Improving Sustainment through Implementation Supports to Reduce Burnout in Therapists Delivering Child Trauma EBPs

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PROJECT SUMMARY/ABSTRACT Many evidence-based mental health interventions have been developed to address the negative outcomes associated with child exposure to early adversity and trauma. Despite these promising advances, however, the majority of children served in publicly funded mental health systems do not receive evidence-based programs (EBPs). To address this research-to-practice gap, several large-scale, system-driven implementation efforts of multiple trauma EBPs have been launched over the last decade, including in the states of California and Arkansas. Though these system-driven initiatives often increase EBP delivery in community settings following the initial implementation push, long-term sustainment of EBP delivery is low. Workforce risk factors, such as provider burnout leading to turnover, have been identified as contributing to the poor long-term sustainment of trauma EBPs. Therefore, an important step to consider in supporting the long- term sustainment of child trauma EBPs is to develop implementation strategies that target provider burnout and organizational climate factors associated with decreased provider retention. This proposed K23 Mentored Patient-Oriented Research Career Development Award will develop and pilot a package of implementation strategies, “Supporting Providers & Preventing the Overwhelming of Resources in Trauma Systems” (SUPPORTS), aimed increasing the sustained delivery of trauma EBPs by addressing the factors associated with provider retention related to burnout. The development of SUPPORTS will be informed by a needs assessment conducted with programs involved with the multiple-EBP implementation efforts in California and Arkansas. This project will build upon the applicant’s foundation of research and clinical experience while also providing specialized training critical for the applicant’s future development. Specifically, the applicant requires additional training in: 1) theory and practice in implementation science with particular emphasis on organizational management and science as it pertains to the development and testing of implementation strategies; 2) advanced methodologies, including qualitative and mixed qualitative and quantitative methods; and 3) healthcare economic techniques to evaluate the impact of implementation strategies. This training will be facilitated by mentorship from the applicant’s primary sponsor, Dr. Lauren Brookman-Frazee, and her co-sponsors, Drs. Gregory Aarons, Todd Gilmer, Lisa Kath, and Allison Hamilton. This project will provide pilot data to motivate a subsequent NIMH R01 application to conduct a large-scale trial of the implementation strategies supporting the sustainment of child trauma EBPs. In addition, this project will provide the applicant with the advanced training and skills required to launch an independent research program focused on improving mental healthcare services for children exposed to early adversity and trauma.