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

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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.