Randomized trial of a leadership and organizational change strategy to improve the implementation and sustainment of digital measurement-based care in youth mental health services

对领导和组织变革策略进行随机试验，以改善青少年心理健康服务中基于数字测量的护理的实施和维持

• 批准号: 10265809
• 负责人: Nathaniel J. Williams
• 金额: $ 7.69万
• 依托单位: BOISE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-06-01 至 2023-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10265809
• 关键词: Caring; Clinical; Communities; Complex; Data; Evidence based practice; Failure; Funding; Healthcare; Infrastructure; Intervention; Interview; Leadership; Link; Measurement; Mental Health; Mental Health Services; Methods; Organizational Change; Outcome; Parents; Policies; Public Health; Randomized Controlled Trials; Research; Research Personnel; Role; Scientist; Supervision; Techniques; Testing; United States National Institutes of Health; Variant; Work; Workforce Development; Workplace; Youth; base; career; clinical practice; cost; design; digital; experimental study; implementation strategy; improved; infrastructure development; innovation; organizational climate; programs; psychosocial; randomized trial; theories

Project Summary/Abstract This proposed Diversity Research Supplement aims to extend the scientific impact of the parent trial to test the effects of the Leadership and Organizational Change for Implementation (LOCI) strategy on the implementation (aim 1) and sustainment (aim 2) of digital measurement-based care (MBC) and the mechanisms that link LOCI to improve MBC fidelity (aim 3) and support a promising early career investigator who will contribute to the diversity of the NIH workforce. Within the scope of Aim 3 (mechanisms), the proposed diversity research supplement extends the study’s scientific impact by generating new data and testing new hypotheses regarding the role of cost-neutral workplace-based clinical supervision in optimizing MBC fidelity and youth clinical outcomes. This work fills a critical gap in scalable, supervision-focused implementation strategies that could be integrated into, or deployed independently of, the LOCI strategy. Workplace-based clinical supervision is an essential, ubiquitous, and often State-mandated infrastructure for delivering community mental health care. As such, it is a potentially powerful, cost-neutral entry point for improving clinical outcomes by supporting high fidelity delivery of evidence-based practices (EBP), such as MBC. However, the evidence-informed clinical supervision strategies (CSS) that are most effective are least used in routine settings and the key determinants of this variation are yet to be discovered. Evidence suggests that the organizational climate for implementation of EBP, which is a key target of LOCI, improves intensity of EBP-related supervision content. However, experiments are needed to test the linkage. Furthermore, beyond organizational climate, quantitative studies have failed to identify tractable determinants, highlighting the importance of qualitative inquiry to generate deeper understanding and new hypotheses regarding the potential multilevel supervision determinants and their potentially complex interactions. The proposed supplement takes the essential first steps toward generating a scalable, effective, and theoretically grounded implementation strategy that leverages routine workplace-based clinical supervision to promote MBC fidelity and clinical outcomes. Within the context of the parent trial, using an explanatory mixed method design, the proposed supplement will: 1) Test the effect of LOCI on supervisors’ use of evidence-informed CSS, 2) Test supervisors’ use of CSS as a link between LOCI and MBC fidelity and clinical outcomes within the parent cluster randomized controlled trial, and 3) Identify the most salient and tractable determinants of supervisors’ use of evidence-informed CSS that are not targeted by LOCI at the policy, agency, supervisor, supervisee, and technique levels through in-depth qualitative interviews with end users and potential adopters. This supplement launches a program of research focused on closing the research-practice gap by applying innovative, theory- driven design approaches to a highly prevalent, impactful, and feasible inflection point for transforming clinical practice—workplace-based clinical supervision.

项目摘要/摘要 这项拟议的多样性研究补充资料旨在将亲本试验的科学影响扩展到测试 领导力和组织变革实施(LOCI)战略对 实施(目标1)和维持(目标2)基于数字测量的护理和 链接基因座以提高MBC保真度的机制(目标3)，并支持有前途的早期职业调查员 世卫组织将为国家卫生研究院工作人员的多样性做出贡献。在目标3(机制)的范围内， 拟议的多样性研究补充方案通过生成新的数据和 测试关于成本中性的基于工作场所的临床监督在优化中的作用的新假设 MBC保真度和青年临床结果。这项工作填补了可扩展、以监管为重点的关键空白 可以整合到LOCI战略中或独立于LOCI战略部署的实施战略。 以工作场所为基础的临床监管是一种基本的、无处不在的基础设施，通常是国家强制要求的基础设施 提供社区精神卫生服务。因此，它是一个潜在的强大的、成本中性的入口点 通过支持高保真的循证实践(EBP)改善临床结果，例如 MBC。然而，最有效的循证临床监督策略(CS)是最不有效的 在常规环境中使用，这种变异的关键决定因素尚未发现。有证据表明 实施EBP的组织氛围是LOCI的一个关键目标，提高了 EBP相关监管内容。然而，需要进行实验来测试这种联系。此外，超越 在组织氛围方面，量化研究未能确定容易处理的决定因素，突显出 定性研究的重要性，以产生更深层次的理解和关于潜力的新假设 多层次监管决定因素及其潜在的复杂相互作用。拟议的补编采取了 生成可扩展的、有效的和理论上有基础的实现的基本第一步 利用以工作场所为基础的常规临床监督来促进MBC保真度和临床 结果。在父母试验的背景下，使用解释性混合方法设计，拟议的 补充：1)测试地点对主管使用循证社交网站的影响；2)测试主管使用循证社交网站的效果 使用css作为基因座与MBC保真度和亲代群内临床结果之间的联系 随机对照试验，以及3)确定最显著和最容易处理的决定因素 不是政策、机构、主管、被监督者和地区目标的循证CS 通过对最终用户和潜在采用者进行深入的定性访谈，提高技术水平。本副刊 启动了一项研究计划，重点是通过应用创新的理论来缩小研究与实践之间的差距 驱动设计方法，以实现高度普遍、有效和可行的拐点，实现临床转型 实践--以工作场所为基础的临床监督。