Exploring perceptions of implementation practice capacity in community-based behavioral health organizations

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.

Moving from Implementation Science to Implementation Practice: The Need to Solve Practical Problems to Improve Behavioral Health Services

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.

Evaluating an Implementation Science Training Program: Impact on Professional Research and Practice

Real-world application and implementation of evidence-based practice continue to be a challenge across multiple sectors, including behavioral health settings. Providing the opportunity for future researchers and practitioners to gain capacity and knowledge through structured experiential learning in implementation science is critical to closing the research to practice gap. The Institute for Translational Research Education in Adolescent Drug Abuse (ITRE) is a graduate certificate program that offers specific coursework, a large-scale service-learning project based in the community, and mentorship related to implementation science research and practice. The purpose of this evaluation was to examine, from the perspective of ITRE scholars, the perceived impact on the development of professional research and practice skills once graduated from the ITRE program. Fifty-eight semi-structured interviews across five cohorts were selected randomly for in-depth thematic analysis (n = 58). Results suggest that the ITRE provides a unique approach grounded in implementation science for building robust and transferable skills for future researchers and practitioners working in a variety of behavioral healthcare settings.

Broadening measures of success: results of a behavioral health translational research training program

Background

While some research training programs have considered the importance of mentoring in inspiring professionals to engage in translational research, most evaluations emphasize outcomes specific to academic productivity as primary measures of training program success. The impact of such training or mentoring programs on stakeholders and local community organizations engaged in translational research efforts has received little attention. The purpose of this evaluation is to explore outcomes other than traditional academic productivity in a translational research graduate certificate program designed to pair graduate students and behavioral health professionals in collaborative service-learning projects.

Methods

Semi-structured qualitative interviews with scholars, community mentors, and academic mentors were conducted regarding a translational research program to identify programmatic impacts. Interviews were transcribed and coded by the research team to identify salient themes related to programmatic outcomes.

Results

Results are framed using the Translational Research Impact Scale which is organized into three overarching domains of potential impact: (1) research-related impacts, (2) translational impacts, and (3) societal impacts. This evaluation demonstrates the program’s impact in all three domains of the TRIS evaluation framework. Graduate certificate participants (scholars) reported that gaining experience in applied behavioral health settings added useful skills and expertise to their present careers and increased their interest in pursuing translational research. Scholars also described benefits resulting from networks gained through participation in the program, including valuable ties between the university and community behavioral health organizations.

Conclusions

This evaluation of the outcomes of a graduate certificate program providing training in translational research highlights the need for more community-oriented and practice-based measures of success. Encouraging practitioner involvement in translational research is vital to translate knowledge into practice and to enable practice-based needs to inform research and policy. A more flexible approach to measuring programmatic success in research training programs can help bridge the knowledge translation gap.

Implementation of Medicaid Managed Long-Term Services and Supports for Adults With Intellectual and/or Developmental Disabilities in Kansas

Many adults with intellectual and/or developmental disabilities (IDD) can access health and long-term services and supports (LTSS) through Medicaid. States are reforming their Medicaid LTSS programs from a fee-for-service model to a Medicaid managed LTSS (MLTSS) approach, anticipating improved quality of care and reduced costs, although there is limited evidence of MLTSS effectiveness. This study's objective was to contribute to the growing MLTSS research literature by describing MLTSS implementation in Kansas for adults with IDD. Thirty-one stakeholders completed in-depth semi-structured interviews, representing state or regional groups, service coordination providers, and family caregivers. Findings identify key aspects of the Centers for Medicare and Medicaid Services' new MLTSS regulations in the design and implementation of MLTSS programs.

A proposed model for the analysis and interpretation of focus groups in evaluation research

Focus groups have an established history in applied research and evaluation. The fundamental methods of the focus group technique have been well discussed, as have their potential advantages. Less guidance tends to be provided regarding the analysis of data resulting from focus groups or how to organize and defend conclusions drawn from the analysis. This article reviews the methodology of the focus group with an emphasis on thematic analysis of latent data at three levels, articulated, attributional, and emergent. The three levels are described and illustrated with respect to their value and contribution to evaluation within the framework of the group method and qualitative standards of thematic analysis.

At-Risk High School Students in the “Gaining Early Awareness and Readiness” Program (GEAR UP): Academic and Behavioral Outcomes

The purpose of this study was to assess the effects of a GEAR UP intervention with at-risk high school students at a large urban high school in Florida. The goals of the GEAR UP program were to improve academic performance, decrease behavior-related problems, and reduce truancy and absenteeism. The study design consisted of a three-group comparison of the 447 students in GEAR UP: the No Participation Group, the Low Participation Group, and the High Participation Group. Participation levels were calculated for each category of activity (academic, behavior-related, and social), and propensity scoring was used to match the groups on sociodemographic characteristics and other differentiating variables. Results indicated that race (i.e., African American) and sex (i.e., female) are associated with high participation in program activities. Also, students who spent a substantial amount of time on academic activities improved their GPAs over a semester, and students who took advantage of behavior-related services and participated in social activities significantly reduced disciplinary referrals (p < .05). Suggestions for program refinement resulting from the study are discussed.

The utility of level of functioning to characterize community residential settings

An assessment of client functioning was utilized to characterize differences among community residential placement facilities, with the aim of understanding the relationships among settings. Clients recommended for placement in one of nine settings differed significantly on seven scales measuring community living skills, self-care skills, sociability, nuisance behaviors, violence, irritability and nursing needs. Results indicate that community residential settings, although characterized as forming a continuum, may be better conceptualized as an array of settings, where clients may differ in some but not all functional abilities. Facilities may also serve different functions for clients of different ages, either because of expectations concerning older clients or due to different patterns of functioning. Illustrations of the implications that can be drawn for purposes of policy-making and service planning are provided.

Development and validation of a level-of-care instrument for predicting residential placement

A level-of-care instrument developed in Missouri uses discriminant analysis and a criterion measure based on the state's continuum of community residential facilities to assess psychiatric patients' abilities and deficits and to match individual patients with a suitable community setting. The instrument assigned 57 percent of the patients in the sample used in development of the instrument and 43 percent in a validation sample to the same type of residential facility recommended by case managers. The instrument more accurately predicted placement than two instruments that were used earlier in the state and were not based on its specific array of facilities.

The development of factor-based level of functioning scales from a level of care instrument

A factor analysis of data from 1,295 administrations of a level of care instrument produced a seven-factor solution. The scales developed from these factors through a simple unit weighting procedure were internally reliable and replicable on an additional sample of clients. The seven factors are discussed in terms of level of functioning measures. Results suggest that community living skills and self-care skills are two among several robust dimensions of level of functioning in psychiatric clients. Implications are discussed.