Andrea K. Graham, Emily G. Lattie, Byron J. Powell, Aaron R. Lyon, Justin D. Smith, Stephen M. Schueller, Nicole A. Stadnick, C. Hendricks Brown, & David C. Mohr
University of Washington affiliated authors are displayed in bold.
Published: November 2020
Madeline Larson, Clayton R. Cook, Stephanie K. Brewer, Michael D. Pullmann, Corinne Hamlin, James L. Merle, Mylien Duong, Larissa Gaias, Margaret Sullivan, Nicole Morrell, Tara Kulkarni, Mollie Weeks, & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: November 2020
Elizabeth H. Connors, Susan Douglas, Amanda Jensen-Doss, Sara J. Landes, Cara C. Lewis, Bryce D. McLeod, Cameo Stanick, & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: July 2020
Molly Adrian, Jessica Coifman, Michael D. Pullmann, Jennifer B. Blossom, Casey Chandler, Glen Coppersmith, Paul Thompson, & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: July 2020
Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential.
This study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting.
A total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES.
Overarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care.
Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Cara C. Lewis, Meredith R. Boyd, Callie Walsh-Bailey, Aaron R. Lyon, Rinad Beidas, Brian Mittman, Gregory A. Aarons, Bryan J. Weiner, & David A. Chambers
University of Washington affiliated authors are displayed in bold.
Published: April 2020
Understanding the mechanisms of implementation strategies (i.e., the processes by which strategies produce desired effects) is important for research to understand why a strategy did or did not achieve its intended effect, and it is important for practice to ensure strategies are designed and selected to directly target determinants or barriers. This study is a systematic review to characterize how mechanisms are conceptualized and measured, how they are studied and evaluated, and how much evidence exists for specific mechanisms.
We systematically searched PubMed and CINAHL Plus for implementation studies published between January 1990 and August 2018 that included the terms “mechanism,” “mediator,” or “moderator.” Two authors independently reviewed title and abstracts and then full texts for fit with our inclusion criteria of empirical studies of implementation in health care contexts. Authors extracted data regarding general study information, methods, results, and study design and mechanisms-specific information. Authors used the Mixed Methods Appraisal Tool to assess study quality.
Search strategies produced 2277 articles, of which 183 were included for full text review. From these we included for data extraction 39 articles plus an additional seven articles were hand-entered from only other review of implementation mechanisms (total = 46 included articles). Most included studies employed quantitative methods (73.9%), while 10.9% were qualitative and 15.2% were mixed methods. Nine unique versions of models testing mechanisms emerged. Fifty-three percent of the studies met half or fewer of the quality indicators. The majority of studies (84.8%) only met three or fewer of the seven criteria stipulated for establishing mechanisms.
Researchers have undertaken a multitude of approaches to pursue mechanistic implementation research, but our review revealed substantive conceptual, methodological, and measurement issues that must be addressed in order to advance this critical research agenda. To move the field forward, there is need for greater precision to achieve conceptual clarity, attempts to generate testable hypotheses about how and why variables are related, and use of concrete behavioral indicators of proximal outcomes in the case of quantitative research and more directed inquiry in the case of qualitative research.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Alex R. Dopp, Kathryn E. Parisi, Sean A. Munson, & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: February 2020
Innovative approaches are needed to maximize fit between the characteristics of evidence-based practices (EBPs), implementation strategies that support EBP use, and contexts in which EBPs are implemented. Standard approaches to implementation offer few ways to address such issues of fit. We characterized the potential for collaboration with experts from a relevant complementary approach, user-centered design (UCD), to increase successful implementation.
Using purposive and snowball sampling, we recruited 56 experts in implementation (n = 34) or UCD (n = 22). Participants had 5+ years of professional experience (M = 10.31), worked across many settings (e.g., healthcare, education, human services), and were mostly female (59%) and white (73%). Each participant completed a web-based concept mapping structured conceptualization task. They sorted strategies from established compilations for implementation (36 strategies) and UCD (30 strategies) into distinct clusters, then rated the importance and feasibility of each strategy.
We used multidimensional scaling techniques to examine patterns in the sorting of strategies. Based on conceptual clarity and fit with established implementation frameworks, we selected a final set of 10 clusters (i.e., groups of strategies), with five implementation-only clusters, two UCD-only clusters, and three trans-discipline clusters. The highest-priority activities (i.e., above-average importance and feasibility) were the trans-discipline clusters plus facilitate change and monitor change. Implementation and UCD experts sorted strategies into similar clusters, but each gave higher importance and feasibility ratings to strategies/clusters from their own discipline.
In this concept mapping study, experts in implementation and UCD had perspectives that both converged (e.g., trans-discipline clusters, which were all rated as high-priority) and diverged (e.g., in importance/feasibility ratings). The results provide a shared understanding of the alignment between implementation science and UCD, which can increase the impact and sustainability of EBP implementation efforts. Implications for improved collaboration among implementation and UCD experts are discussed.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Kevin M. King, Michael D. Pullmann, Aaron R. Lyon, & Cara C. Lewis
University of Washington affiliated authors are displayed in bold.
Published: December 2019
Eric J. Bruns, Elizabeth M. Parker, Spencer Hensley, Michael D. Pullmann, Philip H. Benjamin, Aaron R. Lyon & Kimberly E. Hoagwood
University of Washington affiliated authors are displayed in bold.
Published: November 2019
Despite consistent recognition of their influence, empirical study of how outer setting factors (e.g., policies, financing, stakeholder relationships) influence public systems’ investment in and adoption of evidence-based treatment (EBT) is limited. This study examined associations among unmodifiable (e.g., demographic, economic, political, structural factors) and modifiable (e.g., allocation of resources, social processes, policies, and regulations) outer setting factors and adoption of behavioral health EBT by US states.
Multilevel models examined relationships between state characteristics, an array of funding and policy variables, and state adoption of behavioral health EBTs for adults and children across years 2002–2012, using data from the National Association for State Mental Health Program Directors Research Institute and other sources.
Several unmodifiable state factors, including per capita income, controlling political party, and Medicaid expansion, predicted level of state fiscal investments in EBT. By contrast, modifiable factors, such as interagency collaboration and investment in research centers, were more predictive of state policies supportive of EBT. Interestingly, level of adult EBT adoption was associated with state fiscal supports for EBT, while child EBT adoption was predicted more by supportive policies. State per capita debt and direct state operation of services (versus contracting for services) predicted both child and adult EBT adoption.
State-level EBT adoption and associated implementation support is associated with an interpretable array of policy, financing, and oversight factors. Such information expands our knowledge base of the role of the outer setting in implementation and may provide insight into how best to focus efforts to promote EBT for behavioral health disorders.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Jill Locke, Kristine Lee, Clayton R. Cook, Lindsay Frederick, Cheryl Vázquez-Colón, Mark G. Ehrhart, Gregory A. Aarons, Chayna Davis, & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: November 2019
Aaron R. Lyon, Clayton R. Cook, Jill Locke, Chayna Davis, Byron J.Powell, Thomas J.Waltz
University of Washington affiliated authors are displayed in bold.
Published: October 2019