Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem

Beidas, Rinad S.; Dorsey, Shannon; Lewis, Cara C.; Lyon, Aaron R.; Powell, Byron J.; Purtle, Jonathan; Saldana, Lisa; Shelton, Rachel C.; Stirman, Shannon Wiltsey; Lane‐Fall, Meghan

doi:10.1186/s13012-022-01226-3

Cited by 96 publications

(81 citation statements)

References 128 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Finally, this approach to tailoring the implementation of measurement-based care, although informed by a framework, was largely atheoretical. The field is at a point of readiness for centering theory to inform practical implementation [ 54 , 55 ]. In the case of tailoring implementation, causal theory can be leveraged in at least two ways.…”

Section: Discussionmentioning

confidence: 99%

Mediators of measurement-based care implementation in community mental health settings: results from a mixed-methods evaluation

Lewis

Boyd

Marti³

et al. 2022

Implementation Sci

View full text Add to dashboard Cite

Background Tailored implementation approaches are touted as superior to standardized ones with the reasoning that tailored approaches afford opportunities to select strategies to resolve determinants of the local context. However, results from implementation trials on this topic are equivocal. Therefore, it is important to explore relevant contextual factors that function as determinants to evaluate if they are improved by tailoring and subsequently associated with changes in implementation outcomes (i.e., via statistical mediation) to better understand how tailoring achieves (or does not achieve) its effects. The present study examined the association between a tailored and standardized implementation approach, contextual factors that might mediate change, and a target implementation outcome in an initiative to implement measurement-based care (specifically the clinical integration of the Patient Health Questionnaire [PHQ-9] for depression) in a community mental health organization. Methods Using a cluster randomized control design, twelve community-based mental health clinics were assigned to a tailored or standardized implementation group. Clinicians completed a self-report battery assessing contextual factors that served as candidate mediators informed by the Framework for Dissemination at three time points: baseline, 5 months after active implementation support, and 10 months after sustainment monitoring. A subset of clinicians also participated in focus groups at 5 months. The routine use of the PHQ-9 (implementation outcome) was monitored during the 10-month sustainment period. Multi-level mediation analyses assessed the association between the implementation group and contextual factors and the association between contextual factors and PHQ-9 completion. Quantitative results were then elaborated by analyzing qualitative data from exemplar sites. Results Although tailored clinics outperformed standard clinics in terms of PHQ-9 completion at the end of active implementation, these group differences disappeared post sustainment monitoring. Perhaps related to this, no significant mediators emerged from our quantitative analyses. Exploratory qualitative analyses of focus group content emphasized the importance of support from colleagues, supervisors, and leadership when implementing clinical innovations in practice. Conclusions Although rates of PHQ-9 completion improved across the study, their sustained levels were roughly equivalent across groups and low overall. No mediators were established using quantitative methods; however, several partial quantitative pathways, as well as themes from the qualitative data, reveal fruitful areas for future research. Trial registration Standardized versus tailored implementation of measurement-based care for depression. ClinicalTrials.gov NCT02266134, first posted on October 16, 2014

show abstract

Section: Discussionmentioning

confidence: 99%

Mediators of measurement-based care implementation in community mental health settings: results from a mixed-methods evaluation

Lewis

Boyd

Marti³

et al. 2022

Implementation Sci

View full text Add to dashboard Cite

show abstract

“…Efficient implementation strategies are essential because implementation often occurs in underresourced settings with many competing priorities and demands. If effective but complex implementation strategies that require substantial time and resources to deploy are developed, this would essentially duplicate already-existing challenges in implementing psychotherapy interventions (Beidas et al, 2022). However, in combination with the effort and resources spent on developing and testing interventions, findings from implementation science can foster progress toward the ultimate goals of improving well-being and ensuring equity and access to effective treatments, thereby realizing the promise and expanding the reach of psychological science.…”

Section: Discussionmentioning

confidence: 99%

Implementing Evidence-Based Mental-Health Treatments: Attending to Training, Fidelity, Adaptation, and Context

Stirman

2022

Curr Dir Psychol Sci

Self Cite

View full text Add to dashboard Cite

This article provides a very high-level overview of some key considerations in the field of implementation science as it relates to clinical psychology. The article reviews recent findings regarding treatment fidelity, adaptation of treatments, and clinical outcomes. It then details some recent findings on training therapists to provide evidence-based therapies as they were designed to be delivered, with sufficient skill and adaptations if needed to ensure better fit for clients who receive treatments in different treatment settings. Finally, the article considers implications for implementing and sustaining new treatments and supporting their fidelity and adaptation, as well as key directions for future research.

show abstract

“…These developments are encouraging and in line with calls for advancements expressed in the proceedings from the 2020 conference (Engell et al, 2021 ). However, we urge Norwegian implementation research to take note of potential pitfalls implementation science, in general, is at risk of encountering, such as limitations in the practicality and applicability of implementation frameworks and strategies for natural practice settings and underestimating structural and contextual variation (Beidas et al, 2022 ).…”

Section: Discussionmentioning

confidence: 99%

Proceedings from the Second Annual Conference of the Norwegian Network for Implementation Research

Egeland

Engell

Halvorsen

et al. 2022

Glob Implement Res Appl

View full text Add to dashboard Cite

In 2019, Norwegian implementation researchers formed a network to promote implementation research and practice in the Norwegian context. On November 19th, 2021, the second annual Norwegian implementation conference was held in Oslo. Ninety participants from all regions of the country gathered to showcase the frontiers of Norwegian implementation research. The conference also hosted a panel discussion about critical next steps for implementation science in Norway. The conference included 17 presentations from diverse disciplines within health and welfare services, including schools. The themes presented included stakeholder engagement, implementation mechanisms, evaluations of the implementation of specific interventions, the use of implementation guidelines and frameworks, the development and validation of implementation measurements, and barriers and facilitators for implementation. The panel discussion highlighted several critical challenges with the implementation of evidence-informed practices in Norway, including limited implementation competence and capacity among practice leaders and workforces, few opportunities for education in implementation science, limited implementation research in the Norwegian context, scarce funding possibilities for implementation research, and a lack of long-term perspectives on implementation processes. Overall, the 2021 Norwegian implementation conference showed an encouraging sign of a maturing field of science in Norway. The more voluminous proceedings from the 2020 conference called for several important advancements to improve implementation science and practice in Norway, and the 2021 conference indicates that steps have already been taken in favorable directions in terms of, for instance, research designs and measurements. However, there are still unexploited potentials for improvements in implementation research, funding, policies, and practice. Norwegian implementation researcher should be mindful of the challenges and potential pitfalls implementation science currently face as a scientific discipline.

show abstract

Promises and pitfalls in implementation science from the perspective of US-based researchers: learning from a pre-mortem

Cited by 96 publications

References 128 publications

Mediators of measurement-based care implementation in community mental health settings: results from a mixed-methods evaluation

Mediators of measurement-based care implementation in community mental health settings: results from a mixed-methods evaluation

Implementing Evidence-Based Mental-Health Treatments: Attending to Training, Fidelity, Adaptation, and Context

Proceedings from the Second Annual Conference of the Norwegian Network for Implementation Research

Contact Info

Product

Resources

About