Understanding the impact of organizational implementation strategies on EBT use

描述(由申请人提供)：大约1500万美国儿童患有精神障碍，估计每年的治疗费用为89亿美元。在过去的几年里 30年来，已经开发了几种有效的循证治疗(EBTS)来治疗这些疾病。然而，EBTS很少在通常的护理实践环境中成功实施。鉴于常规护理服务的结果通常很差，国家精神卫生研究所最近优先开展研究，开发和测试实施战略，以有效地将EBTS纳入社区环境。实施研究人员在心理健康环境中测试了一系列实施战略，但有两个关键的知识差距限制了该领域。首先，研究人员尚未确定具体的变革进程(即实施干预措施所需的“积极因素”)或具体的变革机制(即在干预过程中发生并作为效果基础的中间变革)，以解释实施战略如何以及为什么产生期望的变革。确定变革进程和机制对于为目标环境制定最有效和最高效的执行战略至关重要。第二，尽管大多数心理健康服务是在复杂的组织内提供的，而且数十年的研究表明，组织的社会背景对成功实施创新至关重要，但很少有实施战略针对社会背景。推动制定有效的执行战略的下一步包括了解成功的执行战略如何产生其影响，并具体处理社会背景在以成功实施环境技术为特征的跨层级组织变革中的作用。拟议的研究培训计划使PI能够制定一个独立的研究计划，重点是确定有助于将EBTS有效整合到常规临床环境中的组织变化过程和机制。研究培训计划包括高级培训活动，这些活动发展了PI在三个核心领域的能力：实施科学、组织干预和组织变革机制。该计划包括专门的教学活动(选修课程、讲习班和会议)，与三名专家实施科学家合作，他们各自指导由NIMH资助的R01实施研究，以及完成一个独立研究项目。该研究项目是第一个在组织实施战略的随机对照试验的背景下直接测试组织变革过程和变革机制的项目。该培训计划为PI的独立研究生涯做好准备，重点是在日常护理环境中改进有效的心理健康治疗的实施。这项研究可能带来的好处包括提高精神障碍儿童及其家人的生活质量，以及通过提高服务系统的效率和效力来降低精神健康治疗的成本。 公共卫生相关性：拟议的研究培训计划与公共健康相关，因为它提高了我们对如何在常规精神卫生系统中更多地使用有效做法的理解，从而增加了接受有效服务的儿童和家庭的比例，并增加了国家在生物医学和行为研究方面的投资回报。该计划推进了NIMH的战略目标，即缩小新的、基于研究的精神卫生干预措施的开发与广泛提供给最需要的人之间的差距。

DESCRIPTION (provided by applicant): Approximately 15 million American children suffer from psychiatric disorders at an estimated treatment cost of $8.9 billion annually. During the last 30 years several effective evidence-based treatments (EBTs) have been developed to treat these conditions. However, EBTs are rarely implemented successfully in usual care practice settings. Given the typically poor outcomes of usual care services, the National Institute of Mental Health recently prioritized research that develops and tests implementation strategies to effectively integrate EBTs within community settings. Implementation researchers have tested a range of implementation strategies in mental health settings but two key knowledge gaps limit the field. First, researchers have yet to identify the specific change processes (i.e., the require "active ingredients" of implementation interventions), or the specific change mechanisms (i.e., the intermediate changes that occur during the course of the intervention and serve as the basis for the effect) that explain how and why implementation strategies generate desired changes. Identification of change processes and mechanisms is critical to developing the most effective and efficient implementation strategies for targeted settings. Second, although most mental health services are provided within complex organizations and decades of research suggest organizational social context is vital to successful innovation implementation, few implementation strategies target social context. The next steps in advancing the development of effective implementation strategies involve understanding how successful implementation strategies generate their effects, and specifically addressing the role of social context in the cross-level organizational change that characterizes successful EBT implementation. The proposed research training plan enables the PI to develop an independent program of research focused on identifying the organizational change processes and mechanisms that contribute to effective integration of EBTs into routine clinical settings. The research training plan includes advanced training activities that develop the PI's competency across three core areas: implementation science, organizational interventions, and organizational change mechanisms. The plan includes specialized didactic learning activities (elective coursework, workshops, and conferences), collaboration with three expert implementation scientists who are each directing NIMH-funded R01 implementation studies, and completion of an independent research project. The research project is the first to directly test organizational change processes and change mechanisms in the context of a randomized controlled trial of an organizational implementation strategy. The training plan prepares the PI for an independent research career focused on improving the implementation of effective mental health treatments in usual care settings. The likely benefits of this research include enhanced quality of life for children with psychiatric disorders and their families and reduced costs of mental health treatment through greater efficiency and effectiveness of service systems. PUBLIC HEALTH RELEVANCE: The proposed research training plan is relevant to public health because it improves our understanding of how to increase the use of effective practices in routine mental health systems, thereby increasing the proportion of children and families who receive effective services and increasing the nation's return on its investment in biomedical and behavioral research. The plan advances the NIMH's strategic goal of closing the gap between the development of new, research-based mental health interventions and their widespread availability to those most in need.