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

描述（由申请人提供）：已经开发了许多针对常见儿童心理健康障碍的循证治疗（EBT），但它们很少在“真实的世界”护理中提供。如果要实现其承诺，EBT必须辅之以循证实施战略。因此，NIH优先努力确定，开发，完善和测试实施策略（PAR-10-038）。然而，这项研究是不太可能是富有成效的，如果它是进行没有一个透彻的了解服务系统中，这些战略和EBT将（希望）部署。这种混合方法的多个案例研究将涉及七个组织，这些组织参与了NIMH资助的RCT的控制臂，“测试儿童心理健康的组织实施策略”（Glisson，PI）。这提供了审查“照常执行”的机会（即，在通常的护理环境中发生的实施过程），以确保新制定的实施策略在“真实的世界”中是可接受的、可行的、可持续的和可扩展的。“半结构化访谈（与机构和临床主任）和文件审查将用于确定和描述常规儿童心理健康护理中使用的实施策略（目标1），并探讨组织领导者如何决定实施哪些EBT以及如何实施它们（目标2）。将使用焦点小组和特定项目的自我管理在线调查来确定组织领导者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相应组织的组织社会环境（文化和气候）的标准化测量分数相关联，以研究环境如何影响实施过程和对具体实施战略的看法（目标4）。通过阐明“照常实施”，这项研究将为制定和调整战略的努力提供信息，推动该领域朝着循证实施的理想方向发展。它还将通过阐明对照组的策略模式而使RCT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人接受以下方面的培训：1）实施和心理健康服务研究，2）组织行为和变革过程，3）混合方法研究，4）学术写作和研究传播。该培训将促进拟议项目的顺利完成，并将为申请人准备一个独立的研究生涯，致力于通过实施科学和实践的进步，提高儿童，青年和家庭的心理健康服务的质量。拟议的项目与NIH和医学研究所提出的优先事项一致，是通过制定、完善和测试实施策略来提高儿童、青年和家庭心理健康服务质量的更大研究议程的第一步。

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.