Amy Drahota, Rosemary D. Meza, Tatiana E. Bustos, Aksheya Sridhar, Jonathan I. Martinez, Brigitte Brikho, Aubyn C. Stahmer, Gregory A. Aarons
University of Washington affiliated authors are displayed in bold.
Published: September 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**
Lúcia Vieira, Arlete Miloque Mahumane, Manuel Napua, Falume Chale, João Luís Manuel, Jessica Greenberg Cowan, Kenneth Sherr, Rachel R. Chapman & James T. Pfeiffer
University of Washington affiliated authors are displayed in bold.
Published: March 2020
Early infant diagnosis (EID) of HIV-exposed and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor.
The research was conducted in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of clinic waiting times, and 3) patient and health worker focus groups.
HIV testing and ART initiation coverage for mothers tends to be high, but EID and pediatric ART initiation are hampered by lack of patient tracking, long waiting times, and inadequate counseling to navigate the care cascade. About 76% of HIV-positive infants were LTFU and did not initiate ART.
Effective interventions to reduce LTFU in EID and improve pediatric ART initiation should focus on patient tracking, active follow-up of defaulting patients, reduction in EID turn-around times for PCR results, and initiation of ART by nurses in child-at-risk services.
Retrospectively registered, ISRCTN67747315, July 24, 2019.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Oye Gureje, Lola Kola, Bibilola D. Oladeji, Jibril Abdulmalik, Olatunde Ayinde, Phyllis Zelkowitz & Ian Bennett
University of Washington affiliated authors are displayed in bold.
Published: February 2020
Adolescent pregnancy is a pressing public health issue globally, and particularly in low and middle-income countries. Depression occurring in the perinatal period is common among women and more so among adolescent mothers. Effective treatments for the condition have been demonstrated in adults but the needs of adolescents are often unique, making such treatments unlikely to meet those needs.
A hybrid effectiveness–implementation research study is described in which a cluster randomized trial design is used to explore the effectiveness as well as the utility in routine practice of an intervention package specifically designed for adolescents with perinatal depression. Consenting pregnant adolescents (aged less than 20 years) who are newly registered for antenatal care are enrolled into the trial if their fetal gestational age is less than 36 weeks and they score 12 or more on the Edinburgh Postnatal Depression Scale (EPDS). The intervention package consists of structured sessions of behavior activation, problem-solving treatment, and parenting skills training, and is delivered by primary maternal health care providers, complemented by support provided by a “neighborhood mother” identified by the adolescent.
Mothers in the control arm receive care as usual. The trial is conducted in clinics where the maternal providers are trained to deliver routine depression care with the use of the WHO Mental Health Gap Action Programme, intervention guide. Assessments are undertaken by trained blinded assessors at baseline, at childbirth, and at 3 and 6 months postpartum. The primary outcome, assessed at 6 months, is the level of maternal depression (measured with the EPDS). The secondary outcome is parenting skills (assessed with the Home Observation Measurement of the Environment, Infant–Toddler version), while tertiary outcomes include measures of disability, quality of life, mother–child bonding, as well as infants’ nutritional and growth indices.
This, to the best of our knowledge, will be the first fully-powered trial of an intervention package specifically designed to address the unique needs of adolescents with perinatal depression.
ISRCTN16775958. Registered on 30 April 2019.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Sarah J. Shoemaker-Hunt, Leigh Evans, Holly Swan, Olivia Bacon, Brooke Ike, Laura-Mae Baldwin, & Michael L. Parchman
University of Washington affiliated authors are displayed in bold.
Published: February 2020
The Six Building Blocks for improving opioid management (6BBs) is a program for improving the management of patients in primary care practices who are on long-term opioid therapy for chronic pain. The 6BBs include building leadership and consensus; aligning policies, patient agreements, and workflows; tracking and monitoring patient care; conducting planned, patient-centered visits; tailoring care for complex patients; and measuring success. The Agency for Healthcare Research and Quality funded the development of a 6BBs implementation guide: a step-by-step approach for independently implementing the 6BBs in a practice. This mixed-method study seeks to assess practices’ use of the implementation guide to implement the 6BBs and the effectiveness of 6BBs implementation on opioid management processes of care among practices using the implementation guide.
Data collection is guided by the Consolidated Framework for Implementation Research, Proctor’s taxonomy of implementation outcomes, and the Centers for Disease Control and Prevention’s Guideline for Prescribing Opioids for Chronic Pain. A diverse group of health care organizations with primary care clinics across the USA will participate in the study over 15 months. Qualitative data collection will include semi-structured interviews with stakeholders at each organization at two time points, notes from routine check-in calls, and document review. These data will be used to understand practices’ motivation for participation, history with opioid management efforts, barriers and facilitators to implementation, and implementation progress. Quantitative data collection will consist of a provider and staff survey, an implementation milestones assessment, and quarterly opioid prescribing quality measures. These data will supplement our understanding of implementation progress and will allow us to assess changes over time in providers’ opioid prescribing practices, prescribing self-efficacy, challenges to providing guideline-driven care, and practices’ opioid prescribing quality measures. Qualitative data will be coded and analyzed for emergent themes. Quantitative data will be analyzed using descriptive statistics and clustered multivariate regression.
This study contributes to the knowledge of the implementation and effectiveness of a team-based approach to opioid management in primary care practices. Information gleaned from this study can be used to inform efforts to curtail opioid prescribing and assist primary care practices considering implementing the 6BBs.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Krysttel Stryczek, Colby Lea, Chris Gillespie, George Sayre, Scott Wanner, Seppo T. Rinne, Renda Soylemez Wiener, Laura Feemster, Edmunds Udris, David H. Au, & Christian D. Helfrich
University of Washington affiliated authors are displayed in bold.
Published: January 2020
Jennifer Leeman, Natoshia Askelson, Linda K Ko, Catherine L Rohweder, Jade Avelis, Alicia Best, Daniela Friedman, Karen Glanz, Laura Seegmiller, Lindsay Stradtman, & Robin C Vanderpool
University of Washington affiliated authors are displayed in bold.
Published: February 2019
Jillian Pintye, Kristin M. Beima-Sofie, Pamela A. Makabong'O, Anne Njoroge, Susan Brown Trinidad, Renee A. Heffron, Jared M. Baeten, Connie Celum, Daniel Matemo, John Kinuthia, Maureen C. Kelley, and Grace C. John-Stewart
University of Washington affiliated authors are displayed in bold.
Published: July 2018
Read the full text in the subscription access journal AIDS Patient Care and STDs
Lisa D. DiMartino, Sarah A. Birken, Laura C. Hanson, Justin G. Trogdon, Alecia S. Clary, Morris Weinberger, Katherine Reeder-Hayes, & Bryan J. Weiner
University of Washington affiliated authors are displayed in bold.
Published: March 2018
Jonathan D. Fuchs, Kristefer Stojanovski, Eric Vittinghoff, Vanessa M. McMahan, Sybill G. Hosek, K. Rivet Amico, Aminta Kouyate, Hailey J. Gilmore, Susan P. Buchbinder, Richard T. Lester, Robert M. Grant, and Albert Y. Liu
University of Washington affiliated authors are displayed in bold.
Published: March 2018