Community Mental Health Agencies Research Articles

Changing the Game? Increasing the Impact of Peer-Run Organizations.

Employment and deployment of peer support specialists in both clinical and non-clinical mental health settings has increased substantially since the 1990's. Peer-run organizations are defined as those led and managed by individuals with self-disclosed lived experience of mental health conditions. Many peer-run organizations promoting advocacy and offering services have been established during the past 30 years. Some adherents assert the effectiveness of peer-run organizations over hybrid mental health service providers in which peer support workers are integrated or partnered with existing community mental health agency multidisciplinary clinical and treatment teams. Although research has indicated the positive contributions of peer-run organizations to service user recovery, the impact of peer-run organizations on system transformation is not well documented. This concept paper explores benefits, accomplishments, and challenges faced by a peer-run organization during its 30-year evolution in offering self-help groups, supported housing, peer support services, peer specialist training, and systems change projects in Los Angeles County, California. Future research topics and policy options are suggested, along with recommendations for the SAMHSA Office of Recovery.

Implementation of the Community Homes for Opportunity Program Among Community Mental Health Staff in Southwestern Ontario

Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline–spring 2018 and post-implementation – winter 2019). Data analysis guided by Leininger’s ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration.

An Integrated Care Pathway for depression in adolescents: protocol for a Type 1 Hybrid Effectiveness-implementation, Non-randomized, Cluster Controlled Trial

IntroductionOur group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information ‘Bout OUtcomes, 2nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings.Methods and analysisWe will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13–18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale—Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness.Ethics and disseminationResearch ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.

Community Mental Health Services for Frequent Emergency Department Users: A Qualitative Study of Outcomes Perceived by Program Clients and Case Managers.

This study aimed to investigate the perceived outcomes and mechanisms of change of a community mental health service combining system navigation and intensive case management supports for frequent emergency department users presenting with mental illness or addiction. The study setting was a community mental health agency receiving automated referrals directly from hospitals in a midsize Canadian city for all individuals attending an emergency department two or more times within 30 days for mental illness or addiction. Qualitative interviews with 15 program clients. Focus groups with six program case managers. Data were analyzed using pragmatic qualitative thematic analysis. Participants generally reported perceiving that the program contributed to reduced emergency department use, reduced mental illness symptom severity, and improved quality of life. Perceived outcomes were more mixed for outcomes related to addiction. Reported mechanisms of change emphasized the importance of positive working relationships between program clients and case managers, as well as focused efforts to develop practical skills. Community mental health services including intensive case management for frequent emergency department users presenting with mental illness or addiction were perceived to effectively address client needs while reducing emergency department resource burden. Similar programs should emphasize the development of consistent and warm working relationships between program clients and case managers, as well as practical skills development to support client health and well-being.

Policy for Equity: Associations Between Community Mental Health Agency Policies and Clinicians’ Cultural Competence

Systemic reform is needed to address racism as a root cause of mental health inequities, such as understanding how community mental health (CMH) agencies’ practices and policies may impact care provided to racially minoritized populations. This study described and examined associations between CMH clinicians’ multicultural knowledge and awareness and agency practices and policies to improve care for Clients of Color. CMH clinicians (N = 119) across Washington State reported on their multicultural competence and agencies’ practices and policies in an online survey. Multicultural competence was assessed with the Multicultural Counseling Knowledge and Awareness Scale (MCKAS), which assesses respondents’ knowledge of multicultural counseling frameworks and awareness of multicultural counseling issues. Agency policies were examined with an adapted version of the Multiculturally Competent Service System (MCSS) Assessment Guide, which asked respondents to endorse the degree to which their agencies had taken specific steps to better serve racially and ethnically minoritized populations across 11 domains, including policies, linguistic diversity in services, and quality monitoring and improvement. Multicultural knowledge and awareness were generally high across the sample. Clinicians commonly endorsed that their agencies had mission statements that were committed to cultural competence. Endorsement of concrete steps to improve services for non-English speaking clients was associated with greater multicultural knowledge and awareness, and practices to monitor and improve care provided to Clients of Color were associated with lower scores. Addressing mental health inequities requires multifaceted solutions. Results highlight the potential of examining agency practices and policies as one solution to improve care for Clients of Color.

보호관찰 청소년 재범방지를 위한 증거기반원칙과 지역사회 역할에 관한 소고

The current study attempts to provide the roles of communities in terms of reducing recidivism of juvenile probationers and parolees in South Korea. In order to lay the groundwork, the current study also introduces the evidence-based principles and policies regarding juvenile delinquency. Traditionally, the efforts to reduce recidivism among juvenile probationers and parolees have suffered from two limitations. The first one concerns the fact that those policies have not been premised on evidence based principles and programs. Therefore the extant polices have been experimenting with new ideas or have been accepting the policies that have been proven ineffective in other countries. The second limitation is related to the fact that most of those efforts have largely focused on the roles of probation officers or Ministry of Justice. As a result, a serious discussion has gone missing on the basic issue such as what kinds of community resources should be reserved for whom in the community and how?
 Against this backdrop, the current study provides reviews of the extant literature of what works on juvenile delinquents. In doing so, much attention is given to the theory of Risk, Needs, Responsivity Principles (RNR principles). As a main argument advanced for the current paper, the roles of community will be offered in order to reduce recidivism of juvenile probationer and parolees. More specifically, the attention will largely focus on the issues such as the roles of probation officers, voluntary probation officers, school systems, community mental health agencies, and community shelters along with local governments. Finally, this study concludes with some useful tips and recommendations for future research and practices.

Fostering the community participation of individuals with psychiatric disabilities: Effectiveness of a new peer-led photovoice-based intervention.

Having meaningful social roles and full community participation have been examined as a central tenet of the recovery paradigm. We undertook this study to test a new multimodal, peer-led intervention, which we have developed with the aim of fostering the self-efficacy of individuals with psychiatric disabilities to pursue involvement in community activities of their choice. We evaluated the effectiveness of the 6-month manualized peer-delivered "Bridging Community Gaps Photovoice (BCGP)" program with a multisite randomized trial (N = 185), with recipients of services at five community mental health programs. Mixed-effects regression models were used to examine the impact of the program on community participation, loneliness, personal stigma, psychosocial functioning, and personal growth and recovery when compared to services as usual. Individuals who were randomized to the BCGP intervention were also invited to participate in exit focus groups, exploring the program's perceived active ingredients of mechanisms of impact. Participation in the BCGP program facilitated ongoing involvement in community activities and contributed to a decreased sense of alienation from other members of the community due to internalized stigma of mental illness. In addition, greater attendance of group BCGP sessions had a significant impact on participants' sense of self-efficacy in pursuing desired community activities. This study provided initial evidence about the promise of the BCGP program in enhancing community participation. Its implementation in community mental health agencies can further expand the recovery-oriented services provided to people with psychiatric disabilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

A Mixed-Methods Implementation Evaluation of Virtual Reality Job Interview Training in IPS Supported Employment.

Employment rates among individuals with serious mental illness may be improved by engagement in the individual placement and support (IPS) model of supported employment. Results from a recent randomized controlled trial (RCT) indicate that virtual reality job interview training (VR-JIT) improves employment rates among individuals with serious mental illness who have been actively engaged in IPS for at least 90 days. This study reports on an initial implementation evaluation of VR-JIT during the RCT in a community mental health agency. A sequential, complementary mixed-methods design included use of qualitative data to improve understanding of quantitative findings. Thirteen IPS staff trained to lead VR-JIT implementation completed VR-JIT acceptability, appropriateness, and feasibility surveys. Participants randomly assigned to IPS with VR-JIT completed acceptability (N=42) and usability (N=28) surveys after implementation. The authors also conducted five focus groups with IPS staff (N=11) and VR-JIT recipients (N=13) and semistructured interviews with IPS staff (N=9) and VR-JIT recipients (N=4), followed by an integrated analysis process. Quantitative results suggest that IPS staff found VR-JIT to be highly acceptable, appropriate for integration with IPS, and feasible for delivery. VR-JIT was highly acceptable to recipients. Qualitative results add important context to the quantitative findings, including benefits of VR-JIT for IPS staff as well as adaptations for delivering technology-based interventions to individuals with serious mental illness. These qualitative and quantitative findings are consistent with each other and were influenced by VR-JIT's adaptability and perceived benefits. Tailoring VR-JIT instruction and delivery to individuals with serious mental illness may help optimize VR-JIT implementation within IPS.

Care planning needs for youth in custody, inpatient and outpatient settings

BackgroundDespite comparable rates of mental health problems, youth in custody, in- and outpatient groups typically differ with respect to experiences of trauma and expression of internalizing and externalizing behaviours. While comparisons between these groups have been made, an exploration of specific care planning needs have yet to be investigated. ObjectivesTo compare the care planning needs identified for youth in custody and those within inpatient (e.g., mental health hospital admissions) and outpatient treatment (e.g., community mental health agencies), while controlling for age and sex differences. MethodsThe sample consisted of 755 youth aged 16–19 recruited from youth justice and mental health facilities in Ontario, Canada. Semi-structured interviews using the interRAI child and youth suite of instruments were completed. Items that signify imminent risk, as well as the accompanying Collaborative Action Plans among samples of youth were compared. ResultsMale youth in custody were more likely to require care planning related to substance/tobacco/nicotine use and withdrawal symptoms than both in- and outpatient youth. They also were more likely to report harm to others, while inpatient females were most likely to report self-harm. Irrespective of case type, males were more likely to require care planning related to educational needs and communication. Youth in custody were more likely to trigger Collaborative Action Plans related to transition planning compared to patient groups. ConclusionsEvidence suggests that youth involved within the justice system present with a unique and complex set of needs. This research supports the need for tailored services and evidence-based intervention that may transgress the boundaries of the youth justicesetting to the community.

Case managers' reflections of a brief case management intervention in Canada.

As demand for intensive case management services continues to outpace supply, community mental health agencies in Toronto, Ontario, introduced Short-Term Case Management (STCM). This study sought to explore case managers' perspectives and experiences with this new service delivery model. Focus groups were conducted with twenty-one case managers, and transcripts analyzed using thematic analysis. Emerging themes suggest that despite embracing a recovery approach, case managers expressed mixed views on the acceptability and appropriateness of this service delivery model as an intervention. The ideal population for this intervention are adults with mental health issues in need of system navigation, and those motivated to address their goals. Further research is needed to establish fidelity criteria.

From court to the community: improving access to evidence-based treatment for underserved youth involved in the juvenile legal system at-risk for suicide

BackgroundJuvenile legal involved youth (JLIY) experience disproportionately high rates of suicidal and self-injurious thoughts and behaviors (SSITB). Many JLIY lack access to evidence-based treatment specifically designed to treat SSITB, thereby increasing the overall risk of suicide. The overwhelming majority of JLIY are not placed in secure facilities and almost all incarcerated youth are eventually released to the community. Consequently, SSITB are a major concern of JLIY residing in the community and it is critical that this population has access to evidence-based treatment for SSITB. Unfortunately, most community mental health providers who treat JLIY have not been trained in evidence-based interventions that are specifically designed to SSITB, which often leads to youth experiencing prolonged periods of SSITB. Training community mental health providers who serve JLIY in the detection and treatment of SSITB shows promise for decreasing the overall suicide risk for JLIY.MethodsThe current proposal aims to reduce SSITB among JLIY, and thus reduce mental health disparities in this vulnerable and underserved youth population, by increasing access to evidence-based treatment strategies specifically designed to treat SSITB behaviors. We will implement an agency-wide training among at least 9 distinct community mental health agencies that serve JLIY referred to treatment by a statewide court system in the Northeast. Agencies will be trained in an adapted version of the COping, Problem Solving, Enhancing life, Safety, and Parenting (COPES+) intervention. Training will be implemented via a cluster-randomized stepped wedge trial that proceeds through multiple phases.DiscussionThis research engages multiple systems (i.e., juvenile legal and mental health systems) serving JLIY and has the potential to directly inform treatment practices in juvenile legal and mental health systems. The current protocol has significant public health implications as the primary goals are to reduce SSITB among adolescents involved in the juvenile legal system. By implementing a training protocol with community-based providers to help them learn an evidence-based intervention, this proposal aims to reduce mental health disparities in a marginalized and underserved population.Trial registrationosf.io/sq9zt

The impact of child maltreatment on mental health outcome improvements among children and youth accessing community mental health care

BackgroundAlthough children with histories of maltreatment are more likely to engage with mental healthcare than non-maltreated children, few studies have examined the impact of maltreatment on children's mental health outcome improvement over time. ObjectiveThe current study addresses this gap in the present literature by exploring the ways that histories of physical, sexual, and emotional abuse and exposure to domestic violence can influence children's improvement on mental health outcomes commonly associated with trauma. Participants and settingDe-identified routine care data from 58 community mental health agencies across Ontario, Canada, representing 16,517 children was obtained. This data represented assessments that occurred between February 2015 and December 2021. MethodsGeneral linear models were used to illustrate the effect of each trauma type on change scores computed between baseline and follow-up assessments of externalizing behaviours, risk of harm to others, depressive symptoms, risk of suicide and self-harm, and anxiety, while adjusting for baseline scores, inpatient status, time between assessments, and select demographic variables. ResultsWhen the effects of each trauma type was considered separately, children without histories of trauma consistently showed greater improvement than those with that trauma across all mental health outcomes (0.07–0.44, p < 0.01). When all trauma types were considered together, sexual abuse was associated with some of the most significant negative impacts on children's mental health improvements. ConclusionsOur findings highlight an urgent need for the implementation of standardized, evidence-based assessments that screen trauma histories of children accessing mental health supports and research examining the impact of trauma on children's treatment responsiveness.

Parent-child interaction therapy for children in foster care and children with posttraumatic stress: Exploring behavioral outcomes and graduation rates in a large state-wide sample

ObjectiveParent-Child Interaction Therapy (PCIT) is an evidence-based treatment to reduce child disruptive behaviors and has been used for children with co-occurring posttraumatic stress symptoms (PTS). However, many families are faced with barriers that interfere with treatment completion. Engagement and attrition issues remain a continuous concern for families accessing needed services for youth. Furthermore, these issues are exacerbated for children in foster care. MethodsThe present study explored differences in behavioral outcomes and graduation rates for children in foster care, (n = 206), non-foster care children with a history of trauma (n = 249), and non-foster care children without a history of trauma (n = 1,522) who participated in PCIT. Data was collected in community mental health agencies across the state of Oregon. ResultsThere was a significant decrease in caregiver reported disruptive behavior scores for all groups following PCIT. There were no significant differences found in graduation rates and average number of sessions attended between the groups; however, the graduation rate for this sample was low (17.8%). ConclusionsResults demonstrate that PCIT can be similarly effective in reducing problematic behaviors for children placed in foster care when compared to children not in foster care. Practical Implications: Given the low graduation rate, is imperative that we continue to investigate strategies to enhance treatment engagement and reduce barriers to services.

Interprofessional team based learning to enhance behavioral health care for Latinx patients: Results of a teleconsultation program.

Culturally sensitive behavioral health services are scarce, particularly in rural and underserved areas. To expand integrated behavioral health care training for providers, specifically those working in rural communities and federally qualified health centers, an interprofessional teleconsultation program was developed. Given the desire to focus on culturally informed care training, this was done in partnership with a nonprofit community mental health agency which focuses on behavioral health within Latinx populations. The teleconsultation sessions were provided bimonthly using Zoom and included didactic components and case-based discussion using the Multidimensional Ecosystemic Comparative Approach (MECA; Falicov, 1995; Falicov, 2017). Participants represented a diverse, interprofessional group composed of behavioral health professionals (45.2%), primary care physicians (26.8%), family medicine residents (15.3%), and others (medical students and administrative staff [12.7%]). The program evaluation demonstrates that participants valued the teleconsultation sessions and articulated specific skills that they subsequently planned to integrate into their clinical practice to enhance care. This teleconsultation model allows interprofessional training across multiple types of organizations to enhance knowledge in providing integrated behavioral health care for Latinx populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Sequential mixed method evaluation of the acceptability, feasibility, and appropriateness of cognitive behavioral therapy for psychosis stepped care

BackgroundCognitive Behavioral Therapy for psychosis (CBTp) is recommended by national treatment guidelines yet remains widely inaccessible in the U.S. A stepped care model, favored and feasible for other scarce interventions, may improve access to CBTp.MethodsWe employed an exploratory sequential mixed method design inclusive of two distinct phases to quantitatively evaluate the acceptability, feasibility, and appropriateness of CBTp Stepped Care (CBTp-SC) among practitioners who were trained in low-intensity CBTp (Step 1), Group-Administered CBTp (Step 2), and Formulation-based CBTp (Step 3). In Phase 1, we queried respondents using the Acceptability of Intervention Measure, Intervention Appropriateness Measure, and the Feasibility of Intervention Measure to ascertain perceptions of these leading indicators of implementation success. In Phase 2, we conducted focus groups with CBTp-SC-trained practitioners (n = 10) and administrators (n = 2) from 2 of the 4 Phase 1 study sites to evaluate the theoretical assumptions of stepped care and to better understand key barriers and facilitators.ResultsForty-six practitioners trained in all three levels of CBTp-SC completed the online survey in Phase 1. All participants were employed by a community mental health agency currently sustaining CBTp-SC. Respondents endorsed high levels of acceptability, feasibility, and appropriateness for the CBTp-SC model. We found evidence to suggest that licensed practitioners and Step 3 practitioners perceived formulation-based CBTp as more appropriate for their clients. In Phase 2, six themes emerged which affirmed the utility of the model for stakeholders, supported stepped care theoretical assumptions, and revealed key areas for improvement.ConclusionsEarly adopters of CBTp-SC in the U.S. perceive it to be acceptable, feasible, and appropriate in community mental health care settings. Practitioners and administrators identified training and implementation barriers, including the importance of organizational readiness, a CBTp coordinator role, and a desire to adapt the intervention. These early findings will facilitate iterative refinement of the stepped care model for U.S. public behavioral health agencies. Additional research is needed to explore perceptions and clinical outcomes among CBTp service users.

39 Developmental Pediatrics Canadian Workforce Survey

Abstract Background Children with complex developmental needs may require assistance from a developmental pediatric specialist to complete specialized assessments, treatments, and therapies. Despite reports of large waiting lists at many academic centres, there is no workforce information regarding developmental pediatric care in Canada. Prior surveys of the developmental pediatric workforce in the United States have suggested that the pipeline of new trainees completing sub-specialty residency in developmental pediatrics may not be sufficient to meet predicted needs. Objectives In an effort to capture demographic data to understand the current developmental pediatric workforce, we conducted a survey to determine: 1) the demographic profile of developmental pediatric professionals who comprise the current workforce and their career plans; 2) the challenges and trends needing to be considered for future resource planning; and 3) opportunities for innovative care provision within developmental pediatrics. Design/Methods The workforce subcommittee of the Developmental Pediatrics Specialty Committee of the Royal College of Physicians and Surgeons of Canada (RCPSC) drafted a 26-item questionnaire. This cross-sectional survey was pilot tested, and guided by a previous instrument used by the American Academy of Pediatrics. The study population included practicing developmental pediatricians in Canada, who were sent an email link from the RCPSC inviting them to respond. Data analysis was completed using descriptive statistics. Results A total of 145 participants completed the study (91% response rate). Forty-five percent of the responding developmental pediatricians have &amp;gt;20 years of experience. Within the next three to five years, 23% of the respondents plan to retire completely from practice. Trends influencing workforce planning were identified including the influence of government funding resources for specific neurodevelopmental disorders (32% of responses), requirements for translation services (70% of responses), and coordination issues with multi-disciplinary assessments (64% of responses). Top ranked priorities for innovative care provision in this specialty included further collaborations with community mental health agencies, capacity building in Autism Spectrum Disorder diagnosis, and an increased focus on care navigation efficiencies. Conclusion There are concerning trends present in the demographic distribution of developmental pediatricians given upcoming retirements and increasing service demands. Targeted advocacy to promote capacity building and recruitment to the specialty may be needed to ensure service needs continue to be met.

Medicaid, Race, Utilization of Crisis Services at Community Mental Health Agencies

We compare African-American and White clients receiving services at 13 rural and semi-rural community mental health agencies (CMHAs) and the impact of Medicaid on the use of crisis and outpatient services. SEM was utilized to model the indirect effect of crisis services between the association of Medicaid and total hours of outpatient services. We modeled the moderating effects of race using mixture modeling and latent class. The base model showed a non-significant indirect effect between having Medicaid and total hours of services through the use of crisis services (Indirect effect = 0.01, p = .98). African-American clients who received Medicaid were more likely to use crisis services ([Formula: see text], which was associated with increased hours of outpatient services ([Formula: see text]. In general, Medicaid was not related to increase service or crisis service usage. However, African-American clients access crisis services significantly more than White clients.

Michigan seeks to enhance children's crisis care

Community mental health agencies in Michigan are eligible for additional state money under a grant program designed to expand children's access to mobile crisis care services.

Enhancing the quality of cognitive behavioral therapy in community mental health through artificial intelligence generated fidelity feedback (Project AFFECT): a study protocol

BackgroundEach year, millions of Americans receive evidence-based psychotherapies (EBPs) like cognitive behavioral therapy (CBT) for the treatment of mental and behavioral health problems. Yet, at present, there is no scalable method for evaluating the quality of psychotherapy services, leaving EBP quality and effectiveness largely unmeasured and unknown. Project AFFECT will develop and evaluate an AI-based software system to automatically estimate CBT fidelity from a recording of a CBT session. Project AFFECT is an NIMH-funded research partnership between the Penn Collaborative for CBT and Implementation Science and Lyssn.io, Inc. (“Lyssn”) a start-up developing AI-based technologies that are objective, scalable, and cost efficient, to support training, supervision, and quality assurance of EBPs. Lyssn provides HIPAA-compliant, cloud-based software for secure recording, sharing, and reviewing of therapy sessions, which includes AI-generated metrics for CBT. The proposed tool will build from and be integrated into this core platform.MethodsPhase I will work from an existing software prototype to develop a LyssnCBT user interface geared to the needs of community mental health (CMH) agencies. Core activities include a user-centered design focus group and interviews with community mental health therapists, supervisors, and administrators to inform the design and development of LyssnCBT. LyssnCBT will be evaluated for usability and implementation readiness in a final stage of Phase I. Phase II will conduct a stepped-wedge, hybrid implementation-effectiveness randomized trial (N = 1,875 clients) to evaluate the effectiveness of LyssnCBT to improve therapist CBT skills and client outcomes and reduce client drop-out. Analyses will also examine the hypothesized mechanism of action underlying LyssnCBT.DiscussionSuccessful execution will provide automated, scalable CBT fidelity feedback for the first time ever, supporting high-quality training, supervision, and quality assurance, and providing a core technology foundation that could support the quality delivery of a range of EBPs in the future.Trial registrationClinicalTrials.gov; NCT05340738; approved 4/21/2022.

Implementation strategy mapping methods to improve autism intervention use in community settings: a study protocol

BackgroundImplementation strategies are purported to facilitate adoption and use of evidence-based practices (EBPs) across settings. The use of tailored implementation strategies may be particularly effective, as they are selected with the explicit purpose of addressing setting-specific implementation determinants. However, methods to select and tailor implementation strategies, including in community settings, remain understudied. This project will identify and describe implementation strategy mapping methods (ISMMs) from extant peer-reviewed literature and pilot test a method to match implementation strategies with determinants in low-resourced community mental health (CMH) agencies that deliver services to children on the autism spectrum.MethodsAim 1: A scoping review, following PRISMA guidelines, will be conducted to identify implementation strategy mapping methods (ISMMs) utilized in child mental health settings. Data extraction will identify and describe each ISMM, including identifying methodological and procedural steps, analyzing the frequency of ISMM use, and identifying outcomes measured in eligible ISMM studies.Aim 2: Using scoping review findings, select and pilot test one ISMM within five community mental health agencies in Michigan that provide services to autistic children. We will recruit five directors/agency leaders, supervisors, and direct providers at each of the eligible agencies (expected N = 25). A sequential explanatory (QUAN➔ QUAL) mixed methods design will be used. Participants will complete a demographics and client survey, as well as a needs assessment to identify implementation determinants. The impact of the ISMM on organizational readiness for change (from pre- to post-ISMM), as well as implementation outcomes of the ISMM (feasibility, acceptability, appropriateness, usability), will be examined. Semi-structured interviews will elicit stakeholder perspectives on the mapping method.DiscussionThe current project aims to advance our knowledge of methods for selecting, tailoring, and mapping implementation strategies to address context-specific determinants to implementation. Additionally, this project will contribute to growing science found at the intersection of implementation science and autism research by utilizing the implementation determinants framework, the CFIR, to guide data collection, analysis, and interpretation of findings. Finally, these findings may support future EBP implementation efforts within low-resourced communities, with the ultimate goal of increasing equity in access to EBPs for autistic children.