Abstract
ObjectiveAlthough tailored implementation methods are touted as superior to standardized, few researchers have directly compared the two and little guidance regarding the specific details of each method exist. Our study compares these methods in a dynamic cluster randomized trial seeking to optimize implementation of measurement based care (MBC) for depression in community behavioral health. This specific manuscript provides a detailed, replicable account of the components of each multi-faceted implementation method.ResultsThe standardized best practice method includes training, consultation, a clinical guideline, and electronic health record enhancements with the goal to optimize the delivery of MBC with fidelity. Conversely, the tailored, customized and collaborative method is informed by recent implementation science advancements and begins with a needs assessment, followed by tailored training that feeds back barriers data to clinicians, the formation of an implementation team, a clinician-driven clinic-specific guideline, and the use of fidelity data to inform implementation team activities; the goal of the tailored condition is to ensure the intervention and implementation strategies address unique factors of the context. The description of these methods will inform others seeking to implement MBC, as well as those planning to use standardized or tailored implementation methods for interventions beyond behavioral health.
Highlights
Measurement based care is an evidence-based practice (EBP) that involves the routine use of standardized assessment results (i.e., Patient Health Questionnaire, PHQ-9 for depression severity [1]) to guide psychotherapy practice [2], but this practice is used by fewer than 20% of behavioral health clinicians in the United States [3–5]
Building consultation teams all clinicians were invited to join the consultation meetings, opinion leaders and champions, as determined by self-report measures at baseline (i.e., Sociometric Survey [15] and Opinion Leadership Scale [16]), were invited to attend the consultation meetings and their schedules were prioritized, noting that they play a pivotal role in their clinic. Consultation team meetings It is well-documented that training alone is insufficient for changing behavior and consultation is needed to increase skill and support implementation [17]
Teams sorted barriers into one of the four quadrants with the intention of first addressing barriers that were deemed of high feasibility and high importance. In both conditions objective and clinician self-reported measurement based care (MBC) fidelity data was collected from the Electronic Health Record (EHR), this data was consolidated into performance summary reports and disseminated to implementation team members by a research associate 1 day prior to their meetings to guide their work
Summary
The standardized best practice method includes training, consultation, a clinical guideline, and electronic health record enhancements with the goal to optimize the delivery of MBC with fidelity. The tailored, customized and collaborative method is informed by recent implementation science advancements and begins with a needs assessment, followed by tailored training that feeds back barriers data to clinicians, the formation of an implementation team, a clinician-driven clinic-specific guideline, and the use of fidelity data to inform implementation team activities; the goal of the tailored condition is to ensure the intervention and implementation strategies address unique factors of the context The description of these methods will inform others seeking to implement MBC, as well as those planning to use standardized or tailored implementation methods for interventions beyond behavioral health
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