Cati Brown-Johnson, Marie C Haverfield, Karleen F Giannitrapani, Natalie Lo, Jill S Lowery, Mary Beth Foglia, Anne M Walling, David B Bekelman, Scott T Shreve, Lisa Soleymani Lehmann, Karl A Lorenz
University of Washington affiliated authors are displayed in bold.
Published: February 2020
John A.Naslund, Jasmine Kalha, Juliana L. Restivo, Ishmael Amarreh, Tamora Callands, Hongtu Chen, Carlos Gomez-Restrepo, Hesham M. Hamoda, Arjun Kapoor, Sue Levkoff, Jones Masiye, Maria A. Oquendo, Vikram Patel, Inge Petersen, Ozge Sensoy Bahar, Laura Shields-Zeeman, Fred M. Ssewamala, Deepak Tugnawat, José Miguel Uribe-Restrepo, Lakshmi Vijayakumar, Bradley H. Wagenaar, Milton L.Wainberg, Larry Wissow, Haja Ramatulai Wurie, Chifundo Zimba, & Soumitra Pathare
University of Washington affiliated authors are displayed in bold.
Published: January 2021
Bradford L. Felker, Meghan M. McGinn, Erika M. Shearer, Gina T. Raza, Sari D. Gold, Jean M. Kim, Sasha M. Rojas, Milena S. Roussev, Ruth L. Varkovitzky, Huiting Liu, Kate L. Morrison, and Russell A. McCann
University of Washington affiliated authors are displayed in bold.
Published: January 2021
Telemental health (TMH) has increased substantially. However, health care systems have found it challenging to implement TMH ubiquitously. A quality improvement project guided by implementation science methodology was used to design and implement a TMH training program.
Implementation science methodology (Promoting Access to Research Implementation in Health Services, Reach-Effectiveness-Adoption-Implementation-Maintenance, Implementation/Facilitation) provided the framework to design and implement the training program. A total of 100 interdisciplinary mental health providers from outpatient mental health clinics participated.
Providers reported satisfaction with the training program. Results indicated that the training increased providers' TMH knowledge and competence. The number of providers using TMH and patients who received TMH nearly doubled.
Implementation science methodology was important in creating an organizational framework at this facility to design, evaluate, and implement an innovative TMH training program.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Jennifer Coury, Edward J. Miech, Patricia Styer, Amanda F. Petrik, Kelly E. Coates, Beverly B. Green, Laura-Mae Baldwin, Jean A. Shapiro & Gloria D. Coronado
University of Washington affiliated authors are displayed in bold.
Published: January 2021
Mailed fecal immunochemical testing (FIT) programs can improve colorectal cancer (CRC) screening rates, but health systems vary how they implement (i.e., adapt) these programs for their organizations. A health insurance plan implemented a mailed FIT program (named BeneFIT), and participating health systems could adapt the program. This multi-method study explored which program adaptations might have resulted in higher screening rates.
First, we conducted a descriptive analysis of CRC screening rates by key health system characteristics and program adaptations. Second, we generated an overall model by fitting a weighted regression line to our data. Third, we applied Configurational Comparative Methods (CCMs) to determine how combinations of conditions were linked to higher screening rates. The main outcome measure was CRC screening rates.
Seventeen health systems took part in at least 1 year of BeneFIT. The overall screening completion rate was 20% (4–28%) in year 1 and 25% (12–35%) in year 2 of the program. Health systems that used two or more adaptations had higher screening rates, and no single adaptation clearly led to higher screening rates. In year 1, small systems, with just one clinic, that used phone reminders (n = 2) met the implementation success threshold (≥ 19% screening rate) while systems with > 1 clinic were successful when offering a patient incentive (n = 4), scrubbing mailing lists (n = 4), or allowing mailed FIT returns with no other adaptations (n = 1). In year 2, larger systems with 2–4 clinics were successful with a phone reminder (n = 4) or a patient incentive (n = 3). Of the 10 systems that implemented BeneFIT in both years, seven improved their CRC screening rates in year 2.
Health systems can choose among many adaptations and successfully implement a health plan’s mailed FIT program. Different combinations of adaptations led to success with health system size emerging as an important contextual factor.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Aaron R. Lyon, Michael D. Pullmann, Shannon Dorsey, Carol Levin, Larissa M. Gaias, Stephanie K. Brewer, Madeline Larson, Catherine M. Corbin, Chayna Davis, Ian Muse, Mahima Joshi, Rosemary Reyes, Nathaniel J. Jungbluth, Rachel Barrett, David Hong, Michael D. Gomez & Clayton R. Cook
University of Washington affiliated authors are displayed in bold.
Published: January 2021
More than two-thirds of youth experience trauma during childhood, and up to 1 in 5 of these youth develops posttraumatic stress symptoms that significantly impair their functioning. Although trauma-focused cognitive behavior therapy (TF-CBT) has a strong evidence base, it is rarely adopted, delivered with adequate fidelity, or evaluated in the most common setting where youth access mental health services—schools. Given that individual behavior change is ultimately required for successful implementation, even when organizational factors are firmly in place, focusing on individual-level processes represents a potentially parsimonious approach. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a pragmatic, motivationally focused multifaceted strategy that augments training and consultation and is designed to target precise mechanisms of behavior change to produce enhanced implementation and youth clinical outcomes. This study protocol describes a hybrid type 2 effectiveness-implementation trial designed to concurrently evaluate the main effects, mediators, and moderators of both the BASIS implementation strategy on implementation outcomes and TF-CBT on youth mental health outcomes.
Using a cluster randomized controlled design, this trial will assign school-based mental health (SMH) clinicians and schools to one of three study arms: (a) enhanced treatment-as-usual (TAU), (b) attention control plus TF-CBT, or (c) BASIS+TF-CBT. With a proposed sample of 120 SMH clinicians who will each recruit 4–6 youth with a history of trauma (480 children), this project will gather data across 12 different time points to address two project aims. Aim 1 will evaluate, relative to an enhanced TAU condition, the effects of TF-CBT on identified mechanisms of change, youth mental health outcomes, and intervention costs and cost-effectiveness. Aim 2 will compare the effects of BASIS against an attention control plus TF-CBT condition on theoretical mechanisms of clinician behavior change and implementation outcomes, as well as examine costs and cost-effectiveness.
This study will generate critical knowledge about the effectiveness and cost-effectiveness of BASIS—a pragmatic, theory-driven, and generalizable implementation strategy designed to enhance motivation—to increase the yield of evidence-based practice training and consultation, as well as the effectiveness of TF-CBT in a novel service setting.
ClinicalTrials.gov registration number NCT04451161. Registered on June 30, 2020.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Noah S. Triplett, Sean Munson, Anne Mbwayo, Teresia Mutavi, Bryan J. Weiner, Pamela Collins, Cyrilla Amanya, & Shannon Dorsey
University of Washington affiliated authors are displayed in bold.
Published: January 2021
Although research continues to support task-shifting as an effective model of delivering evidence-based practices (EBPs), little scholarship has focused how to scale up and sustain task-shifting in low- and middle-income countries, including how to sustainably supervise lay counselors. Ongoing supervision is critical to ensure EBPs are delivered with fidelity; however, the resources and expertise required to provide ongoing supervision may limit the potential to scale up and sustain task shifting. Opportunities may exist to leverage mobile technology to replace or supplement in-person supervision in low-resource contexts, but contextual variables, such as network connectivity and lay counselor preferences surrounding mobile technology, must be examined and considered when designing and implementing mobile technology supervision.
This study builds from an existing randomized trial in Kenya, wherein teachers and community health volunteers have been trained to provide trauma-focused cognitive behavioral therapy as lay counselors. The study will use an iterative and mixed methods approach, with qualitative interviews and a Human-Centered Design (HCD) workshop informing a non-randomized pilot trial. Semi-structured interviews will be conducted with lay counselors and supervisors to understand how mobile technology is currently being used for supervision and determine the barriers and facilitators to mobile technology supervision. Data from these interviews will inform an HCD workshop, where lay counselors and supervisors “re-design” supervision to most effectively leverage mobile technology. Workshop participants will also participate in focus groups to gather perceptions on the use of HCD techniques. The final outcome of the workshop will be a set of refined workflows, which will be tested in a mixed method, nonrandomized pilot with newly trained lay counselors and existing supervisors. The pilot trial will evaluate the acceptability, feasibility, and usability of mobile technology supervision through self-report questionnaires as well as perceptions of effectiveness through qualitative interviews with a subset of lay counselors and all supervisors.
This study will provide a launching point for future research on supervision and methods to engage stakeholders to design and tailor interventions and implementation supports to fit low-resourced contexts.
The parent trial from which this study builds was registered on ClinicalTrials.gov on August 9, 2017 (NCT03243396).
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Deborah J. Bowen, Catharine Wang, Allison M. Cole, Barbara M. Norquist, Sarah Knerr, Beth Devine, Brian Shirts, Kevin Cain, Heather M. Harris, Helen G. Haile, Elizabeth M. Swisher
University of Washington affiliated authors are displayed in bold.
Published: December 2020
Nicole Martinez-Martin*, Ishan Dasgupta*, Adrian Carter, Jennifer A. Chandler, Philipp Kellmeyer, Karola Kreitmair, Anthony Weiss, & Laura Y. Cabrera
*These authors contributed equally
University of Washington affiliated authors are displayed in bold.
Published: December 2020
Social distancing measures due to the COVID-19 pandemic have accelerated the adoption and implementation of digital mental health tools. Psychiatry and therapy sessions are being conducted via videoconferencing platforms, and the use of digital mental health tools for monitoring and treatment has grown. This rapid shift to telehealth during the pandemic has given added urgency to the ethical challenges presented by digital mental health tools. Regulatory standards have been relaxed to allow this shift to socially distanced mental health care. It is imperative to ensure that the implementation of digital mental health tools, especially in the context of this crisis, is guided by ethical principles and abides by professional codes of conduct. This paper examines key areas for an ethical path forward in this digital mental health revolution: privacy and data protection, safety and accountability, and access and fairness.
**This abstract is posted with permission under the Creative Commons Attribution 4.0 International License**
Nathaniel J. Williams, Lindsay Frederick, Alix Ching, David Mandell, Christina Kang-Yi, Jill Locke
University of Washington affiliated authors are displayed in bold.
Published: December 2020
Andrea K. Graham, Emily G. Lattie, Byron J. Powell, Aaron R. Lyon, Justin D. Smith, Stephen M. Schueller, Nicole A. Stadnick, C. Hendricks Brown, & David C. Mohr
University of Washington affiliated authors are displayed in bold.
Published: November 2020