Understanding the impact of organizational implementation strategies on EBT use

了解组织实施策略对 EBT 使用的影响

• 批准号: 8722035
• 负责人: Nathaniel J. Williams
• 金额: $ 3.07万
• 依托单位: UNIVERSITY OF TENNESSEE KNOXVILLE
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-13 至 2015-08-07
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8722035
• 关键词: Address; Adoption; Advanced Development; American; Area; Behavioral Research; Biomedical Research; Child; Child Mental Health; Childhood; Client; Clinical; Collaborations; Complex; Consultations; Development; Diffusion of Innovation; Educational workshop; Effectiveness; Evidence based treatment; Failure; Family; Funding; Goals; Health system; Intervention; Investments; Knowledge; Learning; Link; Literature; Mental Health; Mental Health Services; Mental disorders; Mentors; National Institute of Mental Health; Organizational Change; Organizational Culture; Outcome; Personal Satisfaction; Personnel Turnover; Process; Public Health; Publications; Quality of life; Randomized Controlled Trials; Reading; Research; Research Personnel; Research Project Grants; Research Training; Role; Science; Scientist; Services; Site; Social Environment; Stress; System; Testing; Training; Training Activity; Treatment Cost; Visit; Work; base; career; community setting; cost; experience; implementation research; implementation science; improved; innovation; organizational climate; programs; research study; skills; success; symposium; theories; treatment as usual

DESCRIPTION (provided by applicant): Approximately 15 million American children suffer from psychiatric disorders at an estimated treatment cost of $8.9 billion annually. During the last 30 years several effective evidence-based treatments (EBTs) have been developed to treat these conditions. However, EBTs are rarely implemented successfully in usual care practice settings. Given the typically poor outcomes of usual care services, the National Institute of Mental Health recently prioritized research that develops and tests implementation strategies to effectively integrate EBTs within community settings. Implementation researchers have tested a range of implementation strategies in mental health settings but two key knowledge gaps limit the field. First, researchers have yet to identify the specific change processes (i.e., the require "active ingredients" of implementation interventions), or the specific change mechanisms (i.e., the intermediate changes that occur during the course of the intervention and serve as the basis for the effect) that explain how and why implementation strategies generate desired changes. Identification of change processes and mechanisms is critical to developing the most effective and efficient implementation strategies for targeted settings. Second, although most mental health services are provided within complex organizations and decades of research suggest organizational social context is vital to successful innovation implementation, few implementation strategies target social context. The next steps in advancing the development of effective implementation strategies involve understanding how successful implementation strategies generate their effects, and specifically addressing the role of social context in the cross-level organizational change that characterizes successful EBT implementation. The proposed research training plan enables the PI to develop an independent program of research focused on identifying the organizational change processes and mechanisms that contribute to effective integration of EBTs into routine clinical settings. The research training plan includes advanced training activities that develop the PI's competency across three core areas: implementation science, organizational interventions, and organizational change mechanisms. The plan includes specialized didactic learning activities (elective coursework, workshops, and conferences), collaboration with three expert implementation scientists who are each directing NIMH-funded R01 implementation studies, and completion of an independent research project. The research project is the first to directly test organizational change processes and change mechanisms in the context of a randomized controlled trial of an organizational implementation strategy. The training plan prepares the PI for an independent research career focused on improving the implementation of effective mental health treatments in usual care settings. The likely benefits of this research include enhanced quality of life for children with psychiatric disorders and their families and reduced costs of mental health treatment through greater efficiency and effectiveness of service systems.

描述（由申请人提供）：大约有 1500 万美国儿童患有精神疾病，每年的治疗费用估计为 89 亿美元。最后期间 30 年来，已经开发出多种有效的循证疗法 (EBT) 来治疗这些疾病。然而，EBT 很少在常规护理实践环境中成功实施。鉴于常规护理服务通常效果不佳，国家心理健康研究所最近优先开展研究，开发和测试实施策略，以有效地将 EBT 纳入社区环境。实施研究人员已经测试了心理健康环境中的一系列实施策略，但两个关键的知识差距限制了该领域。首先，研究人员尚未确定具体的变革过程（即实施干预措施所需的“活性成分”），或具体的变革机制（即干预过程中发生的中间变化，并作为干预措施的基础）。效果），解释实施策略如何以及为何产生所需的变化。确定变革过程和机制对于针对目标环境制定最有效和高效的实施战略至关重要。其次，尽管大多数心理健康服务是在复杂的组织内提供的，并且数十年的研究表明组织的社会背景对于成功的创新实施至关重要，但很少有实施策略针对社会背景。 推进有效实施战略制定的下一步包括了解成功的实施战略如何产生其效果，并具体解决社会背景在跨层级组织变革中的作用，而跨层级组织变革是成功 EBT 实施的特征。拟议的研究培训计划使 PI 能够开发一个独立的研究计划，重点是确定有助于将 EBT 有效整合到常规临床环境中的组织变革过程和机制。研究培训计划包括高级培训活动，旨在培养 PI 在三个核心领域的能力：实施科学、组织干预和组织变革机制。该计划包括专门的教学学习活动（选修课程、研讨会和会议）、与三位专家实施科学家（他们各自指导 NIMH 资助的 R01 实施研究）的合作，以及完成一个独立的研究项目。该研究项目是第一个在组织实施策略的随机对照试验背景下直接测试组织变革过程和变革机制的项目。该培训计划帮助 PI 为独立研究生涯做好准备，重点是改善常规护理环境中有效心理健康治疗的实施。这项研究可能带来的好处包括提高患有精神疾病的儿童及其家人的生活质量，并通过提高服务系统的效率和有效性来降低精神健康治疗的成本。

项目成果

Multilevel Mechanisms of Implementation Strategies in Mental Health: Integrating Theory, Research, and Practice.

心理健康实施策略的多层次机制：理论、研究和实践的结合。

• 发表时间: 2016-09
• 作者: Williams; Nathaniel J
• 通讯作者: Nathaniel J

Assessing mental health clinicians' intentions to adopt evidence-based treatments: reliability and validity testing of the evidence-based treatment intentions scale.

评估心理健康临床医生采用循证治疗的意图：循证治疗意图量表的信度和效度测试。

• 发表时间: 2016-05-05
• 作者: Williams; Nathaniel J
• 通讯作者: Nathaniel J

Aligning organizational priorities with ARC to improve youth mental health service outcomes.

将组织优先事项与 ARC 保持一致，以改善青少年心理健康服务成果。

• 发表时间: 2016-08
• 影响因子: 5.9
• 作者: Glisson, Charles;Williams, Nathaniel J;Hemmelgarn, Anthony;Proctor, Enola;Green, Philip
• 通讯作者: Green, Philip

Assessing and changing organizational social contexts for effective mental health services.

评估和改变组织的社会环境以提供有效的心理健康服务。

• 发表时间: 2015-03-18
• 作者: Glisson, Charles;Williams, Nathaniel J
• 通讯作者: Williams, Nathaniel J

Testing a theory of organizational culture, climate and youth outcomes in child welfare systems: a United States national study.

测试儿童福利系统中的组织文化、气候和青年成果的理论：一项美国国家研究。

• 发表时间: 2014-04
• 影响因子: 4.8
• 作者: Williams NJ;Glisson C
• 通讯作者: Glisson C