Validation of a Causal Model of Implementation

项目摘要 推进因果实施理论对于设计量身定制的实施战略至关重要， 临床医生的行为改变，目标与循证实践（EBP）的使用相关的具体机制。 这种战略可能比一般的执行战略更成功、更有效。的 本研究的总体目标是检验假设因果关系的概念模型的普遍性 组织和社会心理学变量之间预测临床循证实践（EBP） 使用.从广义上讲，该模型提出，组织因素，如气候和文化影响的态度，规范 和自我效能感，而其他组织因素，如工作量，资源和组织摩擦 缓和意图和使用EBP之间的路径。我们最近完成的NIMH资助的R21 表明，该模型解释了在实施三个EBP中高达75%的方差， 社区设置。虽然前景看好，但我们受到样本量小和专注于特殊教育的限制 教师使用自闭症干预措施。这个R 01将测试因果模型的普遍性， 来自一组新的从业者的更大样本，对于一个不同的和更广泛使用的EBP，认知- 行为疗法（CBT）。成功完成将进一步验证模型，推进我们的 理解EBP实施中的因果路径。我们将利用正在进行的CBT实施 努力在两个大型公共卫生机构的40个组织中招募约300名心理健康临床医生， 费城和德克萨斯州（Philadelphia and Texas）完成CBT培训后，临床医生将完成所有 在模型中描绘的结构。临床医生也将通过音频记录进行观察， 客户在他们的案件量在两个场合。在每次观察之后， 将通过调查收集意图与行为差距。一部分临床医生报告说， 显示低EBP使用将被有目的地招募，以完成简短的半结构化面试进一步 评估意图与行为差距的原因。我们的主要因变量和实现 感兴趣的结果是临床医生使用CBT的意图和临床医生使用CBT的直接观察。 然而，由于CBT包括复杂度不同的许多分立组件，因此CBT的每个分立组件都可以包括不同的分立组件。 CBT的使用将单独衡量。数据将通过多层次建模进行分析，以测试 意图和意图的决定因素预测每个离散的CBT组成部分（目标1）和程度， 实施文献中强调的组织和其他背景因素预测了与以下因素相关的因素： 意图的形成和适度的意图和CBT使用之间的关联（目的2）。结果将通知 * 制定执行战略，以可改变的因素为目标， 这是一个可以广泛应用于EBP的意图和实施。

PROJECT SUMMARY Advancing causal implementation theory is critical for designing tailored implementation strategies to facilitate clinician behavior change that target specific mechanisms associated with evidence-based practice (EBP) use. Such strategies may be more successful and more efficient than general implementation strategies. The overall goal of this study is to test the generalizability of a conceptual model that posits the causal relationship among variables from organizational and social psychology to predict clinician evidence-based practice (EBP) use. Broadly, the model proposes that organizational factors like climate and culture influence attitudes, norms and self-efficacy, while other organizational factors like workload, resources and organizational friction moderate the pathway between intentions and the use of an EBP. Our recently completed NIMH-funded R21 demonstrated that this model accounted for up to 75% of variance in implementation of three EBPs in community settings. While promising, we were limited by a small sample, and a focus on special education teachers' use of autism interventions. This R01 will test the generalizability of the causal model in a much larger sample from a new group of practitioners, for a different and more widely-used EBP, cognitive- behavioral therapy (CBT). Successful completion would further validate the model, advancing our understanding of the causal pathways in EBP implementation. We will leverage ongoing CBT implementation efforts to recruit approximately 300 mental health clinicians across 40 organizations in two large public health systems (Philadelphia and Texas). After completing training in CBT, clinicians will complete measures of all constructs delineated in the model. Clinicians also will be observed via audio recording delivering CBT with a client on their caseload on two occasions. Following each observation, data on theorized moderators of the intention to behavior gap will be collected via survey. A subset of clinicians who report high intentions and demonstrate low EBP use will be purposively recruited to complete brief semi-structured interviews further assessing reasons for the intention to behavior gap. Our primary dependent variables and implementation outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT. However, as CBT comprises many discrete components that vary in complexity, each discrete component of CBT use will be measured separately. Data will be analyzed via multilevel modeling to test the extent to which intentions and determinants of intention predict each discrete CBT component (Aim 1) and the extent to which organizational and other contextual factors highlighted in the implementation literature predict factors related to intention formation and moderate the association between intentions and CBT use (Aim 2). Results will inform the development of implementation strategies that target modifiable factors explaining substantial variance in intention and in implementation that can be applied broadly across EBPs.