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 该拟议的多样性研究补充旨在扩展父审判的科学影响以进行测试 领导和组织变革实施（LOCI）战略的影响对 基于数字测量的护理（MBC）的实施（目标1）和维持（目标2）和 将基因座联系起来改善MBC保真度的机制（AIM 3）并支持承诺早期职业调查员 谁将为NIH劳动力的多样性做出贡献。在AIM 3（机制）的范围内 提出的多样性研究补充剂通过生成新数据和 测试有关基于成本中立的基于工作场所的临床监督在优化的作用的新假设 MBC保真度和青年临床结果。这项工作填补了可扩展的，以监督为中心的关键差距 可以独立于基因策略集成或部署到或部署的实施策略。 基于工作场所的临床监督是必不可少的，无处不在且通常是国家建立的基础设施 提供社区心理保健。因此，它是一个潜在强大的，成本中立的入口点 通过支持高保真循证实践（EBP），例如 MBC。但是，最有效的证据信息临床监督策略（CSS） 在常规设置和此变化的关键决定范围内使用。有证据表明 实施EBP的组织氛围是基因座的关键目标，可提高 与EBP相关的监督内容。但是，需要实验来测试链接。此外，超越 组织环境，定量研究未能识别可障碍的决定者，突出了 定性探究的重要性，以产生更深入的理解和有关潜力的新假设 多层监督决定了它们的潜在复杂相互作用。拟议的补充 产生可扩展，有效和理论上的实施的基本第一步 利用常规基于工作场所的临床监督来促进MBC保真度和临床的策略 结果。在父级试验的背景下，使用爆炸性混合方法设计，提议 补充将：1）测试基因座对主管使用证据信息CSS的影响，2）测试主管的测试主管 将CSS用作基因座和MBC保真度与父群集的临床结果之间的联系 随机对照试验，3）确定主管使用的最显着，最可行的决定者 循证信息的CSS，该政策，机构，主管，主管和 通过对最终用户和潜在采用者进行深入的定性访谈，技术水平。此补充 启动了一项研究计划，重点是通过应用创新的理论来解决研究实践差距 驱动的设计方法是转变临床的高度普遍，有影响力和可行的碰撞点 实践 - 基于工作场所的临床监督。