United States Archives - Page 6 of 29 - Implementation Science at UW

✪ Implementation Outcomes From a Pilot Study of Mindful Awareness in Body-Oriented Therapy (MABT) as a Chronic Pain Treatment Modality in an Integrative Health Clinic

Abstract:

Background

As regulation of opioid prescribing evolves, primary care and pain clinics are shifting to provide non-pharmacological and interdisciplinary chronic pain care. An under-utilized but growing area of health care for chronic pain is complementary and integrative health (CIH). However, there is limited availability of CIH approaches within the health care system. Mindful Awareness in Body-Oriented Therapy (MABT) is an evidence-based mind-body therapy, with a manualized protocol, that focuses on developing interoceptive sensibility for improved self-awareness and nervous system regulation. Prior MABT research shows MABT improves self-report and physiological indicators of interoception as well as mental and physical symptoms of distress.

Methods

This pilot single-group study used a hybrid implementation-effectiveness design and mixed methods to study implementation strategies and outcomes for bringing MABT into an integrative chronic pain clinic. Administrative data, staff surveys, and focus groups were used to understand the implementation process and outcomes (see Additional files 2, 3, and 4). Descriptive statistics were used to analyze survey and administrative data. A content analysis approach was used to analyze qualitative data from focus groups.

Results

7 staff surveys were administered over the 24-month study period and showed high acceptability and appropriateness that increased over time. Adoption, feasibility, and sustainability were also high. Clinicians made 70 referrals to MABT, 56 patients scheduled a session, 41 patients completed at least one session, and 71% of these completed the protocol. Focus groups identified MABT as a therapy that filled a gap in services, particularly for patients with a lack of body awareness and high emotion dysregulation.

Conclusion

Implementation of MABT was highly successful in an integrative health clinic focused on chronic pain treatment.

ClinicalTrials.gov registration

NCT05289024 Registered March 11, 2022

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

Feasibility of Using Patient Navigation to Improve Identification of Hereditary Cancer Syndromes in Newly Diagnosed Colorectal Cancer Patients

Pilot Testing a Digital Transdiagnostic Mental Health Intervention for Use Among Immigrant and Refugee Youth in the USA: A Mixed Methods Evaluation of Clinical and Implementation Outcomes

✪ Development of learning health system competency items related to health and healthcare equity and justice for rehabilitation researchers

Authors:

Pamela M. Dunlap, Kathleen M. Poploski, Catherine A. Anderson, Thiru M. Annaswamy, Melissa A. Clark, Peter C. Coyle, Natalie F. Douglas, Ann Marie Flores, Janet K. Freburger, Brian J. Hafner, Kenneth J. Harwood, Jeanne M. Hoffman, Adam R. Kinney, Linda Resnik, Kristin Ressel, Margarite J. Whitten, and Christine M. McDonough

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

✪ Open Access

Published: January 2025

Read the full text in the open access journal Learning Health Systems

Abstract:

Introduction

In 2021, the Learning Health Systems Rehabilitation Research Network (LeaRRn) developed and administered a needs assessment survey, based on the Agency on Healthcare Research and Quality's (AHRQ's) original seven domains of learning health systems (LHS) researcher core competencies, to identify knowledge and interest in LHS research competencies among rehabilitation researchers. In 2022, the AHRQ added a new health and healthcare equity and justice (HE) domain to the existing seven domains for LHS researcher core competencies.

Methods

LeaRRn utilized methods similar to those employed in the development of their original needs assessment survey to generate and refine competency items for the HE domain. In this report, we describe the methods used to develop these HE competency items.

Results & Conclusions

Other training programs and LHS researchers may use the competency items developed for this needs assessment survey to identify training opportunities in the HE domain.

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

✪ Not getting better but not getting worse: A cluster randomized controlled pilot trial of a leadership implementation strategy

Abstract:

Background

Implementation of evidence-based practices (EBPs) in schools is fraught with challenges. Even when EBPs are initiated, deterioration of implementation efforts often hinders their long-term success. School leadership behaviors can influence teachers’ EBP implementation. Our study tested an implementation strategy called Helping Educational Leaders Mobilize Evidence (HELM), adapted from the Leadership and Organizational Change for Implementation strategy, to enhance EBP implementation through improvements in school leadership teams’ implementation leadership and climate to buffer against the deterioration of implementation efforts. This study explores the impact of HELM on theorized mechanisms of change (i.e., implementation leadership, climate), educator-level factors (i.e., implementation citizenship), and implementation outcomes (i.e., fidelity, initiative stability).

Method

One school district and 10 schools in Washington participated. Five of the schools were randomized to receive the HELM strategy and the remaining five schools received an alternative leadership training as an implementation attention control. Teachers at every school (n = 341) received training for an EBP called Positive Greetings at the Door that has been previously demonstrated to reduce student behavior problems. Principals and Assistant Principals (n = 18) received the HELM strategy or alternative leadership training. Three district Administrators also participated in HELM as part of the Organizational Strategy Development meetings.

Results

HELM significantly slowed the average decline of implementation leadership (perseverant leadership and communication), three dimensions of implementation climate (recognition, rewards, and existing supports) and total implementation climate, and one dimension of implementation citizenship (keeping informed). No significant effects were found with regard to implementation outcomes (i.e., fidelity, initiative stability).

Conclusions

HELM shows promise in buffering the deterioration of EBP implementation efforts in schools. HELM positively influenced implementation leadership and climate, which are the hypothesized mechanisms for promoting successful long-term implementation efforts. An appropriately powered trial is needed to determine the efficacy of HELM in the future.

Trial Registration Information

Name of the registry: clinicaltrials.gov
Trial registration number: NCT06340074
Date of registration: March 29, 2024. Retrospectively registered
URL of trial registry record: https://clinicaltrials.gov/study/NCT06340074?intr=helm&rank=

Plain Language Summary

Using practices that have been proven to work in research to support youth social, emotional, and behavioral well-being in schools is hard. Efforts to use these practices decrease across the school year. School leadership behaviors can influence educators’ use of these practices. Our study tested an implementation strategy or support designed to help educators use a research-backed practice called Helping Educational Leaders Mobilize Evidence (HELM). HELM was adapted from the Leadership and Organizational Change for Implementation (LOCI) strategy, to enhance school leadership teams’ specific leadership behaviors to protect against the decline in implementation effort. This study explores the impact of HELM on outcomes related to practice use. One school district and 10 schools in western Washington State participated. Five of the schools received the HELM strategy and the remaining five schools received an alternative leadership training. Teachers at every school (n = 341) received training in a practice called Positive Greetings at the Door (PGD) that has been shown to reduce student behavior problems. Principals and Assistant Principals (n = 18) received the HELM strategy or alternative leadership training. Three district administrators also participated in HELM. HELM unexpectedly slowed the average decline of implementation leadership (perseverant leadership and communication), three dimensions of implementation climate (recognition, rewards, and existing supports), total implementation climate, and one dimension of implementation citizenship (keeping informed). No significant effects were found with regard to use of the practice. The HELM strategy shows promise in slowing the deterioration of practice in schools and positively influenced implementation leadership behaviors.

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

Design of a pragmatic trial integrating human papillomavirus (HPV) self-sampling into primary care to reduce cervical cancer screening disparities in Somali American individuals: The Isbaar project

✪ Study protocol for a hybrid type 3 effectiveness-implementation trial of a team-based implementation strategy to support educators’ use of a social engagement intervention

Abstract:

Background

Remaking Recess (RR) is a school-based evidence-based peer social engagement intervention for autistic students. RR involves direct training and coaching with educators; however, educators face several barriers to implementation at both the individual- and organizational-levels. This protocol paper describes a multi-site study that will test whether an educator-level implementation strategy, coaching, with or without a school-level implementation strategy, school-based teams, will maximize educators’ use (fidelity and sustainment) of RR for autistic students and their peers who are socially-isolated, rejected, or peripheral and may need additional support during recess.

Methods

This study will employ a hybrid type-3 effectiveness-implementation trial. Fifty-five elementary schools will be recruited as well as 121 educators (e.g., classroom assistants, aides), 55 general and special educator teachers, and 83–138 other school personnel (e.g., administrators). Additionally, at least 118 autistic students and allistic or non-autistic classmates will be recruited as RR recipients. Participants will complete baseline assessments at the beginning of the year, and all schools will be provided RR training. Schools will be randomized to coaching with or without school-based teams. This study will measure RR fidelity (primary outcome), RR sustainment, as well as peer engagement, social network inclusion, and social skills (secondary outcomes). It is expected that coaching with school-based teams will improve both RR fidelity and social network inclusion, while coaching with and without school-based teams will result in improved peer engagement and social skills.

Discussion

Previous research has documented barriers to RR implementation at both the individual- (provider) and organization-level (school). Using multi-level implementation strategies such as coaching with school-based teams may address these barriers and support RR implementation in schools. Findings from this study may guide future efforts to scale up tailored implementation strategies for use in public school districts, with the ultimate goal of increasing intervention access and improving student outcomes.

Trial registration

Name of the Registry: clinicaltrials.gov.
Trial Registration: Clinical Trials ID: NCT06559267.
Date of Registration: August 15, 2024. Prospectively registered.

Contributions to the literature

Remaking Recess (RR) is an intervention that improves peer engagement and classroom inclusion in autistic students. Educators, who play an important role in supporting autistic youth and their peers who are socially-isolated, rejected, or peripheral during the school day and at recess, can deliver RR.
Schools face many challenges, at both the individual- (i.e., educator) and organizational-levels (i.e., school), when implementing new interventions.
This study will evaluate the impact of two implementation strategies on the fidelity and sustainment of RR: (a) individual direct coaching for educators (coaching), and (b) supporting a team of school personnel (school-based teams) in addition to coaching.

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

✪ Systems analysis and improvement to optimize opioid use disorder care quality and continuity for patients exiting jail (SAIA-MOUD)

Abstract:

Background

Between 2012–2022 opioid-related overdose deaths in the United States, including Washington State, have risen dramatically. Opioid use disorder (OUD) is a complex, chronic, and criminalized illness with biological, environmental, and social causes. One-fifth of people with OUD have recent criminal-legal system involvement; > 50% pass through WA jails annually.

Medications for Opioid Use Disorder (MOUD) can effectively treat OUD. WA has prioritized improving access to MOUD, including for those in jails. As patients in jail settings are systematically marginalized due to incarceration, it is critical to foster connections to MOUD services upon release, an acknowledged period of high overdose risk. Currently, there is insufficient focus on developing strategies to foster linkages between jail-based MOUD and referral services.

The Systems Analysis and Improvement Approach (SAIA), an evidence-based implementation strategy, may optimize complex care cascades like MOUD provision and improve linkages between jail- and community-based providers. SAIA bundles systems engineering tools into an iterative process to guide care teams to visualize cascade drop-offs and prioritize steps for improvement; identify modifiable organization-level bottlenecks; and propose, implement, and evaluate modifications to overall cascade performance. The SAIA-MOUD study aims to strengthen the quality and continuity of MOUD care across jail and referral clinics in King County, WA, and ultimately reduce recidivism and mortality.

Methods

We will conduct a quasi-experimental evaluation of SAIA effectiveness on improving MOUD care cascade quality and continuity for patients receiving care in jail and exiting to referral clinics; examine determinants of SAIA-MOUD adoption, implementation, and sustainment; and determine SAIA-MOUD’s cost and cost-effectiveness. Clinic teams with study team support will deliver the SAIA-MOUD intervention at the jail-based MOUD program and three referral clinics over a two-year intensive phase, followed by a one-year sustainment phase where SAIA implementation will be led by King County Jail MOUD staff without study support to enable pragmatic evaluation of sustained implementation.

Discussion

SAIA packages user-friendly systems engineering tools to guide decision-making by front-line care providers to identify low-cost, contextually appropriate health care improvement strategies. By integrating SAIA into MOUD care provision in jail and linked services, this pragmatic trial is designed to test a model for national scale-up.

Trial registration

ClinicalTrials.gov NCT06593353 (registered 09/06/2024).

Contributions to the literature

Our study examines whether the introduction of an evidence-based, user-friendly, low-cost package of systems engineering tools can optimize investments in providing medications for opioid use disorder for individuals during the high-risk period immediately after exiting jail.
This is the first application of the Systems Analysis and Improvement Approach (SAIA) across health system levels to optimize both care delivery and continuity of care.
Our study is designed to provide decision-makers with evidence they need to decide whether to invest in systems engineering approaches during the expansion of MOUD in jail settings, including information on acceptability, feasibility, effectiveness and cost.

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

Peer Review reports

✪ A Team Coaching Intervention for Dementia Care: Acceptability and Feasibility Study in Care Communities

Abstract:

Objectives

In 2018, the Alzheimer's Association published the Dementia Care Practice Recommendations (DCPR) to provide guidance on quality care for professionals. This study aimed to examine the feasibility and acceptability of a consultative coaching program to increase adoption of the DCPR.

Design

A single-group pre-post design was employed. A 6-month team coaching intervention was implemented to make organization-wide and measurable changes in the areas of (1) policies and procedures, (2) education and training, or (3) care practices to increase person-centered care practices.

Setting and Participants

A total of 36 care communities in Washington and Montana states were enrolled in this program.

Methods

Focus groups were conducted with participants to explore the acceptability and feasibility of the program. A 35-item employees satisfaction survey was administered both before and after the program.

Results

The findings offer preliminary evidence that implementing a coaching program is desired by care community staff and has a positive impact on staff job satisfaction and the use of person-centered care. The coaching model was received by staff as a supportive and affirming program.

Conclusions and Implications

The team coaching intervention, designed to improve person-centered care and employee satisfaction, is acceptable. However, its efficacy needs to be tested with a larger sample using a randomized controlled design.

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

✪ Organization Theory for Implementation Science (OTIS): Reflections and recommendations

Abstract:

Organizations exert influence on the implementation of evidence-based practices and other innovations that are independent of the influence of organizations' individual constituents. Despite their influence, nuanced explanations of organizations' influence remain limited in implementation science. Organization theories are uniquely suited to offer insights and explain organizational influences on implementation. In this paper, we describe the efforts of the Cancer Prevention and Control Research Network's (CPCRN) Organization Theory for Implementation Science (OTIS) workgroup to equip implementation scientists with theory-guided understanding of organizational influences on implementation. We provide a set of recommendations for future efforts to enhance implementation through the use of organization theories and OTIS tools.

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

Authors:

✪ Open Access

Read the full text in the open access journal Integrative Medicine & Health

Abstract:

Background

Methods

Results

Conclusion

ClinicalTrials.gov registration

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Genetics in Medicine

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access Journal of Technology in Behavioral Science

Authors:

✪ Open Access

Read the full text in the open access journal Learning Health Systems

Abstract:

Introduction

Methods

Results & Conclusions

Authors:

✪ Open Access

Read the full text in the open access journal Implementation Research and Practice

Abstract:

Background

Method

Results

Conclusions

Trial Registration Information

Plain Language Summary

Authors:

Subscription Required for Full Text Access

Read the full text in the subscription access journal Contemporary Clinical Trials

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:

✪ Open Access

Read the full text in the open access journal Implementation Science

Abstract:

Background

Methods

Discussion

Trial registration

Contributions to the literature

Authors:

✪ Open Access

Read the full text open access in the Journal of the American Medical Directors Association

Abstract:

Objectives

Design

Setting and Participants

Methods

Results

Conclusions and Implications

Authors:

✪ Open Access

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

Abstract: