A learning collaborative approach to training school-based health providers in evidence-based mental health treatment

Stephan, Sharon H.; Connors, Elizabeth H.; Arora, Prerna; Brey, Laura

doi:10.1016/j.childyouth.2013.09.008

Cited by 15 publications

(12 citation statements)

References 36 publications

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“… Monthly throughout the SAMHSA/CSAT-funded implementation initiative. [ 70 – 72 ] K. Use other payment schemes: Introduce payment approaches motivate the clinician to provide better service. Our research team funded by NIAAA to test the incremental effectiveness and cost-effectiveness of P4P as an implementation strategy.…”

Section: Methodsmentioning

confidence: 99%

Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial

et al. 2018

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BackgroundPay-for-performance (P4P) has been recommended as a promising strategy to improve implementation of high-quality care. This study examined the incremental cost-effectiveness of a P4P strategy found to be highly effective in improving the implementation and effectiveness of the Adolescent Community Reinforcement Approach (A-CRA), an evidence-based treatment (EBT) for adolescent substance use disorders (SUDs).MethodsBuilding on a $30 million national initiative to implement A-CRA in SUD treatment settings, urn randomization was used to assign 29 organizations and their 105 therapists and 1173 patients to one of two conditions (implementation-as-usual (IAU) control condition or IAU+P4P experimental condition). It was not possible to blind organizations, therapists, or all research staff to condition assignment. All treatment organizations and their therapists received a multifaceted implementation strategy. In addition to those IAU strategies, therapists in the IAU+P4P condition received US $50 for each month that they demonstrated competence in treatment delivery (A-CRA competence) and US $200 for each patient who received a specified number of treatment procedures and sessions found to be associated with significantly improved patient outcomes (target A-CRA). Incremental cost-effectiveness ratios (ICERs), which represent the difference between the two conditions in average cost per treatment organization divided by the corresponding average difference in effectiveness per organization, and quality-adjusted life years (QALYs) were the primary outcomes.ResultsAt trial completion, 15 organizations were randomized to the IAU condition and 14 organizations were randomized to the IAU+P4P condition. Data from all 29 organizations were analyzed. Cluster-level analyses suggested the P4P strategy led to significantly higher average total costs compared to the IAU control condition, yet this average increase of 5% resulted in a 116% increase in the average number of months therapists demonstrated competence in treatment delivery (ICER = $333), a 325% increase in the average number of patients who received the targeted dosage of treatment (ICER = $453), and a 325% increase in the number of days of abstinence per patient in treatment (ICER = $8.134). Further supporting P4P as a cost-effective implementation strategy, the cost per QALY was only $8681 (95% confidence interval $1191–$16,171).ConclusionThis study provides experimental evidence supporting P4P as a cost-effective implementation strategy.Trial registrationNCT01016704.

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Section: Methodsmentioning

confidence: 99%

Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial

et al. 2018

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“…Studies of Learning Collaboratives focused on client outcomes have found that this method is associated with improved engagement in behavioral health services (Cavaleri et al, 2006(Cavaleri et al, , 2007(Cavaleri et al, , 2010Rutkowski et al, 2010), including initiating (Cavaleri et al, 2006) and sustaining (Cavaleri et al, 2007) gains in initial appointment attendance rates. It also has been associated with improvements in children's behavioral support services in schools (Stephan, Connors, Arora, & Brey, 2013) and trauma-focused service providers (Dopp, Hanson, Saunders, Dismuke, & Moreland, 2017;Lang, Franks, Epstein, Stover, & Oliver, 2015).…”

Section: Consultation and Supervision Strategiesmentioning

confidence: 99%

Proposing a mechanistic model of clinician training and consultation.

McLeod

Cox

Jensen‐Doss

et al. 2018

Clinical Psychology: Science and Practice

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To make evidence-based treatments deliverable, effective, and scalable in community settings, it is critical to develop a workforce that can deliver evidence-based treatments as designed with skill. However, the science and practice of clinician training and consultation lags behind other areas of implementation science. In this paper, we present the Longitudinal Education for Advancing Practice (LEAP) model designed to help span this gap. The LEAP model is a mechanistic model of clinician training and consultation that details how training inputs, training and consultation strategies, and mechanisms of learning influence training outcomes. We first describe the LEAP model and then discuss how key implications of the model can be used to develop effective training and consultation strategies.

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“…These approaches are compelling, considering research supporting the effectiveness of common elements interventions relative to both usual care and standard-arranged evidence-based treatment manuals (Weisz et al, 2012). Furthermore, prior research has documented that a modularized, common elements paradigm demonstrates good fit for groups of school-based mental health providers (Lyon, Ludwig, et al, 2014; Lyon, Charlesworth-Attie, Vander Stoep, & McCauley, 2011; Stephan, Wissow, & Pichler, 2010; Weist et al, 2009), with some studies including medical providers as well (Stephan, Connors, Arora, & Brey, 2013). Building on these findings, faculty from the University of Maryland’s Center for School Mental Health have developed an innovative initiative, the Mental Health Training Intervention for Health Providers in Schools (MH-TIPS; Bohnenkamp et al, 2015), which includes training for school nurses in common elements of evidence-based practice.…”

Section: A Preliminary Collaborative Care Model For Schoolsmentioning

confidence: 99%

Collaborative care in schools: enhancing integration and impact in youth mental health

Lyon

Whitaker

French

et al. 2016

Advances in School Mental Health Promotion

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Collaborative Care is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality, and lowering healthcare expenditures. A large body of evidence supports the effectiveness of Collaborative Care models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analog for the accessibility that primary care offers to adults. Collaborative Care aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of Collaborative Care models in schools. Based on the existing evidence for Collaborative Care models, the current paper (1) provides a rationale for the adaptation of Collaborative Care models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary Collaborative Care model for use in schools; and (3) describes avenues for research surrounding school-based Collaborative Care, including the currently funded Accessible, Collaborative Care for Effective School-based Services (ACCESS) project.

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A learning collaborative approach to training school-based health providers in evidence-based mental health treatment

Cited by 15 publications

References 36 publications

Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial

Pay-for-performance as a cost-effective implementation strategy: results from a cluster randomized trial

Proposing a mechanistic model of clinician training and consultation.

Collaborative care in schools: enhancing integration and impact in youth mental health

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