scholarly journals Transforming Mental Health Delivery Through Behavioral Economics and Implementation Science: Protocol for Three Exploratory Projects (Preprint)

2018 ◽  
Author(s):  
Rinad S Beidas ◽  
Kevin G Volpp ◽  
Alison N Buttenheim ◽  
Steven C Marcus ◽  
Mark Olfson ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Data Collection ◽  
Behavioral Economics ◽  
Psychiatric Disorders ◽  
Implementation Science ◽  
Participatory Design ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Evidence Based

BACKGROUND Efficacious psychiatric treatments are not consistently deployed in community practice, and clinical outcomes are attenuated compared with those achieved in clinical trials. A major focus for mental health services research is to develop effective and cost-effective strategies that increase the use of evidence-based assessment, prevention, and treatment approaches in community settings. OBJECTIVE The goal of this program of research is to apply insights from behavioral economics and participatory design to advance the science and practice of implementing evidence-based practice (EBP) for individuals with psychiatric disorders across the life span. METHODS Project 1 (Assisting Depressed Adults in Primary care Treatment [ADAPT]) is patient-focused and leverages decision-making heuristics to compare ways to incentivize adherence to antidepressant medications in the first 6 weeks of treatment among adults newly diagnosed with depression. Project 2 (App for Strengthening Services In Specialized Therapeutic Support [ASSISTS]) is provider-focused and utilizes normative pressure and social status to increase data collection among community mental health workers treating children with autism. Project 3 (Motivating Outpatient Therapists to Implement: Valuing a Team Effort [MOTIVATE]) explores how participatory design can be used to design organizational-level implementation strategies to increase clinician use of EBPs. The projects are supported by a Methods Core that provides expertise in implementation science, behavioral economics, participatory design, measurement, and associated statistical approaches. RESULTS Enrollment for project ADAPT started in 2018; results are expected in 2020. Enrollment for project ASSISTS will begin in 2019; results are expected in 2021. Enrollment for project MOTIVATE started in 2018; results are expected in 2019. Data collection had begun for ADAPT and MOTIVATE when this protocol was submitted. CONCLUSIONS This research will advance the science of implementation through efforts to improve implementation strategy design, measurement, and statistical methods. First, we will test and refine approaches to collaboratively design implementation strategies with stakeholders (eg, discrete choice experiments and innovation tournaments). Second, we will refine the measurement of mechanisms related to heuristics used in decision making. Third, we will develop new ways to test mechanisms in multilevel implementation trials. This trifecta, coupled with findings from our 3 exploratory projects, will lead to improvements in our knowledge of what causes successful implementation, what variables moderate and mediate the effects of those causal factors, and how best to leverage this knowledge to increase the quality of care for people with psychiatric disorders. CLINICALTRIAL ClinicalTrials.gov NCT03441399; https://www.clinicaltrials.gov/ct2/show/NCT03441399 (Archived by WebCite at http://www.webcitation.org/74dRbonBD) INTERNATIONAL REGISTERED REPOR DERR1-10.2196/12121

scholarly journals Engaging Stakeholders to Retrospectively Discern Implementation Strategies in Support of Program Evaluation

2021 ◽  
Author(s):  
Jacob T. Painter ◽  
Rebecca A. Raciborski ◽  
Monica M. Matthieu ◽  
Ciara Oliver ◽  
David A. Adkins ◽  
...  
Keyword(s):  
Program Evaluation ◽  
Quality Improvement ◽  
Data Collection ◽  
Implementation Strategy ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Evidence Based ◽  
Main Body ◽  
Strategy Selection ◽  
Evidence Based Practices

Abstract Background: Successful implementation of evidence-based practices is key to healthcare quality improvement. However, it depends on appropriate selection of implementation strategies, the techniques that improve practice adoption or sustainment. When studying implementation of an evidence-based practice as part of a program evaluation, implementation scientists confront a challenge: the timing of strategy selection rarely aligns with the establishment of data collection protocols. Indeed, the exact implementation strategies used by an organization during a quality improvement initiative may be determined during implementation. Nevertheless, discernment of strategies is necessary to accurately estimate implementation effect and cost because this information can support decision making for sustainment, guide replication efforts, and inform the choice of implementation strategies for other evidence-based practices. Main body: We propose an iterative, stakeholder engaged process to discern implementation strategies when strategy choice was not made before data collection began. Stakeholders are centered in the process, providing a list of current and potential implementation activities. These activities are then mapped by an implementation science expert to an established taxonomy of implementation strategies. The mapping is then presented back to stakeholders for member checking and refinement. The final list can be used to survey those engaged in implementation activities in a language they are familiar with. A case study using this process is provided. Conclusion: It is challenging to estimate implementation effort when implementation strategy selection is disconnected from the data collection process. In these cases, a stakeholder-informed process to retrospectively identify implementation strategies by classifying activities performed using an established implementation strategy taxonomy provides the necessary information.

scholarly journals Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2020 ◽  
Author(s):  
Briana S Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Traumatic Experience ◽  
Evidence Based ◽  
Mental Health Settings

Abstract Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that TF-CBT clinicians complete TNs with only half of their clients, yet little is known about what determines TF-CBT clinicians’ use of TNs. The behavioral insights literature—an interdisciplinary field studying judgment and decision-making—offers theoretical and empirical tools to conceptualize what drives complex human behaviors and decisions. Drawing from the behavioral insights literature, the present study seeks to understand what determines clinician use of TNs and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (N =17) to understand their decisions to use TNs with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of TNs: decision complexity, clinician affective experience, and agency norms. We hypothesized behavioral insights that underlie these implementation determinants and designed a list of nine corresponding behavioral insights strategies that may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

scholarly journals Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2020 ◽  
Author(s):  
Briana S Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Traumatic Experience ◽  
Evidence Based ◽  
Mental Health Settings

Abstract Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is difficult to implement. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

scholarly journals Using behavioral insights to design implementation strategies in public mental health settings: a qualitative study of clinical decision-making

2020 ◽  
Author(s):  
Briana Shiri Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Traumatic Experience ◽  
Evidence Based ◽  
Mental Health Settings

Abstract Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is often neglected. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

scholarly journals Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Molly Davis ◽  
Courtney Benjamin Wolk ◽  
Shari Jager-Hyman ◽  
Rinad S. Beidas ◽  
Jami F. Young ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Behavioral Economics ◽  
Suicide Prevention ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Specialty Mental Health ◽  
Suicide Screening ◽  
Screening Assessment

Abstract Background Suicide is a global health issue. There are a number of evidence-based practices for suicide screening, assessment, and intervention that are not routinely deployed in usual care settings. The goal of this study is to develop and test implementation strategies to facilitate evidence-based suicide screening, assessment, and intervention in two settings where individuals at risk for suicide are especially likely to present: primary care and specialty mental health care. We will leverage methods from behavioral economics, which involves understanding the many factors that influence human decision making, to inform strategy development. Methods We will identify key mechanisms that limit implementation of evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health through contextual inquiry involving behavioral health and primary care clinicians. Second, we will use contextual inquiry results to systematically design a menu of behavioral economics-informed implementation strategies that cut across settings, in collaboration with an advisory board composed of key stakeholders (i.e., behavioral economists, clinicians, implementation scientists, and suicide prevention experts). Finally, we will conduct rapid-cycle trials to test and refine the menu of implementation strategies. Primary outcomes include clinician-reported feasibility and acceptability of the implementation strategies. Discussion Findings will elucidate ways to address common and unique barriers to evidence-based suicide screening, assessment, and intervention practices in primary care and specialty mental health care. Results will yield refined, pragmatically tested strategies that can inform larger confirmatory trials to combat the growing public health crisis of suicide.

scholarly journals The Importance of Mental Models in Implementation Science

2020 ◽  
Author(s):  
Jodi Summers Holtrop ◽  
Laura Scherer ◽  
Daniel Matlock ◽  
Russell E Glasgow ◽  
Lee A Green
Keyword(s):  
Mental Models ◽  
Implementation Science ◽  
Cognitive Task ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Evidence Based ◽  
Structured Interviews ◽  
Implementation Challenges ◽  
The World ◽  
The Way

Abstract Background: Implementation science is concerned with the study of adoption, implementation and maintenance of evidence-based interventions and use of implementation strategies to facilitate translation into practice. Ways to conceptualize and overcome challenges to implementing evidence-based practice may enhance the field of implementation science. The concept of mental models may be one way to view such challenges and to guide selection, use and adaptation of implementation strategies. Methods: A mental model is an interrelated set of beliefs that shape how a person forms expectations for the future and understands the way the world works. Mental models can shape how an individual thinks about or understands how something or someone does, can, or should function in the world. We review the concepts of mental models and illustrate how they pertain to implementation of an example intervention, shared decision making. A range of methods to elicit and analyze mental models are reviewed, including formal methods developed specifically for a given project. Results: Mental models may be sparse or detailed, may be shared among actors in implementation or not, and may be substantially tacit, i.e., of limited accessibility to introspection. Actors’ mental models can determine what information they are willing to accept and what changes they are willing to consider. We describe and illustrate multiple methods for eliciting and analyzing mental models including semi-structured interviews, cognitive task analyses and Delphi methods. Conclusions: Understanding the mental models of actors in implementation can provide crucial information for understanding, anticipating, and overcoming implementation challenges. Successful implementation often requires changing actors’ mental models or the way in which interventions or implementation strategies are presented or implemented. Accurate elicitation and understanding can guide strategies for doing so.

scholarly journals The Importance of Mental Models in Implementation Science

2021 ◽  
Vol 9 ◽  
Author(s):  
Jodi Summers Holtrop ◽  
Laura D. Scherer ◽  
Daniel D. Matlock ◽  
Russell E. Glasgow ◽  
Lee A. Green
Keyword(s):  
Mental Models ◽  
Implementation Science ◽  
Implementation Strategies ◽  
Successful Implementation ◽  
Evidence Based ◽  
Implementation Challenges ◽  
The World ◽  
Crucial Information ◽  
Potential Methods ◽  
The Way

Implementation science is concerned with the study of adoption, implementation and maintenance of evidence-based interventions and use of implementation strategies to facilitate translation into practice. Ways to conceptualize and overcome challenges to implementing evidence-based practice may enhance the field of implementation science. The concept of mental models may be one way to view such challenges and to guide selection, use, and adaptation of implementation strategies to deliver evidence-based interventions. A mental model is an interrelated set of beliefs that shape how a person forms expectations for the future and understands the way the world works. Mental models can shape how an individual thinks about or understands how something or someone does, can, or should function in the world. Mental models may be sparse or detailed, may be shared among actors in implementation or not, and may be substantially tacit, that is, of limited accessibility to introspection. Actors' mental models can determine what information they are willing to accept and what changes they are willing to consider. We review the concepts of mental models and illustrate how they pertain to implementation of an example intervention, shared decision making. We then describe and illustrate potential methods for eliciting and analyzing mental models. Understanding the mental models of various actors in implementation can provide crucial information for understanding, anticipating, and overcoming implementation challenges. Successful implementation often requires changing actors' mental models or the way in which interventions or implementation strategies are presented or implemented. Accurate elicitation and understanding can guide strategies for doing so.

scholarly journals Using Behavioral Insights to Design Implementation Strategies in Public Mental Health Settings: a Qualitative Study of Clinical Decision-Making

2020 ◽  
Author(s):  
Briana S Last ◽  
Simone H Schriger ◽  
Carter E. Timon ◽  
Hannah E Frank ◽  
Alison M. Buttenheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Decision Making ◽  
Clinical Decision Making ◽  
Behavioral Therapy ◽  
Qualitative Interviews ◽  
Public Mental Health ◽  
Implementation Strategies ◽  
Traumatic Experience ◽  
Evidence Based ◽  
Mental Health Settings

Abstract Background: Trauma focused-cognitive behavioral therapy (TF-CBT) is an evidence-based intervention for youth with posttraumatic stress disorder. An important component of TF-CBT is the trauma narrative (TN), a phase in the intervention in which youth are guided to process the memories, thoughts, and feelings associated with their traumatic experience(s). Previous work has shown that only half of TF-CBT clinicians complete the TN with their clients. Drawing from the behavioral insights literature—an interdisciplinary field studying judgment and decision-making—the present study seeks to understand what determines clinician use of the TN and to generate strategies that target these determinants. Methods: Through semi-structured qualitative interviews, we sought the perspectives of trained TF-CBT clinicians working in public mental health settings across the city of Philadelphia (n=17) to understand their decisions to use the TN with clients. We analyzed the qualitative data using a coding approach informed by the behavioral insights literature. We used an iterative process of structured hypothesis generation, aided by a behavioral insights guide, and rapid validation informed by behavioral insights to uncover the determinants of TN use. We then generated implementation strategies that targeted these determinants using the “Easy Attractive Social Timely” framework, a behavioral insights design approach. Results: We generated and validated three broad themes about what determines clinician implementation of the TN: decision complexity, clinician affective experience, and agency norms. We hypothesized the behavioral insights that underlie these implementation determinants and generated a list of nine behavioral insights strategies that theoretically may facilitate TN implementation. Conclusions: Our study investigated why an effective component of an evidence-based intervention is often neglected. We leveraged robust scientific theories and empirical regularities from the behavioral insights literature to understand clinician perspectives on TN implementation. These factors were theoretically linked to implementation strategies. Our work revealed the potential for using behavioral insights in the diagnosis of evidence-based intervention determinants and the design of implementation strategies.

Implementation Strategies

2017 ◽  
Author(s):  
JoAnn E. Kirchner ◽  
Thomas J. Waltz ◽  
Byron J. Powell ◽  
Jeffrey L. Smith ◽  
Enola K. Proctor
Keyword(s):  
Implementation Science ◽  
Comparative Effectiveness ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Efficient Manner

As the field of implementation science moves beyond studying barriers to and facilitators of implementation to the comparative effectiveness of different strategies, it is essential that we create a common taxonomy to define the strategies that we study. Similarly, we must clearly document the implementation strategies that are applied, the factors that influence their selection, and any adaptation of the strategy during the course of implementation and sustainment of the innovation being implemented. By incorporating this type of rigor into our work we will be able to not only advance the science of implementation but also our ability to place evidence-based innovations into the hands of practitioners in a timely and efficient manner.

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