Margaret M. Paschen-Wolff, Aimee N.C. Campbell, Ángel Vásquez, Jill Kessler, Kelley Jansen, Catherine P. Arnatt, Carmen Rosa, Hanna M. Hebden, Sandra Radin, Antony Stately, Jennifer Shaw, Favian Kennedy, Abigail G. Matthews, & Kamilla L. Venner
University of Washington affiliated authors are displayed in bold.
Published: August 2025
Shari S. Rogal, Vera Yakovchenko, Timothy R. Morgan, Jason A. Dominitz, Heather McCurdy, Anna Nobbe, Nsikak R. Ekanem, Chaeryon Kang, Rachel I. Gonzalez, Angela Park, Jennifer Anwar, Brittney Neely, Sandra Gibson, Carolyn Lamorte, Jasmohan S. Bajaj, Heather M. Patton, Yiwen Yao & Andrew J. Gawron
University of Washington affiliated authors are displayed in bold.
Published: August 2025
Screening for gastrointestinal (GI) cancers, specifically colorectal cancer (CRC) and hepatocellular carcinoma (HCC), is often inadequately and inequitably implemented, leading to preventable morbidity and mortality. This protocol paper describes a study designed to compare the effectiveness of external facilitation with patient navigation across hospitals in the Veterans Health Administration (VA).
Two hybrid type 3, cluster-randomized trials will compare the effectiveness of patient navigation versus external facilitation for supporting HCC and CRC screening completion. Twenty-four sites will be included in the HCC trial and 32 in the CRC trial, cluster-randomizing Veterans by their site of primary care. The primary outcome of reach of cancer screening completion will be measured after intervention and during sustainment. Multi-level implementation determinants (i.e., barriers and facilitators), preconditions, and moderators will be evaluated pre- and post-intervention, using Consolidated Framework for Implementation Research (CFIR)-mapped surveys and interviews of Veteran participants and provider participants.
Comparing findings in the two trials will allow researchers to understand how implementation barriers and strategies operate differently for a one-time screening in a relatively healthy population (CRC) vs. repeated screening in a more medically complex population (HCC).
This project was registered at ClinicalTrials.Gov (NCT06458998) on 6/13/24.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Cam Escoffery, Juzhong Sun, Amy DeGroff, Krishna Sharma, Manal Masud, Thuy Vu, Dara Schlueter & Peggy Hannon
University of Washington affiliated authors are displayed in bold.
Published: July 2025
CDC’s Colorectal Cancer Control Program (CRCCP) aims to increase colorectal cancer (CRC) screening prevalence by implementing evidence-based interventions (EBIs) in health system clinics partnering with the program. Program champions, as one of the key program components, are expected to facilitate the implementation of EBIs and support desired changes in many ways. Given limited information about the champions in clinical systems, this study investigated champion types, roles, and sustainability within the CRCCP.
This mixed methods, cross-sectional study included a survey of 205 respondents (health system and clinic staff) representing 303 clinics and 12 qualitative interviews of CRCCP award recipients and partnering clinics. The survey assessed clinic characteristics, EBI implementation, information about program champions, and sustainability. Interview topics included champion roles, benefits, turnover, and maintenance.
Champions worked at either the health system or clinic level. Among health systems, champions were quality improvement (QI) managers (48.5%), physicians (36.4%), or high-level administrators (27.3%). In clinics, champions were physicians (37.0%), QI managers (26.1%) or medical assistants (23.9%). Champions in both health systems and clinics were most often assigned the role (45.5% and 45.7%, respectively); yet clinic champions were more likely to naturally emerge than health system champions (26.1% vs. 15.2%). Among naturally emerging champions, 64.3% experienced zero turnover, more than for assigned champions. While champions in both groups received training, more champions in health systems reported being trained than those in clinics (75.8% vs 52.2%). No significant differences in EBIs implemented were observed between those clinics with and without a champion. Zero champion turnover was associated with great or very great leadership support (68.9%), program adaptation (60.7%) and organizational capacity (54.1%). Interviews found that champions’ roles included advocating for CRC screening, providing technical assistance for EBI implementation, creating organizational policies for CRC screening, and overseeing QI. Interviewees reported a desire to address champion sustainability.
These findings inform the use of program champions for clinic-based public health programs. Naturally emerging champions were more stable than those assigned the role.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Angela C. Wolff, Kate Absolom, Sara Ahmed, Susan J. Bartlett, Maria Jose Santana, Angela M. Stover & Elizabeth J. Austin
University of Washington affiliated authors are displayed in bold.
Published: July 2025
Although the use of patient-reported outcome measures (PROMs) in practice is increasing, successful implementation is contingent on engaging healthcare providers (HCPs). Using Implementation Science (IS), we present the content of two workshops hosted at the International Society for Quality-of-Life annual conferences for individuals seeking to implement PROMs collection and use in their settings. Our goals were to provide workshop participants with knowledge, tools, and resources to prepare HCPs for PROM adoption and to demonstrate tailored strategies to meet context-specific needs.
An interdisciplinary team with diverse expertise in PROMs implementation delivered two workshops guided by the Capability, Opportunity, Motivation – Behavior (COM-B) model and the Theoretical Domains Framework (TDF). Using dotmocracy, participants were asked to consider, for their local context, the factors most important for changing HCPs’ behaviors to adopt PROMs in daily practice.
The workshops incorporated IS theories, models, and frameworks (TMFs) to identify barriers faced by HCPs, support behavior change, and apply tailored theory-informed implementation strategies to prepare HCPs for PROM integration and evaluate adoption success. The factors rated the most important by workshop participants (n = 53) were woven into the discussions to illustrate the most common barriers encountered by HCPs adopting PROMs. Presenters drew on real-world practice and research experiences to identify promising implementation strategies, including education, training, behavioral modeling, persuasion, environmental restructuring, enablement, and audit and feedback to increase the capability, opportunity, and motivation of HCPs.
Given the increasing evidence base supporting the role of PROMs in patient-centered care, it is imperative to understand the mechanisms and best practices for increasing provider adoption of PROMs. This work offers a roadmap for understanding determinants more important to HCPs and systematically selecting theory-informed implementation strategies that may increase the likelihood of HCP adoption of PROMs. Offering tailored HCP training/education programs and implementation strategies can prepare HCPs for timely and effective PROM implementation.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Annice Brown, Sharon M. Kelly, Tracy Agee, Jeffrey Hsu, Nicholas Schweizer, Geetanjali Chander, Larry W. Chang, Sheree Schwartz & Oluwaseun Falade-Nwulia
University of Washington affiliated authors are displayed in bold.
Published: June 2025
Samantha J. Reznik, Bess Friedman, Maria Monroe-DeVita, Stephania L. Hayes & Molly Lopez
University of Washington affiliated authors are displayed in bold.
Published: June 2025
Coordinated specialty care (CSC) programs for early psychosis have expanded rapidly in the United States in recent years due to evidence supporting early intervention and subsequent federal funding. The majority of CSC programs are located in major urban and surrounding suburban areas, although many states are expanding or planning to expand CSC services to rural and remote areas. Despite ongoing implementation efforts, little is known about effective implementation of CSC in rural and remote communities. The present article uses the “scale out” model as a guiding framework to consider how CSC can be implemented in rural areas and describes considerations relevant to infrastructure for rural CSC: defining rurality, priority population, workforce, financing, telehealth, strengths of rural communities, culture, and social determinants of health. We then discuss two overarching challenges of (a) integrating alternative bottom-up, community partnership approaches, such as community-based participatory research, into the scale out model and (b) using the scale out model for an implementation effort that is already underway. We argue that successful rural CSC implementation will involve integrating the scale out model with rigorous community-based participatory research to incorporate theory with real-world needs and learn in real-time from ongoing implementation efforts.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Shari S. Rogal, Brittney Neely, Monica Merante, Karen Slazinski, Lorenzo McFarland, Christina Brodkorb, Jada Cooper, Carolyn Lamorte, Sandra Gibson, Emily Comstock, Jamie Morano, Marissa Maier, Lauren A. Beste, Karine Rozenberg, Maggie Chartier, Matthew J. Chinman, David Ross & Vera Yakovchenko
University of Washington affiliated authors are displayed in bold.
Published: June 2025
Pre-Exposure Prophylaxis (PrEP) dramatically reduces the likelihood of acquiring human immunodeficiency virus (HIV), yet it remains under-prescribed, particularly for people in communities with high HIV incidence. While implementation science and health services researchers aim to address disparities in care, few interventions have proven effective in doing so. We aimed to identify implementation strategies associated with higher PrEP prescribing rates and pilot test a tailored intervention as a proof-of-concept in a single Veterans Health Administration (VA) facility.
VA clinicians were surveyed using an instrument derived from the Evidence-based Recommendations for Implementing Change taxonomy to assess the use of various strategies for PrEP in fiscal years 2019–2021. Correlational analyses identified the strategies associated with the frequency of PrEP prescribing and semi-structured interviews with personnel from 11 VA medical facilities with high PrEP prescribing refined and manualized these strategies into the Getting to Implementation (GTI)-PrEP playbook. The playbook was subsequently pilot tested in a VA facility with high new HIV diagnosis rates and low PrEP prescribing rates.
The clinician survey collected 157 responses from 95 unique VA facilities on implementation strategy use. Analysis identified eight strategies significantly associated with PrEP prescribing, including: networking, clinician education, clinical support tools, dashboard utilization, telehealth, pharmacist involvement, direct patient engagement, and enhanced sexual health history taking. In the pilot study, the site completed the GTI-PrEP Playbook with high fidelity and newly implemented seven of the eight strategies, achieving a 363% increase in PrEP prescribing rates among Black Veterans over the one-year period.
This multi-year national evaluation identified a core subset of effective implementation strategies for increasing PrEP prescribing. The process of empirically specifying these strategies and pilot testing them through the GTI-PrEP playbook demonstrates a promising, data-driven approach to improve PrEP prescribing rates and reduce racial disparities in HIV prevention.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Catherine M. Corbin, Mark G. Ehrhart, Eric C. Brown, Jill Locke, Clayton R. Cook, Gregory A. Aarons & Aaron R. Lyon
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Employee behaviors that strategically support implementation (i.e., implementation citizenship behavior [ICB]) theoretically promote the adoption and high-fidelity use of evidence-based practices (EBPs). ICB (e.g., helping colleagues overcome implementation barriers) may vary across contexts, including schools where children are most likely to access and receive mental and behavioral health services. Pragmatic measures are needed to advance nascent research on school-based ICB and inform how these behaviors can be used to support successful implementation. The current study expanded the Implementation Citizenship Behavior Scale (ICBS) to create and validate the School Implementation Citizenship Behavior Scale (SICBS) in a sample of elementary school teachers implementing evidence-based prevention programs to support children’s mental and behavioral health.
Based on subject matter expert feedback, items were refined from the original ICBS and items for two new subscales (taking initiative, advocacy) were created for the SICBS. A sample of 441 public school teachers from 52 elementary schools in the Midwest and Western United States of America completed a survey that included the SICBS and additional measures to assess convergent and divergent validity. SICBS was refined and validated via examination of item characteristics curves to reduce items and develop a pragmatic instrument, confirmatory factor analyses to evaluate the hypothesized measurement structure, and assessment of convergent and divergent validity.
The original two ICBS subscales (helping others, keeping informed) were retained, and two new three-item subscales resulted from item reduction analyses (taking initiative, advocacy). The hypothesized second-order factor model was generally well fit to the data (CFI = .99, TLI = .99, RMSEA = .09), all first- (λs = .85-.96) and second-order factor loadings (λs = .93-.95) were high. All SICBS subscales demonstrated acceptable reliability (αs = .88-.92). Convergent validity was evidenced by moderate correlations with organizational citizenship behavior items (rs = .42-.49). Divergent validity was demonstrated by weak correlations with teachers’ beliefs about teaching (rs = .31-.38) and null correlations with most school demographics.
Results support the structural, convergent, and divergent validity of the 12-item, 4-factor SICBS. The SICBS provides a deeper understanding of individual implementer actions that may serve as implementation mechanisms or outcomes.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Shannon Dorsey, Rashed AlRasheed, Suzanne EU Kerns, Rosemary D Meza, Noah Triplett, Esther Deblinger, Nathaniel Jungbluth, Lucy Berliner, Lavangi Naithani, and Michael D Pullmann
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Clinicians need supports beyond training to deliver evidence-based treatments with fidelity. Workplace-based clinical supervision often is a commonly provided support in community mental health, yet too few studies have empirically examined supervision and its impact on clinician fidelity and treatment delivery.
Building on a Washington State-funded evidence-based treatment initiative (CBT+), we conducted a randomized controlled trial (RCT), testing two supervision conditions delivered by workplace-based supervisors (supervisors employed by community mental health organizations). The RCT followed a supervision-as-usual (SAU) phase for comparison. The treatment of focus was trauma-focused cognitive behavioral therapy (TF-CBT). Clinicians (N = 238) from 25 organizations participated in the study across the SAU baseline and RCT phases. In the RCT phase, clinicians were randomized to either symptom and fidelity monitoring (SFM) or SFM and behavioral rehearsal (SFM + BR). For BR, clinicians engaged in a short role play of an upcoming treatment element. Supervisors delivered both conditions, with regular study monitoring for drift. Clinicians audiorecorded therapy sessions with enrolled clients, and masked coders coded a subset of recordings for adherence to TF-CBT. One hundred and thirty-three clinicians had recorded TF-CBT session data for 258 youth. We examined six adherence outcomes, including potential moderators.
Results of generalized estimating equations indicated that there were no real differences on adherence outcomes for experimental conditions (SFM, SFM + BR) compared to SAU. Adherence scores in the baseline SAU phase and the RCT conditions were high. Only one interaction was significant.
Contrary to our hypotheses, we did not see improvements in adherence with the RCT conditions. However, nonsignificant findings seem best explained by clinicians’ acceptable/high adherence in SAU. This study was conducted within the context of a long-standing, state-funded EBT initiative, in which clinicians and their supervisors receive training and support, and in which participating community mental health organizations have adopted and supported TF-CBT.
ClinicalTrials.gov ID: NCT01800266
Clinicians often receive training in evidence-based treatments (EBTs), but training alone is not enough for clinicians to deliver EBTs well. They need other supports. One of the necessary supports is clinical supervision. In public community mental health organizations, which are often resource-constrained, routine clinical supervision is a commonly available support. However, its potential for supporting high-quality EBT delivery is not well understood. This study looked at supervision and clinicians’ delivery of trauma-focused cognitive behavioral therapy (TF-CBT), an EBT for youth who have mental health problems subsequent to trauma. We found that clinicians who received workplace-based supervision on TF-CBT from TF-CBT-trained supervisors, within the context of a state-funded EBT initiative, delivered TF-CBT well. This initiative supported delivery by providing training and supervisor-specific supports. In a second phase of the study, we rigorously tested supervisors’ use of two specific technique packages. These packages included having supervisors review: (a) graphed client mental health symptoms across treatment and clinicians’ report of TF-CBT elements delivered each session or (b) these plus having clinicians do a brief demonstration of how they would deliver an upcoming TF-CBT element to their client, so supervisors could “see” clinicians’ skill and provide feedback. Contrary to expectations, we did not see important differences in clinicians’ TF-CBT delivery. This may be because the clinicians enrolled in our study were already delivering TF-CBT well and, therefore, there was less opportunity for changes. Future studies should explore if these techniques are more helpful for specific situations or clinicians.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Katherine A. Cohen, Eric Bruns, Aaron Lyon, Tali Raviv, Sara Becker & Jessica L. Schleider
University of Washington affiliated authors are displayed in bold.
Published: May 2025
Schools are one of the most common settings in which youth seek mental health services, yet existing school-based mental health interventions are often difficult to implement due to time, cost, and staffing limitations. Digital, self-administered Single Session Interventions (SSIs) are evidence-based supports that are intentionally structured to deliver a clinically-meaningful dosage of evidence-based content within one session. Although multiple studies have demonstrated the clinical effectiveness of school-based SSIs, there have been no systemic efforts to understand how SSIs can be practically implemented in schools. The goal of this project is to partner with students, parents, and school staff to identify factors that impact the implementation of SSIs and understand how SSIs can be sustainably integrated as mental health supports into school mental health infrastructure.
We will conduct focus groups (five groups, total n = 35–45) among community members (i.e., students, parents/caregivers, teachers, school administrators, and school mental health providers) to assess perceived facilitators and barriers to the effective implementation of evidence-based SSIs in schools (Aim 1). We will then work in partnership with community members (n = 10–15) to co-design multi-level implementation strategies (i.e., student-directed, staff-directed, system-directed) for increasing uptake and promoting sustainability of school-based SSIs (Aim 2). We will use inductive coding to thematically analyze qualitative data from group sessions. This study is being conducted within the Lake Washington School District in the Seattle, Washington region.
The proposed project will be the first to investigate facilitators and barriers to real-world implementation of SSIs in schools and strategies to improve implementation. Future studies may test the effectiveness of the generated implementation strategies on outcomes such as SSI uptake over time.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**