Integrating multi-level partner perspectives to improve progress monitoring implementation in youth community mental health

About This Grant

PROJECT SUMMARY/ABSTRACT Despite concerted efforts by states, counties, agencies, and researchers to promote evidence-based treatments (EBTs) for youth in community mental health (CMH) settings, youth mental health outcomes are often still poor. Implementing regular assessment of outcomes, or “progress monitoring” (PM), alongside EBTs can support EBT implementation and improve youth outcomes. However, barriers such as competing demands and fear of PM data potentially being used punitively against clinicians hinder the widespread adoption of PM in routine practice. Many studies have investigated ways to address PM implementation barriers, though most neglected addressing important barriers that are perceived to be low in feasibility to address, potentially jeopardizing successful PM implementation. Additionally, system leaders could have valuable insights on solutions for addressing these barriers, but they are rarely included in implementation research efforts. Guided by the Exploration, Preparation, Implementation and Sustainment (EPIS) Framework, the current study engages constituents from both the inner (clinic partners) and outer context (system leaders) to understand barriers to PM identified as priorities by clinics and implementation strategies needed to address these barriers. Findings will be used to develop a tailored implementation blueprint, or plan of action, for PM across the Preparation, Implementation and Sustainment phases in one CMH center serving youth. This study leverages an ongoing Washington (WA) state-wide EBT training initiative called CBT+ that trains youth- focused CMH clinicians on the common elements of cognitive-behavioral therapy (CBT) for anxiety, depression, trauma and behavior disorders. For the proposed project, we will partner with a WA state payer, Community Health Plan of Washington. We use innovative methods from the NIMH-funded ALACRITY Center, IMPACT. Study aims are to: Aim 1. (1a) Identify which barriers to PM implementation are priorities to address using the IMPACT Center barrier prioritization method and (1b) Understand the goals and perceptions of PM from constituents at multiple levels through qualitative focus groups and quantitative assessments; Aim 2. Collaboratively match implementation strategies to prioritized barriers from Aim 1. Clinic partners and system leaders will brainstorm strategies using Ideation (IMPACT method) for prioritized barriers, with a particular focus on engaging system leaders to identify strategies for high importance, low feasibility barriers. Participants will match strategies to barriers and develop enactment plans for a subset of the strategies; Aim 3. Develop and evaluate a 3-phase tailored implementation blueprint for PM at a CMH center that serves youth. Findings from this study will be used to develop practical methods for implementing PM in CMH settings that are scalable and generalizable to other settings, with the ultimate goal of improving youth mental health services and outcomes.