A Stepped-Wedge Randomized trial Investigating the Effect of the Leadership and Organizational Change for Implementation (LOCI) Intervention on Implementation and Transformational Leadership, and Implementation Climate

Skar, Ane‐Marthe Solheim; Braathu, Nora; Peters, Nadina; Bækkelund, Harald; Endsjø, Mathilde; Babaii, Aida; Borge, Randi Hovden; Wentzel‐Larsen, Tore; Ehrhart, Mark G.; Sklar, Marisa; Brown, C. Hendricks; Aarons, Gregory A.; Egeland, Karina M.

doi:10.21203/rs.3.rs-670546/v1

Cited by 2 publications

(2 citation statements)

References 27 publications

(35 reference statements)

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“…Training in implementation leadership is related to a more positive therapist view on implementation leadership and climate (e.g., [1,53]), however less knowledge is available related to the association between leadership training and patient outcomes. From the results, it seems like leadership support might positively affect patient nonresponse and drop-out, although not enough to compensate for less intensive therapist training.…”

Section: Discussionmentioning

confidence: 99%

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

Skar

Braathu

Jensen

et al. 2022

BMC Health Serv Res

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Background There is a paucity of evidence about effective implementation strategies to increase treatment response and prevent drop-out among children receiving evidence-based treatment. This study examines patient, therapist, and implementation factors and their association to nonresponse and drop-out among youth receiving Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Methods Youth (n = 1240) aged 6–18 (M = 14.6) received TF-CBT delivered by 382 TF-CBT therapists at 66 clinics. Odds ratio analyses were used to investigate whether pretreatment child (age, gender, number of trauma experiences, post-traumatic stress symptoms (PTSS), therapist (education), and implementation strategy factors (high-low, low-low, low–high intensity therapist and leadership training respectively) or tele-mental health training during the Covid-19 pandemic are associated with nonresponse (above clinical PTSS level post-treatment) and drop-out (therapist-defined early termination). Fidelity checks were conducted to ensure that TF-CBT was used consistently. Results One fourth of the children (24.4%) were nonresponders and 13.3 percent dropped out. Exposure to three or more traumatic experiences were related to nonresponse and drop-out. Higher baseline PTSS was related to a higher probability of nonresponse. There was no effect of therapist education or child gender on nonresponse and drop-out, whereas children over 15 years had a higher likelihood of both. After controlling for baseline PTSS, the effect of age on nonresponse was no longer significant. Drop-out was related to fewer sessions, and most dropped out during the first two phases of TF-CBT. Fidelity was high throughout the different implementation phases. High-intensity therapist training was related to a lower probability of both nonresponse and drop-out, whereas low therapist and leadership training were related to a higher likelihood of both. Multivariate analysis revealed higher child age and higher PTSS baseline scores as significant predictors of nonresponse, and number of trauma experiences (> = 3) at baseline as the only predictor of drop-out. Conclusions High-intensity therapist training seem key to prevent patient nonresponse and drop-out. Leadership training might positively affect both, although not enough to compensate for less intensive therapist training. More complex cases (higher PTSS and exposure to more traumas) predict nonresponse and drop-out respectively, which underscores the importance of symptom assessment to tailor the treatment. The lack of predictive effect of therapist education increases the utilization of TF-CBT. Trial registration Retrospectively registered in ClinicalTrials, ref. nr. NCT05248971.

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Section: Discussionmentioning

confidence: 99%

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

Skar

Braathu

Jensen

et al. 2022

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

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“…However, peer reviewed evidence on the real-world application of such strategies, especially for intersectoral collaboration, is lacking even in high-income countries. It might be useful to investigate whether a Norwegian evidence-based strategy to improve leadership in a health care setting (Skar et al, 2021) and a mental health stigma-reducing intervention from Nepal (Kohrt et al, 2020) could be applied to the South African context to improve organisational readiness for CC models. In addition, future research could explore whether established CC models focussed on the prevention and treatment of HIV/AIDS and TB can be transferred to CC for MHC.…”

Section: Discussionmentioning

confidence: 99%

Collaborative care for mental health in South Africa: a qualitative systematic review

Truter

2022

South African Journal of Psychology

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Collaborative care for mental health is a strategy that restructures the roles of health care providers, and sectors outside of health care provision, to encourage a team-based approach in dealing with mental illness. Previous research proposed a collaborative care strategy to make mental health care more accessible and culturally appropriate. This study systematically reviewed the available literature to produce a summary of collaborative care in the context of mental health care in South Africa. More specifically, the aims were to document existing efforts towards collaboration and highlight barriers and challenges associated with collaborative care in mental health care in South Africa. This review was conducted in accordance with PRISMA guidelines. South African studies published in English between 2002 and October 2021 were considered for inclusion. Twenty-five studies with heterogeneous study designs were included in this review and analysed using a thematic synthesis approach. Collaborative care models hold promise for closing the mental health treatment gap and providing culturally appropriate mental health care in South Africa. However, despite progress made, several challenges remain in the implementation of collaborative policies. Four main strategies were identified to improve the implementation of collaborative care models in South Africa. These included (1) redirecting resources and improving infrastructure, (2) formalising roles and relationships and improving leadership, (3) improving communication and supervisory structures, and (4) improving training and education. This review offers valuable recommendations for South African mental health care policy that might also be useful for other resource-constrained countries.

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A Stepped-Wedge Randomized trial Investigating the Effect of the Leadership and Organizational Change for Implementation (LOCI) Intervention on Implementation and Transformational Leadership, and Implementation Climate

Cited by 2 publications

References 27 publications

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

Collaborative care for mental health in South Africa: a qualitative systematic review

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