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.

项目概要/摘要 拟议的多样性研究补充旨在将母体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 基于数字测量的护理 (MBC) 的实施（目标 1）和维持（目标 2）以及 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 谁将为 NIH 劳动力的多样性做出贡献。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和扩展研究的科学影响 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、以监督为中心的关键空白 可以集成到 LOCI 策略中或独立于 LOCI 策略部署的实施策略。 基于工作场所的临床监督是必不可少的、普遍存在的且通常是国家授权的基础设施 提供社区精神卫生保健。因此，它是一个潜在的强大、成本中性的切入点 通过支持高保真提供循证实践 (EBP) 来改善临床结果，例如 MBC。然而，最有效的循证临床监督策略 (CSS) 却是最不可行的。 在日常环境中使用，但这种变化的关键决定因素仍有待发现。有证据表明 实施 EBP 的组织氛围（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 就组织氛围而言，定量研究未能确定易于处理的决定因素，这凸显了 定性探究对于产生更深入的理解和关于潜力的新假设的重要性 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 生成可扩展的、有效的、有理论依据的实施的重要的第一步 利用基于工作场所的常规临床监督来促进 MBC 保真度和临床的策略 结果。在母体试验的背景下，使用解释性混合方法设计，提出的 补充将： 1) 测试 LOCI 对主管使用循证 CSS 的影响，2) 测试主管的 使用 CSS 作为父簇内 LOCI 和 MBC 保真度与临床结果之间的联系 随机对照试验，以及 3) 确定主管使用的最显着和最容易处理的决定因素 以证据为依据的 CSS，不属于政策、机构、主管、受监管者和 LOCI 的目标 通过对最终用户和潜在采用者进行深入的定性访谈来提高技术水平。本补充 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、有影响力且可行的拐点，从而改变临床 实践——基于工作场所的临床监督。