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Chaple MJ, Kunins HV, Nass MD, Benjamin AC, Viel CR, Bertone P, Marker L, Warren P, Hartzler B. Exploring the Impact of External Facilitation Using Evidence-Based Implementation Strategies for Increasing Motivational Interviewing Capacity Among Outpatient Substance Use Disorder (SUD) Treatment Providers. J Behav Health Serv Res 2024; 51:185-202. [PMID: 38030934 DOI: 10.1007/s11414-023-09871-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/01/2023]
Abstract
The large majority of individuals who access substance use disorders (SUD) treatment do not receive evidence-based care. Little attention has been paid to the notion that the scale-up of evidence-based practices (EBPs) has been limited in large part due to a weakness in the "distribution system" for bringing new innovations to the attention of practitioners and into practice settings. This study explores the impact of the Training and Practice Implementation Institute (TPII; funded by the New York City Department of Health and Mental Hygiene), an intensive technical assistance initiative that offers external facilitation to outpatient SUD treatment providers via the incorporation of multiple evidence-based implementation strategies to enhance the practice of motivational interviewing (MI). Findings from this study show that staff completed a large majority (86%) of required training/technical assistance (TTA) activities across the 9-month implementation period, demonstrating a high level of engagement among staff and the feasibility of externally facilitated intensive TTA delivered to community-based organizations for the purpose of enhancing implementation of MI for SUDs. Results also show statistically significant improvements in the delivery of MI's technical components among staff, though did not reveal corresponding improvements in the delivery of MI's relational components. An understanding of the potential return on investment associated with externally facilitated TA, offers organizations an opportunity to inform the allocation of limited resources to areas where they will have the greatest impact and ultimately improve the quality and efficacy of services.
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Affiliation(s)
- Michael J Chaple
- New York State Psychiatric Institute, Division on Substance Use Disorders, Columbia University Irving Medical Center, New York, NY, USA.
| | | | - M D Nass
- Bureau of Alcohol and Drug Use Prevention Care and Treatment, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Ajani C Benjamin
- Bureau of Alcohol and Drug Use Prevention Care and Treatment, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Carl R Viel
- Bureau of Alcohol and Drug Use Prevention Care and Treatment, NYC Department of Health and Mental Hygiene, New York, NY, USA
| | - Paula Bertone
- New York State Psychiatric Institute, Division on Substance Use Disorders, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren Marker
- New York State Psychiatric Institute, Division on Substance Use Disorders, Columbia University Irving Medical Center, New York, NY, USA
| | - Paul Warren
- New York State Psychiatric Institute, Division on Substance Use Disorders, Columbia University Irving Medical Center, New York, NY, USA
| | - Bryan Hartzler
- Center for Advancing Addiction Services, Addiction, Drug & Alcohol Institute, University of Washington, Seattle, WA, USA
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Becker-Haimes EM, Schaechter T, Green KL, Bridges K, Jager-Hyman S. Mobile Crisis Services: A Clinician Survey of Current Suicide Prevention Practices and Barriers to Care Delivery. Community Ment Health J 2024; 60:562-571. [PMID: 37982974 DOI: 10.1007/s10597-023-01208-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
Mobile crisis teams (MCTs) deploy clinicians to assist individuals in acute crisis in the community. Little is known about the extent to which these teams provide evidence-based practices (EBPs) for suicide prevention nor the barriers they face. We surveyed 120 MCT clinicians across the United States about their: (1) use of suicide risk screening and assessment tools; (2) strategies used to address suicide risk (both EBPs and non-EBPs); and (3) perceived barriers to high-quality MCT services. Nearly all clinicians reported use of validated suicide screening tools and generic "safety planning." However, a sizeable minority also reported use of non-EBPs. Open-ended responses suggested many client/family-, clinician-, and systems-level barriers to MCT use of EBPs for suicide prevention. We identified several targets for future implementation efforts, including the need for de-implementation strategies to reduce use of ineffective and potentially harmful practices, and unique aspects of MCTs that require tailored implementation supports.
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Affiliation(s)
- Emily M Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA.
| | - Temma Schaechter
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Kelly L Green
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | | | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
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Aydin O. Rise of single-case experimental designs: A historical overview of the necessity of single-case methodology. Neuropsychol Rehabil 2024; 34:301-334. [PMID: 36811612 DOI: 10.1080/09602011.2023.2181191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
ABSTRACTWindelband ([1894]1980) advocated that two approaches are used for accumulating scientific knowledge. The first is the idiographic approach that derives knowledge from a single unit, and the second is the nomothetic approach that accumulates knowledge of a group. Given these two approaches, the former matches case studies while the latter is more appropriate with experimental group studies. Scientists have criticized both methodologies for their various limitations. Later, the single-case methodology emerged as an alternative that potentially allays these limitations. In this context, this narrative review aims to describe the historical roots of single-case experimental designs (SCEDs) that have emerged to eliminate the tension of nomothetic and idiographic approaches over time. First, the review focuses on the emergence of SCEDs. Second, the strengths and challenges of SCEDs are reviewed, including those to address the limitations of group experimental and case studies. Third, the use and analyses of SCEDs are outlined, considering their current status. Fourth, this narrative review continues to delineate the dissemination of SCEDs in the modern scientific world. As a result, SCEDs can be evaluated as a method that has the potential to overcome the issues encountered in case description and group experimental research. Thus, that helps accumulate nomothetic and idiographic knowledge in determining evidence-based practices.
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Affiliation(s)
- Orhan Aydin
- Faculty of Education, Erzincan Binali Yildirim University, Erzincan, Türkiye
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Hoda W, Pandey K. Advancing Evidence-based Palliative Care Research: Navigating Challenges and Proposing Solutions. Indian J Palliat Care 2024; 30:89-92. [PMID: 38633675 PMCID: PMC11021051 DOI: 10.25259/ijpc_243_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 12/16/2023] [Indexed: 04/19/2024] Open
Abstract
Amid the increasing demand for palliative care, driven by demographic shifts and medical progress, evidence-based practices face obstacles due to limited research. Complex patient conditions and ethical considerations challenge traditional methodologies, while the absence of comprehensive clinical trials hinders innovative interventions. Empowering practitioners with research skills and establishing a palliative care research network are efforts aimed at bridging these gaps. It is important to emphasise that these initiatives collectively aspire to enhance evidence-based practices, ensuring quality care for individuals facing severe illnesses.
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Affiliation(s)
- Wasimul Hoda
- Department of Superspeciality Anaesthesiology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Khushboo Pandey
- Department of Anaesthesiology, All India Institute of Medical Sciences, Rajkot, Gujarat, India
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Hamm RF, Levine LD, Quigley E, Beidas RS. An evaluation of implementation climate in inpatient maternity care: a cross-sectional survey study. J Matern Fetal Neonatal Med 2023; 36:2185119. [PMID: 36863714 PMCID: PMC10207965 DOI: 10.1080/14767058.2023.2185119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE Researchers in obstetrics and gynecology are continuously generating new evidence to inform clinical care delivery. Yet, much of this newly emerging evidence fails to be rapidly and effectively integrated into routine clinical practice. Implementation climate refers to clinicians' perceptions of to what degree organizations support and reward use of an evidence-based practice (EBP) and is an important construct in the science of implementation in healthcare. Little is known about implementation climate for EBPs in maternity care. Thus, we aimed to (a) determine the reliability of the Implementation Climate Scale (ICS) for use in inpatient maternity care, (b) describe implementation climate in inpatient maternity care overall, and (c) compare individual perceptions of implementation climate between physician and nursing clinicians on these units. STUDY DESIGN We performed a cross-sectional survey of clinicians in inpatient maternity units across 2 urban, academic hospitals in the northeastern United States in 2020. Clinicians completed the 18-question validated ICS [scored 0-4]. Scale reliability by role was evaluated using Cronbach's α. Subscale and total scores were described overall and compared by physician versus nursing role using independent t-tests, as well as linear regression to control for confounders. RESULTS 111 clinicians completed the survey (physicians = 65; nursing = 46). Physicians were less likely to identify as female (75.4% vs. 100.0%, p < .001), but were of similar age and years of experience as nursing clinicians. Reliability of the ICS was excellent, with Cronbach's α of 0.91 and 0.86 among physicians and nursing clinicians, respectively. Scores were notably low for implementation climate in maternity care overall and for all subscales. ICS total scores were also higher among physicians as compared to nurses (2.18(±0.56) vs. 1.92(±0.50), p = .02), which remained significant in multivariable modeling (p = .02). Unadjusted subscale scores were higher among physicians in Recognition for EBP (2.68(±0.89) vs. 2.30(±0.86), p = .03) and Selection for EBP (2.24(±0.93) vs. 1.62(±1.04), p = .002). After adjustment for potential confounders, subscale scores for Focus on EBP (p = .04) and Selection for EBP (p = .002) were all higher among physicians. CONCLUSIONS This study supports the ICS as a reliable scale for measuring implementation climate in the inpatient maternity care setting. Notably lower implementation climate scores across subscales and roles compared to other settings may underlie the vast evidence to practice gap in obstetrics. In order to successfully implement practices that reduce maternal morbidity, we may need to focus on building educational support and rewarding EBP utilization on labor and delivery units, with an emphasis on nursing clinicians.
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Affiliation(s)
- Rebecca F. Hamm
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lisa D. Levine
- Department of Obstetrics & Gynecology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Quigley
- Department of Nursing, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Rinad S. Beidas
- Leonard Davis Institute of Health Economics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Cohen DA, Klodnick VV, Reznik SJ, Lopez MA. Expanding Early Psychosis Care across a Large and Diverse State: Implementation Lessons Learned from Administrative Data and Clinical Team Leads in Texas. Adm Policy Ment Health 2023; 50:861-875. [PMID: 37530982 PMCID: PMC10543575 DOI: 10.1007/s10488-023-01285-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/03/2023]
Abstract
The U.S. is facing an unprecedented youth mental health crisis. Translating the findings from mental health intervention trials into large scale, accessible community-based services poses substantial challenges. Examination of state actions as a result of research-informed federal policy to improve youth access to quality mental healthcare is necessary. This mixed-methods study examines the implementation of evidence-informed multidisciplinary coordinated specialty care (CSC) for first-episode psychosis (FEP) services across Texas. The study explores CSC service model components, site location and participant characteristics, and implementation barriers. This cross-sectional study analyzes State of Texas public mental health administrative data from 2015 to 2020, including CSC site (n = 23) characteristics and CSC participant (n = 1682) demographics. Texas CSC site contracts were compared to OnTrackNY, a leading CSC model in the U.S. for CSC service element comparison. In-depth interviews with CSC Team Leads (n = 22) were analyzed to further understand CSC service elements and implementation barriers using qualitative content analysis. CSC was implemented across three waves in 2015, 2017, and 2019-serving 1682 participants and families. CSC sites were located in adult mental health programs; approximately one third of CSC participants were under 18 years. CSC implementation challenges reported by Team Leads included: staff role clarification, collaboration and turnover, community outreach and referrals, child and adult service billing issues, and adolescent and family engagement. Study findings have implications for large state-wide evidence-based practice implementation in transition-to-adulthood community mental health.
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Affiliation(s)
- Deborah A Cohen
- Dell Medical School Department of Psychiatry and Behavioral Sciences, The University of Texas at Austin, 1601 Trinity St., Bldg, B., Austin, TX, 78712, USA.
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA.
| | - Vanessa V Klodnick
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Samantha J Reznik
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
| | - Molly A Lopez
- Steve Hicks School of Social Work, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
- Texas Institute for Excellence in Mental Health, The University of Texas at Austin, 1925 San Jacinto Boulevard, Austin, TX, 78712, USA
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Dopp AR, Hunter SB, Godley MD, González I, Bongard M, Han B, Cantor J, Hindmarch G, Lindquist K, Wright B, Schlang D, Passetti LL, Wright KL, Kilmer B, Aarons GA, Purtle J. Comparing organization-focused and state-focused financing strategies on provider-level reach of a youth substance use treatment model: a mixed-method study. Implement Sci 2023; 18:50. [PMID: 37828518 PMCID: PMC10571404 DOI: 10.1186/s13012-023-01305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 09/18/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Financial barriers in substance use disorder service systems have limited the widespread adoption-i.e., provider-level reach-of evidence-based practices (EBPs) for youth substance use disorders. Reach is essential to maximizing the population-level impact of EBPs. One promising, but rarely studied, type of implementation strategy for overcoming barriers to EBP reach is financing strategies, which direct financial resources in various ways to support implementation. We evaluated financing strategies for the Adolescent Community Reinforcement Approach (A-CRA) EBP by comparing two US federal grant mechanisms, organization-focused and state-focused grants, on organization-level A-CRA reach outcomes. METHOD A-CRA implementation took place through organization-focused and state-focused grantee cohorts from 2006 to 2021. We used a quasi-experimental, mixed-method design to compare reach between treatment organizations funded by organization-focused versus state-focused grants (164 organizations, 35 states). Using administrative training records, we calculated reach as the per-organization proportion of trained individuals who received certification in A-CRA clinical delivery and/or supervision by the end of grant funding. We tested differences in certification rate by grant type using multivariable linear regression models that controlled for key covariates (e.g., time), and tested threats to internal validity from our quasi-experimental design through a series of sensitivity analyses. We also drew on interviews and surveys collected from the treatment organizations and (when relevant) interviews with state administrators to identify factors that influenced reach. RESULTS The overall certification rates were 27 percentage points lower in state-focused versus organization-focused grants (p = .01). Sensitivity analyses suggested these findings were not explained by confounding temporal trends nor by organizational or state characteristics. We did not identify significant quantitative moderators of reach outcomes, but qualitative findings suggested certain facilitating factors were more influential for organization-focused grants (e.g., strategic planning) and certain barrier factors were more impactful for state-focused grants (e.g., states finding it difficult to execute grant activities). DISCUSSION As the first published comparison of EBP reach outcomes between financing strategies, our findings can help guide state and federal policy related to financing strategies for implementing EBPs that reduce youth substance use. Future work should explore contextual conditions under which different financing strategies can support the widespread implementation of EBPs for substance use disorder treatment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | | | - Michelle Bongard
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Kerry Lindquist
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Blanche Wright
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
- Department of Health Policy and Management, University of California Los Angeles, 650 Charles Young Dr. S., 31-269 CHS Box 951772, Los Angeles, CA, 90095, USA
| | - Danielle Schlang
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Gregory A Aarons
- Department of Psychiatry and Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, University of California San Diego, 9500 Gilman Dr. (0812), La Jolla, San Diego, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Iniesta J, Verdugo MA, Schalock RL. Organizational change and evidence-based practices in support services for people with intellectual and developmental disabilities. Eval Program Plann 2023; 100:102337. [PMID: 37451034 DOI: 10.1016/j.evalprogplan.2023.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 05/22/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023]
Abstract
The impact on support services for persons with intellectual and developmental disabilities of the socioeconomic movements and theoretical reformulations of the last decades has generated the necessity, in order to guarantee their sustainability, to carry out processes of profound change in their organizational culture, intervening in the elements that compose it. Among them are professional practices as the best way to intervene in culture, with the use of comparative analysis between an organization's current practices and those expected with culture change. In this line, the organizational self-assessment tool "Organizational Effectiveness and Efficiency Scale" (OEES) is applied in a study with 24 organizations, which uses a collaborative assessment approach in the service of a set of evidence-based practices identified as standards in key aspects that guide culture change, specifically, a person-centered approach, participative structures, use of information systems and data management, implementation of quality systems and participative and transformational leadership. The results obtained show that a large majority of organizations have significant discrepancies between their current practices and evidence-based practices. The descriptive analysis allows affirming the usefulness of the scale for an organizational diagnosis and identification of strategies to guide transformational change.
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Macaulay LS, Kurzweil D. Teaching in the "New Normal": Using an Evidence-Based Process to Determine Should It Stay or Should It Go (SISoSIG). Med Sci Educ 2023; 33:1-7. [PMID: 37546206 PMCID: PMC10403415 DOI: 10.1007/s40670-023-01827-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 08/08/2023]
Abstract
After pivoting to emergency remote instruction due to the COVID-19 pandemic, medical educators have added new techniques to their toolbox. As we welcome a "new normal," we may be able to teach even more effectively than we did before by adapting some of these techniques. This paper provides an evidence-based decision-making process for faculty to consider what should stay and what should go as they revise and enhance instruction from one semester to another. The SISoSIG process provides opportunities to reflect on lessons learned and discuss how to build on that learning to become even more effective practitioners.
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Affiliation(s)
- Linda S. Macaulay
- Henry M. Jackson Foundation, in support of the Uniformed Services University of the Health Sciences, Education & Technology Innovation Support Office, Bethesda, MD USA
| | - Dina Kurzweil
- Uniformed Services University of the Health Sciences, Education & Technology Innovation Support Office, Bethesda, MD USA
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Rossmann C, Krnel SR, Kylänen M, Lewtak K, Tortone C, Ragazzoni P, Grasso M, Maassen A, Costa L, van Dale D. Health promotion and disease prevention registries in the EU: a cross country comparison. Arch Public Health 2023; 81:85. [PMID: 37161420 PMCID: PMC10170815 DOI: 10.1186/s13690-023-01097-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/23/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Health promotion and disease prevention programme registries (HPPRs), also called 'best practice portals', serve as entry points and practical repositories that provide decision-makers with easy access to (evidence-based) practices. However, there is limited knowledge of differences or overlaps of howe current national HPPRs in Europe function, the context and circumstances in which these HPPRs were developed, and the mechanisms utilised by each HPPR for the assessment, classification and quality improvement of the included practices. This study prepared an overview of different approaches in several national HPPRs and the EU Best Practice Portal (EU BPP) as well as identified commonalities and differences among the core characteristics of the HPPRs. METHODS We conducted a descriptive comparison - that focused on six European countries with existing or recently developed/implemented national HPPR and the EU BPP -to create a comparative overview. We used coding mechanisms to identify commonalities and differences; we performed data management, collection and building consensus during EuroHealthNet Thematic Working Group meetings. RESULTS All HPPRs offer a broad range of health promotion and disease-prevention practices and serve to support practitioners, policymakers and researchers in selecting practices. Almost all HPPRs have an assessment process in place or planned, requiring the application of assessment criteria that differ among the HPPRs. While all HPPRs collect and share recommendable practices, others have implemented further measures to improve the quality of the submitted practices. Different dissemination tools and strategies are employed to promote the use of the HPPRs, including social media, newsletters and publications as well as capacity building workshops for practice owners or technical options to connect citizens/patients with local practices. CONCLUSIONS Collaboration between HPPRs (at national and EU level) is appreciated, especially regarding the use consistent terminology to avoid misinterpretation, facilitate cross-country comparison and enable discussions on the adaption of assessment criteria by national HPPRs. Greater efforts are needed to promote the actual implementation and transfer of practices at the national level to address public health challenges with proven and effective practices.
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Affiliation(s)
| | | | - Marika Kylänen
- Finnish Institute for Health and Welfare (THL), PO Box 30, Helsinki, 00271, Finland
| | - Katarzyna Lewtak
- National Institute of Public Health NIH-NRI (NIPH NIH-NRI), Warsaw, 00-791, Poland
- Medical University of Warsaw, Warsaw, 02-007, Poland
| | - Claudio Tortone
- DoRS - Health Promotion Regional Documentation Centre, Regione Piemonte ASL TO3, Grugliasco (Turin), I- 10095, Italy
| | - Paola Ragazzoni
- DoRS - Health Promotion Regional Documentation Centre, Regione Piemonte ASL TO3, Grugliasco (Turin), I- 10095, Italy
| | - Mara Grasso
- DoRS - Health Promotion Regional Documentation Centre, Regione Piemonte ASL TO3, Grugliasco (Turin), I- 10095, Italy
| | | | - Luciana Costa
- National Institute of Health Dr. Ricardo Jorge, Lisboa, Lisbon, 1649-016, Portugal
- BioISI-Biosystems and Integrative Sciences Institute, Faculty of Sciences, University of Lisbon, Lisbon, Portugal
| | - Djoeke van Dale
- National Institute for Public Health and the Environment, PO Box 1, Bilthoven, 3720, The Netherlands.
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Adams WE, Rogers ES, McKnight L, Lynde D. Examination of Adaptations to the Evidence Based Supported Employment Model: Individual Placement and Support. Adm Policy Ment Health 2023:10.1007/s10488-023-01267-w. [PMID: 37162603 DOI: 10.1007/s10488-023-01267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
Individual Placement and Support (IPS) is a long-standing and innovative employment service for individuals with mental illness with dozens of clinical trials demonstrating effectiveness. Little is known, however, about intentional adaptations to IPS, especially those outside of the context of research studies. Using an implementation science framework, we conducted an exploratory study to better understand the characteristics of stakeholder-reported adaptions to IPS, the impetus for their development, and perceived impacts. We conducted qualitative interviews to analyze and describe these adaptations. Numerous adaptations of IPS were found that address the needs of new and underserved populations both within and outside of the mental health field. Programs reported adapting IPS because of the dearth of other evidence-based employment services, to serve diverse populations in need, and based on financial incentives. Benefits of adaptations were weighed against impacts on fidelity. As evidence-based practices (EBPs) are adapted, developers of EBPs should determine how fidelity of a program or service can be assessed or preserved in light of adaptations. This is critical with the increase in different service delivery methods, new populations, new service recipient needs, and new settings in need of EBPs.
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Affiliation(s)
- Wallis E Adams
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA
- Department of Sociology, California State University, East Bay, Hayward, USA
| | - E Sally Rogers
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA.
| | - Lauren McKnight
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA
| | - David Lynde
- Independent Mental Health Consultant, Concord, NH, USA
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Singh S, Kannuri NK, Mishra A, Gaikwad L, Shukla R, Tyagi M, Chamarty S. Evaluation of Dakshata, a scale-up WHO SCC and mentoring-based program, for improving quality of intrapartum care in public sector in Rajasthan, India: repeated mixed-methods surveys. Arch Public Health 2023; 81:57. [PMID: 37072820 PMCID: PMC10111820 DOI: 10.1186/s13690-023-01028-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/12/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND The Dakshata program in India aims to improve resources, providers' competence, and accountability in labour wards of public sector secondary care hospitals. Dakshata is based on the WHO Safe Childbirth Checklist coupled with continuous mentoring. In Rajasthan state, an external technical partner trained, mentored and periodically assessed performance; identified local problems, supported solutions and assisted the state in monitoring implementation. We evaluated effectiveness and factors contributing to success and sustainability. METHODS Using three repeated mixed-methods surveys over an 18-month period, we assessed 24 hospitals that were at different stages of program implementation at evaluation initiation: Group 1, training had started and Group 2, one round of mentoring was complete. Data on recommended evidence-based practices in labour and postnatal wards and in-facility outcomes were collected by directly observing obstetric assessments and childbirth, extracting information from case sheets and registers, and interviewing postnatal women. A theory-driven qualitative assessment covered key domains of efficiency, effectiveness, institutionalization, accountability, sustainability, and scalability. It included in-depth interviews with administrators, mentors, obstetric staff, and officers/mentors from the external partner. RESULTS Overall, average adherence to evidence-based practices improved: Group 1, 55 to 72%; and Group 2, 69 to 79%, (for both p < 0.001) from baseline to endline. Significant improvement was noted in several practices in the two groups during admission, childbirth, and within 1 hour of birth but less in postpartum pre-discharge care. We noted a dip in several evidence-based practices in 2nd assessment, but they improved later. The stillbirth rate was reduced: Group 1: 1.5/1000 to 0.2; and Group 2: 2.5 to 1.1 (p < 0.001). In-depth interviews revealed that mentoring with periodic assessments was highly acceptable, efficient means of capacity building, and ensured continuity in skills upgradation. Nurses felt empowered, however, the involvement of doctors was low. The state health administration was highly committed and involved in program management; hospital administration supported the program. The competence, consistency, and support from the technical partner were highly appreciated by the service providers. CONCLUSION The Dakshata program was successful in improving resources and competencies around childbirth. The states with low capacities will require intensive external support for a head start.
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Affiliation(s)
- Samiksha Singh
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Delhi, India.
| | - Nanda Kishore Kannuri
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Hyderabad, India
| | - Aparajita Mishra
- Indian Institute of Public Health-Delhi, Public Health Foundation of India, Delhi, India
| | - Leena Gaikwad
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Hyderabad, India
| | - Rajan Shukla
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Hyderabad, India
| | - Mukta Tyagi
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Hyderabad, India
| | - Swecha Chamarty
- Indian Institute of Public Health-Hyderabad, Public Health Foundation of India, Hyderabad, India
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Eiraldi R, Comly R, Goldstein J, Khanna MS, McCurdy BL, Rutherford LE, Henson K, Bevenour P, Francisco J, Jawad AF. Development of an Online Training Platform and Implementation Strategy for School-Based Mental Health Professionals in Rural Elementary Schools: A Mixed-Methods Study. School Ment Health 2023; 15:1-18. [PMID: 37359158 PMCID: PMC10069346 DOI: 10.1007/s12310-023-09582-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
Children in rural settings are less likely to receive mental health services than their urban and suburban counterparts and even less likely to receive evidence-based care. Rural schools could address the need for mental health interventions by using evidence-based practices within a tiered system of supports such as positive behavioral interventions and supports. However, very few school professionals, with or without mental health training, have received training on evidence-based practices. Rural schools need implementation strategies focused on training to prepare school personnel for the implementation of interventions with fidelity. Little is known about training strategies that are feasible and appropriate for the rural school context. User-centered design is an appropriate framework for the development of training strategies for professionals in rural schools because of its participatory approach and the development of products that fit the context where they are going to be used. The purpose of the study was to develop and assess components of an online training platform and implementation strategy based on the user-centered design. Quantitative and qualitative data from 25 participants from an equal number of schools in rural areas of Pennsylvania were used in the study. A mixed-methods design utilizing complementary descriptive statistics and theme analyses indicated that the training platform and implementation strategy were perceived as highly acceptable, appropriate, feasible and usable by school professionals. The resulting training platform and implementation strategy will fill a void in the training literature in rural schools.
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Affiliation(s)
- Ricardo Eiraldi
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104 USA
| | - Rachel Comly
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
| | - Jessica Goldstein
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
| | | | - Barry L. McCurdy
- Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131 USA
| | | | - Kathryn Henson
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
| | - Patrick Bevenour
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
| | | | - Abbas F. Jawad
- Roberts Center for Pediatric Research, Children’s Hospital of Philadelphia, Philadelphia, PA 19146-2305 USA
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Magura S, Lee-Easton MJ, Abu-Obaid RN, Landsverk J, DeCamp W, Rolls-Reutz J, Moore K, Firpo-Triplett R, Buckley PR, Stout ER, Perkins DF. The influence of evidence-based program registry websites for dissemination of evidence-based interventions in behavioral healthcare. Eval Program Plann 2023; 97:102214. [PMID: 36586304 PMCID: PMC10121732 DOI: 10.1016/j.evalprogplan.2022.102214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/27/2022] [Accepted: 12/19/2022] [Indexed: 05/27/2023]
Abstract
PURPOSE Evidence-based program registries (EBPRs) are web-based databases of evaluation studies that summarize the available evidence for the effectiveness of behavioral healthcare programs, including programs addressing substance misuse, mental health, child welfare, or offender rehabilitation. The study determined the extent to which visitors to selected EBPRs accomplished the objectives of their visits and how often those visits resulted in the adoption of new or improved evidence-based interventions (EBIs). METHOD A follow-up telephone survey was conducted with 216 visitors to a convenience sample of six EBPRs an average of six months after the visitors' incident visit to the EBPR. RESULTS The most frequent objective was to identify evidence-based programs/services, curricula or assessments, followed by finding resources to implement or improve the preceding and writing a grant proposal including to comply with funding requirements; 71% of such objectives were achieved across the full set of objectives. Implementation of an EBI was completely achieved for 31% of relevant objectives and some progress on EBI implementation occurred for 19% of relevant objectives. CONCLUSIONS This is the first study to document the usage of EBPRs as a modality to increase the utilization of EBIs in the actual practice of behavioral healthcare. The results support the continued use of web-based EBPRs for disseminating information on evidence-based interventions for behavioral healthcare.
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Affiliation(s)
- Stephen Magura
- Evaluation Center, Western Michigan University, Kalamazoo, MI, USA.
| | | | | | | | - Whitney DeCamp
- Department of Sociology, Western Michigan University, Kalamazoo, MI, USA
| | | | | | | | - Pamela R Buckley
- Institute of Behavioral Science, University of Colorado Boulder, Boulder, CO, USA
| | - Ellyson R Stout
- Suicide Prevention Resource Center project, Education Development Center, Waltham, MA, USA
| | - Daniel F Perkins
- Clearinghouse for Military Family Readiness, Pennsylvania State University, University Park, PA, USA
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15
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Broffman L, D'Aunno T, Chang JE. Factors associated with the adoption of evidence-based innovations by substance use disorder treatment organizations: A study of HIV testing. J Subst Abuse Treat 2023; 144:108929. [PMID: 36402124 DOI: 10.1016/j.jsat.2022.108929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 09/12/2022] [Accepted: 10/30/2022] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Though prior research shows that a range of important regulatory, market, community, and organizational factors influence the adoption of evidence-based practices (EBPs) among health care organizations, we have little understanding of how these factors relate to each other. To address this gap, we test a conceptual model that emphasizes indirect, mediated effects among key factors related to HIV testing in substance use disorder treatment organizations (SUTs), a critical EBP during the US opioid epidemic. METHODS We draw on nationally representative data from the 2014 (n = 697) and 2017 (n = 657) National Drug Abuse Treatment System Survey (NDATSS) to measure the adoption of HIV testing among the nation's SUTs and their key organizational characteristics; we also draw on data from the US Census Bureau; Centers for Disease Control; and legislative sources to measure regulatory and community environments. We estimate cross-sectional and longitudinal structural equation models (SEM) to test the proposed model. RESULTS Our longitudinal model of the adoption of HIV testing by SUTs in the United States identifies a pathway by which community and market characteristics (rurality and the number of other SUTs in the area) are related to key sociotechnical characteristics of these organizations (alignment of clients, staff, and harm-reduction culture) that, in turn, are related to the adoption of this EBP. CONCLUSIONS Results also show the importance of developing conceptual models that include indirect effects to account for organizational adoption of EBPs.
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Washington-Nortey M, Granger K, Sutherland KS, Conroy M, Kaur N, Hetrick A. Sustaining BEST in CLASS: Teacher-Reported Evidence-Based Practice Use with Students at Risk for Emotional and Behavioral Disorders Amidst the COVID-19 Pandemic. School Ment Health 2022; 15:1-14. [PMID: 36569406 PMCID: PMC9767394 DOI: 10.1007/s12310-022-09561-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2022] [Indexed: 12/24/2022]
Abstract
There is growing evidence of the efficacy of evidence-based interventions in improving the academic and social outcomes of children who exhibit challenging behaviors during program implementation periods. However, less is known about the extent to which practices learned as part of these interventions are sustained after these projects end, when funding is paused temporarily, and in less-than-ideal conditions. This study used qualitative methods to investigate whether teachers previously trained in the BEST in CLASS-Elementary intervention continued to use the program's evidence-based practices with students 1-2 years after completing the program and in the context of the COVID-19 pandemic. It also examined teachers' perceptions of the impact of practice use on students' academic and social outcomes. Thirteen BEST in CLASS-Elementary teachers from elementary schools in two southeastern states in the USA where the program was implemented completed semi-structured interviews on the topic. Data were coded thematically, and the results indicated that over 50% of teachers reported using "rules," "supportive relationships," and "praise" frequently with their students. However, "precorrection" and "opportunities to respond" were reportedly used less often. Teachers also perceived that their use of these evidence-based practices was linked to increases in their students' academic engagement and academic performance and knowledge, improvements in students' behaviors, their relationships with teachers, and general comfort and self-confidence. The discussion highlights modality-specific patterns noted in the results that might influence sustainment and the implication of these findings for interventions and programs aimed at promoting positive behavioral outcomes for early elementary school students.
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Affiliation(s)
- Melissa Washington-Nortey
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, Addison House, Guy’s Campus, London, SE1 1UL UK
| | - Kristen Granger
- Department of Special Education, Peabody College, Vanderbilt University, 230 Appleton Place, Nashville, TN 37203 USA
| | - Kevin S. Sutherland
- Department of Counseling and Special Education, School of Education, Virginia Commonwealth University, Box 842020, Richmond, VA 23284-2020 USA
| | - Maureen Conroy
- Anita Zucker Center for Excellence in Early Childhood Studies, University of Florida, PO Box 117050, Gainesville, FL 32611 USA
| | - Navneet Kaur
- Department of Psychology, Virginia Commonwealth University, Box 842020, Richmond, VA 23284-2020 USA
| | - Allyse Hetrick
- Institute for Child Health Policy, University of Florida, 2004 Mowry Rd, Gainesville, FL 32603 USA
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17
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Ervin JN, Dibble MR, Rentes VC, Sjoding MW, Gong MN, Hough CL, Iwashyna TJ, Sales AE. Prioritizing evidence-based practices for acute respiratory distress syndrome using digital data: an iterative multi-stakeholder process. Implement Sci 2022; 17:82. [PMID: 36527136 PMCID: PMC9756680 DOI: 10.1186/s13012-022-01255-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Evidence-based practices (EBPs) for patients receiving invasive mechanical ventilation vary in the quality of their underlying evidence and ease of implementation. RESEARCH QUESTION How do researchers and clinicians prioritize EBPs to help guide clinical decision-making and focus implementation efforts to improve patient care using existing, validated measures? STUDY DESIGN AND METHODS We developed a 4-step rapid method using existing criteria to prioritize EBPs associated with lower mortality and/or shorter duration of invasive mechanical ventilation for patients suffering from acute respiratory failure or acute respiratory distress syndrome. Using different types of data including surveys, we (1) identified relevant EBPs, (2) rated EBPs using the Guideline Implementability Appraisal (GLIA) tool, (3) surveyed practicing ICU clinicians from different hospital systems using a subset of GLIA criteria, and (4) developed metrics to assess EBP performance. In this paper, we describe steps 2 and 3. RESULTS In step 2, we prioritized 11 EBPs from an initial list of 30, using surveys and ratings among a small group of clinician researchers. In step 3, 42 clinicians from 8 different hospital systems provided assessments of these 11 EBPs which inform the final step of metric development. INTERPRETATION Our prioritization process allowed us to identify 11 EBPs out of a larger group that clinicians perceive is most likely to help optimize invasive mechanical ventilation and improve the outcomes of this vulnerable patient population. While this method was developed in critical care related to adults receiving invasive mechanical ventilation, it is adaptable to other health contexts.
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Affiliation(s)
- Jennifer N. Ervin
- grid.268154.c0000 0001 2156 6140Health Sciences, Office of Health Affairs, West Virginia University, Morgantown, WV USA ,grid.214458.e0000000086837370Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA
| | - Millie R. Dibble
- grid.214458.e0000000086837370Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - Victor C. Rentes
- grid.214458.e0000000086837370Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA
| | - Michael W. Sjoding
- grid.214458.e0000000086837370Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI USA
| | - Michelle N. Gong
- grid.251993.50000000121791997Divisions of Critical Care Medicine and Pulmonary Medicine, Department of Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, NY USA
| | - Catherine L. Hough
- grid.5288.70000 0000 9758 5690Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, Portland, OR USA
| | - Theodore J. Iwashyna
- grid.214458.e0000000086837370Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.21107.350000 0001 2171 9311Division of Pulmonary and Critical Care, Department of Medicine and Department of Health Policy and Management, Johns Hopkins University, Baltimore, MD USA
| | - Anne E. Sales
- grid.214458.e0000000086837370Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Department of Learning Health Sciences, University of Michigan, Ann Arbor, MI USA ,grid.134936.a0000 0001 2162 3504Sinclair School of Nursing and Department of Family and Community Medicine, University of Missouri, Columbia, MO USA ,grid.497654.d0000 0000 8603 8958VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI USA
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18
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Carcone AI, Coyle K, Butame S, Harper GW, Aarons GA, Naar S. Using the Exploration-Preparation-Implementation-Sustainment (EPIS) Framework to prepare for the implementation of evidence-based practices into adolescent HIV settings. AIDS Behav 2022; 26:4093-4106. [PMID: 36066763 PMCID: PMC9643628 DOI: 10.1007/s10461-022-03735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/01/2022]
Abstract
Despite advances in evidence-based practices (EBP) to support HIV prevention and treatment, youth ages 13-24 experience significant disparities in HIV risk and outcomes. An important factor in this disparity is poor EBP implementation, yet implementation research is limited, particularly in youth-serving settings. This study used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide the implementation of four Motivational Interviewing (MI) and MI-framed interventions into youth-serving HIV prevention and treatment settings. Key stakeholders (n = 153) across 13 sites completed pre-implementation interviews. Stakeholders' comments identified two critical factors for effective implementation: fit with the patient population and provider receptivity, including concerns about scope of practice, buy-in, and time. Stakeholders recommended strategies for structuring training, fidelity monitoring, and facilitating implementation including engaging informal leaders, collaboratively developing the implementation strategy, and site-wide implementation. Results highlight the importance of pre-implementation contextual assessment and strategic planning for identifying provider concerns and developing responsive implementation strategies.
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Affiliation(s)
- April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, United States
| | - Karin Coyle
- Education, Training, and Research (ETR), Scotts Valley, California, United States
| | - Seyram Butame
- Center for Translational Behavioral Science, Florida State University, Tallahassee, Florida, United States
| | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, Michigan, United States
| | - Gregory A Aarons
- ACTRI Dissemination and Implementation Science Center, University of California, San Diego, La Jolla, California, United States
| | - Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, Florida, United States
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D'Orazio DM. No Exceptions to the Rules: Professional Ethics Should Apply to Sexual Offender Civil Commitment Proceedings. Curr Psychiatry Rep 2022; 24:741-748. [PMID: 36534316 DOI: 10.1007/s11920-022-01397-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW We review the non-punitive intents and goals of sexual offender civil commitment ("SOCC") proceedings. We apply the impacts of open courtrooms in SOCC hearings to what is known about the provision of effective, ethical, and constitutional interventions to those committed and we examine whether open proceedings are consistent with evidence-based practices, including the risk, needs, and responsivity principles. RECENT FINDINGS The use of open courtrooms in SOCC proceedings presents numerous barriers to ethical, effective, and efficient interventions. Open courtrooms fuel treatment resistance, low treatment enrollment, exacerbation of risk factors, and mental conditions, and they disrupt protective factors, undermining the integrity of SOCC systems. These negative consequences are punitive and inconsistent with evidence-based practices, the RNR principles, and do not facilitate positive treatment outcomes. The SOCC's purpose is to prevent sexual re-offense by helping those committed improve their sexual offense risk-related mental conditions. Open courtrooms and the harm they cause undermine the constitutionality pillars of SOCC proceedings and are inconsistent with best practice principles. Legislators, judges, attorneys, and policymakers should monitor and reform courtroom procedures to ensure they are consistent with evidence-based practices and the non-punitive intent and goals of civil commitment.
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Affiliation(s)
- Deirdre M D'Orazio
- Central Coast Clinical and Forensic Psychological Services, Atascadero, CA, USA.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Coyle K, Carcone AI, Butame S, Pooler-Burgess M, Chang J, Naar S. Adapting the self-assessment of contextual fit scale for implementation of evidence-based practices in adolescent HIV settings. Implement Sci Commun 2022; 3:115. [PMID: 36273221 PMCID: PMC9588200 DOI: 10.1186/s43058-022-00349-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
Abstract
Background Contextual fit is an important variable in the implementation of evidence-based programs (EBPs). The objectives of the current study were to examine the psychometric properties of the adapted Self-Assessment of Contextual Fit (SACF) measure for HIV clinical care settings (calling it SACF-HIV) and explore how perceptions of contextual fit varied across two different interventions (an intervention to scale up tailored motivational interviewing and an individually focused HIV prevention intervention) and 12 clinical sites. Methods We collected SACF-HIV data as part of a larger cross-project implementation science study (ATN 153). The study sample includes 128 clinicians, community health workers, interventionists, adherence counselors, and other members of the prevention and care team who engage in the implementation of EBPs at 12 HIV prevention and clinical care sites in the USA. We assessed the internal consistency of the SACF-HIV using Cronbach’s alpha and examined the sub-dimensionality of the scale with an exploratory factor analysis. To explore concurrent validity, we examined Pearson’s correlation coefficients between the adapted scale and fit-related sub-scale scores from the Evidence-Based Practice Attitudes Scale-50 (EBPAS-50). Variation in perceptions of fit by intervention was examined using descriptive statistics. Results Internal consistency of the adapted scale was strong (α=0.895). Factor analyses revealed two sub-scales—one capturing general insights regarding contextual fit, such as perceptions of skill, experience, and alignment with client needs (loadings ranging from .5 to .84), and a second centering perceptions regarding implementation support, such as resources and administrative support (loadings ranging from .89 to .97). Concurrent validity was supported by statistically significant correlations in the expected direction with EBPAS-50 fit-related sub-scales (r=.33–.35, p ≤ 0.05). SACF-HIV mean fit scores varied by intervention and the difference was statistically significant (2.78 vs. 2.53, p < 0.05). Conclusions There are relatively few tools assessing perceptions of contextual fit in HIV clinical settings. These results suggest the 12-item adapted SACF is a reliable, valid global assessment of perceptions of contextual fit and implementation support. The SACF-HIV can be used by practitioners and researchers interested in understanding an implementation context when planning to prepare and support EBP implementation. Trial registration TMI ClinicalTrials.gov NCT03681912; YMPH ClinicalTrials.gov NCT03488914
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Affiliation(s)
- Karin Coyle
- grid.420864.cETR, 5619 Scotts Valley Dr., Suite 140, Scotts Valley, CA 95066 USA
| | - April Idalski Carcone
- grid.254444.70000 0001 1456 7807Division of Behavioral Sciences, Family Medicine and Public Health Sciences, Wayne State University, Integrated Biosciences Building (IBio) #3128, 6135 Woodward, Detroit, MI 48202 USA
| | - Seyram Butame
- grid.255986.50000 0004 0472 0419Center for Translational Behavioral Science, College of Medicine, Florida State University, 2010 Levy Ave., Bldg. B, Suite 0266, Tallahassee, FL 32310 USA
| | - Meardith Pooler-Burgess
- grid.255986.50000 0004 0472 0419Center for Translational Behavioral Science, College of Medicine, Florida State University, 2010 Levy Ave., Bldg. B, Suite 0266, Tallahassee, FL 32310 USA
| | - Jason Chang
- grid.420864.cETR, 5619 Scotts Valley Dr., Suite 140, Scotts Valley, CA 95066 USA
| | - Sylvie Naar
- grid.255986.50000 0004 0472 0419Center for Translational Behavioral Science, College of Medicine, Florida State University, 2010 Levy Ave., Bldg. B, Suite 0266, Tallahassee, FL 32310 USA
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22
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Cho E, Tugendrajch SK, McMillen JC, Proctor EK, Hawley KM. Implementation of Evidence-Based Practices within Treatment-As-Usual and Evidence-Based Practice Initiatives. Adm Policy Ment Health 2022; 49:757-784. [PMID: 35501585 PMCID: PMC11003240 DOI: 10.1007/s10488-022-01197-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2022] [Indexed: 11/25/2022]
Abstract
Publicly funded initiatives are underway to improve implementation of evidence-based practices (EBP) in youth mental health services. However, we know little about the success of these initiatives or about EBP implementation independent of such initiatives. We examined EBP implementation in a treatment as usual (TAU) state and in six states with publicly funded EBP initiatives (EBPIs). In Study 1, we examined providers' use of practices derived from the evidence base (PDEB) and their predictors among 780 providers in a TAU state. In Study 2, we conducted a systematic review of implementation strategies, outcomes, and predictors of EBP use in six state funded EBPIs. Study 1 suggests TAU providers use PDEB alongside practices without consistent research support; provider racial/ethnic minority status, learning theory orientation, and manual use predict greater PDEB use. Study 2 indicates EBPIs employ multiple recommended implementation strategies with variable outcomes across studies and measurement approaches. Predictors of EBP use in EBPIs also varied, though training, setting, and youth age were consistent predictors across studies. While sample differences and inconsistent measurement across studies made direct comparisons somewhat tenuous, rates of PDEB use in the TAU sample appeared similar to those in publicly funded EBPIs. However, two states reported comparisons with TAU samples and found higher EBP implementation under EBPI. Different predictors impacted EBP use in TAU versus EBPIs. Our findings highlight the need for improved evaluation of EBPIs including clear reporting standards for outcomes and more consistent, standardized measurement of EBP use in order to better understand and improve EBPIs.
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Affiliation(s)
- E Cho
- Harvard University, 33 Kirkland St, Cambridge, MA, 02138, USA
| | - S K Tugendrajch
- University of Missouri, 200 South 7th Street, Columbia, MO, 65211, USA
| | - J C McMillen
- University of Chicago, 969 E. 60th Street, Chicago, IL, 60637, USA
| | - E K Proctor
- Washington University in St. Louis, One Brookings Drive, St. Louis, MO, 63130, USA
| | - K M Hawley
- University of Missouri, 204C McAlester Hall, Columbia, MO, 65211, USA.
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da Hora CL, Sella AC. Evaluation parameters for evidence-based practices for people with autism spectrum disorder: a narrative review of group and single-subject design studies. Psicol Reflex Crit 2022; 35:23. [PMID: 35857210 PMCID: PMC9300806 DOI: 10.1186/s41155-022-00213-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/18/2022] [Indexed: 11/21/2022]
Abstract
Recommendations for using evidence-based practices have become increasingly common in services for individuals diagnosed with autistic spectrum disorder (ASD). The aim of this study was to conduct a narrative literature review to identify differences and similarities in evidence-evaluation criteria for group and single-subject designs that empirically support interventions for people with ASD. Data sources used in this analysis were reports and articles elaborated by different clearinghouses (i.e., National Autism Center, National Professional Development Center, and the National Clearinghouse on Autism Evidence and Practice). The criteria for evaluating evidence, as defined by these documents, contained specific components or quality indicators for each type of study design. The different criteria for evaluating evidence and for classifying the interventions (once evidence was evaluated) were identified and described. This manuscript discusses the need for (a) expanding the analysis beyond the evidence identified by different researchers and organizations such as the clearinghouses, (b) proposing interventions that are based not only on scientific evidence but also on social validity — which is directed by client idiosyncrasies, and (c) attention to the fact that EBPs should not be seen as static information regarding interventions with empirical support: evidence-based practices are the result of constant analysis of the intervention implementation data added to professional training and client values and context. Some additional issues and the study limitations are also presented.
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Affiliation(s)
- Cássia Leal da Hora
- Paradigma, Behavioral Science and Technology Center, Rua Bartira, 1294, Perdizes, São Paulo, SP, CEP: 05011-001, Brazil.
| | - Ana Carolina Sella
- Aprendizagem em Pauta, Rua Olindina Campos Teixeira, 172/601, Maceió, Alagoas, CEP: 57036-690, Brazil
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Dopp AR, Hunter SB, Godley MD, Pham C, Han B, Smart R, Cantor J, Kilmer B, Hindmarch G, González I, Passetti LL, Wright KL, Aarons GA, Purtle J. Comparing two federal financing strategies on penetration and sustainment of the adolescent community reinforcement approach for substance use disorders: protocol for a mixed-method study. Implement Sci Commun 2022; 3:51. [PMID: 35562836 PMCID: PMC9099033 DOI: 10.1186/s43058-022-00298-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Sustained, widespread availability of evidence-based practices (EBPs) is essential to address the public health and societal impacts of adolescent substance use disorders (SUD). There remains a particularly significant need to identify effective financing strategies, which secure and direct financial resources to support the costs associated with EBP implementation and sustainment. This protocol describes a new project comparing two types of U.S. federal grant mechanisms (i.e., a type of financing strategy), which supported the implementation of the Adolescent Community Reinforcement Approach (A-CRA) EBP for SUD, through either organization-focused or state-focused granting of funds. The Exploration-Preparation-Implementation-Sustainment (EPIS) framework will guide our study aims, hypotheses, and selection of measures. METHOD We will employ a longitudinal, mixed-method (i.e., web surveys, semi-structured interviews, document review, focus groups, administrative data), quasi-experimental design to compare the grant types' outcomes and examine theoretically informed mediators and moderators. Aim 1 will examine the proportion of eligible clinicians certified in A-CRA with adequate fidelity levels (i.e., penetration outcomes) at the end of grant funding. Aim 2 will examine the sustainment of A-CRA up to 5 years post-funding, using a 10-element composite measure of treatment delivery and supervision activities. We will integrate the new data collected from state-focused grant recipients (~85 organizations in 19 states) with previously collected data from organization-focused grant recipients (Hunter et al., Implement Sci 9:104, 2014) (82 organizations in 26 states) for analysis. We will also use sensitivity analyses to characterize the effects of observed and unobserved secular trends in our quasi-experimental design. Finally, aim 3 will use comparative case study methods (integrating diverse quantitative and qualitative measures) to identify and disseminate policy implications about the roles of state- and organization-focused federal grants in efforts to promote adolescent SUD EBP implementation and sustainment. DISCUSSION The proposed research will have direct, practical implications for behavioral health administrators, policymakers, implementation experts, and the public. It will offer new knowledge that can directly inform financing strategies to support large-scale, sustained EBP delivery in behavioral health-while advancing implementation science through the use of novel methods to study financing strategies and sustainment.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Sarah B Hunter
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Chau Pham
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Bing Han
- Department of Research and Evaluation, Division of Biostatistics Research, Kaiser Permanente Southern California, 100 South Los Robles Avenue 2nd Floor, Pasadena, CA, 91101, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Jonathan Cantor
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Beau Kilmer
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Grace Hindmarch
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Isabelle González
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, 22202, USA
| | - Lora L Passetti
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Kelli L Wright
- Chestnut Health Systems, 448 Wylie Drive, Normal, IL, 61761, USA
| | - Gregory A Aarons
- Department of Psychiatry, 9500 Gilman Dr. (0812), University of California San Diego, La Jolla, CA, 92093, USA
- UC San Diego Altman Clinical and Translational Research Institute Dissemination and Implementation Science Center, La Jolla, CA, 92093, USA
| | - Jonathan Purtle
- Department of Public Health Policy & Management and Global Center for Implementation Science, New York University School of Global Public Health, 708 Broadway, New York, NY, 10003, USA
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Achola KA, Kajjo D, Santos N, Butrick E, Otare C, Mubiri P, Namazzi G, Merai R, Otieno P, Waiswa P, Walker D. Implementing the WHO Safe Childbirth Checklist modified for preterm birth: lessons learned and experiences from Kenya and Uganda. BMC Health Serv Res 2022; 22:294. [PMID: 35241076 PMCID: PMC8896298 DOI: 10.1186/s12913-022-07650-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 02/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background The WHO Safe Childbirth Checklist (SCC) contains 29 evidence-based practices (EBPs) across four pause points spanning admission to discharge. It has been shown to increase EBP uptake and has been tailored to specific contexts. However, little research has been conducted in East Africa on use of the SCC to improve intrapartum care, particularly for preterm birth despite its burden. We describe checklist adaptation, user acceptability, implementation and lessons learned. Methods The East Africa Preterm Birth Initiative (PTBi EA) modified the SCC for use in 23 facilities in Western Kenya and Eastern Uganda as part of a cluster randomized controlled trial evaluating a package of facility-based interventions to improve preterm birth outcomes. The modified SCC (mSCC) for prematurity included: addition of a triage pause point before admission; focus on gestational age assessment, identification and management of preterm labour; and alignment with national guidelines. Following introduction, implementation lasted 24 and 34 months in Uganda and Kenya respectively and was supported through complementary mentoring and data strengthening at all sites. PRONTO® simulation training and quality improvement (QI) activities further supported mSCC use at intervention facilities only. A mixed methods approach, including checklist monitoring, provider surveys and in-depth interviews, was used in this analysis. Results A total of 19,443 and 2229 checklists were assessed in Kenya and Uganda, respectively. In both countries, triage and admission pause points had the highest rates of completion. Kenya’s completion was greater than 70% for all pause points; Uganda ranged from 39 to 75%. Intervention facilities exposed to PRONTO and QI had higher completion rates than control sites. Provider perceptions cited clinical utility of the checklist, particularly when integrated into patient charts. However, some felt it repeated information in other documentation tools. Completion was hindered by workload and staffing issues. Conclusion This study highlights the feasibility and importance of adaptation, iterative modification and complementary activities to reinforce SCC use. There are important opportunities to improve its clinical utility by the addition of prompts specific to the needs of different contexts. The trial assessing the PTBi EA intervention package was registered at ClinicalTrials.gov NCT03112018 Registered December 2016, retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07650-x.
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Affiliation(s)
| | - Darious Kajjo
- Makerere University School of Public Health, Kampala, Uganda
| | - Nicole Santos
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, USA
| | - Elizabeth Butrick
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, USA.
| | | | - Paul Mubiri
- Makerere University School of Public Health, Kampala, Uganda
| | | | - Rikita Merai
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, USA
| | | | - Peter Waiswa
- Makerere University School of Public Health, Kampala, Uganda.,Department of Global Public Health, Karolinska Institutet, Stockolm, Sweden
| | - Dilys Walker
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, USA.,Dept. of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, San Francisco, USA
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Vax S, Farkas M, Mueser KT, Drainoni ML, Russinova Z. Building organizational readiness: initial field testing of an expert-informed typology of implementation strategies. Implement Sci Commun 2022; 3:22. [PMID: 35236502 PMCID: PMC8889398 DOI: 10.1186/s43058-022-00257-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 01/12/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Organizational readiness is a known barrier to implementing evidence-based practices (EBPs) in community mental health services. A robust methodology for enhancing organizational readiness for implementation (ORI) has the potential to improve implementation outcomes of EBPs and ensure better services for people with a psychiatric disability. Prior work established a framework of implementation strategies targeting ORI enhancement by asking a group of implementation experts from various fields to categorize strategies from the "Expert Recommendations for Implementing Change" (ERIC) Project into three readiness stages, consistent with the pre-action stages of the Transtheoretical Model of behavioral change: Pre-contemplation, Contemplation, and Preparation. The current study provides initial confirmation and refinement to this expert-driven typology based on community mental health field experiences. METHODS We conducted in-depth interviews with stakeholders involved in a recent EBP implementation project. Participants included staff (n=9) from four community mental health agencies and the implementation team who facilitated the project (n=3). Their pre-implementation experiences were compared with the experts' typology to identify consistencies and discrepancies. RESULTS The participants' experiences were congruent with two thirds of the strategies identified by the experts for specific ORI stages. The refinements included 12 strategies used in additional stages beyond the experts' classification, four strategies from the ERIC list that were not included in the ORI typology, and five new strategies. CONCLUSIONS This study provides initial confirmation and refinements to the previously published ORI typology. The results offer guidance as to how ORI could be enhanced in the community mental health field.
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Affiliation(s)
- Sigal Vax
- Rehabilitation Sciences Program, College of Health & Rehabilitation: Sargent College, Boston University, Boston, USA
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation: Sargent College, Boston University, 940 Commonwealth Ave W, Boston, MA 02215 USA
| | - Marianne Farkas
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation: Sargent College, Boston University, 940 Commonwealth Ave W, Boston, MA 02215 USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation: Sargent College, Boston University, 940 Commonwealth Ave W, Boston, MA 02215 USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, USA
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, USA
| | - Zlatka Russinova
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation: Sargent College, Boston University, 940 Commonwealth Ave W, Boston, MA 02215 USA
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Baker-Ericzén MJ, ElShamy R, Kammes RR. Current Status of Evidence-Based Practices to Enhance Employment Outcomes for Transition Age Youth and Adults on the Autism Spectrum. Curr Psychiatry Rep 2022; 24:161-170. [PMID: 35192114 DOI: 10.1007/s11920-022-01327-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This review provides a highlight of existing evidence-based practices and community support systems that exist to enhance employment outcomes for autistic transition-age youth (TAY) and adults. An update is provided on the current status of these programs and the impact they are having on employment outcomes for this population. RECENT FINDINGS Many programs exist that prove to be efficacious in improving employment outcomes. These programs can be categorized as vocational rehabilitation service system level interventions, provider and consumer level interventions targeting skills related to employment, and consumer level interventions delivered within community vocational rehabilitation or education settings. A more recent increase in programs is consistent with multiple research and policy calls for amplified programming in this area. Despite these recent increases, there is still a need to further develop effective programming to support employment outcomes as the growing autistic population age into adulthood. Community-based research and practice should continue to be developed and tested.
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Affiliation(s)
- Mary J Baker-Ericzén
- Department of Administration, Rehabilitation and Post-Secondary Education, San Diego State University, San Diego, CA, USA.
- Interwork Institute, 6367 Alvarado Court, Suite 350, San Diego, CA, 92120, USA.
- Child and Adolescent Services Research Center, San Diego, CA, USA.
- Intricate Mind Institute, San Diego, CA, USA.
| | | | - Rebecca R Kammes
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI, USA
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Le PD, Eschliman EL, Grivel MM, Tang J, Cho YG, Yang X, Tay C, Li T, Bass J, Yang LH. Barriers and facilitators to implementation of evidence-based task-sharing mental health interventions in low- and middle-income countries: a systematic review using implementation science frameworks. Implement Sci 2022; 17:4. [PMID: 35022081 PMCID: PMC8756725 DOI: 10.1186/s13012-021-01179-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 12/05/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Task-sharing is a promising strategy to expand mental healthcare in low-resource settings, especially in low- and middle-income countries (LMICs). Research on how to best implement task-sharing mental health interventions, however, is hampered by an incomplete understanding of the barriers and facilitators to their implementation. This review aims to systematically identify implementation barriers and facilitators in evidence-based task-sharing mental health interventions using an implementation science lens, organizing factors across a novel, integrated implementation science framework. METHODS PubMed, PsychINFO, CINAHL, and Embase were used to identify English-language, peer-reviewed studies using search terms for three categories: "mental health," "task-sharing," and "LMIC." Articles were included if they: focused on mental disorders as the main outcome(s); included a task-sharing intervention using or based on an evidence-based practice; were implemented in an LMIC setting; and included assessment or data-supported analysis of barriers and facilitators. An initial conceptual model and coding framework derived from the Consolidated Framework for Implementation Research and the Theoretical Domains Framework was developed and iteratively refined to create an integrated conceptual framework, the Barriers and Facilitators in Implementation of Task-Sharing Mental Health Interventions (BeFITS-MH), which specifies 37 constructs across eight domains: (I) client characteristics, (II) provider characteristics, (III) family and community factors, (IV) organizational characteristics, (V) societal factors, (VI) mental health system factors, (VII) intervention characteristics, and (VIII) stigma. RESULTS Of the 26,935 articles screened (title and abstract), 192 articles underwent full-text review, yielding 37 articles representing 28 unique intervention studies that met the inclusion criteria. The most prevalent facilitators occur in domains that are more amenable to adaptation (i.e., the intervention and provider characteristics domains), while salient barriers occur in domains that are more challenging to modulate or intervene on-these include constructs in the client characteristics as well as the broader societal and structural levels of influence (i.e., the organizational, mental health system domains). Other notable trends include constructs in the family and community domains occurring as barriers and as facilitators roughly equally, and stigma constructs acting exclusively as barriers. CONCLUSIONS Using the BeFITS-MH model we developed based on implementation science frameworks, this systematic review provides a comprehensive identification and organization of barriers and facilitators to evidence-based task-sharing mental health interventions in LMICs. These findings have important implications for ongoing and future implementation of this critically needed intervention strategy, including the promise of leveraging task-sharing intervention characteristics as sites of continued innovation, the importance of but relative lack of engagement with constructs in macro-level domains (e.g., organizational characteristics, stigma), and the need for more delineation of strategies for task-sharing mental health interventions that researchers and implementers can employ to enhance implementation in and across levels. TRIAL REGISTRATION PROSPERO CRD42020161357.
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Affiliation(s)
- PhuongThao D. Le
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA
| | - Evan L. Eschliman
- grid.21107.350000 0001 2171 9311Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe St., Baltimore, MD 21205 USA
| | - Margaux M. Grivel
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA
| | - Jeffrey Tang
- grid.137628.90000 0004 1936 8753Department of Psychology, New York University Graduate School of Arts and Science, One-Half Fifth Avenue, New York, NY 10003 USA
| | - Young G. Cho
- grid.21729.3f0000000419368729New York State Psychiatric Institute, Columbia University, 1051 Riverside Dr., New York, NY 10032 USA
| | - Xinyu Yang
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032 USA
| | - Charisse Tay
- grid.21729.3f0000000419368729Columbia University Teachers College, 525 West 120th Street, New York, NY 10027 USA
| | - Tingyu Li
- grid.21729.3f0000000419368729Columbia University Teachers College, 525 West 120th Street, New York, NY 10027 USA
| | - Judith Bass
- grid.21107.350000 0001 2171 9311Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, Hampton House, 8th Floor, 624 N. Broadway, Baltimore, MD 21205 USA
| | - Lawrence H. Yang
- grid.137628.90000 0004 1936 8753Department of Social and Behavioral Sciences, New York University School of Global Public Health, 708 Broadway, NY 10012 New York, USA ,grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 West 168th St., New York, NY 10032 USA
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Borge RH, Egeland KM, Aarons GA, Ehrhart MG, Sklar M, Skar AS. "Change Doesn't Happen by Itself": A Thematic Analysis of First-Level Leaders' Experiences Participating in the Leadership and Organizational Change for Implementation (LOCI) Strategy. Adm Policy Ment Health 2022; 49:785-97. [PMID: 35583566 DOI: 10.1007/s10488-022-01199-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 10/26/2022]
Abstract
The Leadership and Organizational Change for Implementation (LOCI) strategy is a multifaceted implementation strategy that aims to support successful evidence-based practice (EBP) implementation by fostering effective general leadership, implementation leadership, and implementation climate. How implementation strategies are experienced by participants is important for their utilization and effectiveness in supporting EBP implementation. The current study is the first in-depth qualitative study exploring first-level leaders' experiences of participating in the LOCI strategy. Data were collected as part of a trial where Norwegian child and adult mental health outpatient clinics implemented EBPs for posttraumatic stress disorder (PTSD). Eleven first-level leaders from adult and child clinics participated in semi-structured interviews after completing the LOCI strategy. Data were analyzed through reflexive thematic analysis. The analysis generated four themes related to leaders' experiences of participating in the LOCI strategy: (1) structuring the EBP implementation, (2) taking responsibility for the EBP implementation, (3) interacting with others about the EBP implementation, and (4) becoming aware of EBP implementation and their own leadership. Most participants experienced the LOCI strategy as beneficial for implementing EBPs for PTSD in their clinic. The strategy succeeded in raising awareness of leadership for EBP implementation, and simultaneously provided participants with tools and support for leading the implementation in their clinic. Two participants experienced LOCI as less beneficial than the others. Our results support the strategy's potential to engage and empower first-level leaders to get involved in implementation processes and point to important challenges for future research on implementation strategies.
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Dopp AR, Manuel JK, Breslau J, Lodge B, Hurley B, Kase C, Osilla KC. Value of family involvement in substance use disorder treatment: Aligning clinical and financing priorities. J Subst Abuse Treat 2021; 132:108652. [PMID: 34742609 DOI: 10.1016/j.jsat.2021.108652] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 08/27/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Family members' support (e.g., informational, tangible, emotional) has important and lasting impacts on individuals' recovery from substance use disorders (SUDs). Unfortunately, SUD services in the United States do not consistently incorporate patients' family members effectively. One barrier to family involvement in SUD services is the mechanisms through which SUD services in the United States are commonly financed. METHOD Using our recent experiences with developing a group intervention for support persons of patients with opioid use disorder, we illustrate how gaps in feasible financing models limit SUD service systems from effectively implementing and sustaining family services for individuals receiving SUD treatment. DISCUSSION Long-term availability of family-inclusive interventions will require collaboration with payors and health systems. We offer two sets of recommendations for funding family involvement in SUD services; one set of immediately implementable recommendations and other longer-term goals requiring structural changes in SUD service delivery and financing.
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Affiliation(s)
- Alex R Dopp
- RAND Corporation, 1776 Main Street, Santa Monica, CA, United States of America.
| | - Jennifer K Manuel
- University of California, San Francisco, Department of Psychiatry and Behavioral Sciences, 401 Parnassus Ave, San Francisco, CA 94143, United States of America; San Francisco Veterans Affairs Health Care System, 4150 Clement St., San Francisco, CA 94121, United States of America.
| | - Joshua Breslau
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, United States of America.
| | | | - Brian Hurley
- Los Angeles County Department of Health Services, 313 N. Figueroa St., Los Angeles, CA 90012, United States of America.
| | - Courtney Kase
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, United States of America.
| | - Karen Chan Osilla
- Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA 94305, United States of America.
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31
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Bankanie V, Outwater AH, Wan L, Yinglan L. Assessment of knowledge and compliance to evidence-based guidelines for VAP prevention among ICU nurses in Tanzania. BMC Nurs 2021; 20:209. [PMID: 34696753 PMCID: PMC8543108 DOI: 10.1186/s12912-021-00735-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 09/29/2021] [Indexed: 01/22/2023] Open
Abstract
Background Implementation of evidence-based guidelines (EBGs) related to VAP is an effective measure for the prevention of ventilator-associated pneumonia (VAP). While low knowledge regarding the EBGs related to VAP prevention among ICU nurses is still a major concern among nurses in ICUs globally, the situation in Tanzania is scarcely known. This study aimed to assess the ICU nurses’ knowledge, compliance, and barriers toward evidence-based guidelines for the prevention of VAP in Tanzania. Methods A cross-sectional study, involving ICU nurses of major hospitals in Tanzania, was conducted. A structured questionnaire was administered among 116 ICU nurses. Data analysis included descriptive statistics and the independent sample t-test. Results The mean knowledge score was 3.86(SD = 1.56), based on ten questions (equivalent to 38.6%). Nurses with a degree or higher level of nursing education performed significantly better than the nurses with a diploma or lower level of nursing education (p = 0.004). The mean self-reported compliance score for EBGs for the prevention of VAP was 15.20 (SD = 0.93) which is equivalent to 60.8% based on 25 questions. The main barriers to the implementation of EBGs for VAP prevention were lack of skills (96.6%), lack of adequate staff (95.5%), and lack of knowledge (79.3%). Conclusion Considering the severity and impact of VAP, and the higher risks of HAIs in resource-limited countries like Tanzania, the lower level of knowledge and compliance implies the need for ongoing educational interventions and evaluation of the implementation of the EBGs for VAP prevention by considering the local context.
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Affiliation(s)
- Vicent Bankanie
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.,Department of Clinical Nursing, University of Dodoma, Dodoma, Tanzania
| | - Anne H Outwater
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Li Wan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China
| | - Li Yinglan
- XiangYa school of Nursing, Central South University, No.172Tongzi po Road, Changsha, Yuelu District, China.
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Abstract
Psychiatric crisis care in the U.S. exemplifies the "more is less paradox" of U.S. health care. We spend more for health care than any other high-income country, yet our outcomes are typically poor compared to these other countries (OECD in OECD health statistics. Retrieved from https://www.oced.org/health/health-data.html , 2020). We do this, in part, by emphasizing medical treatments for problems that are inherently social, rather than addressing social determinants of health. Medical interventions for socio-economic problems are usually expensive and ineffective. For mental health crisis care, adding unfunded, untested, medical interventions to the current mélange of poorly funded, disorganized arrangements will not help. Instead, the U.S. should address social determinants, emphasize research-based interventions, and emphasize prevention-proven strategies that decrease costs and improve outcomes.
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Affiliation(s)
- Robert E Drake
- Westat, IPS Employment Center, 85 Mechanic Street, Lebanon, NH, 03766, USA.
| | - Gary R Bond
- Westat, IPS Employment Center, 85 Mechanic Street, Lebanon, NH, 03766, USA
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Latulippe K, LeBlanc A, Gagnon MP, Boivin K, Lavoie P, Dufour J, Raynard EP, Richard E, Lamontagne MÈ. Organizational knowledge translation strategies for allied health professionals in traumatology settings: realist review protocol. Syst Rev 2021; 10:255. [PMID: 34556170 PMCID: PMC8461924 DOI: 10.1186/s13643-021-01793-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/17/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knowledge translation (KT) is an important means of improving the health service quality. Most research on the effectiveness of KT strategies has focused on individual strategies, i.e., those directly targeting the modification of allied health professionals' knowledge, attitudes, and behaviors, for example. In general, these strategies are moderately effective in changing practices (maximum 10% change). Effecting change in organizational contexts (e.g., change readiness, general and specific organizational capacity, organizational routines) is part of a promising new avenue to service quality improvement through the implementation of evidence-based practices. The objective of this study will be to identify why, how, and under what conditions organizational KT strategies have been shown to be effective or ineffective in changing the (a) knowledge, (b) attitudes, and (c) clinical behaviors of allied health professionals in traumatology settings. METHODS This is a realist review protocol involving four iterative steps: (1) Initial theory formulation, (2) search for Evidence search, (3) knowledge extraction and synthesis, and (4) recommendations. We will search electronic databases such as PubMed, Embase, CINHAL, Cochrane Library, and Conference Proceedings Citation Index - Science. The studies included will be those relating to the use of organizational KT strategies in trauma settings, regardless of study designs, published between January 1990 and October 2020, and presenting objective measures that demonstrate change in allied health professionals' knowledge, attitudes, and clinical behaviors. Two independent reviewers will select, screen, and extract the data related to all relevant sources in order to refine or refute the context-mechanism-outcome (CMO) configurations developed in the initial theory and identify new CMO configurations. DISCUSSION Using a systematic and rigorous method, this review will help guide decision-makers and researchers in choosing the best organizational strategies to optimize the implementation of evidence-based practices. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020216105.
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Affiliation(s)
- Karine Latulippe
- Centre de recherche interdisciplinaire en réadaptation du Montréal métropolitain (CRIR), Pavillon Lindsay de l'IURDPM, 6363, Chemin Hudson, Montréal, Québec, H3S 1M9, Canada
| | - Annie LeBlanc
- Département de médecine familiale et de médecine d'urgence, Faculté de médecine, Pavillon Ferdinand-Vandry, Université Laval, 1050 av. de la Médecine, Québec, Québec, G1V 0A6, Canada
| | - Marie-Pierre Gagnon
- Chaire de recherche du Canada en technologies et pratiques en santé, Faculté des sciences infirmières, Pavillon Ferdinand-Vandry, Université Laval, Canada, 1050 av. de la Médecine, Québec, Québec, G1V 0A6, Canada
| | - Katia Boivin
- Direction de l'enseignement et des affaires universitaires, CHU de Québec-Université Laval, 2705 Boulevard Laurier, Québec, Québec, G1V 4G2, Canada
| | - Pascale Lavoie
- Direction de l'enseignement et des affaires universitaires, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525, boul. Wilfrid Hamel, Québec, Québec, G1M 2S8, Canada
| | - Joëlle Dufour
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Institut de réadaptation en déficience physique de Québec, 525 boul. Wilfrid-Hamel, Québec, Québec, G1M 2S8, Canada
| | | | - Eve Richard
- Bibliothèque de l'Université Laval, 2345, allée des Bibliothèques, Québec, Québec, G1V 0A6, Canada
| | - Marie-Ève Lamontagne
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale, Institut de réadaptation en déficience physique de Québec, 525 boul. Wilfrid-Hamel, Québec, Québec, G1M 2S8, Canada.
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Yamaguchi S, Sato S, Shiozawa T, Matsunaga A, Ojio Y, Fujii C. Predictive Association of Low- and High-Fidelity Supported Employment Programs with Multiple Outcomes in a Real-World Setting: A Prospective Longitudinal Multi-site Study. Adm Policy Ment Health 2021; 49:255-266. [PMID: 34476622 PMCID: PMC8850236 DOI: 10.1007/s10488-021-01161-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs). METHODS A prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups. RESULTS There were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p < 0.001), and better match for illness disclosure preference (92.6% versus 68.0%, respectively, aOR = 5.9, p = 0.003). However, we found no differences between groups in other preference matches or PROM outcomes. CONCLUSION High-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future. CLINICAL TRIAL REGISTRATION UMIN000025648.
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Affiliation(s)
- Sosei Yamaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Sayaka Sato
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Takuma Shiozawa
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Asami Matsunaga
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Yasutaka Ojio
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Chiyo Fujii
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
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Smith EP, Witherspoon DP, Lei PW. The "Haves, Have Some, and Have Nots:" a Latent Profile Analysis of Capacity, Quality, and Implementation in Community-Based Afterschool Programs. Prev Sci 2021. [PMID: 34191244 DOI: 10.1007/s11121-021-01258-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/09/2022]
Abstract
Implementation of evidence-based practices is a critical factor in whether afterschool programs are successful in having a positive impact upon risk reduction and positive youth development. However, important prevention research reveals that contextual and organizational factors can affect implementation (Bradshaw & Pas in School Psychology Review, 40, 530–548, 2011) (Flaspohler et al., in American Journal of Community Psychology, 50(3-4), 271-281, 2012) (Gottfredson et al., Prevention Science, 3, 43–56, 2002) (McIntosh et al., Journal of Positive Behavior Interventions, 18(4), 209-218, 2016) (Payne in Prevention Science, 10, 151–167, 2009). Using a latent profile approach (LPA), this paper examines multiple organizational and neighborhood contextual factors that might affect the degree to which afterschool programs effectively implement evidence-based practices in the context of a cluster-randomized trial of the Paxis Good Behavior Game (PaxGBG). The Interactive Systems Framework (ISF) explores dimensions of capacity that might matter for prevention efforts. As expected, we found that well-resourced and high-quality programs performed well in terms of implementation (the Haves) and, in neighborhood contexts rich in racial-ethnic diversity. Yet, we found that some programs with less physical and material capacity (the Have Nots), demonstrated greater program quality (i.e., supportive adult and peer relationships, engagement, a sense of belonging) and implementation, relative to programs with better capacity (e.g., space, material resources, staffing, and leadership, the Have Somes). While capacity matters, intentional prevention initiatives that seek to promote evidence-based practices are helpful to sites in supporting organizations that might otherwise fail to provide quality programming for youth. This paper addresses a conundrum in prevention science, namely, how to make programming accessible to those who need it with a focus on organizational processes, program quality, and implementation of evidence-based practices.
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Vax S, Farkas M, Russinova Z, Mueser KT, Drainoni ML. Enhancing organizational readiness for implementation: constructing a typology of readiness-development strategies using a modified Delphi process. Implement Sci 2021; 16:61. [PMID: 34112191 PMCID: PMC8194182 DOI: 10.1186/s13012-021-01132-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 05/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Knowledge about the development of organizational readiness for implementation (ORI) is limited. ORI, referred to as the willingness and capacity of all relevant stakeholders to change practice, is critical for increasing the adoption rate of evidence-based practices and improving implementation outcomes. However, no methodology currently guides ORI's enhancement or addresses differences in readiness needs across an organization. This study used the transtheoretical model (TTM) as a framework for classifying a well-established compilation of implementation strategies into three readiness stages: pre-contemplation, contemplation, and preparation. METHODS A modified Delphi method was used to establish consensus among a panel of purposefully selected research and field implementation experts. The Delphi process involved three rounds of online questionnaires. The third round also included a live video discussion to clarify definitions in an effort to increase consensus among experts. RESULTS Of the 73 strategies reviewed, the experts identified 75% (n = 55) as relevant for pre-implementation and reached a high-level agreement on the assignment of 7% (n = 5) of the strategies to the pre-contemplation stage (ORI-1), 25% (n = 18) to the contemplation stage (ORI-2), and 52% (n = 38) to the preparation stage (ORI-3). Several strategies were identified as relevant to more than one stage. CONCLUSIONS Participating experts were able to reach high-level agreement on the relevance of specific sets of implementation strategies to each of the three ORI stages. The lowest number of strategies was assigned to ORI-1 and the highest number to ORI-3. Given the overlap of strategies across ORI stages, there is a need to better understand the specific utilization of such strategies at different stages. Future studies are needed to empirically evaluate the relevance and applicability of this expert-informed typology based on implementers' experiences in the field.
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Affiliation(s)
- Sigal Vax
- Rehabilitation Sciences Program, College of Health & Rehabilitation, Sargent College, Boston University, 940 Commonwealth Ave W, Boston, MA, 02215, USA.
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation, Sargent College, Boston University, Boston, MA, USA.
| | - Marianne Farkas
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation, Sargent College, Boston University, Boston, MA, USA
| | - Zlatka Russinova
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation, Sargent College, Boston University, Boston, MA, USA
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, College of Health & Rehabilitation, Sargent College, Boston University, Boston, MA, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Health Law Policy & Management, Boston University School of Public Health, Boston, MA, USA
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Helseth SA, Peer SO, Are F, Korell AM, Saunders BE, Schoenwald SK, Chapman JE, Hanson RF. Sustainment of Trauma-Focused and Evidence-Based Practices Following Learning Collaborative Implementation. Adm Policy Ment Health 2020; 47:569-80. [PMID: 32090298 DOI: 10.1007/s10488-020-01024-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Given the need to develop and validate effective implementation models that lead to sustainable improvements, we prospectively examined changes in attitudes, behaviors, and perceived organizational support during and after statewide Community-Based Learning Collaboratives (CBLCs) promoting trauma-focused evidence-based practices (EBPs). Participants (N = 857; i.e., 492 clinicians, 218 brokers, and 139 senior leaders) from 10 CBLCs completed surveys pre- and post-CBLC; a subsample (n = 146) completed a follow-up survey approximately two years post-CBLC. Results indicated (a) medium, sustained increases in clinician-reported use of trauma-focused EBPs, (b) medium to large, sustained increases in perceived organizational support for trauma-focused EBPs, and (c) trivial to small, sustained increases in perceived organizational support for EBPs broadly. In contrast, clinician-reported overall attitudes towards EBPs decreased to a trivial degree pre- to post-CBLC, but then increased to a small, statistically significant degree from post-CBLC to follow-up. Notably, the degree of perceived improvements in organizational support for general and trauma-focused EBPs varied by professional role. Findings suggest the CBLC implementation strategies may both increase and sustain provider practices and organizational support towards EBPs, particularly those EBPs a CBLC explicitly targets.
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Lawson GM, Moore TM, Okamura KH, Becker-Haimes EM, Beidas RS. Knowledge of Evidence-Based Services Questionnaire: Development and Validation of a Short Form. Adm Policy Ment Health 2020; 47:581-96. [PMID: 32076887 DOI: 10.1007/s10488-020-01020-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The Knowledge of Evidence-Based Services Questionnaire (KEBSQ) is an objective measure of therapist knowledge of practices derived from the evidence base for the treatment of youth psychopathology. However, the length of this measure (i.e., 40 items) and respondent demands associated with each item makes it burdensome for researchers and clinicians. This study developed and validated a Short Form of the KEBSQ using Item Response Theory measurement models. The Short Form consists of 17 items and generates two separate scores: Correct Endorsements and Correct Rejections. The Short Form was found to correlate highly with and perform similarly to the Full Form, providing preliminary validity evidence.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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MacKenzie NE, Tutelman PR, Chambers CT, Parker JA, MacDonald NE, McMurtry CM, Pluye P, Granikov V, Taddio A, Barwick M, Birnie KA, Boerner KE. Factors associated with parents' experiences using a knowledge translation tool for vaccination pain management: a qualitative study. BMC Health Serv Res 2021; 21:355. [PMID: 33863339 PMCID: PMC8052692 DOI: 10.1186/s12913-021-06326-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/28/2021] [Indexed: 12/18/2022] Open
Abstract
Background Vaccination is a common painful procedure for children. Parents’ concern regarding vaccination pain is a significant driver of vaccine hesitancy. Despite the wealth of evidence-based practices available for managing vaccination pain, parents lack knowledge of, and access to, these strategies. Knowledge translation (KT) tools can communicate evidence-based information to parents, however little is known about what factors influence parents’ use of these tools. A two-page, electronic KT tool on psychological, physical, and pharmacological vaccination pain management strategies for children, was shared with parents as part of a larger mixed methods study, using explanatory sequential design, exploring factors related to uptake of this KT tool. The aim of this qualitative study was to understand what influenced parents’ perceptions of the relevance of the KT tool, as well as their decision as to whether to use the tool. Methods A qualitative descriptive design was used. A total of 20 parents of children aged 0–17 years (n = 19 mothers) reviewed the KT tool ahead of their child’s upcoming vaccination and participated in a semi-structured interview at follow-up. Interviews were recorded, transcribed verbatim, and analyzed with reflexive thematic analysis using an inductive approach. Results The analysis generated three interrelated themes which described factors related to parents’ use of the KT tool: (1) Relevance to parents’ needs and circumstances surrounding their child’s vaccination; (2) Alignment with parents’ personal values around, and experiences with, vaccination pain management (e.g., the importance of managing pain); and (3) Support from the clinical environment for implementing evidence-based strategies (e.g., physical clinical environment and quality of interactions with the health care provider). Conclusions Several factors were identified as central to parents’ use of the KT tool, including the information itself and the clinical environment. When the tool was perceived as relevant, aligned with parents’ values, and was supported by health care providers, parents were more inclined to use the KT tool to manage their children’s vaccination pain. Future research could explore other factors related to promoting engagement and uptake when creating parent-directed KT tools for a range of health-related contexts. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06326-2.
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Affiliation(s)
- Nicole E MacKenzie
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Perri R Tutelman
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Christine T Chambers
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada. .,IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada. .,Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia, Canada.
| | - Jennifer A Parker
- IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada
| | - Noni E MacDonald
- Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia, Canada
| | - C Meghan McMurtry
- University of Guelph, Department of Psychology, Guelph, Ontario, Canada and Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Pierre Pluye
- McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Vera Granikov
- McGill University, Department of Family Medicine, Montreal, Quebec, Canada
| | - Anna Taddio
- University of Toronto, Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada.,Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Melanie Barwick
- Child Health Evaluative Sciences Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada.,8University of Toronto, Department of Psychiatry, Faculty of Medicine and University of Toronto, Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Kathryn A Birnie
- Dalhousie University, Department of Psychology and Neuroscience, Halifax, Nova Scotia, Canada.,University of Calgary, Department of Anesthesiology, Perioperative and Pain Medicine, Calgary, Alberta, Canada
| | - Katelynn E Boerner
- BC Children's Hospital & University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
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Maranda MJ, Magura S, Gugerty R, Lee MJ, Landsverk JA, Rolls-Reutz J, Green B. State behavioral health agency website references to evidence-based program registers. Eval Program Plann 2021; 85:101906. [PMID: 33567376 PMCID: PMC7932747 DOI: 10.1016/j.evalprogplan.2021.101906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/19/2020] [Accepted: 01/18/2021] [Indexed: 05/27/2023]
Abstract
PURPOSE Evidence-based program registers (EBPRs) are important tools for facilitating the use of evidence-based practices or programs (EBPs) by state statutory agencies responsible for behavioral healthcare, broadly defined as substance misuse, mental health, HIV/AIDS prevention, child welfare, and offender rehabilitation. There are currently no data on the purposes for which such state agencies reference EBPRs on their official websites. METHOD A webscraping method was used to identify and classify relevant "hits", defined as a state behavioral health webpage with single or multiple references to a study EBPR. A total of 778 hits (unique combinations of webpage and register) were coded. Up to three codes were applied to each hit for the "reasons for the EBPR reference" (EBPR use) dimension, one code was applied to each hit for the "purpose of the EBPR reference" and "intended audience of the webpage containing the hit" dimensions, and up to two codes were applied to each hit for the "funding mentions" dimension. RESULTS Three EBPRs out of 28 accounted for 73.6% of the hits. The most frequent reason for referencing EBPRs were as a resource for selecting EBPs or validating existing programs and practices. The references tended to appear in reports from the state, in training materials, or guidelines. The references tended to address broad groups of behavioral healthcare professionals. EBPRs were frequently referenced in the context of federal block grants or other federal funding. CONCLUSIONS Increasing state agencies' awareness and use of the entire range of existing EBPRs may improve implementation of EBPs nationally.
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Affiliation(s)
- Michael J Maranda
- Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo MI 49008, USA
| | - Stephen Magura
- Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo MI 49008, USA.
| | | | - Miranda J Lee
- Western Michigan University, 1903 W. Michigan Avenue, Kalamazoo MI 49008, USA
| | - John A Landsverk
- Oregon Social Learning Center, 10 Shelton McMurphey Blvd, Eugene, OR 97401, USA
| | - Jennifer Rolls-Reutz
- Chadwick Center for Children and Families, 3020 Children's Way-Mailcode 5131, San Diego CA 92123, USA
| | - Brandn Green
- Development Services Group Inc., 7315 Wisconsin Avenue, 800 East Bethesda, MD 20814-3210, USA
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Bowser DM, Henry BF, McCollister KE. Cost analysis in implementation studies of evidence-based practices for mental health and substance use disorders: a systematic review. Implement Sci 2021; 16:26. [PMID: 33706780 PMCID: PMC7953634 DOI: 10.1186/s13012-021-01094-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/22/2021] [Indexed: 12/02/2022] Open
Abstract
Background This study is a systematic literature review of cost analyses conducted within implementation studies on behavioral health services. Cost analysis of implementing evidence-based practices (EBP) has become important within implementation science and is critical for bridging the research to practice gap to improve access to quality healthcare services. Costing studies in this area are rare but necessary since cost can be a barrier to implementation and sustainment of EBP. Methods We followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology and applied the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist. Key search terms included: (1) economics, (2) implementation, (3) EBP, and (4) behavioral health. Terms were searched within article title and abstracts in: EconLit, SocINDEX, Medline, and PsychINFO. A total of 464 abstracts were screened independently by two authors and reduced to 37 articles using inclusion and exclusion criteria. After a full-text review, 18 articles were included. Results Findings were used to classify costs into direct implementation, direct services, and indirect implementation. While all studies included phases of implementation as part of their design, only five studies examined resources across multiple phases of an implementation framework. Most studies reported direct service costs associated with adopting a new practice, usually summarized as total EBP cost, cost per client, cost per clinician, and/or cost per agency. For studies with detailed analysis, there were eleven direct cost categories represented. For five studies that reported costs per child served, direct implementation costs varied from $886 to $9470 per child, while indirect implementation costs ranged from $897 to $3805 per child. Conclusions This is the first systematic literature review to examine costs of implementing EBP in behavioral healthcare settings. Since 2000, 18 studies were identified that included a cost analysis. Given a wide variation in the study designs and economic methods, comparison across studies was challenging, which is a major limitation in the field, as it becomes difficult to replicate studies or to estimate future costs to inform policy decisions related to budgeting. We recommend future economic implementation studies to consider standard economic costing methods capturing costs across implementation framework phases to support comparisons and replicability.
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Affiliation(s)
- Diana M Bowser
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA
| | - Brandy F Henry
- Heller School for Social Policy and Management, Brandeis University, 415 South St, Waltham, MA, 02453, USA. .,School of Social Work, Columbia University, 1255 Amsterdam Ave, New York, NY, 10027, USA.
| | - Kathryn E McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, 1120 NW 14th St., CRB 1019, Miami, FL, 33136, USA
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Zamboni K, Singh S, Tyagi M, Hill Z, Hanson C, Schellenberg J. Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study. Implement Sci 2021; 16:4. [PMID: 33413504 PMCID: PMC7788546 DOI: 10.1186/s13012-020-01058-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 10/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change. Methods We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results. Results Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD − 1.3 percentage points, 95% CI − 2.6–0.1], on neonatal mortality at age 7 days [DiD − 1.6, 95% CI − 9–6.2] or 28 days [DiD − 3.0, 95% CI − 12.9—6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms. Conclusion Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-020-01058-z.
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Affiliation(s)
- Karen Zamboni
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Samiksha Singh
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Mukta Tyagi
- Public Health Foundation, India, Kavuri Hills, Madhapur, Hyderabad, India
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | - Claudia Hanson
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.,Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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Keles S, Taraldsen K, Røyrhus Olseth A. Identification of Multisystemic Therapy (MST) Subgroups with Distinct Trajectories on Ultimate Outcomes in Norway. Res Child Adolesc Psychopathol 2021; 49:429-442. [PMID: 33404953 PMCID: PMC7943514 DOI: 10.1007/s10802-020-00735-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2020] [Indexed: 11/28/2022]
Abstract
The effect of Multisystemic Therapy (MST) treatment for serious behavior problems among adolescents has been established through multiple studies. However, variations across individuals should also be examined to better understand how MST works or for whom. In this study, we explored and identified subgroups of youth with serious problems in Norway regarding their responses to MST in terms of ultimate MST outcomes (e.g., living at home, abstaining from violence) over time. We further explored whether immigrant background, in addition to gender and age of the youth at intake, predicted belonging to the subgroups. Data came from 1674 adolescents (MeanAge = 14.55, SDAge = 1.58; 60.7% boys) and their families referred to MST treatment by the municipal Child Welfare Services for serious and persistent antisocial behavior. The outcomes were assessed at five time-points from intake to 18-months after discharge for youth and families who completed the treatment. Latent class growth analyses revealed heterogeneous trajectories regarding youths’ responses to MST. Results indicated a high and sustained degree of improvement across the ultimate outcomes for the vast majority of the youths. However, there was still variation in the groups, with improvement and deterioration trajectories for various outcomes. Most of these trajectories were predicted by gender and youth’s age at intake, but not by immigrant status. Not every youth-at-risk responds similarly to MST, and more studies examining heterogeneity will help us to identify factors to be targeted to better tailor the MST interventions for youth with serious problems.
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Affiliation(s)
- Serap Keles
- Norwegian Center for Child Behavioral Development, P.O. Box 7053, 0306, Oslo, Majorstuen, Norway. .,Knowledge Center for Education, University of Stavanger, Stavanger, Norway.
| | - Knut Taraldsen
- Norwegian Center for Child Behavioral Development, P.O. Box 7053, 0306, Oslo, Majorstuen, Norway
| | - Asgeir Røyrhus Olseth
- Norwegian Center for Child Behavioral Development, P.O. Box 7053, 0306, Oslo, Majorstuen, Norway
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Olson JR, Lucy M, Kellogg MA, Schmitz K, Berntson T, Stuber J, Bruns EJ. What Happens When Training Goes Virtual? Adapting Training and Technical Assistance for the School Mental Health Workforce in Response to COVID-19. School Ment Health 2021; 13:160-173. [PMID: 33425042 PMCID: PMC7781169 DOI: 10.1007/s12310-020-09401-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 12/19/2022]
Abstract
The Northwest Mental Health Technology Transfer Center (MHTTC) provides workforce training and technical assistance (TA) to support evidence-based school mental health practices. Historically, this support targeted school professionals through in-person and online trainings, workshops, and coaching. However, in response to COVID-19 restrictions, all support moved to online formats, and the Center introduced trainings for families and caregivers. The purpose of this article is to present preliminary process and outcome data that compare the reach and impact of support before and following COVID-19-related restrictions. Results suggest that transition to online support resulted in a wider reach and a more diverse audience, with no decrease in trainee satisfaction and perceived impact. Furthermore, families and caregivers reported positive gains in knowledge and behaviors following participation in a virtual youth suicide prevention training. Together, these findings suggest that online training and TA can provide tangible benefits to professionals and family members who support student mental health.
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Affiliation(s)
- Jonathan R. Olson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Megan Lucy
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Marianne A. Kellogg
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Kelcey Schmitz
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Taylor Berntson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
| | - Jennifer Stuber
- Forefront Suicide Prevention, University of Washington School of Social Work, Seattle, WA USA
| | - Eric J. Bruns
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA USA
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Margolies PJ, Covell NH, Patel SR. Applying Implementation Drivers to Scale-up Evidence-Based Practices in New York State. ACTA ACUST UNITED AC 2021; 1:53-64. [PMID: 34622210 PMCID: PMC7775828 DOI: 10.1007/s43477-020-00002-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022]
Abstract
Mental health authorities in several states, often working with academic partners, have played important roles in disseminating evidence-based practices (EBPs) for adults diagnosed with serious mental illness. This work has been facilitated by intermediary organizations that work directly with providers to implement EBPs. This report uses two case studies to describe how the Center for Practice Innovations (CPI), an intermediary organization, has used the Active Implementation Research Network’s nine implementation drivers to successfully implement EBPs across the large state of New York. One case study focuses on supported employment and the second on integrated treatment for co-occurring mental health and substance use conditions. We provide these case studies to illustrate how intermediary organizations can use implementation science to organize and select effective support strategies to disseminate and implement a range of EBPs within a state system.
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Affiliation(s)
- Paul J Margolies
- Columbia University Vagelos College of Physicians and Surgeons, Center for Practice Innovations, New York State Psychiatric Institute, New York, NY USA
| | - Nancy H Covell
- Columbia University Vagelos College of Physicians and Surgeons, Center for Practice Innovations, New York State Psychiatric Institute, New York, NY USA
| | - Sapana R Patel
- Columbia University Vagelos College of Physicians and Surgeons, Center for Practice Innovations, New York State Psychiatric Institute, New York, NY USA
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Chandler RK, Villani J, Clarke T, McCance-Katz EF, Volkow ND. Addressing opioid overdose deaths: The vision for the HEALing communities study. Drug Alcohol Depend 2020; 217:108329. [PMID: 33075691 PMCID: PMC7528974 DOI: 10.1016/j.drugalcdep.2020.108329] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/10/2020] [Accepted: 09/11/2020] [Indexed: 12/20/2022]
Abstract
The United States is facing two devastating public health crises- the opioid epidemic and the COVID-19 pandemic. Within this context, one of the most ambitious implementation studies in addiction research is moving forward. Launched in May 2019, the HEALing Communities Study (HCS) was developed by the National Institutes of Health (NIH) and the Substance Abuse and Mental Health Services Administration (SAMHSA) as part of the Helping to End Addiction Long-termSM Initiative (National Institutes of Health, 2020). The goal for this research was to reduce opioid overdose deaths by 40 % in three years by enhancing and integrating the delivery of multiple evidence-based practices (EBPs) with proven effectiveness in reducing opioid overdose deaths across health care, justice, and community settings. This paper describes the initial vision, goals, and objectives of this initiative; the impact of COVID-19; and the potential for knowledge to be generated from HCS at the intersection of an unrelenting epidemic of opioid misuse and overdoses and the ravishing COVID-19 pandemic.
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Affiliation(s)
- Redonna K. Chandler
- National Institute on Drug Abuse, National Institutes of Health, 3WFN, 301 North Stonestreet Ave, Bethesda, MD, 20892, United States,Corresponding author at: National Institute on Drug Abuse, National Institutes of Health, 3WFN RM 09D02, 301 North Stonestreet Ave, Bethesda, MD, 20892, United States
| | - Jennifer Villani
- National Institute on Drug Abuse, National Institutes of Health, 3WFN, 301 North Stonestreet Ave, Bethesda, MD, 20892, United States
| | - Thomas Clarke
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD, 20852, United States
| | - Elinore F. McCance-Katz
- Substance Abuse and Mental Health Services Administration, 5600 Fishers Lane, Rockville, MD, 20852, United States
| | - Nora D. Volkow
- National Institute on Drug Abuse, National Institutes of Health, 3WFN, 301 North Stonestreet Ave, Bethesda, MD, 20892, United States
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Abstract
Determining the most effective strategies to educate children and youth with autism spectrum disorder (ASD) can be daunting. Dr Stephen Shore, an autism advocate who is on the spectrum, said, "If you've met one person with autism, you've met one person with autism." Individuals diagnosed with ASD present with unique strengths and difficulties and experience characteristics of their disability in different ways. General and special educators must be prepared with a variety of evidence-based practices and instructional strategies to engage and educate students diagnosed with autism. This article discusses current methods, techniques, evidence, and controversies for educating individuals diagnosed with autism.
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Lefebvre RC, Chandler RK, Helme DW, Kerner R, Mann S, Stein MD, Reynolds J, Slater MD, Anakaraonye AR, Beard D, Burrus O, Frkovich J, Hedrick H, Lewis N, Rodgers E. Health communication campaigns to drive demand for evidence-based practices and reduce stigma in the HEALing communities study. Drug Alcohol Depend 2020; 217:108338. [PMID: 33152673 PMCID: PMC7534788 DOI: 10.1016/j.drugalcdep.2020.108338] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 09/25/2020] [Accepted: 09/25/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The HEALing Communities Study (HCS) is testing whether the Communities that Heal (CTH) intervention can decrease opioid overdose deaths through the implementation of evidence-based practices (EBPs) in highly impacted communities. One of the CTH intervention components is a series of communications campaigns to promote the implementation of EBPs, increase demand for naloxone and medications for opioid use disorder (MOUD), and decrease stigma toward people with opioid use disorder and the use of EBPs, especially MOUD. This paper describes the approach to developing and executing these campaigns. METHODS The HCS communication campaigns are developed and implemented through a collaboration between communication experts, research site staff, and community coalitions using a three-stage process. The Prepare phase identifies priority groups to receive campaign messages, develops content for those messages, and identifies a "call to action" that asks people to engage in a specific behavior. In the Plan phase, campaign resources are produced, and community coalitions develop plans to distribute campaign materials. During the Implement stage, these distribution plans guide delivery of content to priority groups. Fidelity measures assess how community coalitions follow their distribution plan as well as barriers and facilitators to implementation. An evaluation of the communication campaigns is planned. CONCLUSIONS If successful, the Prepare-Plan-Implement process, and the campaign materials, could be adapted and used by other communities to address the opioid crisis. The campaign evaluation will extend the evidence base for how communication campaigns can be developed and implemented through a community-engaged process to effectively address public health crises.
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Affiliation(s)
- R. Craig Lefebvre
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA,Corresponding author
| | - Redonna K. Chandler
- National Institute on Drug Abuse, 3WFN RM 09D02, 301 North Stonestreet Ave, Bethesda, MD, 20892, USA
| | - Donald W. Helme
- Department of Communication, University of Kentucky, 271 Blazer Dining, Lexington, KY, 40506-0042, USA
| | - Robin Kerner
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, Suite 810, New York, NY, 10027, USA.
| | - Sarah Mann
- Center for Clinical and Translational Science, College of Medicine, The Ohio State University, 376 W 10th Avenue, Columbus, OH, 43210, USA.
| | - Michael D. Stein
- School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA
| | - Jennifer Reynolds
- Health Communications and Marketing, Oak Ridge Institute for Science and Education (ORAU), 100 ORAU Way, Oak Ridge, TN, 37830, USA.
| | - Michael D. Slater
- School of Communication, The Ohio State University, 3016 Derby Hall, Columbus, OH, 43210, USA
| | - Amarachi R. Anakaraonye
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA
| | - Dacia Beard
- School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, USA.
| | - Olivia Burrus
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Jenna Frkovich
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Haley Hedrick
- Center for Communication Science, RTI International, 3040 East Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC, 27709-2194, USA.
| | - Nicky Lewis
- Department of Communication, University of Kentucky, 363 S. Martin Luther King Blvd., Lexington, KY 40526, USA.
| | - Emma Rodgers
- School of Social Work, Columbia University, 1255 Amsterdam Avenue, Suite 810, New York, NY, 10027, USA.
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Kouo JL, Kouo TS. A Scoping Review of Targeted Interventions and Training to Facilitate Medical Encounters for School-Aged Patients with an Autism Spectrum Disorder. J Autism Dev Disord 2020; 51:2829-2851. [PMID: 33068218 DOI: 10.1007/s10803-020-04716-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Individuals with an autism spectrum disorder (ASD) have a greater number of healthcare provider interactions than individuals without ASD. The obstacles to patient-centered care for this population, which include inflexibility of hospital environments, limited resources, and inadequate training, has been documented. However, there is little knowledge on efforts to address such concerns. A scoping review was conducted and the systematic search of the literature resulted in 23 relevant studies. The predominant themes include the use of data collection instruments, application of evidence-based practices and resources, and training of providers. The results of this review have implications for practitioners and future research to adapt and improve upon the provision of medical care for individuals with ASD across the lifespan.
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Affiliation(s)
- Jennifer L Kouo
- Department of Special Education, College of Education, Towson University, 8000 York Road, Psychology Building, Towson, MD, 21252, USA.
| | - Theodore S Kouo
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins Hosptial, Baltimore, MD, 21287, USA
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