Practice: The Need to Solve Practical Problems to Improve Behavioral Health Services. J Behav Health Serv Res 2022; 49:106-116. [PMID: 34357498 PMCID: PMC10585649 DOI: 10.1007/s11414-021-09765-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 11/30/2022]
Abstract
It is well recognized that the use of evidence-based practices (EBPs) is critical to improving service outcomes for those receiving behavioral health services. However, EBPs are not easily implemented in behavioral health settings, and there are many challenges to supporting these services over time. Recently, research efforts in implementation science (IS) have greatly expanded our understanding of issues that influence the successful implementation of EBPs. Unfortunately, less effort has been devoted to translating this research theory on a practical level to help individual service entities solve the specific problems of putting programs into place. A process is needed where service organizations and practitioners can build their capacity, informed by IS research, to improve service outcomes. The purpose of this commentary is to describe the IS research base, provide an introduction to implementation practice, describe challenges confronting practitioners, and propose necessary steps in building organizational capacity that enables practitioners to implement the most effective services available.
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Affiliation(s)
- Enya B Vroom
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA.
| | - Oliver T Massey
- Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL, USA
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19
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Leveraging implementation science to advance antibiotic stewardship practice and research. Infect Control Hosp Epidemiol 2021; 43:139-146. [PMID: 34852212 DOI: 10.1017/ice.2021.480] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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20
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Proctor EK, Toker E, Tabak R, McKay VR, Hooley C, Evanoff B. Market viability: a neglected concept in implementation science. Implement Sci 2021; 16:98. [PMID: 34801036 PMCID: PMC8605560 DOI: 10.1186/s13012-021-01168-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 10/26/2021] [Indexed: 11/15/2022] Open
Abstract
This debate paper asserts that implementation science needs to incorporate a key concept from entrepreneurship—market demand—and demonstrates how assessing an innovation’s potential market viability might advance the pace and success of innovation adoption and sustainment. We describe key concepts, language distinctions, and questions that entrepreneurs pose to implementation scientists—many of which implementation scientists appear ill-equipped to answer. The paper concludes with recommendations about how concepts from entrepreneurship, notably market viability assessment, can enhance the translation of research discoveries into real-world adoption, sustained use, and population health benefits. The paper further proposes activities that can advance implementation science’s capacity to draw from the field of entrepreneurship, along with the data foundations required to assess and cultivate market demand.
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Affiliation(s)
- Enola K Proctor
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO, 63130, USA.
| | - Emre Toker
- Washington University Medical School in St. Louis and the University of Arizona, 1110 E. Campus Drive, P.O. Box 210033, Tucson, AZ, USA, 85721-0033
| | - Rachel Tabak
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO, 63130, USA
| | - Virginia R McKay
- Brown School, Washington University in St. Louis, One Brookings Drive, Saint Louis, MO, 63130, USA
| | - Cole Hooley
- School of Social Work, Brigham Young University, 2166 JFSB, Provo, UT, 84602, USA
| | - Bradley Evanoff
- Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, 660 S. Euclid Drive, St. Louis, MO, 63110, USA
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21
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Lewis CC, Powell BJ, Brewer SK, Nguyen AM, Schriger SH, Vejnoska SF, Walsh-Bailey C, Aarons GA, Beidas RS, Lyon AR, Weiner B, Williams N, Mittman B. Advancing mechanisms of implementation to accelerate sustainable evidence-based practice integration: protocol for generating a research agenda. BMJ Open 2021; 11:e053474. [PMID: 34663668 PMCID: PMC8524292 DOI: 10.1136/bmjopen-2021-053474] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/04/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Mechanisms explain how implementation strategies work. Implementation research requires careful operationalisation and empirical study of the causal pathway(s) by which strategies effect change, and factors that may amplify or weaken their effects. Understanding mechanisms is critically important to replicate findings, learn from negative studies or adapt an implementation strategy developed in one setting to another. Without understanding implementation mechanisms, it is difficult to design strategies to produce expected effects across contexts, which may have disproportionate effects on settings in which priority populations receive care. This manuscript outlines the protocol for an Agency for Healthcare Research and Quality-funded initiative to: (1) establish priorities for an agenda to guide research on implementation mechanisms in health and public health, and (2) disseminate the agenda to research, policy and practice audiences. METHODS AND ANALYSIS A network of scientific experts will convene in 'Deep Dive' meetings across 3 years. A research agenda will be generated through analysis and synthesis of information from six sources: (1) systematic reviews, (2) network members' approaches to studying mechanisms, (3) new proposals presented in implementation proposal feedback sessions, (4) working group sessions conducted in a leading implementation research training institute, (5) breakout sessions at the Society for Implementation Research Collaboration's (SIRC) 2019 conference and (6) SIRC conference abstracts. Two members will extract mechanism-relevant text segments from each data source and a third member will generate statements as an input for concept mapping. Concept mapping will generate unique clusters of challenges, and the network will engage in a nominal group process to identify priorities for the research agenda. ETHICS AND DISSEMINATION This initiative will yield an actionable research agenda to guide research to identify and test mechanisms of change for implementation strategies. The agenda will be disseminated via multiple channels to solicit feedback and promote rigorous research on implementation mechanisms.
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Affiliation(s)
- Cara C Lewis
- MacColl Center, Kaiser Permanente, Seattle, Washington, USA
| | - Byron J Powell
- Brown School, Washington University in St Louis, St. Louis, Missouri, USA
| | - Stephanie K Brewer
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
| | - Ann M Nguyen
- Center for State Health Policy, Rutgers, New Brunswick, New Jersey, USA
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sarah F Vejnoska
- Department of Psychiatry and Behavioral Sciences, UC Davis MIND Institute, Sacramento, California, USA
| | | | - Gregory A Aarons
- Department of Psychiatry and Dissemination and Implementation Science Center, University of California San Diego, La Jolla, California, USA
| | - Rinad S Beidas
- Departments of Psychiatry, Medical Ethics and Health Policy, and Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Penn Implementation Science Center at the Leonard Davis Institute (PISCE@LDI), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Aaron R Lyon
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Bryan Weiner
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Brian Mittman
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA
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Maxwell CA, Ehrhart MG, Williams NJ, Moore TM, Kendall PC, Beidas RS. The Organizational Financial Context of Publicly-Funded Mental Health Clinics: Development and Preliminary Psychometric Evaluation of the Agency Financial Status Scales. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:780-792. [PMID: 33740163 DOI: 10.1007/s10488-021-01128-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 01/08/2023]
Abstract
Funding is a major barrier to implementation of evidence-based practices (EBPs) in publicly-funded community mental health clinics (CMHCs). Understanding how best to deploy implementation strategies that address this barrier requires greater clarity on the financial context within agencies. We developed the Agency Financial Status Scales (AFSS) to assess employee perceptions of the level of three hypothesized and theoretical funding related constructs in organizations: (a) perceptions of financial health, (b) financial attitudes toward EBPs, and (c) strategic financial climate. This investigation serves as a preliminary evaluation of this measure. Participants were 239 therapists and 40 supervisors from 25 publicly-funded CMHCs providing outpatient mental health services for young people. Confirmatory factor analysis was used to investigate the latent trait structure of the items. Internal consistency, interrater agreement, concordance between therapists and supervisors, and convergent validity were also examined. A two-factor model measuring perceptions of financial health and strategic financial climate best fit the data. For both of these scales, alpha reliability was acceptable and agreement statistics provided moderate support for aggregation at the organizational level. Analyses supported the convergent validity of the scales. The development and preliminary evaluation of the AFSS is an important first step in understanding the financial context of publicly-funded CMHCs. Though findings from this investigation are promising, additional development and testing are needed to develop a more thorough understanding of the constructs and to improve the validity and reliability of this measure.
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Affiliation(s)
| | - Mark G Ehrhart
- Department of Psychology, University of Central Florida, Orlando, USA
| | | | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA
| | | | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3rd Floor, 3015, Philadelphia, PA, 19104, USA.
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
- Penn Implementation Science Center At the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, USA.
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania Perelman School of Medicine, Philadelphia, USA.
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Agbejule OA, Hart NH, Ekberg S, Koczwara B, Ladwa R, Simonsen C, Pinkham EP, Chan RJ. Bridging the research to practice gap: a systematic scoping review of implementation of interventions for cancer-related fatigue management. BMC Cancer 2021; 21:809. [PMID: 34261438 PMCID: PMC8278687 DOI: 10.1186/s12885-021-08394-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 05/23/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer-related fatigue (CRF) is one of the most common and distressing symptoms in people with cancer. Although efficacy of interventions for CRF have been extensively investigated, less has been done to ensure successful translation into routine clinical practice. The aim of this systematic scoping review was to synthesise knowledge surrounding the implementation of CRF interventions, summarise the processes and outcomes of implementation strategies used, and identify opportunities for further research. METHODS PubMed, Cochrane CENTRAL, EMBASE and CINAHL databases were searched (up to December 2020). The Cochrane Effective Practice and Organisation of Care (EPOC) Group taxonomy and the RE-AIM Framework were used to guide the evaluation of implementation strategies and outcomes, respectively. RESULTS Six studies were included. Three used an implementation framework (PARIHS, KTA, Cullens & Adams' Implementation Guide) to guide implementation. Overall, the implementation strategies used across all studies were reported to have directly resulted in immediate changes at the clinician level (e.g., increased clinician behaviours, self-efficacy, attitudes, knowledge of CRF management). No clear relationship was found between the use of implementation models and the number or type of implementation strategies used. For outcomes, Effectiveness and Implementation were the most highly reported RE-AIM measures followed by Reach then Maintenance. Adoption was the least reported. CONCLUSIONS Despite the high prevalence of CRF and evidence-based interventions for managing CRF, there is limited evidence informing the sustainable implementation of these interventions. This systematic scoping review emphasises the lack of quality CRF implementation studies presently available in the literature leading to a disconnect between effective CRF interventions, routine clinical care, and cancer survivors at present. This review highlights the need for robust study designs guided by established frameworks to methodically design and evaluate the implementation of CRF management interventions in the future.
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Affiliation(s)
- Oluwaseyifunmi Andi Agbejule
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia.
| | - Nicolas H Hart
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, 6027, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, 6959, Australia
| | - Stuart Ekberg
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
| | - Bogda Koczwara
- Flinders University and Flinders Medical Centre, Flinders Drive, Bedford Park, South Australia, 5048, Australia
| | - Rahul Ladwa
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
- School of Medicine, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Camilla Simonsen
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
| | - Elizabeth P Pinkham
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
- School of Health and Behavioural Science, University of Queensland, St Lucia, Queensland, 4072, Australia
| | - Raymond Javan Chan
- Cancer and Palliative Care Outcomes Centre, School of Nursing, N Block, Kelvin Grove Campus,, Queensland University of Technology (QUT), Kelvin Grove, Queensland, 4059, Australia
- Princess Alexandra Hospital, Metro South Hospital and Health Services, Woolloongabba, Queensland, 4102, Australia
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Sridhar A, Drahota A, Walsworth K. Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study. Implement Sci Commun 2021; 2:55. [PMID: 34039434 PMCID: PMC8157454 DOI: 10.1186/s43058-021-00158-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based practices (EBPs) have been shown to improve behavioral and mental health outcomes for children diagnosed with autism spectrum disorder (ASD). Research suggests that the use of these practices in community-based organizations is varied; however, the utilization of implementation guides may bridge the gap between research and practice. The Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART) Implementation Toolkit is a web-based implementation toolkit developed to guide organization-based implementation teams through EBP identification, adoption, implementation, and sustainment in ASD community-based organizations. METHODS This study examined the facilitators and barriers (collectively termed "determinants") to the utilization of this toolkit, based on the perspectives of implementation teams at six ASD community-based organizations. Two independent coders utilized the adapted EPIS framework and the Technology Acceptance Model 3 to guide qualitative thematic analyses of semi-structured interviews with implementation teams. RESULTS Salient facilitators (e.g., facilitation teams, facilitation meetings, phase-specific activities) and barriers (e.g., website issues, perceived lack of ease of use of the website, perceived lack of resources, inner context factors) were identified, highlighting key determinants to the utilization of this toolkit. Additionally, frequent determinants and determinants that differed across adapted EPIS phases of the toolkit were noted. Finally, analyses highlighted two themes: (a) Inner Context Determinants to use of the toolkit (e.g., funding) and (b) Innovation Determinants (e.g., all website-related factors), indicating an interaction between the two models utilized to guide study analyses. CONCLUSIONS Findings highlighted several factors that facilitated the utilization of this implementation guide. Additionally, findings identified key areas for improvement for future iterations of the ACT SMART Implementation Toolkit. Importantly, these results may inform the development, refinement, and utilization of implementation guides with the aim of increasing the uptake of EBPs in community-based organizations providing services to children with ASD and their families. Finally, these findings contribute to the implementation science literature by illustrating the joint use of the EPIS framework and Technology Acceptance Model 3 to evaluate the implementation of a web-based toolkit within community-based organizations.
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Affiliation(s)
- Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, USA.
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, USA
- Child & Adolescent Services Research Center, San Diego, CA, USA
| | - Kiersten Walsworth
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Bailin A, Burton S, Rego S, Alpert J, Pimentel S. Integrating Advocacy for Marginalized Children and Families Into Evidence-Based Care During COVID-19: Clinical Vignettes. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:701-715. [PMID: 33994768 PMCID: PMC8112892 DOI: 10.1016/j.cbpra.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 04/19/2021] [Indexed: 01/17/2023]
Abstract
The novel coronavirus (COVID-19) has disproportionately impacted the health and socioeconomic outcomes for low-income populations, people of color, and immigrant children and families in the United States. As inequities in resources (i.e., food, internet, housing), health care, and education increased for marginalized families as a result of COVID-19, child-focused clinicians had to broaden their professional scope and implement new advocacy efforts. The current paper uses clinical vignettes taken from a New York State Office of Mental Health-licensed child and adolescent outpatient clinic in the Bronx, New York. The vignettes highlight the social inequities that impacted marginalized children and families during the pandemic, as well as the clinical team's response through the integration of evidence-base practice and advocacy. Implications for practice with vulnerable populations as the COVID-19 pandemic persists are discussed.
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Affiliation(s)
| | | | - Simon Rego
- Montefiore Medical Center/Albert Einstein, College of Medicine
| | - Jonathan Alpert
- Montefiore Medical Center/Albert Einstein, College of Medicine
| | - Sandra Pimentel
- Montefiore Medical Center/Albert Einstein, College of Medicine
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26
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Gulati S, Palczewski K. New focus on regulation of the rod photoreceptor phosphodiesterase. Curr Opin Struct Biol 2021; 69:99-107. [PMID: 33945959 DOI: 10.1016/j.sbi.2021.03.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/18/2021] [Accepted: 03/25/2021] [Indexed: 02/03/2023]
Abstract
Rod photoreceptor phosphodiesterase (PDE6) is the key catalytic enzyme of visual phototransduction. PDE6 is the only member of the phosphodiesterase family that consists of a heterodimeric catalytic core composed of PDE6α and PDE6β subunits and two inhibitory PDE6γ subunits. Both PDE6α and PDE6β contain two regulatory GAF domains and one catalytic domain. GAF domains and the tightly bound PDE6γ subunits allosterically regulate the activity of the catalytic domain in association with the GTP-bound transducin alpha subunit (Gtα-GTP). Recent cryo-electron microscopy structures of the PDE6αγβγ and PDE6αγβγ-(Gtα-GTP)2 complexes have provided valuable knowledge shedding additional light on the allosteric activation of PDE6 by Gtα-GTP. Here we discuss recent developments in our understanding of the mechanism of PDE6 activation.
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Affiliation(s)
| | - Krzysztof Palczewski
- Gavin Herbert Eye Institute and the Department of Ophthalmology, Center for Translational Vision Research, University of California, 829 Health Sciences Road, Irvine, CA 92617, USA; The Department of Physiology & Biophysics, University of California, Irvine, CA 92697, USA; The Department of Chemistry, University of California, Irvine, CA 92697, USA.
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27
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Ryan G, Avdic L, Daly E, Askelson N, Farris PE, Shannon J, McRee AL, Hanson J, Kenyon DB, Seegmiller L. Influences on HPV vaccination across levels of the social ecological model: perspectives from state level stakeholders. Hum Vaccin Immunother 2021; 17:1006-1013. [PMID: 33327850 DOI: 10.1080/21645515.2020.1839290] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Nationally, human papillomavirus (HPV) vaccination rates fall short of the Healthy People 2020 goal of 80% completion. Although strategies to increase these rates exist, low rates persist. We used concept mapping with state-level stakeholders to better understand barriers and facilitators to HPV vaccination. Concept mapping is a participatory research process in which respondents brainstorm ideas to a prompt and then sort ideas into piles. We present results of the brainstorming phase. We recruited participants identified by researchers' professional connections (n = 134) via e-mail invitations from five states (Iowa, South Dakota, Minnesota, Oregon, and Washington) working in adolescent health, sexual health, cancer prevention and control, or immunization. Using Concept Systems' online software we solicited participants' beliefs about what factors have the greatest influence on HPV vaccination rates in their states. From the original sample 58.2% (n = 78) of participants completed the brainstorming activity and generated 372 statements, our team removed duplicates and edited statements for clarity, which resulted in 172 statements. We coded statements using the Social Ecological Model (SEM) to understand at what level factors affecting HPV vaccination are occurring. There were 53 statements at the individual level, 22 at the interpersonal level, 21 in community, 51 in organizational, and 25 in policy. Our results suggest that a tiered approach, utilizing multi-level interventions instead of focusing on only one level may have the most benefit. Moreover, the policy-level influences identified by participants may be difficult to modify, thus efforts should focus on implementing evidence-based interventions to have the most meaningful impact.
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Affiliation(s)
- Grace Ryan
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Lejla Avdic
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Eliza Daly
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Natoshia Askelson
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Paige E Farris
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University/Portland State University School of Public Health, Oregon Health & Science University, Bend, OR, USA
| | - Jackilen Shannon
- Knight Cancer Institute, School of Medicine, Oregon Health & Science University/Portland State University School of Public Health, Oregon Health & Science University, Bend, OR, USA
| | - Annie-Laurie McRee
- Division of General Pediatrics and Adolescent Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Jessica Hanson
- College of Education and Human Service Professions, University of Minnesota Duluth, Duluth, MN, USA
| | - DenYelle Baete Kenyon
- Sanford School of Medicine, School of Health Sciences, University of South Dakota, SD, USA
| | - Laura Seegmiller
- Department of Community and Behavioral Health, College of Public Health, University of Iowa, Iowa City, IA, USA
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28
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Schriger SH, Becker-Haimes EM, Skriner L, Beidas RS. Clinical Supervision in Community Mental Health: Characterizing Supervision as Usual and Exploring Predictors of Supervision Content and Process. Community Ment Health J 2021; 57:552-566. [PMID: 32671507 PMCID: PMC7855099 DOI: 10.1007/s10597-020-00681-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Abstract
Clinical supervision can be leveraged to support implementation of evidence-based practices in community mental health settings, though it has been understudied. This study focuses on 32 supervisors at 23 mental health organizations in Philadelphia. We describe characteristics of supervisors and organizations and explore predictors of supervision content and process. Results highlight a low focus on evidence-based content and low use of active supervision processes. They underscore the need for further attention to the community mental health context when designing supervision-targeted implementation strategies. Future work should assess whether supervision models specific to community mental health are needed.
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Affiliation(s)
- Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 3015, Philadelphia, PA, 19104, USA.,Hall-Mercer Community Mental Health Center, Philadelphia, PA, USA
| | - Laura Skriner
- Evidence-Based Practitioners of New Jersey, Summit, NJ, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, Room 3015, Philadelphia, PA, 19104, USA. .,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. .,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA. .,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Making Implementation Last: The Impact of Training Design on the Sustainability of an Evidence-Based Treatment in a Randomized Controlled Trial. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:757-767. [PMID: 33728558 DOI: 10.1007/s10488-021-01126-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 10/21/2022]
Abstract
Although advances have been made in facilitating the implementation of evidence-based treatments, little is known about the most effective way to sustain their use over time. The current study examined the sustainability of one evidence-based treatment, Parent-Child Interaction Therapy (PCIT), following a statewide implementation trial testing three training methods: Cascading Model, Learning Collaborative, and Distance Education. Participants included 100 clinicians and 50 administrators from 50 organizations across Pennsylvania. Clinicians and administrators reported on sustainability at 24-months, as measured by the number of clients receiving PCIT and the continued use of the PCIT protocol. Multi-level path analysis was utilized to examine the role of training on sustainability. Clinicians and administrators reported high levels of sustainability at 24-months. Clinicians in the Cascading Model reported greater average PCIT caseloads at 24-months, whereas clinicians in the Learning Collaborative reported greater full use of the PCIT protocol at 24-months. Attending consultation calls was associated with delivering PCIT to fewer families. Implications for the sustainable delivery of PCIT beyond the training year as well as for the broader field of implementation science are discussed.
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30
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Weeks A. Important Factors for Evidence-Based Implementation in Child Welfare Settings: A Systematic Review. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2021; 18:129-154. [PMID: 32893742 DOI: 10.1080/26408066.2020.1807433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE This systematic review synthesizes the common barriers and facilitators to implementing research-supported interventions with child welfare agencies using implementation frameworks. METHODS For this systematic review, database searches, and quality assessments of relevant literature produced 24 studies that examined the implementation of RSIs in child welfare using an implementation framework. RESULTS The studies were coded for themes and the thematic analysis found several common factors to RSI implementation across child welfare agencies including funding, collaboration with external stakeholders, agency culture, staff burden, leadership support, worker's buy-in, client resistance, program fit, intervention clarity, supporting staff competency, and implementation teams. DISCUSSION The findings provide important information on the most common barriers and facilitators of implementation in child welfare settings.
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Affiliation(s)
- Angela Weeks
- The Institute of Innovation and Implementation, School of Social Work, University of Maryland
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Traveling Without a Map: An Incomplete History of the Road to Implementation Science and Where We May Go from Here. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:272-278. [PMID: 31938973 DOI: 10.1007/s10488-020-01013-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
This editorial provides a brief history of mental health services research over the last 30 years and how findings from large-scale studies shocked the field and led to the lines of inquiry culminating in current implementation science research. I review the manuscripts published in this special issue of Administration and Policy in Mental Health in light of that history and usethese studies as a way to assess the state of the field. Finally, I present five takeaways extracted from these articles that may be useful in considering future directions for implementation research.
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Sung JY, Kacmarek CN, Schleider JL. Economic Evaluations of Mental Health Programs for Children and Adolescents in the United States: A Systematic Review. Clin Child Fam Psychol Rev 2021; 24:1-19. [PMID: 33428069 DOI: 10.1007/s10567-020-00333-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 10/22/2022]
Abstract
The United States (US) spent 201 billion dollars on mental health-related concerns in 2016, ranking mental illness as the leading cause of disability and the single largest source of economic burden worldwide. With mental health-related treatment costs and economic burden only projected to rise, there is an increasing need for cost-inclusive evaluations of mental health interventions in the US. This systematic review evaluated the intervention characteristics and the quality of 9 economic evaluation studies (e.g., cost-effectiveness, cost-benefit) of youth mental health services conducted in the US from 2003 to 2019. Existing evaluations suggest that certain mental health interventions for youth, among the few that have been formally evaluated, may be cost-effective and cost-beneficial. However, intervention characteristics were generally homogenous, a majority of studies did not adhere to the standard of economic evaluations of the CHEERS checklist, and outcome measures were not consistently clinically useful, limiting the utility of such youth mental health economic evaluations to policymakers. By adhering to standards of economic evaluations and diversifying the characteristics of interventions subject to economic evaluations, intervention researchers can increase confidence in conclusions about which youth mental health interventions are cost-effective or cost-beneficial and more meaningfully inform evidence-based mental health policy.
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Affiliation(s)
- Jenna Y Sung
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA.
| | | | - Jessica L Schleider
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
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Last BS, Schriger SH, Timon CE, Frank HE, Buttenheim AM, Rudd BN, Fernandez-Marcote S, Comeau C, Shoyinka S, Beidas RS. Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making. Implement Sci Commun 2021; 2:6. [PMID: 33431032 PMCID: PMC7802291 DOI: 10.1186/s43058-020-00105-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/17/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Trauma-focused cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that TF-CBT clinicians complete TNs with only half of their clients, yet little is known about what determines TF-CBT clinicians' use of TNs. The behavioral insights literature-an interdisciplinary field studying judgment and decision-making-offers theoretical and empirical tools to conceptualize what drives complex human behaviors and decisions. Drawing from the behavioral insights literature, the present study seeks to understand what determines clinician use of TNs and to generate strategies that target these determinants. METHODS Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (N = 17) to understand their decisions to use TNs with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the "Easy Attractive Social Timely" framework, a behavioral insights design approach. RESULTS We generated and validated three broad themes about what determines clinician implementation of TNs: decision complexity, clinician affective experience, and agency norms. We hypothesized behavioral insights that underlie these implementation determinants and designed a list of nine corresponding behavioral insights strategies that may facilitate TN implementation. CONCLUSIONS Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.
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Affiliation(s)
- Briana S Last
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA.
| | - Simone H Schriger
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA
| | - Carter E Timon
- College of Liberal and Professional Studies, University of Pennsylvania, Philadelphia, PA, USA
| | - Hannah E Frank
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Alison M Buttenheim
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
| | - Brittany N Rudd
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Carrie Comeau
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Sosunmolu Shoyinka
- Department of Behavioral Health and Intellectual Disability Services, Philadelphia, PA, USA
| | - Rinad S Beidas
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Alonge O, Chiumento A, Hamoda HM, Gaber E, Huma ZE, Abbasinejad M, Hosny W, Shakiba A, Minhas A, Saeed K, Wissow L, Rahman A. Identifying pathways for large-scale implementation of a school-based mental health programme in the Eastern Mediterranean Region: a theory-driven approach. Health Policy Plan 2020; 35:ii112-ii123. [PMID: 33156933 PMCID: PMC7646738 DOI: 10.1093/heapol/czaa124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 11/28/2022] Open
Abstract
Globally there is a substantial burden of mental health problems among children and adolescents. Task-shifting/task-sharing mental health services to non-specialists, e.g. teachers in school settings, provide a unique opportunity for the implementation of mental health interventions at scale in low- and middle-income countries (LMICs). There is scant information to guide the large-scale implementation of school-based mental health programme in LMICs. This article describes pathways for large-scale implementation of a School Mental Health Program (SMHP) in the Eastern Mediterranean Region (EMR). A collaborative learning group (CLG) comprising stakeholders involved in implementing the SMHP including policymakers, programme managers and researchers from EMR countries was established. Participants in the CLG applied the theory of change (ToC) methodology to identify sets of preconditions, assumptions and hypothesized pathways for improving the mental health outcomes of school-aged children in public schools through implementation of the SMHP. The proposed pathways were then validated through multiple regional and national ToC workshops held between January 2017 and September 2019, as the SMHP was being rolled out in three EMR countries: Egypt, Pakistan and Iran. Preconditions, strategies and programmatic/contextual adaptations that apply across these three countries were drawn from qualitative narrative summaries of programme implementation processes and facilitated discussions during biannual CLG meetings. The ToC for large-scale implementation of the SMHP in the EMR suggests that identifying national champions, formulating dedicated cross-sectoral (including the health and education sector) implementation teams, sustained policy advocacy and stakeholders engagement across multiple levels, and effective co-ordination among education and health systems especially at the local level are among the critical factors for large-scale programme implementation. The pathways described in this paper are useful for facilitating effective implementation of the SMHP at scale and provide a theory-based framework for evaluating the SMHP and similar programmes in the EMR and other LMICs.
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Affiliation(s)
- Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, E8140, Baltimore, MD 21205, USA
| | - Anna Chiumento
- Department of Psychological Sciences, Institute of Population Health Sciences, The University of Liverpool, Block B, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK
| | - Hesham M Hamoda
- Department of Psychiatry, Boston Children’s Hospital 300 Longwood Avenue, Boston, MA 02115, USA
| | - Eman Gaber
- General Secretariat of Mental Health and Addiction Treatment, Ministry of Health, Al-Inshaa WA Al-Munirah, El-Sayeda Zainab, Cairo Governorate, Egypt
| | - Zill-e- Huma
- Human Development Research Foundation, House 06, Street 55, F-7/4, Islamabad, Pakistan
| | - Maryam Abbasinejad
- Department for Mental Health and Substance Abuse, Ministry of Health and Medical Education, Shahrak-e-Gharb, Eivanak Blvd, Islamic Republic of Iran
| | - Walaa Hosny
- General Secretariat of Mental Health and Addiction Treatment, Ministry of Health, Al-Inshaa WA Al-Munirah, El-Sayeda Zainab, Cairo Governorate, Egypt
| | - Alia Shakiba
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Ayesha Minhas
- Institute of Psychiatry, Benazir Bhutto Hospital, Benazir Bhutto Road, Chah Sultan, Rawalpindi, Punjab 46000, Pakistan
| | - Khalid Saeed
- Department of Non-communicable Diseases and Mental Health, World Health Organization, Regional Office for the Eastern Mediterranean, Monazamet El Seha El Alamia Street, Nasr City, Cairo 11371, Egypt
| | - Lawrence Wissow
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, University of Washington, 1959 NE Pacific Street, Seattle WA 98195, USA
| | - Atif Rahman
- Department of Psychological Sciences, Institute of Population Health Sciences, The University of Liverpool, Block B, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool L69 3GL, UK
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Aronson ID, Bennett AS, Freeman R. Toward a human-centered use of technology: a stakeholder analysis of harm reduction and CBO staff. Harm Reduct J 2020; 17:77. [PMID: 33076911 PMCID: PMC7570409 DOI: 10.1186/s12954-020-00422-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Technology can enable syringe service programs (SSPs) and other community-based organizations (CBOs) operating under a harm reduction framework to work with an increased number of clients and can also enable organizations to offer services more effectively (e.g., offering HIV testing in ways participants may be more likely to accept). In the current time of COVID-19 social distancing, technology can also help organizations more safely provide services to people with compromised immune systems and to clients who might otherwise not be reached. However, technology projects implemented in harm reduction settings are frequently conceptualized and developed by researchers or technology specialists rather than by SSP staff or clients. Methods To more effectively meet the needs of SSPs and other CBOs across the USA, our team conducted qualitative interviews with 16 individuals who have extensive backgrounds working in the field of harm reduction. Interviews were digitally recorded and professionally transcribed, and the transcripts were checked for accuracy by the interviewers. The resulting transcripts were coded and analyzed to determine emerging themes. Results Interviewees mentioned the ability of technology to deliver consistent quality messaging to multiple clients at the same time and the potential to customize or tailor technology-based messaging to specific client populations as positive benefits. Clear barriers to technology use also emerged, in particular regarding privacy, data security, and the need to maintain client trust when discussing sensitive issues (e.g., illicit drug use). Conclusions Technology offers the potential to deliver consistently high-quality health communication and maintain contact with clients who may have no other access to care. If designed and managed effectively, technology can also address issues related to providing services during times when physical contact is limited due to COVID-19 social distancing measures.
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Affiliation(s)
- Ian David Aronson
- Digital Health Empowerment, Brooklyn, USA. .,New York University, School of Global Public Health, New York, USA.
| | - Alex S Bennett
- Digital Health Empowerment, Brooklyn, USA.,New York University, School of Global Public Health, New York, USA
| | - Robert Freeman
- New York University, School of Global Public Health, New York, USA
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Brabson LA, Herschell AD, Snider MDH, Jackson CB, Schaffner KF, Scudder AT, Kolko DJ, Mrozowski SJ. Understanding the Effectiveness of the Cascading Model to Implement Parent-Child Interaction Therapy. J Behav Health Serv Res 2020; 48:427-445. [DOI: 10.1007/s11414-020-09732-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Allchin B, Goodyear M, O'Hanlon B, Weimand BM. Leadership perspectives on key elements influencing implementing a family-focused intervention in mental health services. J Psychiatr Ment Health Nurs 2020; 27:616-627. [PMID: 32037644 DOI: 10.1111/jpm.12615] [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] [Received: 09/17/2019] [Revised: 01/22/2020] [Accepted: 02/07/2020] [Indexed: 01/09/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Family-focused interventions in Adult Mental Health Services (AMHS) address the needs of families where a parent is diagnosed with a mental illness. One of these interventions is the "Let's Talk about Children" programme (Let's Talk) (Solantaus & Toikka, 2006 International Journal of Mental Health Promotion, 8(3), 37). There is limited implementation knowledge on family-focused interventions. A body of research to better understand the transfer of evidence-based interventions into everyday practice has identified multiple influencing elements. The Consolidated Framework for Implementation Research (CFIR) has combined these known elements from research into five domains of influence. Elements that influence the implementation of evidence-based practice are inter-related and need to be understood in combination. Understanding different stakeholder perspectives on implementation in real-world settings helps to understand uptake, challenges and opportunities. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: As the first study to document leadership's perspectives of implementing Let's Talk, this paper contributes to the evidence base on their role in implementing family-focused practice models in mental health. There are specific roles of leadership that need to be addressed to support implementing Let's Talk in changing environments. Leadership's knowledge of Let's Talk and approach to change influences implementation. Questions are raised about the role the readiness of the parent and the impact that the dynamic process between the practitioner and parent has on implementing Let's Talk. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Engaging leadership needs to address the influence of their different organizational roles in shaping implementation for Let's Talk. Further research is needed to understand the dynamic process between parent and practitioner that influences readiness for trialling Let's Talk. ABSTRACT: Introduction Different stakeholder's perspectives are needed to understand challenges and opportunities in implementing and sustaining evidence-based practices (EBP) in real-world settings. Aim/Question To identify leadership perspectives on key elements influencing the process of implementation of Let's Talk about Children (Let's Talk), a family-focused practice for practitioners working with parents diagnosed with a mental illness. Method Semi-structured interviews were conducted with 16 service managers and implementation leads, to establish their views on key elements influencing implementation of Let's Talk during a randomized controlled trial. A thematic analysis applied both inductive and deductive approaches, using the Consolidated Framework for Implementation Research (CFIR). Results Impacts to effective translation to practice were grouped into three broad themes with eight subthemes: inner and outer setting impacting organization, leadership affecting readiness and parent and practitioner readiness. Discussion The findings suggest that specific roles for leadership are vital to implementation within an environment of constant change, and more attention is needed to understand the dynamics of parent and practitioner readiness for delivering Let's Talk. Implications for practice Different leadership roles need to be engaged to sustain Let's Talk in changing real-world environments. The dynamic processes between parent and practitioner are suggested to influence readiness and need further research.
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Affiliation(s)
- Becca Allchin
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Clayton, Vic., Australia.,Eastern Health Mental Health Program, Melbourne, Vic., Australia
| | - Melinda Goodyear
- Faculty of Medicine, Nursing and Health Sciences, School of Rural Health, Monash University, Clayton, Vic., Australia.,Emerging Minds, Hilton, SA, Australia
| | - Brendan O'Hanlon
- The Bouverie Centre, La Trobe University, Melbourne, Vic., Australia
| | - Bente M Weimand
- Department of Nursing and Health Promotion, Faculty of Health Sciences, OsloMet - Oslo Metropolitan University, Oslo, Norway.,Division Mental Health Services, Akershus University Hospital, Lørenskog, Norway.,School of Nursing and Midwifery, Queens University Belfast, Belfast, Northern Ireland
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Gabet M, Grenier G, Cao Z, Fleury MJ. Implementation of three innovative interventions in a psychiatric emergency department aimed at improving service use: a mixed-method study. BMC Health Serv Res 2020; 20:854. [PMID: 32917199 PMCID: PMC7488576 DOI: 10.1186/s12913-020-05708-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/02/2020] [Indexed: 11/16/2022] Open
Abstract
Background Emergency department (ED) use is often viewed as an indicator of health system quality. ED use for mental health (MH) reasons is increasing and costly for health systems, patients, and their families. Patients with mental disorders (MD) including substance use disorders (SUD) and suicidal behaviors are high ED users. Improving ED services for these patients and their families, and developing alternatives to ED use are thus key issues. This study aimed to: (1) describe the implementation of three innovative interventions provided by a brief intervention team, crisis center team, and family-peer support team in a Quebec psychiatric ED, including the identification of implementation barriers, and (2) evaluate the impacts of these ED innovations on MH service use and response to needs. Method Using mixed methods with data triangulation, the implementation and impact of the three above-named ED interventions were studied. Quantitative data were collected from 101 participants (81 patients, 20 family members) using a user questionnaire and patient medical records. Qualitative data were gathered from focus groups (n = 3) with key intervention staff members (n = 14). The user questionnaire also included open-ended questions. Descriptive, comparative and content analyses were produced. Results Key implementation issues were identified in relation to system, organizational and patient profiles, similar to results identified in most studies in the ED implementation literature aimed at improving responsiveness to patients with MD. Results were encouraging, as the innovations had a significant impact for improved patient MH service use and adequacy of care. Services also seemed adapted to patient profiles. Family members were grateful for the help received in the ED. Conclusions Before implementing innovations, managers need to recognize the basic issues common to all new healthcare interventions: the need for staff training and strong involvement, particularly among physicians, development of collaborative tools especially in cases of potential cultural clash between staff and organizations, and continuous quality assessment. Future research needs to confirm the pertinence of these interventions, especially use of family-peer support teams in ED, as a highly innovative intervention. Broader ED strategies could also be deployed to improve MH services and decrease ED use for MH reasons.
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Affiliation(s)
- Morgane Gabet
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada.,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Guy Grenier
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Zhirong Cao
- Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada
| | - Marie-Josée Fleury
- Management, Evaluation and Health Policies Department, School of Public Health, Université de Montréal, 7101 av. du Parc, Montreal, QC, H3X1X9, Canada. .,Research Center, Douglas Mental Health University Institute, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada. .,Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC, H3A 1A1, Canada.
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Factors Affecting Implementation of Evidence-Based Practices in Public Health Preparedness and Response. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 26:434-442. [PMID: 32732716 DOI: 10.1097/phh.0000000000001178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT There is limited research on what factors are most salient to implementation of evidence-based practices (EBPs) among public health agencies in public health emergency preparedness and response (PHPR) and under what conditions EBP implementation will occur. OBJECTIVE This study assessed the conditions, barriers, and enablers affecting EBP implementation among the PHPR practice community and identified opportunities to support EBP implementation. DESIGN A Web-based survey gathered information from public health agencies. Data obtained from 228 participating agencies were analyzed. SETTING State, local, and territorial public health agencies across the United States. PARTICIPANTS Preparedness program officials from 228 public health agencies in the United States, including Public Health Emergency Preparedness (PHEP) cooperative agreement awardees (PHEP awardees) and a random sample of local health departments (LHDs). RESULTS Respondents indicated that EBP is necessary and improves PHPR functions and tasks and that staff are interested in improving skills for EBP implementation. Top system-level barriers to EBP implementation were insufficient funding, lack of EBP, and lack of clarity regarding which practices are evidence based. PHEP awardees were significantly more likely to report a lack of EBP in the field, whereas LHDs were significantly more likely to report a lack of incentives. The top organizational-level barrier was insufficient staff. Most respondents indicated their agency culture supports EBP; however, LHDs were significantly more likely to report a lack of support from supervisors and leadership. Few respondents reported individual barriers to EBP implementation. CONCLUSIONS Findings indicate an opportunity to improve dissemination strategies, communication efforts, and incentives to support EBP implementation in PHPR. Potential strategies include improving awareness of and accessibility to EBPs through targeted dissemination efforts; building organizational capacity to support EBP implementation, particularly staff capacity, knowledge, and skills; and identifying funding and incentives to promote EBP uptake and sustainment.
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Developing a Framework for Curtailing Exclusionary Discipline for African-American Students with Disruptive Behavior Problems: A Mixed-Methods Approach. SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09380-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodriguez A, Kim JJ, Zhan C, Lau AS, Hamilton AB, Palinkas LA, Gellatly R, Brookman-Frazee L. A Mixed-Method Analysis on the Impacts of a System-Driven Implementation of Multiple Child Evidence-Based Practices on Community Mental Health Providers. ACTA ACUST UNITED AC 2020; 52:67-79. [PMID: 34349341 DOI: 10.1037/pro0000353] [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: 11/08/2022]
Abstract
Initiatives to scale up evidence-based practices (EBPs) in routine care are likely to have myriad impacts on community providers, but these impacts have not yet been examined in depth. This is especially true within the context of simultaneous implementation of multiple evidence-based practices. The aim of this study was to characterize the multifaceted impacts on community mental health therapists within a system-driven implementation of multiple EBPs for youth and families. Semistructured interview and survey data were gathered from 60 therapists at 11 agencies contracted with the Los Angeles County Department of Mental Health to deliver EBPs within the Prevention and Early Intervention initiative. Therapists' accounts of impacts varied, and were either predominately negative, predominantly positive, or mixed-valence. Mixed-methods analyses using Kruskal-Wallis tests showed therapist valence groups varied on mean levels of self-reported burnout on surveys. Themes from qualitative data revealed several favorable (e.g., increased EBP knowledge, structure) and unfavorable (e.g., distress, feeling constrained by EBPs) impacts of county-contracted EBP implementation. These findings inform the development and implementation of future system-driven EBP initiatives that consider therapist perspective to optimize positive impacts and minimize negative impacts on therapists.
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Affiliation(s)
| | | | | | | | | | | | | | - Lauren Brookman-Frazee
- University of California, San Diego and San Diego State University/University of California, San Diego
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McNeish R, Tran Q. Leadership that promotes successful implementation of community-based mental health interventions. JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 48:1500-1511. [PMID: 32176322 DOI: 10.1002/jcop.22343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/27/2020] [Accepted: 03/02/2020] [Indexed: 06/10/2023]
Abstract
Community-based interventions (CBIs) have become an effective approach to promote mental well-being. To increase organizational capacity and effectively deliver CBIs, leadership is crucial. The current study aims to identify leadership qualities that are facilitators of CBI implementation. This paper presents evaluation findings from a national effort emphasizing CBIs for improving the mental well-being of men and boys in 16 local communities. The study utilized a mixed-method design, including both examining each grantee as a case study and conducting a cross-site evaluation. Findings revealed five leadership qualities that contributed to CBIs' success: personal vision, value-based leadership, relationship-oriented leadership, task-oriented leadership, and leadership development. The results outline strategies for strengthening organizational capacity through these leadership qualities. This study adds to the limited literature on leadership qualities that strengthen organizational capacity to successfully implement CBIs and can serve as a guide for funders, program planners, and evaluators.
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Affiliation(s)
- Roxann McNeish
- Department of Child and Family Studies, University of South Florida, Tampa, Florida
| | - Quynh Tran
- Department of Child and Family Studies, University of South Florida, Tampa, Florida
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Flynn D, Joyce M, Gillespie C, Kells M, Swales M, Spillane A, Hurley J, Hayes A, Gallagher E, Arensman E, Weihrauch M. Evaluating the national multisite implementation of dialectical behaviour therapy in a community setting: a mixed methods approach. BMC Psychiatry 2020; 20:235. [PMID: 32410670 PMCID: PMC7227064 DOI: 10.1186/s12888-020-02610-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 04/19/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The implementation of evidence-based interventions for borderline personality disorder in community settings is important given that individuals with this diagnosis are often extensive users of both inpatient and outpatient mental health services. Although work in this area is limited, previous studies have identified facilitators and barriers to successful DBT implementation. This study seeks to expand on previous work by evaluating a coordinated implementation of DBT in community settings at a national level. The Consolidated Framework for Implementation Research (CFIR) (Damschroder et al., Implementation Sci. 4:50, 2009) provided structural guidance for this national level coordinated implementation. METHODS A mixed methods approach was utilised to explore the national multisite implementation of DBT from the perspective of team leaders and therapists who participated in the coordinated training and subsequent implementation of DBT. Qualitative interviews with DBT team leaders (n = 8) explored their experiences of implementing DBT in their local service and was analysed using content analysis. Quantitative surveys from DBT therapists (n = 74) examined their experience of multiple aspects of the implementation process including orienting the system, and preparations and support for implementation. Frequencies of responses were calculated. Written qualitative feedback was analysed using content analysis. RESULTS Five themes were identified from the interview data: team formation, implementation preparation, client selection, service level challenges and team leader role. Participants identified team size and support for the team leader as key points for consideration in DBT implementation. Key challenges encountered were the lack of system support to facilitate phone coaching and a lack of allocated time to focus on DBT. Implementation facilitators included having dedicated team members and support from management. CONCLUSIONS The barriers and facilitators identified in this study are broadly similar to those reported in previous research. Barriers and facilitators were identified across several domains of the CFIR and are consistent with a recently published DBT implementation Framework (Toms et al., Borderline Personal Disord Emot Dysregul. 6: 2, 2019). Future research should pay particular attention to the domain of characteristics of individuals involved in DBT implementation. The results highlight the importance of a mandated service plan for the coordinated implementation of an evidence-based treatment in a public health service. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT03180541; Registered June 7th 2017 'retrospectively registered'.
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Affiliation(s)
- Daniel Flynn
- Cork Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, St Finbarr's Hospital, Cork, Ireland
| | - Mary Joyce
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland.
| | - Conall Gillespie
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - Mary Kells
- Cork Mental Health Services, Cork Kerry Community Healthcare, Health Service Executive, Inniscarraig House, Western Road, Cork, Ireland
| | - Michaela Swales
- Betsi Cadwaladr University Health Board & North Wales Clinical Psychology Programme, School of Psychology, Bangor University, Bangor, Wales
| | - Ailbhe Spillane
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - Justina Hurley
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - Aoife Hayes
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - Edel Gallagher
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
| | - Ella Arensman
- National Suicide Research Foundation and School of Public Health, University College Cork, Western Gateway Building, Cork, Ireland
| | - Mareike Weihrauch
- National Suicide Research Foundation, University College Cork, Western Gateway Building, Cork, Ireland
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Cidav Z, Mandell D, Pyne J, Beidas R, Curran G, Marcus S. A pragmatic method for costing implementation strategies using time-driven activity-based costing. Implement Sci 2020; 15:28. [PMID: 32370752 PMCID: PMC7201568 DOI: 10.1186/s13012-020-00993-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 04/16/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Implementation strategies increase the adoption of evidence-based practices, but they require resources. Although information about implementation costs is critical for decision-makers with budget constraints, cost information is not typically reported in the literature. This is at least partly due to a need for clearly defined, standardized costing methods that can be integrated into implementation effectiveness evaluation efforts. METHODS We present a pragmatic approach to systematically estimating detailed, specific resource use and costs of implementation strategies that combine time-driven activity-based costing (TDABC), a business accounting method based on process mapping and known for its practicality, with a leading implementation science framework developed by Proctor and colleagues, which guides specification and reporting of implementation strategies. We illustrate the application of this method using a case study with synthetic data. RESULTS This step-by-step method produces a clear map of the implementation process by specifying the names, actions, actors, and temporality of each implementation strategy; determining the frequency and duration of each action associated with individual strategies; and assigning a dollar value to the resources that each action consumes. The method provides transparent and granular cost estimation, allowing a cost comparison of different implementation strategies. The resulting data allow researchers and stakeholders to understand how specific components of an implementation strategy influence its overall cost. CONCLUSION TDABC can serve as a pragmatic method for estimating resource use and costs associated with distinct implementation strategies and their individual components. Our use of the Proctor framework for the process mapping stage of the TDABC provides a way to incorporate cost estimation into implementation evaluation and may reduce the burden associated with economic evaluations in implementation science.
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Affiliation(s)
- Zuleyha Cidav
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - David Mandell
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Pyne
- Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, AR, USA
- South Central Mental Illness Research, Education and Clinical Center, Central Arkansas, Little Rock, USA
- Veterans Healthcare System, North Little Rock, AR, USA
- Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Rinad Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Implementation Science Center, Leonard Davis Institute of Health Economics, Philadelphia, USA
| | - Geoffrey Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Center for Implementation Research, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Healthcare System, Little Rock, AR, USA
| | - Steven Marcus
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
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Fleury MJ, Grenier G, Farand L, Ferland F. Use of Emergency Rooms for Mental Health Reasons in Quebec: Barriers and Facilitators. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 46:18-33. [PMID: 30074113 DOI: 10.1007/s10488-018-0889-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study explored barriers and facilitators in mental health (MH) patient management in four Quebec (Canada) emergency rooms (ERs) that used different operational models. Forty-nine stakeholders (managers, physicians, ER and addiction liaison team members) completed semi-structured interviews. Barriers and facilitators affecting patient management emanated from health systems, patients, organizations, and from professionals themselves. Effective management of MH patients requires ER access to a rich network of outpatient, community-based MH services; integration of general and psychiatric ERs; on-site addiction liaison teams; round-the-clock ER staffing, including psychiatrists; ER staff training in MH; and adaptation to frequent and challenging ER users.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033 Pine Avenue West, Montreal, QC, H3A 1A1, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, QC, H4H 1R3, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Laval University, Quebec City, QC, Canada
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Smith F, Gunnarsdóttir KÁ, Genell A, McLinden D, Vaughn L, Garelius H, Nilsson-Ehle H, Lönqvist U, Björk-Eriksson T. Evaluating the implementation and use of the regional cancer plan in Western Sweden through concept mapping. Int J Qual Health Care 2020; 31:44-52. [PMID: 30576515 DOI: 10.1093/intqhc/mzy241] [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] [Received: 03/30/2018] [Revised: 12/09/2018] [Accepted: 11/21/2018] [Indexed: 11/13/2022] Open
Abstract
QUALITY PROBLEM OR ISSUE Within healthcare, policy documents are often used to strategically standardize, streamline or change how general health issues are managed for a specific patient group or treatment. Despite significant effort in developing policy and strategic planning documents, these may not have the intended impact and their value has long been questioned by practitioners. CHOICE OF SOLUTION To identify barriers and affordances for the implementation and use of a strategic plan for cancer care in the Western Sweden Healthcare Region, we used Concept Mapping; a participatory mixed method approach to inquiry consisting of both qualitative and quantitative tasks intended to elicit and integrate the diverse perspectives of multiple stakeholders. IMPLEMENTATION The study was carried out between April and October 2017 and consisted of several sequential data collection steps: idea generation, sorting and rating ideas for importance and feasibility. Stakeholders from different levels and professions in cancercare participated, but the number varied in the separate steps of data collection: idea generation (n = 112), sorting (n = 16) and rating (n = 38). EVALUATION A concept map visualized seven areas that stakeholders throughout the cancer-care process considered necessary to address in order to enable the implementation of the plan. Skills provision was considered the most important cluster but also rated as least feasible. A consistent theme emerged that information, or lack thereof, might be a barrier for the plan being put into action to a greater extent in the cancer-care units. Nine actionable ideas rated highly on both importance and feasibility were presented as a go-zone. LESSONS LEARNED Our results suggest that efforts might be better spent on ensuring information about and accessibility to strategic documents throughout the organization, rather than frequently updating them or producing new ones. Having sufficient skills provision seems to be the prerequisite for successful implementation.
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Affiliation(s)
- Frida Smith
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Chalmers University of Technology, Chalmersplatsen 4, Gothenburg, Sweden
| | | | - Anna Genell
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel McLinden
- University of Cincinnati College of Medicine, 3230 Eden Ave Cincinnati, OH, USA.,Cincinnati Children's Hospital Medical Center, Division of General & Community Pediatrics, 3333 Burnet Ave Cincinnati, OH, USA
| | - Lisa Vaughn
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA.,Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA.,Educational Studies, University of Cincinnati College of Education, Criminal Justice, and Human Services, 3333 Burnet Ave ML 2008 Cincinnati, OH, USA
| | - Hege Garelius
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Herman Nilsson-Ehle
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Section of Hematology and Coagulation, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Ulf Lönqvist
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Björk-Eriksson
- Regional Cancer Center West, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Oncology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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French B, Perez Vallejos E, Sayal K, Daley D. Awareness of ADHD in primary care: stakeholder perspectives. BMC FAMILY PRACTICE 2020; 21:45. [PMID: 32111169 PMCID: PMC7047346 DOI: 10.1186/s12875-020-01112-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 02/17/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs' ADHD awareness, this qualitative study aims to further explore individual stakeholders' experiences. METHODS Semi-structured interviews explored the views of multiple stakeholders- GPs (n = 5), healthcare specialists (n = 5), patients (adults with ADHD n = 5) and parents (n = 5) with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. RESULTS Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. CONCLUSION This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.
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Affiliation(s)
- B French
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, England.
- UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, England.
| | - E Perez Vallejos
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, England
- UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, England
| | - K Sayal
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, England
- UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, England
| | - D Daley
- Division of Psychiatry & Applied Psychology, University of Nottingham, Nottingham, England
- UK & Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan (CANDAL), Institute of Mental Health, University of Nottingham, Nottingham, England
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48
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Williams NJ, Wolk CB, Becker-Haimes EM, Beidas RS. Testing a theory of strategic implementation leadership, implementation climate, and clinicians' use of evidence-based practice: a 5-year panel analysis. Implement Sci 2020; 15:10. [PMID: 32033575 PMCID: PMC7006179 DOI: 10.1186/s13012-020-0970-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 01/31/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Implementation theory suggests that first-level leaders, sometimes referred to as middle managers, can increase clinicians' use of evidence-based practice (EBP) in healthcare settings by enacting specific leadership behaviors (i.e., proactive, knowledgeable, supportive, perseverant with regard to implementation) that develop an EBP implementation climate within the organization; however, longitudinal and quasi-experimental studies are needed to test this hypothesis. METHODS Using data collected at three waves over a 5-year period from a panel of 30 outpatient children's mental health clinics employing 496 clinicians, we conducted a quasi-experimental difference-in-differences study to test whether within-organization change in implementation leadership predicted within-organization change in EBP implementation climate, and whether change in EBP implementation climate predicted within-organization change in clinicians' use of EBP. At each wave, clinicians reported on their first-level leaders' implementation leadership, their organization's EBP implementation climate, and their use of both EBP and non-EBP psychotherapy techniques for childhood psychiatric disorders. Hypotheses were tested using econometric two-way fixed effects regression models at the organization level which controlled for all stable organizational characteristics, population trends in the outcomes over time, and time-varying covariates. RESULTS Organizations that improved from low to high levels of implementation leadership experienced significantly greater increases in their level of EBP implementation climate (d = .92, p = .017) and within-organization increases in implementation leadership accounted for 11% of the variance in improvement in EBP implementation climate beyond all other covariates. In turn, organizations that improved from low to high levels of EBP implementation climate experienced significantly greater increases in their clinicians' average EBP use (d = .55, p = .007) and within-organization improvement in EBP implementation climate accounted for 14% of the variance in increased clinician EBP use. Mediation analyses indicated that improvement in implementation leadership had a significant indirect effect on clinicians' EBP use via improvement in EBP implementation climate (d = .26, 95% CI [.02 to .59]). CONCLUSIONS When first-level leaders increase their frequency of implementation leadership behaviors, organizational EBP implementation climate improves, which in turn contributes to increased EBP use by clinicians. Trials are needed to test strategies that target this implementation leadership-EBP implementation climate mechanism.
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Affiliation(s)
- Nathaniel J Williams
- School of Social Work, Boise State University, Boise, ID, USA. .,Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA. .,School of Social Work, Boise State University, Room 711, 1910 University Drive, Boise, ID, 83725, USA.
| | - Courtney Benjamin Wolk
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Hall Mercer Community Mental Health Center, Pennsylvania Hospital, Philadelphia, PA, USA
| | - Rinad S Beidas
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
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49
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Palmer Molina A, Palinkas LA, Monro W, Mennen FE. Barriers to Implementing a Group Treatment for Maternal Depression in Head Start: Comparing Staff Perspectives. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:545-554. [PMID: 31933218 DOI: 10.1007/s10488-020-01012-7] [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: 11/25/2022]
Abstract
Although providing depression treatment for Head Start mothers may improve child wellbeing, interventions have not been widely used for this purpose. This failure may be due to the characteristics of clients, interventions, or the systems of care in which services are delivered. This study explored barriers to implementing Interpersonal Psychotherapy-Group with ethnic minority Head Start mothers, including differences in the level of staff consensus regarding barriers, which may predict implementation success. Barriers included resource challenges, cultural and linguistic differences, and participant concerns, and staff demonstrated low to moderate consensus. Results emphasize the importance of engaging diverse stakeholders in implementation.
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Affiliation(s)
- Abigail Palmer Molina
- University of Southern California Suzanne Dworak-Peck School of Social Work, 669 W. 34th Street, Los Angeles, CA, 90089, USA.
| | - Lawrence A Palinkas
- Chair of the Department of Children, Youth, and Families, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, USA
| | - William Monro
- University of Southern California Suzanne Dworak-Peck School of Social Work, 669 W. 34th Street, Los Angeles, CA, 90089, USA
| | - Ferol E Mennen
- Department of Children, Youth, and Families, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, USA
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Stone EM, Daumit GL, Kennedy-Hendricks A, McGinty EE. The Policy Ecology of Behavioral Health Homes: Case Study of Maryland's Medicaid Health Home Program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:60-72. [PMID: 31506860 PMCID: PMC7040852 DOI: 10.1007/s10488-019-00973-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Behavioral health homes, shown to improve receipt of evidence-based medical services among people with serious mental illness in randomized clinical trials, have had limited results in real-world settings; nonetheless, these programs are spreading rapidly. To date, no studies have considered what set of policies is needed to support effective implementation of these programs. As a first step toward identifying an optimal set of policies to support behavioral health home implementation, we use the policy ecology framework to map the policies surrounding Maryland's Medicaid behavioral health home program. Results suggest that existing policies fail to address important implementation barriers.
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Affiliation(s)
- Elizabeth M Stone
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Gail L Daumit
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Alene Kennedy-Hendricks
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Emma E McGinty
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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