Measuring implementation climate: psychometric properties of the Implementation Climate Scale (ICS) in Norwegian mental health care services

BackgroundEmployees’ perceptions of organizational climate for implementation of new methods are important in assessing and planning for implementation efforts. More specifically, feedback from employees’ points to which implementation strategies to select, adopt, and tailor in building positive climate for implementation of new evidence-based practices within the organization. Implementation climate can be measured with the Implementation Climate Scale (ICS). The purpose of this study was to investigate the psychometric properties of the Norwegian version of the ICS in outpatient mental health clinics.MethodsThe ICS was administered to 383 clinicians within 47 different child and adult mental health clinics across the country. We conducted confirmatory factor analysis to assess the psychometric functioning of the ICS. Cronbach’s alpha was examined to assess internal consistency. We also examined criterion related validity of the scale by comparing it with an alternative measure of implementation climate (concurrent validity) and by examining correlations with clinicians’ intentions to use evidence-based practices.ResultsResults supported the 6-factor structure and the internal consistency reliability of the ICS. One exception was poor functioning of the Reward scale. Concurrent validity was stronger at the group than at the individual level, and assessment of associations with clinicians’ intentions to use evidence- based practices showed positive correlations.ConclusionsThe Norwegian version of the ICS is a promising tool for assessing implementation climate which can provide organizations with specific feedback concerning which aspects of the implementation climate to attend to. Due to poor functioning of the Reward scale, adaptations and further testing of this is recommended.

Dissemination of a COVID-19 Rapid Response Telehealth Group Addressing Worry and Social Isolation Among Older Adults

In response to the urgent need for virtual mental health treatments during the COVID-19 pandemic, an 8-week group intervention deliverable over video or telephone was developed and disseminated in March 2020. Manual content addressed social isolation and information related to COVID-19. In August 2020, a national web-based provider feedback survey was disseminated to evaluate feasibility of the manual. Respondents (n = 21) across a variety of geriatric mental health clinics reported this intervention to be effective and clinically useful with their patients in providing social support and in mitigating COVID-19 anxieties. The majority of respondents delivered the group in multiple cohorts and found the manual adaptable beyond the early pandemic period.

Ushering in the Silver Age of Telehealth: Addressing Telehealth Disparities for Older Adults With Disabilities

One silver lining of COVID-19 has been the ushering in of ‘the golden age of telehealth’. However, this unplanned rapid conversion to telehealth left many providers and clinics unprepared to address systemic barriers that adversely affect older adults, particularly those with disabilities. Data from the VA Corporate Data Warehouse suggest that the rapid adoption of telehealth in mental health clinics during COVID-19 widened telehealth utilization disparities for older Veterans (65+) with disabilities. With 4.5 million Veterans 55+ who have at least one disability more attention to addressing this widening gap is needed. For those with hearing, vision, and complex mobility impairments, there are unique challenges to initiating telehealth services. Dr. Touchett will present preliminary findings while discussing ethical and contextual considerations when using telehealth with older Veterans who have disabilities, while discussing ways to facilitate robust clinical encounters for this population.

Post-Traumatic Stress Disorder Treatment Outcomes in Military Clinics

ABSTRACT Introduction Despite a wide literature describing the impact of PTSD on military personnel, there is limited information concerning the results of PTSD treatment within military clinics mental health. Having such information is essential for making predictions about service members’ chances of recovery, choosing best treatments, and for understanding if new interventions improve upon the standard of care. Materials and Methods We reviewed data from the Psychological Health Pathways (PHP) database. Psychological Health Pathways is a standardized battery of demographics and psychometric outcome measures, including measurement of PTSD symptom severity, that is collected in military mental health clinics. We examined changes in PTSD symptom severity scores over time and developed logistic regression models to predict who responded to treatment, showed clinical success, or improved to the point that they could likely stay in the military. Results After about 10 weeks in mental health clinics, severity scores for PTSD, sleep, depression, resilience, and disability all improved significantly. Of 681 patients tracked, 38% had clinically significant reductions on the PTSD Checklist (PCL) (i.e., “treatment response”), 28% no longer met criteria for PTSD on the PCL, and 23% did both (i.e., “clinical treatment success”). For the ultimate end point of “military treatment success,” defined as meeting criteria for both clinical treatment success and reporting that their work-related disability was mild or better, 12.8% of patients succeeded. Depression scores were the most powerful predictor of treatment failure. Conclusions Recovery from PTSD is possible during military service, but it is less likely in individuals with certain negative prognostic factors, most notably severe depression.

Clinical leaders and providers’ perspectives on delivering medications for the treatment of opioid use disorder in Veteran Affairs’ facilities

Background Improving access to medication treatment of opioid use disorder (MOUD) is a national priority, yet common modifiable barriers (e.g., limited provider knowledge, negative beliefs about MOUD) often challenge implementation of MOUD delivery. To address these barriers, the VA launched a multifaceted implementation intervention focused on planning and educational strategies to increase MOUD delivery in 18 medical facilities. The purpose of this investigation was to determine if a multifaceted intervention approach to increase MOUD delivery changed providers’ perceptions about MOUD over the first year of implementation. Methods Cross-disciplinary teams of clinic providers and leadership from primary care, pain, and mental health clinics at 18 VA medical facilities received invitations to complete an anonymous, electronic survey prior to intervention launch (baseline) and at 12- month follow-up. Responses were summarized using descriptive statistics, and changes over time were compared using regression models adjusted for gender and prescriber status, and clustered on facility. Responses to open-ended questions were thematically analyzed using a template analysis approach. Results Survey response rates at baseline and follow-up were 57.1% (56/98) and 50.4% (61/121), respectively. At both time points, most respondents agreed that MOUD delivery is important (94.7 vs. 86.9%), lifesaving (92.8 vs. 88.5%) and evidence-based (85.2 vs. 89.5%). Over one-third (37.5%) viewed MOUD delivery as time-consuming, and only 53.7% affirmed that clinic providers wanted to prescribe MOUD at baseline; similar responses were seen at follow-up (34.5 and 52.4%, respectively). Respondents rated their knowledge about OUD, comfort discussing opioid use with patients, job satisfaction, ability to help patients with OUD, and support from colleagues favorably at both time points. Respondents’ ratings of MOUD delivery filling a gap in care were high but declined significantly from baseline to follow-up (85.7 vs. 73.7%, p < 0.04). Open-ended responses identified implementation barriers including lack of support to diagnose and treat OUD and lack of time. Conclusions Although perceptions about MOUD generally were positive, targeted education and planning strategies did not improve providers’ and clinical leaders’ perceptions of MOUD over time. Strategies that improve leaders’ prioritization and support of MOUD and address time constraints related to delivering MOUD may increase access to MOUD in non-substance use treatment clinics.

Proportion of U.S. Clinics Offering LGBT-Tailored Mental Health Services Decreased Over Time: A Panel Study of the National Mental Health Services Survey

Our objective was to characterize the proportion of U.S. mental health clinics that offered LGBT-tailored mental health services between 2014 and 2018. We used data from the National Mental Health Services Survey (NMHSS) to construct a mixed logistic model of availability of LGBT-tailored mental health services over time, by region (Northeast, South, Midwest and West), and by facility type (Veterans Administration, inpatient/residential, outpatient, community mental health centers and mixed). Our results show that the overall proportion of mental health clinics that offered LGBT-tailored services decreased from 2014 to 2018. Our results also indicate that Veteran Affairs clinics and facilities in the West and Northeast were most likely to offer LGBT-tailored mental health services. Given the temporal, regional, and facility gaps in LGBT-tailored mental health services availability, more effort should be dedicated to addressing this disparity.

Turnover and Retention Strategies Among Mental Health Workers

BackgroundThe purpose of this study was to explore retention strategies that healthcare administrators use to retain mental health workers in community mental health clinics. The study was guided by the question What strategies do HCAs use to retain their MHWs with more than 2 years of experience? MethodsA qualitative case study analysis was performed. Interviews were conducted with six healthcare administrators at Fort Worth area community mental health clinics. Interviews were coded using thematic analysis. To increase the study’s reliability and validity, the interview guide was field checked by experts and member checking performed on interview transcripts.ResultsThe healthcare administrators identified six strategies for retention: providing good benefits packages, promoting worker health and wellness, providing competitive salaries, giving workers flexible scheduling options, incentivizing workers with rewards and positive reinforcement, and maintaining open communication channels.ConclusionsThe results from this study have positive implications for mental health workers, patients, and community mental health clinics. The strategies identified in this study can be implemented to increase worker satisfaction and reduce turnover. In doing so, patients will receive higher quality care and organizations will be more attractive to prospective employees.