Michelle C. Kegler, Shuting Liang, Bryan J. Weiner, Shin Ping Tu, Daniela B. Friedman, Beth A. Glenn, Alison K. Herrmann, Betsy Risendal, Maria E. Fernandez
University of Washington affiliated authors are displayed in bold.
Published: September 2018
Christopher G. Kemp & Jennifer Velloza
University of Washington affiliated authors are displayed in bold.
Published: September 2018
Clayton R. Cook, Chayna Davis, Eric C. Brown, Jill Locke, Mark G. Ehrhart, Gregory A. Aarons, Madeline Larson and Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: August 2018
The Evidence-Based Practice Attitude Scale (EBPAS) is a widely used tool, but it has not been adapted and validated for use in schools, the most common setting where youth access behavioral health services. This study examined the factor structure, psychometric properties, and criterion-related validity of the school-adapted EBPAS in a sample of school-based behavioral health consultants.
A research team comprised of experts in implementation of evidence-based practices in schools along with the original developer adapted the EBPAS for the school setting. The adapted instrument was administered to a representative sample (n = 196) of school-based behavioral health consultants to assess the reliability and structural validity via a series of confirmatory factor analyses.
The original EBPAS factor structure was confirmed, with the final model supporting four first-order factors that load onto a second-order factor capturing general attitudes toward evidence-based practice. Correlations among the subscales indicated both unique and shared variance. Correlations between EBPAS scores and consultant variables demonstrated differential criterion-related validity, with the total score and the Requirements and Openness subscales demonstrating the strongest correlations.
The adapted EBPAS performed well when administered to behavioral health consultants operating in the educator sector, supporting the relevance of assessing attitudes in school settings. Potential directions for future research and applications of the EBPAS in schools and other service sectors are discussed.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Joseph E. Glass, Jennifer F. Bobb, Amy K. Lee, Julie E. Richards, Gwen T. Lapham, Evette Ludman, Carol Achtmeyer, Ryan M. Caldeiro, Rebecca Parrish, Emily C. Williams, Paula Lozano and Katharine A. Bradley
University of Washington affiliated authors are displayed in bold.
Published: August 2018
Read the full text in the open access journal Implementation Science
Experts recommend that alcohol-related care be integrated into primary care (PC) to improve prevention and treatment of unhealthy alcohol use. However, few healthcare systems offer such integrated care. To address this gap, implementation researchers and clinical leaders at Kaiser Permanente Washington (KPWA) partnered to design a high-quality program of evidence-based care for unhealthy alcohol use: the Sustained Patient-centered Alcohol-related Care (SPARC) program. SPARC implements systems of clinical care designed to increase both prevention and treatment of unhealthy alcohol use. This clinical care for unhealthy alcohol use was implemented using three strategies: electronic health record (EHR) decision support, performance monitoring and feedback, and front-line support from external practice coaches with expertise in alcohol-related care (“SPARC implementation intervention” hereafter).
The purpose of this report is to describe the protocol of the SPARC trial, a pragmatic, cluster-randomized, stepped-wedge implementation trial to evaluate whether the SPARC implementation intervention increased alcohol screening and brief alcohol counseling (so-called brief interventions), and diagnosis and treatment of alcohol use disorders (AUDs) in 22 KPWA PC clinics.
The SPARC trial sample includes all adult patients who had a visit to any of the 22 primary care sites in the trial during the study period (January 1, 2015–July 31, 2018). The 22 sites were randomized to implement the SPARC program on different dates (in seven waves, approximately every 4 months). Primary outcomes are the proportion of patients with PC visits who (1) screen positive for unhealthy alcohol use and have documented brief interventions and (2) have a newly recognized AUD and subsequently initiate and engage in alcohol-related care. Main analyses compare the rates of these primary outcomes in the pre- and post-implementation periods, following recommended approaches for analyzing stepped-wedge trials. Qualitative analyses assess barriers and facilitators to implementation and required adaptations of implementation strategies.
The SPARC trial is the first study to our knowledge to use an experimental design to test whether practice coaches with expertise in alcohol-related care, along with EHR clinical decision support and performance monitoring and feedback to sites, increase both preventive care—alcohol screening and brief intervention—as well as diagnosis and treatment of AUDs.
The trial is registered at ClinicalTrials.Gov: NCT02675777. Registered February 5, 2016, https://clinicaltrials.gov/ct2/show/NCT02675777.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Lisa Amaya-Jackson, Dana Hagele, John Sideris, Donna Potter, Ernestine C. Briggs, Leila Keen, Robert A. Murphy, Shannon Dorsey, Vanessa Patchett, George S. Ake and Rebecca Socolar
University of Washington affiliated authors are displayed in bold.
Published: July 2018
A model for statewide dissemination of evidence-based treatment (EBT) for traumatized youth was piloted and taken to scale across North Carolina (NC). This article describes the implementation platform developed, piloted, and evaluated by the NC Child Treatment Program to train agency providers in Trauma-Focused Cognitive Behavioral Therapy using the National Center for Child Traumatic Stress Learning Collaborative (LC) Model on Adoption & Implementation of EBTs. This type of LC incorporates adult learning principles to enhance clinical skills development as part of training and many key implementation science strategies while working with agencies and clinicians to implement and sustain the new practice.
Clinicians (n = 124) from northeastern NC were enrolled in one of two TF-CBT LCs that lasted 12 months each. During the LC clinicians were expected to take at least two clients through TF-CBT treatment with fidelity and outcomes monitoring by trainers who offered consultation by phone and during trainings. Participating clinicians initiated treatment with 281 clients. The relationship of clinician and client characteristics to treatment fidelity and outcomes was examined using hierarchical linear regression.
One hundred eleven clinicians completed general training on trauma assessment batteries and TF-CBT. Sixty-five clinicians met all mastery and fidelity requirements to meet roster criteria. One hundred fifty-six (55%) clients had fidelity-monitored assessment and TF-CBT. Child externalizing, internalizing, and post-traumatic stress symptoms, as well as parent distress levels, decreased significantly with treatment fidelity moderating child PTSD outcomes. Since this pilot, 11 additional cohorts of TF-CBT providers have been trained to these roster criteria.
Scaling up or outcomes-oriented implementation appears best accomplished when training incorporates: 1) practice-based learning, 2) fidelity coaching, 3) clinical assessment and outcomes-oriented treatment, 4) organizational skill-building to address barriers for agencies, and 5) linking clients to trained clinicians via an online provider roster. Demonstrating clinician performance and client outcomes in this pilot and subsequent cohorts led to legislative support for dissemination of a service array of EBTs by the NC Child Treatment Program.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Timothy J. Walker, Betsy Risendal, Michelle C. Kegler, Daniela B. Friedman, Bryan J. Weiner, Rebecca S. Williams, Shin-Ping Tu, and Maria E. Fernandez
University of Washington affiliated authors are displayed in bold.
Published: July 2018
Read the full text in the subscription access journal Health Education & Behavior
Meredith R. Boyd, Byron J. Powell, David Endicott, Cara C. Lewis
University of Washington affiliated authors are displayed in bold.
Published: July 2018
Meredith R. Boyd, Byron J. Powell, David Endicott, & Cara C. Lewis
University of Washington affiliated authors are displayed in bold.
Published: July 2018
Swann Arp Adams, Catherine L. Rohweder, Jennifer Leeman, Daniela B. Friedman, Ziya Gizlice, Robin C. Vanderpool, Natoshia Askelson, Alicia Best, Susan A. Flocke, Karen Glanz, Linda K. Ko, & Michelle Kegler
University of Washington affiliated authors are displayed in bold.
Published: May 2018
Christian D. Helfrich, Marlana J. Kohn, Austin Stapleton, Claire L. Allen, Kristen Elizabeth Hammerback, K. C. Gary Chan, Amanda T. Parrish, Daron E. Ryan, Bryan J. Weiner, Jeffrey R. Harris, & Peggy A. Hannon
University of Washington affiliated authors are displayed in bold.
Published: April 2018
Organizational readiness to change may be a key determinant of implementation success and a mediator of the effectiveness of implementation interventions. If organizational readiness can be reliably and validly assessed at the outset of a change initiative, it could be used to assess the effectiveness of implementation-support activities by measuring changes in readiness factors over time.
We analyzed two waves of readiness-to-change survey data collected as part of a three-arm, randomized controlled trial to implement evidence-based health promotion practices in small worksites in low-wage industries. We measured five readiness factors: context (favorable broader conditions); change valence (valuing health promotion); information assessment (demands and resources to implement health promotion); change commitment (an intention to implement health promotion); and change efficacy (a belief in shared ability to implement health promotion). We expected commitment and efficacy to increase at intervention sites along with their self-reported effort to implement health promotion practices, termed wellness-program effort. We compared means between baseline and 15 months, and between intervention and control sites. We used linear regression to test whether intervention and control sites differed in their change-readiness scores over time.
Only context and change commitment met reliability thresholds. Change commitment declined significantly for both control (−0.39) and interventions sites (−0.29) from baseline to 15 months, while context did not change for either. Only wellness program effort at 15 months, but not at baseline, differed significantly between control and intervention sites (1.20 controls, 2.02 intervention). Regression analyses resulted in two significant differences between intervention and control sites in changes from baseline to 15 months: (1) intervention sites exhibited significantly smaller change in context scores relative to control sites over time and (2) intervention sites exhibited significantly higher changes in wellness program effort relative to control sites.
Contrary to our hypothesis, change commitment declined significantly at both Healthlinks and control sites, even as wellness-program effort increased significantly at HealthLinks sites. Regression to the mean may explain the decline in change commitment. Future research needs to assess whether baseline commitment is an independent predictor of wellness-program effort or an effect modifier of the HealthLinks intervention.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**