Implementing Chronic Care Management for Bipolar Disorder

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DESCRIPTION (provided by applicant): Few evidence-based treatment models for mental disorders have been translated into community-based practices. A primary reason for this research-to-practice gap is the lack of tools and incentives to maintain treatment fidelity (e.g., training) while maximizing generalizability across different settings. The goal of this randomized controlled trial is to determine whether a systematic framework for implementing behavioral health treatment models leads to improved intervention fidelity and patient outcomes in community-based mental health practices. We will test components of the Replicating Effective Programs (REP) implementation framework, which includes: 1) translation of effective treatment models into culturally appropriate, non- technical components ("packaging"), 2) formal training of providers in implementing the package, and 3) supporting the transfer of the package through technical assistance (TA). Using the bipolar disorder care model (BCM) as an example of an effective intervention, we will package the BCM, and then randomize 60 community-based practices from three large behavioral health organizations to receive the BCM package along with training and TA, or the BCM package only. All practices will receive the BCM package, which includes: 1) self-management education scripts, 2) care management protocols, and 3) simplified practice guidelines. In the training/TA arm, selected staff at sites will receive standardized training in the BCM and structured TA via a specialist who will contact site representatives on a regular basis to problem-solve local barriers to BCM implementation. Primary (12-month) outcomes include patient-level fidelity to BCM core elements, clinical status (e.g., symptoms, functioning, quality of life), and REP/BCM cost-effectiveness. Translating effective treatment models from research to practice is a public health priority articulated by the NIH Roadmap. There have been no implementation frameworks applied to health care settings that have successfully demonstrated improved patient outcomes. While training and TA are designed to maximize model fidelity, they can be costly for programs. Yet training and TA may enhance fidelity and buy-in from local practices through consultations on reducing implementation barriers. Determining the marginal benefit of training and TA on improved fidelity and patient outcomes is crucial for making the business case for REP to health care stakeholders, ultimately facilitating translation of evidence-based treatment models to community- based practices.