Using implementation science to enhance specialized mental health supervision: pre-implementation assessment and rapid qualitative methods.

Background: Although implementation science methods have been widely used across all sectors of healthcare, they are less commonly used to promote health interventions within criminal legal system settings. This gap in the research is problematic given the need for effective treatments to address comparatively worse health and mental health outcomes among people involved in the criminal legal system. Additionally, there have been relatively few published studies documenting methods at the pre-implementation phase. This article reports on a pre-implementation assessment conducted as part of a grant-funded initiative with a statewide community supervision agency to address key limitations in the state's Specialized Mental Health Supervision program by piloting two implementation strategies: clinical case consultation and enhancing mental health officers' relationships with behavioral health service providers.

Methods: The purpose of this study was to provide agency leaders with practical and timely information to make decisions regarding their plan for rolling out the initiative. Within a 30-day timeframe, the research team conducted 22 brief, semi-structured interviews with members of the implementation team and community supervision officers and their supervisors. The team then used rapid qualitative analysis methods to identify potential challenges and facilitators of the implementation strategies and make recommendations to improve implementation.

Results: Although participants indicated that considering mental health symptoms was a top factor in caseload assignment and step-down, they believed other stabilizing factors (e.g., housing, employment) and risk for re-offense should also be considered. Participants described the need for more training on mental health topics and the local service system. Lastly, the agency learned about factors that could impact the consultation process (e.g., trusting the consultant, maintaining a growth mindset) and relationships with behavioral health service providers (e.g., having a common language between community supervision and behavioral health), officer workload, and leadership engagement.

Conclusions: Pre-implementation assessments, including those conducted using rapid analysis methods, should be routine practices when launching an intervention or an implementation strategy under real-world conditions. These assessments provide agencies and their research partners with actionable and tailored information that can enhance the pace and effectiveness of their implementation efforts.