Implementing Evidence Based Practices for Children’s Mental Health: A Case Study in Implementing Modular Treatments in Community Mental Health
- 42 Downloads
Abstract
There is strong enthusiasm for utilizing implementation science in the implementation of evidence-based programs in children’s community mental health, but there remains work to be done to improve the process. Despite the proliferation of implementation frameworks, there is limited literature providing case examples of overcoming implementation barriers. This article examines whether the use of three implementations strategies, a structured training and coaching program, the use of professional development portfolios for coaching, and a progress monitoring data system, help to overcome barriers to implementation by facilitating four implementation drivers at a community mental health agency. Results suggest that implementation is a process of recognizing and adapting to both predictable and unpredictable barriers. Furthermore, the use of these implementation strategies is important in improving implementation outcomes.
Keywords
Implementation Youth mental health Modular treatmentNotes
Funding
This study was funded by grants from the Peter and Elizabeth C. Tower Foundation, The Blue Cross and Blue Shield of Massachusetts Foundation, and The John D. and Katherine T. MacArthur Foundation.
Compliance with Ethical Standards
Conflict of interest
Drs. Chorpita and Daleiden are partners in PracticeWise, LLC, which publishes the MATCH-ADTC program referred to in this study. Drs. Stanick and Chiu were consultants for PracticeWise, LLC at the time of the study.
Ethical Approval
All procedures performed in this study were conducted in accordance with the ethical standards of the first author’s institution and with the 1964 Helsinki declaration and its later amendments.
Informed Consent
Informed consent was obtained from all individual participants included in the study.
References
- Aarons, G., & Sawitzky, A. (2006). Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 33, 289–301.Google Scholar
- Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23.Google Scholar
- Achenbach, T., McConaughy, S., Ivanova, M., & Rescorla, L. (2011). Manual for the ASEBA Brief Problem Monitor (BPM). Burlington: ASEBA.Google Scholar
- Barwick, M. A., Boydell, K. M., Stasiulis, E., Ferguson, H. B., Blase, K., & Fixsen, D. (2005). Knowledge transfer and implementation of evidence-based practices in children’s mental health. Ontario: Children’s Mental Health Ontario.Google Scholar
- Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17(1), 1–30.Google Scholar
- Beidas, R. S., Marcus, S., Aarons, G. A., Hoagwood, K. E., Schoenwald, S., Evans, A. C., … Adams, D. R. (2015). Predictors of community therapists’ use of therapy techniques in a large public mental health system. JAMA Pediatrics, 169(4), 374–382.Google Scholar
- Beidas, R. S., Stewart, R. E., Adams, D. R., Fernandez, T., Lustbader, S., Powell, B. J., … Rubin, R. (2016). A multi-level examination of stakeholder perspectives of implementation of evidence-based practices in a large urban publicly-funded mental health system. Administration and Policy in Mental Health and Mental Health Services Research, 43(6), 893–908.Google Scholar
- Bernstein, A., Chorpita, B. F., Rosenblatt, A., Becker, K. D., Daleiden, E. L., & Ebesutani, C. K. (2015). Fit of evidence-based treatment components to youths served by wraparound process: A relevance mapping analysis. Journal of Clinical Child and Adolescent Psychology, 44(1), 44–57. https://doi.org/10.1080/15374416.2013.828296.Google Scholar
- Bickman, L., Breda, C., deAndrade, A. R. V., & Kelley, S. D. (2010). CFIT evaluation Report: The effects of CFIT on clinician behavior and youth mental health outcomes. Nashville: Center for Evaluation and Program Improvement.Google Scholar
- Bickman, L., Kelley, S. D., Breda, C., de Andrade, A. R., & Riemer, M. (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services, 62(12), 1423–1429. https://doi.org/10.1176/appi.ps.002052011.Google Scholar
- Birken, S., Powell, B., Shea, C., Haines, E., Kirk, M. A., Leeman, J., Rohweder, C., Damschroder, L., & Presseau, J. (2017). Criteria for selecting implementation science theories and frameworks: Results from an international survey. Implementation Science, 12, 24. https://doi.org/10.1186/s13012-017-0656-7.Google Scholar
- Bjork, E. L., & Bjork, R. A. (2011). Making things hard on yourself, but in a good way: Creating desirable difficulties to enhance learning. In M. A. Gernsbacher, R. W. Pew, L. M. Hough & J. R. Pomerantz (Eds.), FABBS foundation, psychology and the real world: Essays illustrating fundamental contributions to society (pp. 56–64). New York: Worth Publishers.Google Scholar
- Bond, G. R., Drake, R. E., McHugo, G. J., Peterson, A. E., Jones, A. M., & Williams, J. (2014). Long-term sustainability of evidence-based practices in community mental health agencies. Administration and Policy in Mental Health and Mental Health Services Research, 41(2), 228–236.Google Scholar
- Chorpita, B. F., Daleiden, E. L., Park, A. L., Ward, A. M., Levy, M. C., Cromley, T.,.. . Krull, J. L. (2017). Child STEPs in California: A cluster randomized effectiveness trial comparing modular treatment with community implemented treatment for youth with anxiety, depression, conduct problems, or traumatic stress. Journal of Consulting Clinical Psychology, 85(1), 13–25. https://doi.org/10.1037/ccp0000133.Google Scholar
- Chorpita, B. F., & Weisz, J. R. (2009). Modular approach to therapy for children with anxiety, depression, trauma, and conduct problems (MATCH-ADTC). Satellite Beach: PracticeWise.Google Scholar
- Chuang, E., Collins-Carmago, C., & McBeath, B. (2017). Organizational supports used by private child and family serving agencies to facilitate evidence use: A mixed methods study protocol. Implementation Science, 12, 49.Google Scholar
- Collins, P. Y., Patel, V., Joestl, S. S., March, D., Insel, T. R., Daar, A. S.,.. . Stein, D. J. (2011). Grand challenges in global mental health. Nature, 475(7354), 27–30. https://doi.org/10.1038/475027a.Google Scholar
- Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.Google Scholar
- Delgadillo, J., de Jong, K., Lucock, M., Lutz, W., Rubel, J., Gilbody, S.,.. . McMillan, D. (2018). Feedback-informed treatment versus usual psychological treatment for depression and anxiety: A multisite, open-label, cluster randomised controlled trial. The Lancet Psychiatry, 5(7), 564–572.Google Scholar
- Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation science. Implementation Science. https://doi.org/10.1186/1748-5908-1-1.Google Scholar
- Edmunds, J. M., Beidas, R. S., & Kendall, P. C. (2013). Dissemination and implementation of evidence-based practices: Training and consultation as implementation strategies. Clinical Psychology: Science and Practice, 20(2), 152–165.Google Scholar
- Ellen, M., Leon, G., Bouchard, G., Lavis, J., Quimet, M., & Grimshaw, J. (2013). What supports do health system organizations have in place to facilitate evidence-informed decision-making? A qualitative study. Implementation Science, 8, 84.Google Scholar
- Fixsen, D. L., & Blase, K. A. (2008). Establishing an infrastructure for implementing substance abuse programs. Albany, NY: Invited presentations and workshop, Office of Alcohol and Substance Abuse Services (OASAS).Google Scholar
- Fixsen, D. L., Naoom, S. F., Blase, K. A., & Friedman, R. M. (2005). Implementation research: A synthesis of the literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, National Implementation Research Network.Google Scholar
- Franks, R. P., & Bory, C. T. (2015). Who supports the successful implementation and sustainability of evidence-based practices? Defining and understanding the roles of intermediary and purveyor organizations. New Directions for Child and Adolescent Development, 2015(149), 41–56.Google Scholar
- Gallon, S., Gabriel, R., & Knudsen, J. (2003). The toughest job you’ll ever love: A Pacific Northwest treatmetn workforce survey. Journal of Substance Abuse Treatment, 24, 183–196.Google Scholar
- Glisson, C., Schoenwald, S. K., Kelleher, K., Landsverk, J., Hoagwood, K. E., & Mayberg, S. … Research Network on Youth Mental Health. (2008). Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 124–133.Google Scholar
- Institute of Medicine. (2001). Crossing the quality chasm: a new health system for the 21st century. Washington: National Academy Press.Google Scholar
- Kataoka, S. H., Podell, J. L., Zima, B. T., Best, K., Sidhu, S., & Jura, M. B. (2014). MAP as a Model for Practice-Based Learning and Improvement in Child Psychiatry Training. Journal of Clinical Child and Adolescent Psychology, 43(2), 312–322. https://doi.org/10.1080/15374416.2013.848773.Google Scholar
- Kaufman, D. M. (2003). Applying educational theory in practice. Bmj, 326(7382), 213–216.Google Scholar
- Lambert, M. J. (2010). Prevention of treatment failure: The use of measuring, monitoring, and feedback in clinical practice. Worcester: American Psychological Association.Google Scholar
- Lyon, A. R., & Lewis, C. C. (2016). Designing health information technologies for uptake: Development and implementation of measurement feedback systems in mental health service delivery. Administration and Policy in Mental Health and Mental Health Services Research, 43(3), 344–349. https://doi.org/10.1007/s10488-015-0704-3.Google Scholar
- Mcgovern, M., McHugo, G. J., Drake, R. E., Bond, G. R., & Merrens, M. R. (2013). Implementing evidence-based practices in behavioral health. Center City: Hazelden.Google Scholar
- McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65(2), 73–84. https://doi.org/10.1037/a0018121.Google Scholar
- McMillen, J. C., & Adams, D. R. (2012). Dissemination and implementation in social service settings. Dissemination and implementation research in health: Translating science to practice. 384–399.Google Scholar
- Metz, A., Bartley, L., Ball, H., Wilson, D., Naoom, S., & Redmond, P. (2015). Active implementation frameworks for successful service delivery: Catawba County Child Wellbeing Project. Research on Social Work Practice, 25(4), 415–422. https://doi.org/10.1177/1049731514543667.Google Scholar
- Moullin, J. C., Sabater-Hernández, D., Fernandez-Llimos, F., & Benrimoj, S. I. (2015). A systematic review of implementation frameworks of innovations in healthcare and resulting generic implementation framework. Health Research Policy and Systems, 13(1), 16. https://doi.org/10.1186/s12961-015-0005-z.Google Scholar
- National Implementation Research Network. (2017). Module 1: An overview of active implementation frameworks. Retrieved from http://implementation.fpg.unc.edu/module-1.
- Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., … Abraham, J. P. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: A systematic analysis for the Global Burden of Disease Study 2013. The Lancet, 384(9945), 766–781.Google Scholar
- Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science, 10(1), 53. https://doi.org/10.1186/s13012-015-0242-0.Google Scholar
- Pinnock, H., Barwick, M., Carpenter, C. R., Eldridge, S., Grandes, G., Griffiths, C. J., … Sheikh, A. (2017). Standards for reporting implementation studies (StaRI) statement. Bmj, 356, i6795.Google Scholar
- Powell, B. J., Proctor, E. K., Glisson, C. A., Kohl, P. L., Raghavan, R., Brownson, R. C., … Palinkas, L. A. (2013). A mixed methods multiple case study of implementation as usual in children’s social service organizations: study protocol. Implementation Science, 8(1), 92.Google Scholar
- Powell, B. J., Waltz, T. J., Chinman, M. J., Damschroder, L. J., Smith, J. L., Matthieu, M. M.,.. . Kirchner, J. E. (2015). A refined compilation of implementation strategies: Results from the expert recommendations for implementing change (ERIC) project. Implementation Science, 10(1), 21. https://doi.org/10.1186/s13012-015-0209-1.Google Scholar
- PracticeWise, L. L. C. (2013). Therapist Portfolio: Promotion review for the modular approach to therapy for children (MATCH). Satellite Beach: PracticeWise.Google Scholar
- Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., … Hensley, M. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health and Mental Health Services Research, 38(2), 65–76.Google Scholar
- Proctor, E. K., Powell, B. J., & McMillen, J. C. (2013). Implementation strategies: Recommendations for specifying and reporting. Implementation Science, 8, 1–11.Google Scholar
- Regan, J., Chorpita, B., & Daleiden, E. (2013). Integrity in mental health systems: An expanded framework for managing uncertainty in clinical care. Clinical Psychology: Science and Practice, 20, 78–98. https://doi.org/10.1111/cpsp.12024.Google Scholar
- Rogers, E. M. (2010). Diffusion of innovations (4th edn.). New York: Simon and Schuster.Google Scholar
- Saraceno, B., van Ommeren, M., Batniji, R., Cohen, A., Gureje, O., Mahoney, J., … Underhill, C. (2007). Barriers to improvement of mental health services in low-income and middle-income countries. The Lancet, 370(9593), 1164–1174.Google Scholar
- Stein, B. D., Kogan, J. N., Hutchison, S. L., Magee, E. A., & Sorbero, M. J. (2010). Use of outcomes information in child mental health treatment: Results from a pilot study. Psychiatric Services, 61(12), 1211–1216. https://doi.org/10.1176/ps.2010.61.12.1211.Google Scholar
- Stetler, C. B., Legro, M. W., Rycroft-Malone, J., Bowman, C., Curran, G., Guihan, M., … Wallace, C. M. (2006). Role of” external facilitation” in implementation of research findings: A qualitative evaluation of facilitation experiences in the Veterans Health Administration. Implementation Science, 1(1), 23.Google Scholar
- Stewart, R. E., Adams, D. R., Mandell, D. S., Hadley, T. R., Evans, A. C., Rubin, R.,.. . Beidas, R. S. (2016). The perfect storm: Collision of the business of mental health and the implementation of evidence-based practices. Psychiatric Services, 67(2), 159–161. https://doi.org/10.1176/appi.ps.201500392.Google Scholar
- Tabak, R., Khoong, E., Chambers, D., & Brownson, R. (2012). Bridging research and practice: Models for disseminatino and implementation research. American Journal of Preventative Medicine, 43(3), 337–350.Google Scholar
- Tweed, J. L., Cheron, D. M., Herren, J. A., Marriner, V. S. & Weisz, J. R. (2012). Mental health problems and treatment needs of child welfare involved youth in a randomized effectiveness trial of modular EBP. Poster presentation at the 59th Annual Convention of the American Academy of Child and Adolescent Psychiatry, San Francisco.Google Scholar
- Weisz, J., Thurber, C., Sweeney, L., Proffitt, V., & LeGagnoux, G. (1997). Brief treatment of mild-to-moderate child depression using primary and secondary control enhancement training. Journal of Consulting and Clinical Psychology, 65, 703–707.Google Scholar
- Weisz, J. R., Chorpita, B. F., Frye, A., Ng, M. Y., Lau, N., Bearman, S. K.,.. . Hoagwood, K. E. (2011). Youth top problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Consulting and Clinical Psychology, 79(3), 369–380. https://doi.org/10.1037/a0023307.Google Scholar
- Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., & Bearman, S. K. (2012). Research Network on Youth Mental. Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69(3), 274–282. https://doi.org/10.1001/archgenpsychiatry.2011.147.Google Scholar
- Weisz, J. R., Ugueto, A. M., Cheron, D. M., & Herren, J. A. (2013). Evidence-based youth psychotherapy in the mental health ecosystem. Journal of Clinical Child and Adolescent Psychology, 42(2), 274–286. https://doi.org/10.1080/15374416.2013.764824.Google Scholar
- Woltman, E., Whitley, R., McHugo, G., Brunette, M., Torrey, W., Coots, L., Lynde, D., & Drake, R. (2008). The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services, 59, 732.Google Scholar