Nathaniel J Williams1, Rinad S Beidas2,3,4. 1. School of Social Work, Boise State University, Boise, ID, USA. 2. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 3. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 4. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
Abstract
BACKGROUND: Scientists have developed evidence-based interventions that improve the symptoms and functioning of youth with psychiatric disorders; however, these interventions are rarely used in community settings. Eliminating this research-to-practice gap is the purview of implementation science, the discipline devoted to the study of methods to promote the use of evidence-based practices in routine care. METHODS: We review studies that have tested factors associated with implementation in child psychology and psychiatry, explore applications of social science theories to implementation, and conclude with recommendations to advance implementation science through the development and testing of novel, multilevel, causal theories. RESULTS: During its brief history, implementation science in child psychology and psychiatry has documented the implementation gap in routine care, tested training approaches and found them to be insufficient for behavior change, explored the relationships between variables and implementation outcomes, and initiated randomized controlled trials to test implementation strategies. This research has identified targets related to implementation (e.g., clinician motivation, organizational culture) and demonstrated the feasibility of activating these targets through implementation strategies. However, the dominant methodological approach has been atheoretical and predictive, relying heavily on a set of variables from heuristic frameworks. CONCLUSIONS: Optimizing the implementation of effective treatments in community care for youth with psychiatric disorders is a defining challenge of our time. This review proposes a new direction focused on developing and testing integrated causal theories. We recommend implementation scientists: (a) move from observational studies of implementation barriers and facilitators to trials that include causal theory; (b) identify a core set of implementation determinants; (c) conduct trials of implementation strategies with clear targets, mechanisms, and outcomes; (d) ensure that behaviors that are core to EBPs are clearly defined; and (e) agree upon standard measures. This agenda will help fulfill the promise of evidence-based practice for improving youth behavioral health.
BACKGROUND: Scientists have developed evidence-based interventions that improve the symptoms and functioning of youth with psychiatric disorders; however, these interventions are rarely used in community settings. Eliminating this research-to-practice gap is the purview of implementation science, the discipline devoted to the study of methods to promote the use of evidence-based practices in routine care. METHODS: We review studies that have tested factors associated with implementation in child psychology and psychiatry, explore applications of social science theories to implementation, and conclude with recommendations to advance implementation science through the development and testing of novel, multilevel, causal theories. RESULTS: During its brief history, implementation science in child psychology and psychiatry has documented the implementation gap in routine care, tested training approaches and found them to be insufficient for behavior change, explored the relationships between variables and implementation outcomes, and initiated randomized controlled trials to test implementation strategies. This research has identified targets related to implementation (e.g., clinician motivation, organizational culture) and demonstrated the feasibility of activating these targets through implementation strategies. However, the dominant methodological approach has been atheoretical and predictive, relying heavily on a set of variables from heuristic frameworks. CONCLUSIONS: Optimizing the implementation of effective treatments in community care for youth with psychiatric disorders is a defining challenge of our time. This review proposes a new direction focused on developing and testing integrated causal theories. We recommend implementation scientists: (a) move from observational studies of implementation barriers and facilitators to trials that include causal theory; (b) identify a core set of implementation determinants; (c) conduct trials of implementation strategies with clear targets, mechanisms, and outcomes; (d) ensure that behaviors that are core to EBPs are clearly defined; and (e) agree upon standard measures. This agenda will help fulfill the promise of evidence-based practice for improving youth behavioral health.
Authors: Byron J Powell; Sheila V Patel; Amber D Haley; Emily R Haines; Kathleen E Knocke; Shira Chandler; Colleen Cary Katz; Heather Pane Seifert; George Ake; Lisa Amaya-Jackson; Gregory A Aarons Journal: Adm Policy Ment Health Date: 2020-09
Authors: Lauren S Wakschlag; Megan Y Roberts; Rachel M Flynn; Justin D Smith; Sheila Krogh-Jespersen; Aaron J Kaat; Larry Gray; John Walkup; Bradley S Marino; Elizabeth S Norton; Matthew M Davis Journal: J Clin Child Adolesc Psychol Date: 2019-03-27
Authors: Vera Yakovchenko; Edward J Miech; Matthew J Chinman; Maggie Chartier; Rachel Gonzalez; JoAnn E Kirchner; Timothy R Morgan; Angela Park; Byron J Powell; Enola K Proctor; David Ross; Thomas J Waltz; Shari S Rogal Journal: Med Care Date: 2020-05 Impact factor: 2.983