Improving measurement-based care implementation in youth mental health through organizational leadership and climate: a mechanistic analysis within a randomized trial

Implementation Science, Journal Year: 2024, Volume and Issue: 19(1)

Published: March 28, 2024

Abstract Background Theory and correlational research indicate organizational leadership climate are important for successful implementation of evidence-based practices (EBPs) in healthcare settings; however, experimental evidence is lacking. We addressed this gap using data from the WISDOM (Working to Implement Sustain Digital Outcome Measures) hybrid type III effectiveness-implementation trial. Primary outcomes indicated Leadership Organizational Change Implementation (LOCI) strategy improved fidelity measurement-based care (MBC) youth mental health services. In study, we tested LOCI’s hypothesized mechanisms change, namely: (1) LOCI will improve transformational leadership, which turn (2) mediate effect on climate, (3) MBC fidelity. Methods Twenty-one outpatient clinics serving were randomly assigned plus training technical assistance or only. Clinicians rated their leaders’ clinic at five time points (baseline, 4-, 8-, 12-, 18-months post-baseline). was assessed electronic metadata outpatients who initiated treatment 12 months following training. Hypotheses longitudinal mixed-effects models multilevel mediation analyses. Results significantly baseline follow-up 18-month post-baseline (all p s < .01), producing large effects (range ds = 0.76 1.34). small 4 ( d 0.31, .019) nonsignificant thereafter > .05). improvement mediated by (proportion [ m ] 0.82, .004). Transformational did not 0.136). Improvement during same period 0.71, .045). Conclusions services improving itself increased leadership. Fidelity EBPs settings can be developing leaders strong climates. Trial registration ClinicalTrials.gov identifier: NCT04096274. Registered September 18, 2019.

Language: Английский

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Randomized Trial of an Organizational Implementation Strategy to Improve Measurement-Based Care Fidelity and Youth Outcomes in Community Mental Health

Journal of the American Academy of Child & Adolescent Psychiatry, Journal Year: 2023, Volume and Issue: 63(10), P. 991 - 1004

Published: Dec. 7, 2023

Objective Measurement-based care (MBC), which collects session-by-session symptom data from patients and provides clinicians with feedback on treatment response, is a highly generalizable evidence-based practice significant potential to improve the outcomes of mental health in youth when implemented fidelity; however, it rarely used community settings. This study tested whether an implementation strategy targeting organizational leadership climate could MBC fidelity clinical for outpatient clinics. Method In cluster randomized trial, 21 clinics were assigned Leadership Organizational Change Implementation plus training technical assistance (k = 11, n 117) or only 10, 117). Primary (assessed via electronic metadata) improvement caregiver-reported change Shortform Assessment Children Total Problem Score) collected consecutively enrolled youths (ages 4-18 years) who initiated 12 months following training. Outcomes each assessed 6 baseline. Results A total 234 included intent-to-treat analyses. At baseline, there no differences by condition clinic, clinician, characteristics. Youths using experienced significantly higher compared control (23.1% vs 3.4%, p .014), exhibited greater reductions symptoms baseline (d 0.31, 95% CI: 0.04-0.58, .023). Conclusion strategies focused can practices services. Clinical trial registration information Working Implement Sustain Digital Outcome Measures (WISDOM); https://clinicaltrials.gov/; NCT04096274.

Language: Английский

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Provider Use of, Attitudes Towards, and Self-efficacy with Key Measurement-based Care Practices in Youth Mental Health Treatment: A Multi-site Examination

Administration and Policy in Mental Health and Mental Health Services Research, Journal Year: 2024, Volume and Issue: 52(1), P. 146 - 158

Published: Feb. 9, 2024

Language: Английский

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A multilevel framework for recruitment and retention in implementation trials: An illustrative example

Clinical Trials, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 10, 2025

Background: Implementation and hybrid effectiveness–implementation trials aspire to speed the translation of science into practice by generating crucial evidence for improving uptake effective health interventions. By design, they pose unique recruitment retention challenges due their aims, units analysis, sampling plans, which typically require many clinical sites (i.e. often 20 or more) participation individuals who are related across multiple levels (e.g. linked organizational leaders, clinicians, patients). In this article, we present a new multilevel, theory-informed, relationship-centered framework conceptualizing in implementation integrates builds on prior work strategies patient-focused trials. We describe framework’s application Working Implement Sustain Digital Outcome Measures type III trial, occurred part during COVID-19 pandemic. Methods: Recruitment trial from October 2019 February 2022. Development was guided newly developed multilevel framework, targeted capability, opportunity, motivation patient-facing administrative staff, patients engage research. A structured assessment guide applied refine approaches throughout trial. its amid onset pandemic required rapid adjustments address numerous barriers. Results: The enrolled 21 outpatient clinics three US states, incorporating 252 clinicians 686 caregivers youth (95% patient target) two distinct phases. Data completion rates leaders averaged 90% over five waves spanning 18 months, despite COVID Caregiver monthly follow-up assessments ranged 80%–88% 6 months. This article presents guide, used achieve targets at each level. Conclusion: conducted multi-state that maintained high all relevant global presented here, behavioral theory, relationship-focused lens, evidence-based participant levels, can be adapted other researchers implementation, hybrid, pragmatic as well studies.

Language: Английский

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Effects of an Organizational Implementation Strategy on Sustainment of Measurement-Based Care in Community Mental Health

Psychiatric Services, Journal Year: 2025, Volume and Issue: unknown

Published: Jan. 30, 2025

Little is known about how to sustain evidence-based interventions with fidelity in community mental health settings. Phase 1 of the Working Implement and Sustain Digital Outcome Measures (WISDOM) trial showed that an organizational strategy improved implementation measurement-based care (MBC) services for youths 1-12 months after clinician MBC training. The authors report results from phase 2 trial, which strategy's effects on sustainment 13-26 training were examined. Twenty-one outpatient clinics randomly assigned technical assistance plus Leadership Organizational Change Implementation (LOCI) (11 clinics) or only (10 clinics). In 2, primary outcomes completion rate, youth symptom improvement, examined 452 who entered treatment No differences found rate improvement between two conditions; however, among 81 received MBC, was significantly higher at LOCI sites relative control (24%, SE=11.1 vs. 1%, SE=1.0, respectively; p=0.003). During (vs. sites) sustained superior when used; rates clinical not sustained. Sustainment may require strategies improve its fit regulatory reimbursement environments addition develop clinic infrastructure.

Language: Английский

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Clinician Perspectives on Measurement-Based Care to Inform Pre-Implementation Training and Workflow Design on an Adolescent Psychiatric Inpatient Unit

Evidence-Based Practice in Child and Adolescent Mental Health, Journal Year: 2025, Volume and Issue: unknown, P. 1 - 18

Published: April 22, 2025

Language: Английский

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Study protocol for testing the efficacy of the Helping Educational Leaders Mobilize Evidence (HELM) implementation strategy in elementary schools: a hybrid type 3 effectiveness-implementation randomized controlled trial

Implementation Science, Journal Year: 2025, Volume and Issue: 20(1)

Published: April 24, 2025

Language: Английский

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Motives of Therapists for Using Routine Outcome Monitoring (ROM) and How it is Used by Them in Clinical Practice: Two Qualitative Studies

Administration and Policy in Mental Health and Mental Health Services Research, Journal Year: 2024, Volume and Issue: 52(1), P. 159 - 170

Published: April 8, 2024

Abstract Despite its demonstrated value, many mental health institutions struggle to implement progress feedback effectively. There is also insufficient information about how therapists utilize feedback. To gain more insight, two qualitative studies were conducted. The first study compared the attitudes and motives of who used those did not use second examined psychologists incorporated into their practice. In total, 23 interviewed, data analyzed using thematic analysis. found that almost all had a positive attitude Those it indicated reasons such as heavy workload patient-related factors, they lacked sufficient potential benefits revealed four major ways in which utilized feedback, namely: supporting actions discuss discussing with patients, modifications ongoing treatment, peer consultation. However, discussions during consultations for patients benefitting from treatment might be adjusted accordingly often lacking. conclusion, crucial training education provided on Having regular could facilitate integration clinical

Language: Английский

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Testing an Organizational Implementation Process Model Related to Teachers’ Implementation-Related Attitudes and Behaviors: a Multilevel Mediation Analysis

Prevention Science, Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 13, 2024

Language: Английский

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Individual-level associations between implementation leadership, climate, and anticipated outcomes: a time-lagged mediation analysis

Implementation Science Communications, Journal Year: 2023, Volume and Issue: 4(1)

Published: July 11, 2023

Abstract Background Leaders can improve implementation outcomes by developing an organizational climate conducive to the of evidence-based practices (EBP). This study tested lagged associations between individual-level perceptions leadership, climate, and three anticipated outcomes, that is EBP acceptability, appropriateness, feasibility. Methods Screening tools treatment methods for posttraumatic stress disorder were implemented in 43 Norwegian mental health services. A sample 494 child adult care professionals ( M = years, 78% female) completed surveys addressing first-level leaders’ n 47) leadership their clinics’ climate. Single-level structural equation models estimating both direct, indirect, total effects used investigate whether perceived mediated association feasibility screening methods. Results Regarding methods, was associated with therapists’ Implementation also outcomes. tools, not However, acceptability feasibility, but appropriateness. Analyses subscales showed stronger than tools. Conclusions may promote positive directly through With regard effect sizes explained variance, results indicated more strongly one group therapists, all therapists. imply have smaller teams within a larger system system-wide implementations or when clinical interventions being are complex rather simple ones. Trial registration ClinicalTrials NCT03719651, 25 October 2018.

Language: Английский

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