Innovations in mental health services implementation: A report on state-level data from the U.S. Evidence-Based Practices Project

VA Center for the Study of Healthcare Provider Behavior, VA Greater Los Angeles Healthcare System, Sepulveda, California, USA.
Implementation Science (Impact Factor: 4.12). 02/2006; 1(1):13. DOI: 10.1186/1748-5908-1-13
Source: PubMed


The Evidence-Based Practice (EBP) Project has been investigating the implementation of evidence-based mental health practices (Assertive Community Treatment, Family Psychoeducation, Integrated Dual Diagnosis Treatment, Illness Management and Recovery, and Supported Employment) in state public mental health systems in the United States since 2001. To date, Project findings have yielded valuable insights into implementation strategy characteristics and effectiveness. This paper reports results of an effort to identify and classify state-level implementation activities and strategies employed across the eight states participating in the Project.
Content analysis and Greenhalgh et al's (2004) definition of innovation were used to identify and classify state-level activities employed during three phases of EBP implementation: Pre-Implementation, Initial Implementation and Sustainability Planning. Activities were coded from site visit reports created from documents and notes from key informant interviews conducted during two periods, Fall 2002-Spring 2003, and Spring 2004. Frequency counts and rank-order analyses were used to examine patterns of implementation activities and strategies employed across the three phases of implementation.
One hundred and six discreet implementation activities and strategies were identified as innovative and were classified into five categories: 1) state infrastructure building and commitment, 2) stakeholder relationship building and communications, 3) financing, 4) continuous quality management, and 5) service delivery practices and training. Implementation activities from different categories were employed at different phases of implementation.
Insights into effective strategies for implementing EBPs in mental health and other health sectors require qualitative and quantitative research that seeks to: a) empirically test the effects of tools and methods used to implement EBPs, and b) establish a stronger evidence-base from which to plan, implement and sustain such efforts. This paper offers a classification scheme and list of innovative implementation activities and strategies. The classification scheme offers potential value for future studies that seek to assess the effects of various implementation processes, and helps establish widely accepted standards and criteria that can be used to assess the value of innovative activities and strategies.

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Available from: Jennifer L. Magnabosco, Apr 04, 2014
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    • "Barriers may exist when policies or mandates for EBP use are enacted without incentives or other changes to the system to support their adoption, integration, and sustainment. While scant, the literature on funding and financing in EBPs in health care indicates that funding plays an important role in obtaining training in EBPs, its implementation, and sustainment (Bond et al., 2014; Isett et al., 2007; Magnabosco, 2006; Massatti, Sweeney, Panzano, & Roth, 2008; Swain, Whitley, McHugo, & Drake, 2010). "

    Full-text · Chapter · Sep 2015
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    • "Financing for innovative mental health services is a challenge for many states and providers because of standardization and billing procedures (Magnabosco 2006). Medical necessity criteria involve documenting diagnoses and functional deficits in clients. "
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    • "The adoption, implementation, and sustainment of evidenced-based practices (EBPs) are becoming increasingly important for health and allied healthcare organizations and providers, and widespread adoption of EBPs holds promise to improve quality of care and patient outcomes [1,2]. Considerable resources are being allocated to increase the implementation of EBPs in community care settings with support for activities such as training service providers and increased staffing to support monitoring of implementation-related activities [3]. Although there are calls for increased attention to organizational context in EBP dissemination and implementation [4,5], there are gaps in examining how organizational context affects EBP implementation. "
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    ABSTRACT: In healthcare and allied healthcare settings, leadership that supports effective implementation of evidenced-based practices (EBPs) is a critical concern. However, there are no empirically validated measures to assess implementation leadership. This paper describes the development, factor structure, and initial reliability and convergent and discriminant validity of a very brief measure of implementation leadership: the Implementation Leadership Scale (ILS). Participants were 459 mental health clinicians working in 93 different outpatient mental health programs in Southern California, USA. Initial item development was supported as part of a two United States National Institutes of Health (NIH) studies focused on developing implementation leadership training and implementation measure development. Clinician work group/team-level data were randomly assigned to be utilized for an exploratory factor analysis (n = 229; k = 46 teams) or for a confirmatory factor analysis (n = 230; k = 47 teams). The confirmatory factor analysis controlled for the multilevel, nested data structure. Reliability and validity analyses were then conducted with the full sample. The exploratory factor analysis resulted in a 12-item scale with four subscales representing proactive leadership, knowledgeable leadership, supportive leadership, and perseverant leadership. Confirmatory factor analysis supported an a priori higher order factor structure with subscales contributing to a single higher order implementation leadership factor. The scale demonstrated excellent internal consistency reliability as well as convergent and discriminant validity. The ILS is a brief and efficient measure of unit level leadership for EBP implementation. The availability of the ILS will allow researchers to assess strategic leadership for implementation in order to advance understanding of leadership as a predictor of organizational context for implementation. The ILS also holds promise as a tool for leader and organizational development to improve EBP implementation.
    Full-text · Article · Apr 2014 · Implementation Science
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