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Implementation Science at UW

Keywords: Context

Two Medicaid health plans’ models and motivations for improving colorectal cancer screening rates

Authors:

Jennifer K Coury, Jennifer L Schneider, Beverly B Green, Laura-Mae Baldwin, Amanda F Petrik, Jennifer S Rivelli, Malaika R Schwartz, & Gloria D Coronado

University of Washington affiliated authors are displayed in bold.

Subscription Required for Full Text Access

Published: February 2020

Read the full text in the subscription access journal Translational Behavioral Medicine

Effectiveness of Task-Shifted Trauma-Focused Cognitive Behavioral Therapy for Children Who Experienced Parental Death and Posttraumatic Stress in Kenya and Tanzania

Authors:

Shannon Dorsey, Leah Lucid, Prerna Martin, Kevin M. King, Karen O’Donnell, Laura K. Murray, Augustine I. Wasonga, Dafrosa K. Itemba, Judith A. Cohen, Rachel Manongi, Kathryn Whetten

University of Washington affiliated authors are displayed in bold.

Published: January 2020

Read the full text in the subscription access journal JAMA Psychiatry

Understanding the Organizational Implementation Context of Schools: A Qualitative Study of School District Administrators, Principals, and Teachers

Authors:

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

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Read the full text in the subscription access journal School Mental Health

✪ Expanding Hybrid Studies for Implementation Research: Intervention, Implementation Strategy, and Context

Authors:

Christopher G. Kemp, Bradley H. Wagenaar, and Emily E. Haroz

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: November 2019

Read the full text in the open access journal Frontiers in Public Health

Abstract:

Successful implementation reflects the interplay between intervention, implementation strategy, and context. Hybrid effectiveness-implementation studies allow investigators to assess the effects of both intervention and implementation strategy, though the role of context as a third independent variable (IV) is incompletely specified. Our objective is to expand the hybrid typology to include mixtures of all three types of IVs: intervention, implementation strategy, and context.

We propose to use I to represent the IV of intervention, IS to represent implementation strategy, and C to represent context. Primary IVs are written first and in upper case. Secondary IVs are written after a forward slash and in lower case; co-primary IVs are written after a dash and in upper case. The expanded framework specifies nine two-variable hybrid types: I/is, I-IS, IS/i, IS/c, IS-C, C/is, C/i, I-C, and I/c. We describe four in detail: I/is, IS/c, IS-C, and C/is. We also specify seven three-variable hybrid types. We argue that many studies already meet our definitions of two- or three-variable hybrids.

Our proposal builds from the typology proposed by Curran et al. (1), but offers a more complete specification of hybrid study types. We need studies that measure the implementation-related effects of variations in contextual determinants, both to advance the science and to optimize intervention delivery in the real world. Prototypical implementation studies that evaluate the effectiveness of an implementation strategy, in isolation from its context, risk perpetuating the gap between evidence and practice, as they will not generate context-specific knowledge around implementation, scale-up, and de-implementation.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**

✪ The impact of inter-organizational alignment (IOA) on implementation outcomes: evaluating unique and shared organizational influences in education sector mental health

Authors:

Aaron R. Lyon, Kelly Whitaker, Jill Locke, Clayton R. Cook, Kevin M. King, Mylien Duong, Chayna Davis, Mark D. Weist, Mark G. Ehrhart, & Gregory A. Aarons

University of Washington affiliated authors are displayed in bold.

✪ Open Access

Published: February 2018

Read the full text in the open access journal Implementation Science

Abstract:

Background

Integrated healthcare delivered by work groups in nontraditional service settings is increasingly common, yet contemporary implementation frameworks typically assume a single organization—or organizational unit—within which system-level processes influence service quality and implementation success. Recent implementation frameworks predict that inter-organizational alignment (i.e., similarity in values, characteristics, activities related to implementation across organizations) may facilitate the implementation of evidence-based practices (EBP), but few studies have evaluated this premise. This study’s aims examine the impact of overlapping organizational contexts by evaluating the implementation contexts of externally employed mental health clinicians working in schools—the most common integrated service delivery setting for children and adolescents. Aim 1 is to estimate the effects of unique intra-organizational implementation contexts and combined inter-organizational alignment on implementation outcomes. Aim 2 is to examine the underlying mechanisms through which inter-organizational alignment facilitates or hinders EBP implementation.

Methods/design

This study will conduct sequential, exploratory mixed-methods research to evaluate the intra- and inter-organizational implementation contexts of schools and the external community-based organizations that most often employ school-based mental health clinicians, as they relate to mental health EBP implementation. Aim 1 will involve quantitative surveys with school-based, externally-employed mental health clinicians, their supervisors, and proximal school-employed staff (total n = 120 participants) to estimate the effects of each organization’s general and implementation-specific organizational factors (e.g., climate, leadership) on implementation outcomes (fidelity, acceptability, appropriateness) and assess the moderating role of the degree of clinician embeddedness in the school setting. Aim 2 will explore the mechanisms through which inter-organizational alignment influences implementation outcomes by presenting the results of Aim 1 surveys to school-based clinicians (n = 30) and conducting semi-structured qualitative interviews. Qualitative data will be evaluated using an integrative inductive and deductive approach.

Discussion

The study aims are expected to identify intra- and inter-organizational constructs that are most instrumental to EBP implementation success in school-based integrated care settings and illuminate mechanisms that may account for the influence of inter-organizational alignment. In addition to improving school-based mental health, these findings will spur future implementation science that considers the relationships across organizations and optimize the capacity of implementation science to guide practice in increasingly complex systems of care.

**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**