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      The 4KEEPS study: identifying predictors of sustainment of multiple practices fiscally mandated in children’s mental health services

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          Research to date has largely focused on predictors of adoption and initial implementation of evidence-based practices (EBPs), yet sustained implementation is crucial to deliver a return on investments in dissemination. Furthermore, most studies focus on single EBPs, limiting opportunities to study the fit between practice characteristics EBPs and implementation contexts.


          This observational study will characterize implementation sustainment and identify organizational and therapist characteristics that predict sustainment of multiple practices being implemented within a fiscal mandate in the largest public mental health system in the USA. Specific aims are to (1) characterize sustainment outcomes (volume/penetration, EBP concordant care); (2) use mixed methods to characterize inner context (agency- and therapist-level) factors and early implementation conditions; and (3) identify inner context factors and early implementation conditions that predict sustainment outcomes. This study will undertake original data collection and analysis of existing data sources to achieve its aims. Archived reports and documents will be used to characterize early implementation conditions in 102 agencies. Administrative claims data will be used to characterize volume and penetration outcomes over 8 years. Therapist and program manager surveys will be administered to characterize sustained EBP concordant care and inner context determinants of sustainment. An in-depth study in a subset of agencies will yield interview data and recordings of treatment sessions for validation of the EBP concordant care scale.


          This project will yield new understanding of whether and how multiple EBPs can be sustained in public mental health systems undergoing a policy-driven community implementation effort. We will produce generalizable models for characterizing sustainment, including feasible and flexible measurement of practice across multiple EBPs. The findings will inform the development of implementation interventions to promote sustained delivery of EBPs to maximize their public health impact.

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          The online version of this article (doi:10.1186/s13012-016-0388-4) contains supplementary material, which is available to authorized users.

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          Most cited references 34

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          The dissemination and implementation of evidence-based psychological treatments. A review of current efforts.

          Recognizing an urgent need for increased access to evidenced-based psychological treatments, public health authorities have recently allocated over $2 billion to better disseminate these interventions. In response, implementation of these programs has begun, some of it on a very large scale, with substantial implications for the science and profession of psychology. But methods to transport treatments to service delivery settings have developed independently without strong evidence for, or even a consensus on, best practices for accomplishing this task or for measuring successful outcomes of training. This article reviews current leading efforts at the national, state, and individual treatment developer levels to integrate evidence-based interventions into service delivery settings. Programs are reviewed in the context of the accumulated wisdom of dissemination and implementation science and of methods for assessment of outcomes for training efforts. Recommendations for future implementation strategies will derive from evaluating outcomes of training procedures and developing a consensus on necessary training elements to be used in these efforts. 2009 APA, all rights reserved.
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            Implementing computerized technology: an organizational analysis.

            Why do some organizations succeed and others fail in implementing the innovations they adopt? To begin to answer this question, the authors studied the implementation of manufacturing resource planning, an advanced computerized manufacturing technology, in 39 manufacturing plants (number of individual respondents = 1,219). The results of the plant-level analyses suggest that financial resource availability and management support for technology implementation engender high-quality implementation policies and practices and a strong climate for implementation, which in turn foster implementation effectiveness--that is, consistent and skilled technology use. Further research is needed to replicate and extend the findings.
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              Dynamic adaptation process to implement an evidence-based child maltreatment intervention

              Background Adaptations are often made to evidence-based practices (EBPs) by systems, organizations, and/or service providers in the implementation process. The degree to which core elements of an EBP can be maintained while allowing for local adaptation is unclear. In addition, adaptations may also be needed at the system, policy, or organizational levels to facilitate EBP implementation and sustainment. This paper describes a study of the feasibility and acceptability of an implementation approach, the Dynamic Adaptation Process (DAP), designed to allow for EBP adaptation and system and organizational adaptations in a planned and considered, rather than ad hoc, way. The DAP involves identifying core elements and adaptable characteristics of an EBP, then supporting implementation with specific training on allowable adaptations to the model, fidelity monitoring and support, and identifying the need for and solutions to system and organizational adaptations. In addition, this study addresses a secondary concern, that of improving EBP model fidelity assessment and feedback in real-world settings. Methods This project examines the feasibility, acceptability, and utility of the DAP; tests the degree to which fidelity can be maintained using the DAP compared to implementation as usual (IAU); and examines the feasibility of using automated phone or internet-enabled, computer-based technology to assess intervention fidelity and client satisfaction. The study design incorporates mixed methods in order to describe processes and factors associated with variations in both how the DAP itself is implemented and how the DAP impacts fidelity, drift, and adaptation. The DAP model is to be examined by assigning six regions in California (USA) to either the DAP (n = 3) or IAU (n = 3) to implement an EBP to prevent child neglect. Discussion The DAP represents a data-informed, collaborative, multiple stakeholder approach to maintain intervention fidelity during the implementation of EBPs in the field by providing support for intervention, system, and organizational adaptation and intervention fidelity to meet local needs. This study is designed to address the real-world implications of EBP implementation in public sector service systems and is relevant for national, state, and local service systems and organizations.

                Author and article information

                Implement Sci
                Implement Sci
                Implementation Science : IS
                BioMed Central (London )
                9 March 2016
                9 March 2016
                : 11
                [ ]University of California, Los Angeles, USA
                [ ]University of California, San Diego, USA
                © Lau and Brookman-Frazee. 2016

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;
                Award ID: R01 MH100134
                Award ID: R01 MH100134-S
                Study Protocol
                Custom metadata
                © The Author(s) 2016


                children’s mental health, fiscally driven implementation


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