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.

项目总结/摘要 这项拟议的多样性研究补充计划旨在扩大母公司试验的科学影响， 领导力和组织变革促进实施（LOCI）战略对 实施（目标1）和维持（目标2）数字化基于测量的护理（MBC）， 将LOCI联系起来以提高MBC保真度（目标3）并支持有前途的早期职业研究者的机制 他们将为NIH员工的多样性做出贡献。在目标3（机制）的范围内， 拟议的多样性研究补充通过生成新数据来扩大研究的科学影响， 测试新的假设，关于成本中立的工作场所为基础的临床监督的作用， MBC忠诚度和青年临床结果。这项工作填补了可扩展的、以监督为重点的 实施战略，可以集成到，或部署独立于，LOCI战略。 基于工作场所的临床监督是一个必不可少的，无处不在的，往往是国家授权的基础设施 提供社区精神健康护理。因此，它是一个潜在的强大的，成本中性的切入点， 通过支持高保真的循证实践（EBP）来改善临床结局，例如 MBC。然而，最有效的循证临床监督策略（CSS）最少 在常规环境中使用，这种变化的关键决定因素尚未被发现。证据表明 实施EBP的组织氛围，这是LOCI的一个关键目标，提高了 EBP相关监管内容。然而，需要实验来测试这种联系。此外，除了 组织气候，定量研究未能确定易处理的决定因素，突出了 定性调查的重要性，以产生更深入的了解和新的假设， 多层次的监督决定因素及其潜在的复杂相互作用。拟议的补充需要 为生成可扩展的、有效的和有理论基础的实现而迈出的重要的第一步 战略，利用基于工作场所的常规临床监督，以促进MBC的保真度和临床 结果。在母试验的背景下，使用解释性混合方法设计， 补充将：1）测试LOCI对主管使用循证CSS的影响，2）测试主管使用循证CSS的影响， 使用CSS作为LOCI和MBC保真度与母群集内临床结局之间的联系 随机对照试验，和3）确定最突出的和易处理的决定因素，主管的使用 基于证据的CSS，LOCI不针对政策、机构、监督者、被监督者， 通过对最终用户和潜在采用者进行深入的定性访谈，了解技术水平。这种补充剂 启动了一项研究计划，重点是通过应用创新，理论， 驱动设计方法，以达到高度流行、有影响力且可行的拐点，实现临床变革 基于实践工作场所的临床监督。