Category: Dissemination & Implementation Science
Amanda Jensen-Doss, Ph.D.
Professor
University of Miami
Miami, Florida
Kelsie Okamura, Ph.D.
Judge Baker Children's Center
Honolulu, Hawaii
Elizabeth Casline, M.S.
Doctoral Candidate
University of Miami
Coral Gables, Florida
Elizabeth Connors, Ph.D.
Yale University
New Haven, Connecticut
Susan Douglas, Ph.D.
Vanderbilt University
Nashville, Tennessee
Jill Donelan, Psy.D.
University of Massachusetts
Springfield, Massachusetts
Measurement-based care (MBC) is the use of frequent assessment data to guide clinical care. As an evidence-based practice, MBC has been shown to improve mental health outcomes and increase treatment efficiency. MBC can also enhance client safety through monitoring of risk events such as suicidal ideation and has been used during the COVID-19 pandemic to improve communication with clients during the transition to telehealth. Aggregated MBC data can also provide substantial value for quality improvement and organizational learning. As a result, accreditation and regulatory bodies are beginning to require MBC as a component of quality care. Despite all these benefits, however, successful adoption and sustained implementation remain elusive, with rates of ongoing use estimated at around 20% globally, dropping to 5% when MBC is used as intended on a session-to-session basis. There is a dire need for novel research approaches to understanding of the factors that influence the use of MBC in every mental health practice. This symposium will address this need by presenting a series of studies that apply mixed methods approaches to dig deeper into identifying implementation barriers and facilitators and effective MBC implementation strategies in youth mental health settings.
The first presentation draws data from a large effectiveness trial for adolescent emotional disorders that included an MBC arm. While previous studies have typically classified MBC fidelity as administering measures and viewing feedback reports, this study addressed an under-studied aspect of MBC implementation by asking clinicians to report weekly on their use of MBC during sessions. The presenter will discuss how the qualitative coding of these responses can be used to make clinician-directed MBC trainings more effective.
Next, a mixed-methods latent class analysis study will be presented. Investigators identified two implementation outcome classes among community clinicians using MBC and combined this information with thematic coding of clinician qualitative feedback to identify determinants of MBC uptake. Findings suggest that MBC implementers identified more facilitators to MBC use than non-implementers, which can inform development of implementation supports in agencies.
Third, data from an ongoing Type 1 Effectiveness Implementation Hybrid trial is being analyzed to identify implementation strategies and agency practices related to fluctuations in MBC fidelity over time. Weekly quantitative implementation metric data is being combined with logs of implementation activities and qualitative coding of implementation meeting transcripts to identify strategies that can be applied in other settings to facilitate MBC implementation success.
Finally, a mixed-methods case study will describe an implementation in which MBC was utilized to help a partial hospitalization setting transition to telehealth services during the COVID-19 pandemic. Findings will illustrate how an iterative implementation approach with feedback loops was used to support MBC and telehealth implementation.
The symposium discussant will integrate and reflect on these papers from the lens of her experiences implementing MBC in a statewide public mental health system.
Presenter: Elizabeth P. Casline, M.S. – University of Miami
Co-author: Grace Woodard, BS – Unviersity of Miami
Co-author: Zabin S. Patel, MS, MPH – University of Miami
Co-author: Dominique Phillips, B.S. – University of Miami
Co-author: Jill Ehrenreich-May, Ph.D. – University of Miami
Co-author: Golda Ginsburg, PhD – University of Connecticut School of medicine
Co-author: Amanda Jensen-Doss, Ph.D. – University of Miami
Presenter: Elizabeth Connors, Ph.D. – Yale University
Co-author: Corianna E. Sichel, Ph.D. – Columbia University/New York State Psychiatric Institute
Presenter: Susan Douglas, Ph.D. – Vanderbilt University
Co-author: Amanda Jensen-Doss, Ph.D. – University of Miami
Co-author: Ariane Wilson, M.Ed – Vanderbilt University
Co-author: Briana Martinez, Undergraduate – University of Miami
Presenter: Jill Donelan, Psy.D. – University of Massachusetts