United States Archives - Page 4 of 29 - Implementation Science at UW

✪ Integrating behavioral health care into a low-barrier HIV clinic using the Collaborative Care Model: a mixed methods evaluation of patient care cascade outcomes and determinants

Abstract:

Background

Low-barrier HIV care is an evidence-based intervention to improve HIV outcomes among those who have complex barriers to care, but the walk-in model poses challenges to integrating behavioral health services. We evaluated the acceptability and feasibility of a Collaborative Care Model (CoCM) for treatment of depression and opioid use disorder in a low-barrier clinic.

Methods

In a sequential explanatory mixed methods pilot study, we accessed data from patient records to generate a care cascade for the number of patients enrolled in the first six months of the program and conducted individual interviews with patients and staff to interpret the care cascade findings.

Results

Among 175 patients who visited the clinic, 36% were screened for, 24% were referred to, 15% completed an intake for, and 9% engaged in CoCM. The interviews revealed that screening was limited by a lack of clarity among staff about services offered in CoCM, staff forgetting the screening process, and limited time during patent visits. Referrals were limited by low buy-in among staff and patient complexity. Intakes were limited by time and space constraints in the care setting and competing acute patient needs. The care manager’s ability to embody the clinic’s culture facilitated engagement among patients who completed intakes.

Conclusions

Staff perceived CoCM to be acceptable and feasible to implement, but only in the context of multiple barriers to implementation and challenges to systematic screening and measurement-based care.

Trial registration

Not applicable.

Contributions to the literature

We evaluated implementation of the Collaborative Care Model, an evidence-based model for integrating behavioral healthcare into primary care settings, for treating depression and opioid-use disorder in a low-barrier HIV clinic. To our knowledge, this is the first implementation of the Collaborative Care Model in a low-barrier HIV clinic.
By specifying a multi-component implementation strategy, our evaluation provides a foundation for selecting and tailoring implementation strategies for use with integrated behavioral healthcare interventions.
Through use of a joint visual display showing a care cascade with illustrative quotes, our evaluation demonstrates a novel approach to using explanatory mixed methods in implementation science.

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

✪ Partnering with Policymakers to Design Suicide Care Research: Maximizing Impact in Adolescent Mental Health Policy

Abstract:

Outpatient medical settings are a critical source of mental health care for adolescents and young adults. This is due to the familiarity and accessibility of those settings and challenges accessing mental health care elsewhere. Adolescents and young adults who die by suicide are more likely to have seen a medical provider in the prior month than a mental health specialist, but few suicide care interventions have been developed to specifically address the challenges of working in these outpatient medical settings. This paper provides the perspective of the University of Washington Suicide Care Research Center on the importance of incorporating evidence into public policy decisions regarding workforce development and standards of care for adolescents and young adults experiencing suicidal thoughts and behaviors, their families, and their outpatient medical setting providers; and the equal importance of integrating policy and funding perspectives in clinical services and implementation science. The paper will review the trends in suicide care policy and funding structures as relevant to adolescents and young adults in outpatient medical settings, provide recommendations to advance the translation of research into evidence-based policy decisions for adolescents and young adults at risk of suicide, and recommendations for researchers on incorporating policy perspectives in the development and evaluation of evidence-based interventions. We will share how the University of Washington Suicide Care Research Center is operationalizing these recommendations.

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

Formative Evaluation to Inform Implementation of Sepsis Bundles in Emergency Departments

✪ Evaluating spoke facilitation costs of implementing TelePain in the Veterans Health Administration

Abstract:

Background

The high prevalence and significant morbidity and mortality associated with chronic pain among veterans has made expansion of pain services within the Veterans Health Administration (VHA) a key priority. TelePain, in which services are provided via telehealth from central “hub” sites to patients at decentralized “spoke” sites, is one such model with positive implementation findings to date. However, the staff effort and cost of implementation have yet to be examined when considering TelePain or similar virtual hub-and spoke models of specialty pain care, information that is critical for expansion of services.

Methods

Using an established time-based activity tracker designed for implementation facilitation, study staff tracked minutes spent on implementation activities at 11 spoke sites. Annual salaries were extracted to calculate an average cost per minute for each personnel type. Costs per personnel minute were combined with activity data to calculate costs of implementation activities at spoke sites. Implementation reach outcomes for the first 36 months of implementation were extracted from the electronic health record. Service utilization data was combined with cost data to calculate cost per patient reached and per clinical encounter achieved at each site.

Results

Total facilitation costs (range: $1,746-$7,978) and unique patients reached (range: 2–46) varied considerably across spoke sites and greater staff implementation efforts (measured in time or cost) were not associated with greater numbers of patients reached. Therefore, costs per patient reached also varied widely (range: $120–2,569) across spoke sites. Key challenges included high rurality and small clinic size; insufficient engagement of frontline providers; lack of referral options for high acuity patients; and lack of existing programming within which to situate pain services.

Conclusions

At spoke sites where patients were consistently referred and reached, costs were relatively modest, particularly compared to the high cost of untreated chronic pain, suggesting the potential impact of this model at scale. However, in spoke sites where referrals and encounters were low during initial implementation, cost per patient was high. Findings highlight the need for better methods for tailoring of facilitation interventions to spoke site’s individual needs to maximize impact.

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

✪ Study protocol for testing the efficacy of the Helping Educational Leaders Mobilize Evidence (HELM) implementation strategy in elementary schools: a hybrid type 3 effectiveness-implementation randomized controlled trial

Abstract:

Background

Schools need to implement universal student supports that prevent social, emotional, and behavioral difficulties; minimize associated risks; and promote social, emotional, and behavioral competencies. The purpose of this study is to examine the efficacy of the Helping Educational Leaders Mobilize Evidence (HELM) implementation strategy for promoting school-level implementation leadership, implementation climate, and high-fidelity delivery of an evidence-based practice. We will test HELM with an exemplar EBP, Positive Behavioral Interventions and Supports (PBIS). The specific aims of the study are to: 1) experimentally evaluate the effects of HELM versus PBIS training and technical assistance only (control condition); and 2) explore for whom, under what conditions, how equitably, and through which processes HELM works to improve outcomes, as well as its cost-effectiveness.

Methods

This study will use a hybrid type 3 effectiveness-implementation trial to provide a rigorous test of the effects of HELM in elementary schools. Schools will be randomly assigned to HELM + PBIS training and technical assistance (n = 21 schools; n = 210 educators) or PBIS training and technical assistance only (n = 21 schools; n = 210 educators) in a 1:1 ratio within cohorts using covariate constrained randomization that accounts for degree of prior PBIS exposure (measured using the Tiered Fidelity Inventory at baseline) and school size. A series of mixed effects models (time within educator, educator within school) will test within-subject/between-subject interactions across three timepoints (12 months total) to examine whether HELM will show steeper gains than the control on implementation leadership (primary outcome), implementation climate, PBIS fidelity, and student outcomes. Mediational analyses will test hypothesized mechanisms of change (i.e., implementation leadership and climate) of HELM on PBIS fidelity. Sequential mixed-methods data collection and analyses will further explore how organizational mechanisms are linked to implementation outcomes. Cost-effectiveness analyses will compare costs and outcomes of PBIS training and technical assistance only versus PBIS implementation with HELM.

Discussion

The nature of leadership support in schools can make the difference between successful and unsuccessful EBP implementation. Testing HELM within the context of PBIS implementation will provide rigorous evidence about whether and how HELM can equitably address important EBP and student outcomes.

Trial Registration

Clinical Trials ID: NCT06586723. Date of Registration: August 27, 2024. Prospectively registered. URL of Trial Registry Record: https://clinicaltrials.gov/study/NCT06586723?intr=helm&rank=1

Contributions to the Literature

Few effective strategies to enhance evidence-based practice implementation in schools address implementation leadership and climate, and those that do have only been evaluated qualitatively.
Schools have unique organizational characteristics, and it is important to test whether organizational implementation strategies developed in other contexts can be effective in improving implementation outcomes in schools.
This study will evaluate the effects of a tailored adaptation of the Leadership and Organizational Change for Implementation (LOCI) strategy for schools, entitled Helping Educational Leaders Mobilize Evidence (HELM), on implementation mechanisms (implementation leadership and implementation climate), PBIS fidelity, and student outcomes.
This study also will explore for whom, under what conditions, and how equitably HELM demonstrates its effects, providing critical information about influence on – and the limitations of – the impact of this organizational implementation strategy.
Finally, the study will evaluate the processes through which HELM works to improve outcomes, contributing to the emerging literature on implementation mechanisms, as well as its cost-effectiveness.

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

Name of the registry
clinicaltrials.gov.

Peer Review reports

Developing and implementing a process improvement intervention to expand evidence-based psychotherapy in the Department of Defense

Authors:

Jeffrey Cook, Melissa Mistretta, Carmen P. McLean, Jeffrey Mann, Erin Frick, Alan L. Peterson, Stacey Young-McCaughan, Elisa V. Borah, Katherine Anne Comtois, Katherine A. Dondanville, Allison M. Conforte, Jeremy Jinkerson, Zachary K. Jones
81st Medical Group, Keesler Air Force Base, Biloxi, Mississippi, United States
Hana J. Kim, Jared S. Link, Debra Nofziger, Erik N. Ringdahl, John Waggoner, Craig Woodworth, Craig S. Rosen, & David S. Riggs

^{University of Washington affiliated authors are displayed in bold.}

Subscription Required for Full Text Access

Published: April 2025

Read the full text in the subscription access journal Psychological Services

✪ Lessons learnt from the 2021 Pacific Northwest heat dome: a qualitative study of western Washington’s healthcare community response

Abstract:

Objective

The 2021 Pacific Northwest heat dome was Washington state’s deadliest recorded weather event and presented unprecedented response challenges to the state’s health sector. Understanding the impacts of this extreme heat event (EHE) on the sector as well as the barriers to and facilitators of implementing effective heat response is critical to preparing for future events, which are happening more frequently in the region due to climate change.

Design

Guided by an implementation science framework, we convened listening sessions and focus groups of the health sector in western Washington to reflect on regional response efforts.

Setting

Health sector organisations in 15 counties in western Washington State, USA: Clallam, Grays Harbor, Island, Jefferson, King, Kitsap, Lewis, Mason, Pacific, Pierce, San Juan, Skagit, Snohomish, Thurston and Whatcom.

Participants

A convenience sample of 109 listening group participants was recruited through the professional networks of the Northwest Healthcare Response Network, a regional healthcare coalition. 27 of the health sector professionals were recruited using purposive sampling to participate in seven focus groups organised by organisation type.

Results

The co-presence of the COVID-19 pandemic, limited staff capacity, resource acquisition challenges and inadequate regional collaboration emerged as key barriers, while advanced planning, indoor cooling capabilities, adapting strategies to local needs, robust internal relationships and strong external partnerships were reported to facilitate effective response. Establishing centralised coordination ahead of heat events, making improvements to the cooling capabilities of the built environment, developing plans and policies for EHEs that have co-benefits for other events, adopting evidence-informed response strategies, institutionalising the knowledge and relationships developed through prior events and improving evaluative processes (such as developing real-time monitoring capacity) will enable more effective response to future EHEs.

Conclusions

Western Washington’s health sector implemented EHE response activities that enabled essential service continuity, despite limited resources, unfamiliarity with EHEs and other systemic challenges. The recency of the heat dome presents an opportunity to incorporate lessons learnt into practice, policies, plans and built environment; these are necessary improvements ahead of future large-scale events the region may experience in the coming decades.

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

✪ Strengthening the US Health Workforce to End the HIV Epidemic: Lessons Learned From 11 Ending the HIV Epidemic Jurisdictions

Authors:

Phillip L Marotta, Debbie Humphries, Daniel Escudero, David A Katz, Joseph G Rosen, Samantha Veronica Hill, Jennifer L Glick, Dennis H Li, Latosha Elopre, Fatemeh Ghadimi, Rinad S Beidas, Jose Bauermeister, Stephen Bonett, Drew B Cameron, LaRon E Nelson, Serena Rajabiun, Larry R Hearld, Mansoorah Kermani, Sarah Stoltman, Darjai Payne, Tobeya Ibitayo, Faiad Alam, Amanda Williams, Corilyn Ott, Emma Kay, Sarah Chrestman, Scott Batey, Laramie R Smith, Robin Gaines Lanzi, Karen Musgrove, Mayra Malagon, Jeannette Bailey-Webb, Florence Momplaisir, Robert Gross, Gregory Gross, Taylor Kaser, Tawnya Brown, Chelsey R Carter, Michael Mugavero , Tequetta Valeriano, Sarah Shaw, Anjuli D Wagner, Bakari Atiba, & Russell A Brewer

^{University of Washington affiliated authors are displayed in bold.}

✪ Open Access

Published: April 2025

Read the full text open access in the journal JAIDS: Journal of Acquired Immune Deficiency Syndrome

✪ Community-Engaged Research in HIV Implementation Science: Characterizing Academic and Community Partnerships in the “Ending the HIV Epidemic” Supplement Awards

✪ Building the Road to End the HIV Epidemic Through Coordinating and Capacity-Building Hubs to Enhance the Science of HIV Implementation REsearch (CHESHIRE): Reflections and Directions

Authors:

Debbie L Humphries, Carolyn M Audet, Bijal A Balasubramanian, Nanette Benbow, Christopher G Kemp, Robin Gaines Lanzi, Sung-Jae Lee, Hannah Mestel, Alexandra B Morshed, Brian Mustanski, April Pettit, Borsika A Rabin, Olivia Sadler, Alison B Hamilton, Mary-Louise E Millett, Sheree Schwartz, Kenneth Sherr, Nicole A Stadnick, & Dennis H Li

^{University of Washington affiliated authors are displayed in bold.}

✪ Open Access

Published: April 2025

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Science Communications

Abstract:

Background

Methods

Results

Conclusions

Trial registration

Contributions to the literature

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✪ Open Access

Read the full text in the open access journal Evidence-Based Practice in Child and Adolescent Mental Health

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Read the full text in the subscription access journal Annals of Emergency Medicine

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✪ Open Access

Read the full text in the open access journal Implementation Science Communications

Abstract:

Background

Methods

Results

Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Science

Abstract:

Background

Methods

Discussion

Trial Registration

Contributions to the Literature

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Psychological Services

Authors:

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Read the full text in the open access journal BMJ Open

Abstract:

Objective

Design

Setting

Participants

Results

Conclusions

Authors:

✪ Open Access

Read the full text open access in the journal JAIDS: Journal of Acquired Immune Deficiency Syndrome

Authors:

✪ Open Access

Read the full text open access in the journal JAIDS: Journal of Acquired Immune Deficiency Syndrome

Authors:

✪ Open Access

Read the full text open access in the journal JAIDS: Journal of Acquired Immune Deficiency Syndrome