A Multiple Case Study of Implementation as Usual in Children's Mental Health

描述(由申请人提供)：许多针对常见儿童精神健康障碍的循证治疗(EBT)已经开发出来，但它们很少在“真实世界”的护理中提供。如果要实现其承诺，循证技术必须得到循证执行战略的补充。因此，美国国家卫生研究院将确定、开发、改进和测试实施战略的工作列为优先事项(PAR-10-038)。然而，如果不彻底了解这些战略和EBTS将在其中部署的服务系统，这项研究不太可能取得成果。这项混合方法多案例研究将涉及七个组织，这些组织将参与由NIMH资助的RCT的控制部门，名为“测试儿童心理健康中的组织实施战略”(Glisson，PI)。这就提供了审查“照常执行”(即在日常护理环境中进行的执行过程)的机会，以确保新制定的执行战略在“现实世界”中是可接受的、可行的、可持续的和可扩展的。将使用半结构化访谈(与机构和临床主任)和文件审查来确定和描述常规儿童心理健康护理中使用的实施战略(目标1)，并探索组织领导人如何就实施哪些EBT和如何实施这些战略做出决定(目标2)。将使用焦点小组和特定于项目的自我管理在线调查来确定组织领导人和临床医生对实施策略的相对重要性、可接受性、可行性和适当性的看法(目标3)。最后，前三个目标的数据将与其相应组织在组织社会背景(文化和气候)的标准化衡量标准上的得分挂钩，以审查背景如何影响执行进程和对具体执行战略的看法(目标4)。通过阐明“照常执行”，这项研究将为制定和调整战略的努力提供信息，推动该领域朝着以证据为基础的执行的理想迈进。它还将通过阐明控制组中的策略模式而使随机对照试验受益，这可能有助于解释结果。拟议的研究和培训计划将允许奖学金申请者接受以下方面的培训：1)实施和精神健康服务研究，2)组织行为和变化过程，3)混合方法研究，以及4)学术写作和研究传播。这一培训将有助于成功完成拟议的项目，并将为申请人从事独立研究职业做好准备，致力于通过促进执行科学和实践来提高儿童、青年和家庭的心理健康服务质量。拟议的项目与美国国立卫生研究院和医学研究所确定的优先事项一致，是通过制定、完善和测试实施战略来提高儿童、青年和家庭心理健康服务质量的更大研究议程的第一步。 公共卫生相关性：每年有高达20%的儿童和青年受到心理健康问题的影响。然而，这些弱势群体继续得到不符合标准的精神卫生保健，这主要是因为我们不了解如何有效地实施循证治疗(EBTS)。这项研究将通过检查儿童心理健康组织中的“照常实施”来解决这一差距，这将为确定、开发、改进和测试能够有效地将EBTS纳入“现实世界”护理的实施战略提供信息。

DESCRIPTION (provided by applicant): Many evidence-based treatments (EBTs) for common children's mental health disorders have been developed, but they are rarely delivered in "real world" care. EBTs must be complemented by evidence-based implementation strategies if they are to achieve their promise. Accordingly, the NIH has prioritized efforts to identify, develop, refine, and test implementation strategies (PAR-10-038). Yet, this research is not likely to be fruitful if it is conducted without a thorough understanding of the service systems in which these strategies and EBTs will (hopefully) be deployed. This mixed methods multiple case study will involve seven organizations that are participating in the control arm of an NIMH funded RCT, "Testing an Organizational Implementation Strategy in Children's Mental Health" (Glisson, PI). This affords the opportunity to examine "implementation as usual" (i.e., implementation processes that occur in usual care settings) in order to ensure that newly developed implementation strategies will be acceptable, feasible, sustainable, and scalable in the "real world." Semi-structured interviews (with agency and clinical directors) and document review will be used to identify and characterize the implementation strategies used in routine children's mental health care (Aim 1), and to explore how organizational leaders make decisions about which EBTs to implement and how to implement them (Aim 2). Focus groups and a project specific self-administered online survey will be used to determine organizational leaders' and clinicians' perceptions regarding the relative importance, acceptability, feasibility, and appropriateness of implementation strategies (Aim 3). Finally, data from the first three aims will be linked to their corresponding organization's scores on a standardized measure of organizational social context (culture and climate) in order to examine how context influences implementation processes and perceptions about specific implementation strategies (Aim 4). By shedding light on "implementation as usual," this study will inform efforts to develop and tailor strategies, propelling the field toward the ideal of evidence-based implementation. It will also benefit the RCT by illuminating strategy patterns in the control group, which may aid in the interpretation of results. The proposed research and training plan will allow the fellowship applicant to receive training in: 1) implementation and mental health services research, 2) organizational behavior and change processes, 3) mixed methods research, and 4) scholarly writing and research dissemination. This training will facilitate the successful completion of the proposed project, and will prepare the applicant for an independent research career dedicated to improving the quality of mental health services for children, youth, and families through the advancement of implementation science and practice. The proposed project is consistent with priorities set forth by the NIH and the Institute of Medicine, and is the first step in a larger research agenda to improve the quality of mental health services for children, youth, and families by developing, refining, and testing implementation strategies. PUBLIC HEALTH RELEVANCE: Mental health problems affect a staggering 20% of children and youth each year. Yet, this vulnerable population continues to receive substandard mental health care, largely because we do not understand how to effectively implement evidence-based treatments (EBTs). This study will address this gap by examining "implementation as usual" in children's mental health organizations, which will inform efforts to identify, develop, refine, and test implementation strategies that can effectively integrate EBTs into "real world" care.