Implementation research and practice最新文献

{"title":"Rapid adaptation during the COVID crisis: Challenges experienced in delivering service to those with Opioid Use Disorders.","authors":"Holly A Hills, Rebecca Lengnick-Hall, Kimberly A Johnson, Wouter Vermeer, C Hendricks Brown, Mark McGovern","doi":"10.1177/26334895221096295","DOIUrl":"10.1177/26334895221096295","url":null,"abstract":"<p><strong>Background: </strong>Adaptation is an accepted part of implementing evidence-based practices. COVID-19 presented a unique opportunity to examine adaptation in evolving contexts. Delivering service to people with opioid use disorder during the pandemic required significant adaptation due to revised regulations and limited service access. This report evaluated changes to addiction medication services caused by the pandemic, challenges encountered in rapidly adapting service delivery, and initial impressions of which changes might be sustainable over time.</p><p><strong>Methods: </strong>Qualitatively-evaluated structured interviews (N  =  20) were conducted in late 2020 with key informants in Pinellas County (FL) to assess the pandemic's impact. Interviewees represented a cross-section of the professional groups including direct SUD/HIV service providers, and sheriff's office, Department of Health, and regional clinical program administrative staff. The interview questions examined significant changes necessitated by the pandemic, challenges encountered in adapting to this evolving context, and considerations for sustained change.</p><p><strong>Results: </strong>The most significant changes to service delivery identified were rapid adaptation to a telehealth format, and modifying service consistent with SAMHSA guidance, to allow for 'take-home' doses of methadone. Limitations imposed by access to technology, and the retraining of staff and patients to give and receive service differently were the most common themes identified as challenging adaptation efforts. Respondents saw shifts towards telehealth as most likely to being sustained.</p><p><strong>Conclusions: </strong>COVID-19 provided an unprecedented opportunity to examine adaptation in a fast-paced, dynamic, and evolving context. Adaptations identified will only be sustained through multisystem collaboration and validation. Results suggest that additional components could be added to implementation frameworks to assess rapid adaptation during unplanned events, such as access to additional resources or local decision-making that impacts service delivery. Findings will also be integrated with quantitative data to help inform local policy decisions.</p><p><strong>Plain language summary: </strong>Adaptation is an accepted part of implementing evidencebased practices. COVID-19 presented a unique opportunity to examine rapid adaptation necessitated within evolving contexts. Delivering services to people with opioid use disorder required significant adaptation due to changing regulations and limited access to lifesaving services. This study examined changes in service delivery due to the pandemic, challenges encountered in rapid adaptation, and initial impressions of which changes might be sustainable over time. Qualitatively-evaluated structured interviews were conducted with a cross-section of professional groups (direct substance use disorder (SUD) and human immunodeficiency virus (HIV","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221096295"},"PeriodicalIF":0.0,"publicationDate":"2022-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/00/af/10.1177_26334895221096295.PMC9924287.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9387747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers to recruiting primary care practices for implementation research during COVID-19: A qualitative study of practice coaches from the Stop Unhealthy (STUN) Alcohol Use Now trial.","authors":"Casey P Balio, Sean R Riley, Debbie Grammer, Chris Weathington, Colleen Barclay, Daniel E Jonas","doi":"10.1177/26334895221094297","DOIUrl":"10.1177/26334895221094297","url":null,"abstract":"<p><p><b>Background:</b> The COVID-19 pandemic has brought widespread change to health care practice and research. With heightened stress in the general population, increased unhealthy alcohol use, and added pressures on primary care practices, comes the need to better understand how we can continue practice-based research and address public health priorities amid the ongoing pandemic. The current study considers barriers and facilitators to conducting such research, especially during the COVID-19 pandemic, within the context of recruiting practices for the STop UNhealthy (STUN) Alcohol Use Now trial. The STUN trial uses practice facilitation to implement screening and interventions for unhealthy alcohol use in primary care practices across the state of North Carolina. <b>Methods:</b> Semistructured interviews were conducted with a purposive sample of 15 practice coaches to discuss their recruitment experiences before and after recruitment was paused due to the pandemic. An inductive thematic analysis was used to identify themes and subthemes. <b>Results:</b> Pandemic-related barriers, including challenges in staffing, finances, and new COVID-19-related workflows, were most prominent. Competing priorities, such as quality improvement measures, North Carolina's implementation of Medicaid managed care, and organizational structures hampered recruitment efforts. Coaches also described barriers specific to the project and to the topic of alcohol. Several facilitators were identified, including the rising importance of behavioral health due to the pandemic, as well as existing relationships between practice coaches and practices. <b>Conclusions:</b> Difficulty managing competing priorities and obstacles within existing practice infrastructure inhibit the ability to participate in practice-based research and implementation of evidence-based practices. Lessons learned from this trial may inform strategies to recruit practices into research and to gain buy-in from practices in adopting evidence-based practices more generally.</p><p><strong>Plain language summary: </strong><i>What is known:</i> Unhealthy alcohol use is a significant public health issue, which has been exacerbated during the COVID-19 pandemic. Screening and brief intervention for unhealthy alcohol use is an evidence-based practice shown to help reduce drinking-related behaviors, yet it remains rare in practice. <i>What this study adds:</i> Using a qualitative approach, we identify barriers and facilitators to recruiting primary care practices into a funded trial that uses practice facilitation to address unhealthy alcohol use. We identify general insights as well as those specific to the COVID-19 pandemic. Barriers are primarily related to competing priorities, incentives, and lack of infrastructure. Facilitators are related to framing of the project and the anticipated level and type of resources needed to address unhealthy alcohol use especially as the pandemic wanes. <i>Implications:</i","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221094297"},"PeriodicalIF":0.0,"publicationDate":"2022-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/0e/16/10.1177_26334895221094297.PMC9924268.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9381858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tailored isn't always better: Impact of standardized versus tailored training on intention to use measurement-based care.","authors":"Hannah Kassab, Kelli Scott, Meredith R Boyd, Ajeng Puspitasari, David Endicott, Cara C Lewis","doi":"10.1177/26334895221087477","DOIUrl":"10.1177/26334895221087477","url":null,"abstract":"<p><p><b>Background:</b> Brief educational trainings are often used for disseminating and implementing evidence-based practices (EBPs). However, many accessible trainings are ubiquitously standardized. Tailored training focused on modifying individual or contextual factors that may hinder EBP implementation is recommended, but there is a dearth of research comparing standardized versus tailored training. This study sought to: (a) assess the impact of MBC training on clinician intention to use measurement-based care (MBC); (b) compare the effect of standardized versus tailored training on clinician intention to MBC; and (c) identify clinician-level predictors of intention. <b>Methods:</b> Clinicians (<i>n</i> = 152) treating adult clients with depression at 12 community mental health clinics were randomized to either tailored or standardized MBC training. Clinic-specific barriers and facilitators were used to inform training content and structure tailoring. Linear mixed modeling tested the association between training condition and post-training intention to use MBC, as well as hypothesized individual-level predictors of post-training intention (e.g., age, gender). <b>Results:</b> Clinician intention pre- and post-training increased across training conditions (<i>B</i> = 0.38, <i>t</i> = -5.95, <i>df</i> = 36.99, <i>p </i>< .01, Cohen's <i>d</i> = 0.58). Results of linear mixed modeling procedures suggest no significant difference in clinician intention between conditions post-training (<i>B</i> = -0.03, <i>SE</i> = .19, <i>p </i>> .05, Cohen's <i>d</i> = .15). Only baseline intention emerged as a predictor of post-training intention (<i>B</i> = 0.39, <i>SE</i> = .05, <i>p </i>< .05). <b>Conclusions:</b> These findings suggest the additional effort to tailor training may not yield incremental benefit over standardized training, at least in the short term. As a result, implementation efforts may be able to reserve time and finances for other elements of implementation beyond the training component.</p><p><strong>Plain language summary: </strong>Educational training is a common approach for enhancing knowledge about research-supported mental health treatments. However, these trainings are often not tailored to meet the needs of the trainees, and there is insufficient evidence about whether tailoring might improve the impact of training compared to a one-size-fits-all, standard version. This study compared the impact of a tailored versus standard training on mental health clinician's intentions to use measurement-based (MBC) care for monitoring treatment progress for clients with depression. Study results indicated that intention to use MBC improved for clinicians receiving both the tailored and standard training after training completion. There were no differences in intention to use MBC care when the two types of training were compared. These study findings suggest that tailoring, which may require substantial time and effort, may not be a necessar","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221087477"},"PeriodicalIF":0.0,"publicationDate":"2022-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/07/fa/10.1177_26334895221087477.PMC9924248.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9387745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development and Preliminary Evaluation of an Implementation Facilitation Training Program.","authors":"JoAnn E Kirchner, Katherine M Dollar, Jeffrey L Smith, Jeffery A Pitcock, Nyssa D Curtis, Krissi K Morris, Terri L Fletcher, David R Topor","doi":"10.1177/26334895221087475","DOIUrl":"10.1177/26334895221087475","url":null,"abstract":"<p><p><b>Background:</b> Implementation scientists are identifying evidence-based implementation strategies that support the uptake of evidence-based practices and other clinical innovations. However, there is limited information regarding the development of training methods to educate implementation practitioners on the use of implementation strategies and help them sustain these competencies. <b>Methods:</b> To address this need, we developed, implemented, and evaluated a training program for one strategy, implementation facilitation (IF), that was designed to maximize applicability in diverse clinical settings. Trainees included implementation practitioners, clinical managers, and researchers. From May 2017 to July 2019, we sent trainees an electronic survey via email and asked them to complete the survey at three-time points: approximately 2 weeks before and 2 weeks and 6 months after each training. Participants ranked their knowledge of and confidence in applying IF skills using a 4-point Likert scale. We compared scores at baseline to post-training and at 6 months, as well as post-training to 6 months post-training (nonparametric Wilcoxon signed-rank tests). <b>Results:</b> Of the 102 participants (76 in-person, 26 virtual), there was an increase in perceived knowledge and confidence in applying IF skills across all learning objectives from pre- to post-training (95% response rate) and pre- to 6-month (35% response rate) follow-up. There was no significant difference in results between virtual and in-person trainees. When comparing post-training to 6 months (30% response rate), perceptions of knowledge increase remained unchanged, although participants reported reduced perceived confidence in applying IF skills for half of the learning objectives at 6 months. <b>Conclusions:</b> Findings indicated that we have developed a promising IF training program. Lack of differences in results between virtual and in-person participants indicated the training can be provided to a remote site without loss of knowledge/skills transfer but ongoing support may be needed to help sustain perceived confidence in applying these skills.</p><p><strong>Plain language summary: </strong>While implementation scientists are documenting an increasing number of implementation strategies that support the uptake of evidence-based practices and other clinical innovations, little is known about how to transfer this knowledge to those who conduct implementation efforts in the frontline clinical practice settings. We developed, implemented, and conducted a preliminary evaluation of a training program for one strategy, implementation facilitation (IF). The training program targets facilitation practitioners, clinical managers, and researchers. This paper describes the development of the training program, the program components, and the results from an evaluation of IF knowledge and skills reported by a subset of people who participated in the training. Findings from the evalu","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221087475"},"PeriodicalIF":0.0,"publicationDate":"2022-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/d5/a3/10.1177_26334895221087475.PMC9924286.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9388978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing provider perceptions of training: Initial evaluation of the Acceptability, Feasibility, and Appropriateness Scale.","authors":"Evelyn Cho, Aaron R Lyon, Siena K Tugendrajch, Brigid R Marriott, Kristin M Hawley","doi":"10.1177/26334895221086269","DOIUrl":"10.1177/26334895221086269","url":null,"abstract":"<p><p>There is a well-documented gap between research and practice in the treatment of mental health problems. One promising approach to bridging this gap is training community-based providers in evidence-based practices (EBPs). However, a paucity of valid, reliable measures to assess a range of outcomes of such trainings impedes our ability to evaluate and improve training toward this end. The current study examined the factor structure of the Acceptability, Feasibility, Appropriateness Scale (AFAS), a provider-report measure that assesses three perceptual implementation outcomes of trainings that may be leading indicators of training success (i.e., acceptability, feasibility, and appropriateness). Providers who attended half-day EBP trainings for common mental health problems reported on the acceptability, feasibility, and appropriateness of these trainings using the AFAS (<i>N</i>  =  298). Confirmatory factor analysis indicates good fit to the hypothesized three-factor structure (RMSEA  =  .058, CFI  =  .990, TLI  =  .987). Acceptability, feasibility, and appropriateness were three distinct but related constructs. Cronbach's alpha ranged from .86 to .91, indicating acceptable internal consistency for the three subscales. Acceptability and feasibility, but not appropriateness, scores varied between workshops, though variability across workshops was generally limited. This initial evaluation of the AFAS is in line with recent efforts to enhance psychometric reporting practices for implementation outcome measures and provides future directions for further development and refinement of the AFAS.</p><p><strong>Plain language summary: </strong>Clinician training in evidence-based practices is often used to increase implementation of evidence-based practices in mental health service settings. However, one barrier to evaluating the success of clinician trainings is the lack of measures that reliably and accurately assess clinician training outcomes. This study was the initial evaluation of the Acceptability, Feasibility, Appropriateness Scale (AFAS), a measure that assesses the immediate outcomes of clinician trainings. This study found some evidence supporting the AFAS reliability and its three subscales. With additional item refinement and psychometric testing, the AFAS could become a useful measure of a training's immediate impact on providers.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221086269"},"PeriodicalIF":0.0,"publicationDate":"2022-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8d/a2/10.1177_26334895221086269.PMC9924265.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time-motion analysis of external facilitation for implementing the Collaborative Chronic Care Model in general mental health clinics: Use of an interval-based data collection approach.","authors":"Bo Kim, Christopher J Miller, Mona J Ritchie, Jeffrey L Smith, JoAnn E Kirchner, Kelly Stolzmann, Samantha L Connolly, Karen L Drummond, Mark S Bauer","doi":"10.1177/26334895221086275","DOIUrl":"10.1177/26334895221086275","url":null,"abstract":"<p><p><b>Background:</b> Facilitation is an effective strategy to implement evidence-based practices, often involving external facilitators (EFs) bringing content expertise to implementation sites. Estimating time spent on multifaceted EF activities is complex. Furthermore, collecting continuous time-motion data for facilitation tasks is challenging. However, organizations need this information to allocate implementation resources to sites. Thus, our objectives were to conduct a time-motion analysis of external facilitation, and compare continuous versus noncontinuous approaches to collecting time-motion data. <b>Methods:</b> We analyzed EF time-motion data from six VA mental health clinics implementing the evidence-based Collaborative Chronic Care Model (CCM). We documented EF activities during pre-implementation (4-6 weeks) and implementation (12 months) phases. We collected continuous data during the pre-implementation phase, followed by data collection over a 2-week period (henceforth, \"a two-week interval\") at each of three time points (beginning/middle/end) during the implementation phase. As a validity check, we assessed how closely interval data represented continuous data collected throughout implementation for two of the sites. <b>Results:</b> EFs spent 21.8 ± 4.5 h/site during pre-implementation off-site, then 27.5 ± 4.6 h/site site-visiting to initiate implementation. Based on the 2-week interval data, EFs spent 2.5 ± 0.8, 1.4 ± 0.6, and 1.2 ± 0.6 h/week toward the implementation's beginning, middle, and end, respectively. Prevalent activities were preparation/planning, process monitoring, program adaptation, problem identification, and problem-solving. Across all activities, 73.6% of EF time involved email, phone, or video communication. For the two continuous data sites, computed weekly time averages toward the implementation's beginning, middle, and end differed from the interval data's averages by 1.0, 0.1, and 0.2 h, respectively. Activities inconsistently captured in the interval data included irregular assessment, stakeholder engagement, and network development. <b>Conclusions:</b> Time-motion analysis of CCM implementation showed initial higher-intensity EF involvement that tapered. The 2-week interval data collection approach, if accounting for its potential underestimation of irregular activities, may be promising/efficient for implementation studies collecting time-motion data.</p>","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221086275"},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/dd/e3/10.1177_26334895221086275.PMC9924237.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinician adoption of Parent-Child Interaction Therapy: A systematic review of implementation interventions.","authors":"Melanie J Woodfield, Sally Merry, Sarah E Hetrick","doi":"10.1177/26334895221082330","DOIUrl":"10.1177/26334895221082330","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Parent-Child Interaction Therapy (PCIT) is a parent training intervention for childhood conduct problems, distinctive in its use of live clinician coaching of the parent-child dyad via a one-way mirror and discrete earpiece. However, despite a compelling evidence base, uptake of evidence-based parent training programmes such as PCIT by clinicians in routine care settings remains poor. This systematic review aimed to identify and synthesise implementation interventions that have sought to increase clinician adoption of PCIT in usual care settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We searched MEDLINE (Ovid), Embase (Ovid), PsycInfo (Ovid), CINAHL (EBSCO), Science Citation Index and Social Sciences Citation Index, and Web of Science Core Collection from inception to October 2020. Articles were included if they tested (by way of randomised controlled trials, controlled clinical trials, interrupted time series and controlled before and after trials) implementation interventions across any and all of the patient, clinician, clinic, system or policy domains. Two independent reviewers screened and selected studies, assessed risk of bias and extracted data - summarising implementation intervention components according to items from the Template for Intervention Description and Replication (TIDieR) checklist ( Hoffmann et al., 2014).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Of the 769 articles identified once duplicates were removed, 13 papers relating to three studies met the inclusion criteria - all were quantitative or mixed-methods examinations of the effectiveness of different PCIT clinician training or training-related consultation methods. A narrative description of interventions was provided, as quantitative synthesis was not possible.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Research attention has to date been focussed on the establishment of an evidence-base for PCIT's effectiveness, with relatively little attention to the dissemination, implementation and sustainment of this treatment. Those studies that do exist have focused on training methods and training-related expert consultation. Research attention could usefully turn to both adoption and sustainment of this effective treatment in usual care settings.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;In this review, we aimed to summarise what is already known about how to implement PCIT in community settings after clinicians have received training in the approach. While research relating to the implementation of other parent training programmes is interesting and informative, implementation efforts are most effective when tailored to a specific programme in a specific context. As such, it was important to review published studies relating to PCIT specifically. We identified three relevant studies, one of which is yet to publish its main implementation findings. The three studies have focused on how best to train clinicians in PCIT, including how best to provide post-training","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221082330"},"PeriodicalIF":0.0,"publicationDate":"2022-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/67/c8/10.1177_26334895221082330.PMC9924277.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9393575","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovations in implementing a health systems response to violence against women in 3 tertiary hospitals of Maharashtra India: Improving provider capacity and facility readiness.","authors":"Srinivas Gadappa, Priya Prabhu, Sonali Deshpande, Nandkishor Gaikwad, Sanjida Arora, Sangeeta Rege, Sarah R Meyer, Claudia Garcia-Moreno, Avni Amin","doi":"10.1177/26334895211067988","DOIUrl":"10.1177/26334895211067988","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Violence against women [VAW] is an urgent public health issue and health care providers [HCPs] are in a unique position to respond to such violence within a multi-sectoral health system response. In 2013, the World Health Organization (WHO) published clinical and policy guidelines (henceforth - the Guidelines) for responding to intimate partner violence and sexual violence against women. In this practical implementation report, we describe the adaptation of the Guidelines to train HCPs to respond to violence against women in tertiary health facilities in Maharashtra, India.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We describe the strategies employed to adapt and implement the Guidelines, including participatory methods to identify and address HCPs' motivations and the barriers they face in providing care for women subjected to violence. The adaptation is built on querying health-systems level enablers and obstacles, as well as individual HCPs' perspectives on content and delivery of training and service delivery.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The training component of the intervention was delivered in a manner that included creating ownership among health managers who became champions for other health care providers; joint training across cadres to have clear roles, responsibilities and division of labour; and generating critical reflections about how gender power dynamics influence women's experience of violence and their health. The health systems strengthening activities included establishment of standard operating procedures [SOPs] for management of VAW and strengthening referrals to other services.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In this intervention, standard training delivery was enhanced through participatory, joint and reflexive methods to generate critical reflection about gender, power and its influence on health outcomes. Training was combined with health system readiness activities to create an enabling environment. The lessons learned from this case study can be utilized to scale-up response in other levels of health facilities and states in India, as well as other LMIC contexts.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Plain language summary: &lt;/strong&gt;Violence against women affects millions of women globally. Health care providers may be able to support women in various ways, and finding ways to train and support health care providers in low and middle-income countries to provide high-quality care to women affected by violence is an urgent need. The WHO developed Clinical and Policy Guidelines in 2013, which provide guidance on how to improve health systems response to violence against women. We developed and implemented a series of interventions, including training of health care providers and innovations in service delivery, to implement the WHO guidelines for responding to violence against women in 3 tertiary hospitals of Maharashtra, India. The nascent published literature on health systems approaches to addressing violence a","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895211067988"},"PeriodicalIF":0.0,"publicationDate":"2022-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/72/76/10.1177_26334895211067988.PMC9924251.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10195214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessing practical implementation of modular psychotherapy for youth in community-based settings using benchmarking.","authors":"Daniel M Cheron,&nbsp;Emily M Becker-Haimes,&nbsp;H Gemma Stern,&nbsp;Aberdine R Dwight,&nbsp;Cameo F Stanick,&nbsp;Angela W Chiu,&nbsp;Eric L Daleiden,&nbsp;Bruce F Chorpita","doi":"10.1177/26334895221115216","DOIUrl":"https://doi.org/10.1177/26334895221115216","url":null,"abstract":"<p><strong>Background: </strong>Achieving high quality outcomes in a community context requires the strategic coordination of many activities in a service system, involving families, clinicians, supervisors, and administrators. In modern implementation trials, the therapy itself is guided by a treatment manual; however, structured supports for other parts of the service system may remain less well-articulated (e.g., supervision, administrative policies for planning and review, information/feedback flow, resource availability). This implementation trial investigated how a psychosocial intervention performed when those non-therapy supports were not structured by a research team, but were instead provided as part of a scalable industrial implementation, testing whether outcomes achieved would meet benchmarks from published research trials.</p><p><strong>Method: </strong>In this single-arm observational benchmarking study, a total of 59 community clinicians were trained in the Modular Approach to Therapy for Children (MATCH) treatment program. These clinicians delivered MATCH treatment to 166 youth ages 6 to 17 naturally presenting for psychotherapy services. Clinicians received substantially fewer supports from the treatment developers or research team than in the original MATCH trials and instead relied on explicit process management tools to facilitate implementation. Prior RCTs of MATCH were used to benchmark the results of the current initiative. Client improvement was assessed using the Top Problems Assessment and Brief Problem Monitor.</p><p><strong>Results: </strong>Analysis of client symptom change indicated that youth experienced improvement equal to or better than the experimental condition in published research trials. Similarly, caregiver-reported outcomes were generally comparable to those in published trials.</p><p><strong>Conclusions: </strong>Although results must be interpreted cautiously, they support the feasibility of using process management tools to facilitate the successful implementation of MATCH outside the context of a formal research or funded implementation trial. Further, these results illustrate the value of benchmarking as a method to evaluation industrial implementation efforts.<b>Plain Language Summary:</b> Randomized effectiveness trials are inclusive of clinicians and cases that are routinely encountered in community-based settings, while continuing to rely on the research team for both clinical and administrative guidance. As a result, the field still struggles to understand what might be needed to support sustainable implementation and how interventions will perform when brought to scale in community settings without those clinical trial supports. Alternative approaches are needed to delineate and provide the clinical and operational support needed for implementation and to efficiently evaluate how evidence-based treatments perform. Benchmarking findings in the community against findings of more rigorous clinical","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895221115216"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/1e/d2/10.1177_26334895221115216.PMC9924269.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9387744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework.","authors":"Isabel Zbukvic,&nbsp;Demee Rheinberger,&nbsp;Hannah Rosebrock,&nbsp;Jaclyn Lim,&nbsp;Lauren McGillivray,&nbsp;Katherine Mok,&nbsp;Eve Stamate,&nbsp;Katie McGill,&nbsp;Fiona Shand,&nbsp;Joanna C Moullin","doi":"10.1177/26334895211065786","DOIUrl":"https://doi.org/10.1177/26334895211065786","url":null,"abstract":"<p><p><b>Background:</b> Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. <b>Methods:</b> Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a 'tailored blueprint' methodology. <b>Results:</b> A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. <b>Conclusions:</b> This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. <b>Plain language abstract:</b> This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health servi","PeriodicalId":73354,"journal":{"name":"Implementation research and practice","volume":"3 ","pages":"26334895211065786"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c1/26/10.1177_26334895211065786.PMC9924249.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9387753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}