A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions

Objective: This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. Method: A literature search was conducted using electronic databases and a manual search. Results: Eleven studies were identified that tested implementation strategies with a randomized (n = 10) or controlled clinical trial design (n = 1). The wide range of clinical interventions, implementation strategies, and outcomes evaluated precluded meta-analysis. However, the majority of studies (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome. Conclusion: There is a clear need for more rigorous research on the effectiveness of implementation strategies, and we provide several suggestions that could improve this research area.

[1]  M. A. Scheirer.  Linking sustainability research to intervention types. , 2013, American journal of public health.

[2]  J. Grimshaw,et al.  Knowledge translation of research findings , 2012, Implementation Science.

[3]  E. Proctor,et al.  Implementation Research in Mental Health Services , 2009 .

[4]  Karen A. Blase,et al.  Implementation Research: A Synthesis of the , 2005 .

[5]  J. Unützer,et al.  Taking an evidence-based model of depression care from research to practice: making lemonade out of depression. , 2006, General hospital psychiatry.

[6]  Richard Baker,et al.  A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice , 2013, Implementation Science.

[7]  Rachel Haine-Schlagel,et al.  Mental health care for children with disruptive behavior problems: a view inside therapists' offices. , 2010, Psychiatric services.

[8]  Laura Mufson,et al.  National survey of psychotherapy training in psychiatry, psychology, and social work. , 2006, Archives of general psychiatry.

[9]  Lawrence A. Palinkas,et al.  Mixed-methods designs in mental health services research: a review. , 2011, Psychiatric services.

[10]  Ross C. Brownson,et al.  Measurement Issues in Dissemination and Implementation Research , 2012 .

[11]  H. Soydan,et al.  Evidence-Based Clearinghouses in Social Work , 2010 .

[12]  R. Cicerone.  Initial National Priorities for Comparative Effectiveness Research , 2009 .

[13]  S. Shortell.  Increasing Value: A Research Agenda for Addressing the Managerial and Organizational Challenges Facing Health Care Delivery in the United States , 2004, Medical care research and review : MCRR.

[14]  Jo Rycroft-Malone,et al.  An implementation research agenda , 2009, Implementation science : IS.

[15]  Luke Vale,et al.  Toward evidence-based quality improvement. Evidence (and its limitations) of the effectiveness of guideline dissemination and implementation strategies 1966-1998. , 2006, Journal of general internal medicine.

[16]  M. Eccles,et al.  Planning and Studying Improvement in Patient Care: The Use of Theoretical Perspectives , 2007, The Milbank quarterly.

[17]  C. Bright,et al.  Toward a policy ecology of implementation of evidence-based practices in public mental health settings , 2008, Implementation science : IS.

[18]  D M Berwick,et al.  A primer on leading the improvement of systems , 1996, BMJ.

[19]  V. Hasselblad,et al.  Data Abstraction Form , 2011 .

[20]  F. Azocar,et al.  The impact of evidence-based guideline dissemination for the assessment and treatment of major depression in a managed behavioral health care organization , 2005, The Journal of Behavioral Health Services & Research.

[21]  Jill J. Francis,et al.  Designing theoretically-informed implementation interventions , 2006, Implementation science : IS.

[22]  R. Raghavan,et al.  A preliminary analysis of the receipt of mental health services consistent with national standards among children in the child welfare system. , 2010, American journal of public health.

[23]  J. Fairbank,et al.  Use of the Breakthrough Series Collaborative to Support Broad and Sustained Use of Evidence-Based Trauma Treatment for Children in Community Practice Settings , 2012, Administration and Policy in Mental Health and Mental Health Services Research.

[24]  Ross C. Brownson,et al.  Dissemination and implementation research in health : translating science to practice , 2012 .

[25]  S. Mccracken,et al.  Practitioner Expertise in Evidence-Based Practice Decision Making , 2008 .

[26]  Jennie Popay,et al.  Guidance on the conduct of narrative synthesis in systematic Reviews. A Product from the ESRC Methods Programme. Version 1 , 2006 .

[27]  P. Kendall,et al.  Training Therapists in Evidence-Based Practice: A Critical Review of Studies From a Systems-Contextual Perspective. , 2010, Clinical psychology : a publication of the Division of Clinical Psychology of the American Psychological Association.

[28]  J. Geller,et al.  What Works for Whom? A Critical Review of Psychotherapy Research , 1997 .

[29]  Trudie Aberdeen.  Yin, R. K. (2009). Case study research: Design and methods (4th Ed.). Thousand Oaks, CA: Sage. , 2013, The Canadian Journal of Action Research.

[30]  N. Duan,et al.  Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics: a randomized controlled trial. , 2005, JAMA.

[31]  M. Menear,et al.  Knowledge translation in mental health: a scoping review. , 2011, Healthcare policy = Politiques de sante.

[32]  R Brian Haynes,et al.  A cross-sectional study of the number and frequency of terms used to refer to knowledge translation in a body of health literature in 2006: a Tower of Babel? , 2010, Implementation science : IS.

[33]  R. Levant.  Report of the 2005 Presidential Task Force on Evidence-Based Practice 1 , 2005 .

[34]  Kimberley R. Isett,et al.  The state policy context of implementation issues for evidence-based practices in mental health. , 2007, Psychiatric services.

[35]  Enola K Proctor,et al.  A mixed methods multiple case study of implementation as usual in children’s social service organizations: study protocol , 2013, Implementation Science.

[36]  N. Duan,et al.  Quality of publicly-funded outpatient specialty mental health care for common childhood psychiatric disorders in California. , 2005, Journal of the American Academy of Child and Adolescent Psychiatry.

[37]  I. Janszky,et al.  Supported local implementation of clinical guidelines in psychiatry: a two-year follow-up , 2010, Implementation science : IS.

[38]  J. Lochman,et al.  Dissemination of the Coping Power program: importance of intensity of counselor training. , 2009, Journal of consulting and clinical psychology.

[39]  E. Rogers.  Diffusion of Innovations , 1962 .

[40]  T. Boat,et al.  Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities , 2009 .

[41]  Michael R. Kauth,et al.  Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study , 2010, Implementation science : IS.

[42]  Ross C. Brownson,et al.  Dissemination and implementation research in health : translating science to practice , 2012 .

[43]  B. Thyer.  Evidence-based practice and clinical social work , 2002, Evidence-based mental health.

[44]  Sheila R. Woody,et al.  An Update on Empirically Validated Therapies , 1998 .

[45]  Bryan J Weiner,et al.  The meaning and measurement of implementation climate , 2011, Implementation science : IS.

[46]  J. Landsverk,et al.  Cascading implementation of a foster and kinship parent intervention. , 2008, Child welfare.

[47]  Lara J. Jakobsons,et al.  Teacher key opinion leaders and mental health consultation in low-income urban schools. , 2008, Journal of consulting and clinical psychology.

[48]  R. Yin,et al.  Case Study Research: Design and Methods (4th ed. , 2009 .

[49]  Jo Rycroft-Malone,et al.  The PARIHS framework--a framework for guiding the implementation of evidence-based practice. , 2004, Journal of nursing care quality.

[50]  R. DeRubeis,et al.  Update on Empirically Validated Therapies, II , 1998 .

[51]  L. Jaycox,et al.  Outcomes for youths from racial-ethnic minority groups in a quality improvement intervention for depression treatment. , 2009, Psychiatric services.

[52]  Karen A. Blase,et al.  Implementation research: A synthesis of the literature (No. 231). University of South Florida, Louis de la Parte Florida Mental Health Implementation Research Network. , 2012 .

[53]  Jane M. Young,et al.  Audit and feedback: effects on professional practice and healthcare outcomes. , 2012, The Cochrane database of systematic reviews.

[54]  Jo Rycroft-Malone,et al.  Evaluating the successful implementation of evidence into practice using the PARiHS framework: theoretical and practical challenges , 2008, Implementation science : IS.

[55]  A D Oxman,et al.  No magic bullets: a systematic review of 102 trials of interventions to improve professional practice. , 1995, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[56]  F. Mcmanus,et al.  Establishing evidence-based training in cognitive behavioral therapy: A review of current empirical findings and theoretical guidance. , 2010, Clinical psychology review.

[57]  R. Menninger.  Administration and policy in mental health , 1993, Administration and Policy in Mental Health and Mental Health Services Research.

[58]  Lawrence A. Palinkas,et al.  Translational Science at the National Institute of Mental Health: Can Social Work Take Its Rightful Place? , 2007 .

[59]  Marije Bosch,et al.  Selecting, Tailoring, and implementing knowledge translation interventions , 2009 .

[60]  C. McNeil,et al.  Evaluation of a Treatment Manual and Workshops for Disseminating, Parent–Child Interaction Therapy , 2008, Administration and Policy in Mental Health and Mental Health Services Research.

[61]  S. Straus,et al.  Knowledge translation in health care : moving from evidence to practice , 2009 .

[62]  Robert D Gibbons,et al.  Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: a randomized effectiveness trial. , 2012, Archives of general psychiatry.

[63]  F. Damanpour.  Organizational Innovation: A Meta-Analysis Of Effects Of Determinants and Moderators , 1991 .

[64]  L. Palinkas,et al.  An ethnographic study of implementation of evidence-based treatments in child mental health: first steps. , 2008, Psychiatric services.

[65]  Patricia L. Kohl,et al.  The State of Parent Training: Program Offerings and Empirical Support , 2009, Families in society : the journal of contemporary human services.

[66]  Marije Bosch,et al.  Tailoring quality improvement interventions to identified barriers: a multiple case analysis. , 2007, Journal of evaluation in clinical practice.

[67]  Anthony L. Hemmelgarn,et al.  Randomized trial of MST and ARC in a two-level evidence-based treatment implementation strategy. , 2010, Journal of consulting and clinical psychology.

[68]  Jennifer L. Magnabosco.  Innovations in mental health services implementation: a report on state-level data from the U.S. Evidence-Based Practices Project , 2006, Implementation science : IS.

[69]  Enola K Proctor,et al.  Advancing the application, quality and harmonization of implementation science measures , 2012, Implementation Science.

[70]  Alan E Kazdin,et al.  Evidence-based treatment and practice: new opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. , 2008, The American psychologist.

[71]  S. Scott,et al.  Development of a checklist to assess the quality of reporting of knowledge translation interventions using the Workgroup for Intervention Development and Evaluation Research (WIDER) recommendations , 2013, Implementation Science.

[72]  M. Eccles,et al.  Welcome to Implementation Science , 2006, Implementation Science.

[73]  K. Hawley,et al.  Mental health clinicians' motivation to invest in training: results from a practice-based research network survey. , 2013, Psychiatric services.

[74]  Grant S. Fletcher,et al.  Strategies to implement alcohol screening and brief intervention in primary care settings: a structured literature review. , 2011, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[75]  Susan Michie,et al.  Specifying and reporting complex behaviour change interventions: the need for a scientific method , 2009, Implementation science : IS.

[76]  D. Pollio,et al.  Teaching Evidence-Based Practice: Toward a New Paradigm for Social Work Education , 2003 .

[77]  David A Chambers,et al.  Bridging research and practice: models for dissemination and implementation research. , 2012, American journal of preventive medicine.

[78]  Charles Glisson,et al.  The effects of the ARC organizational intervention on caseworker turnover, climate, and culture in children's service systems. , 2006, Child abuse & neglect.

[79]  Bruce F Chorpita,et al.  Understanding the common elements of evidence-based practice: misconceptions and clinical examples. , 2007, Journal of the American Academy of Child and Adolescent Psychiatry.

[80]  S. Michie,et al.  Validation of the theoretical domains framework for use in behaviour change and implementation research , 2012, Implementation Science.

[81]  Enola K. Proctor,et al.  A Compilation of Strategies for Implementing Clinical Innovations in Health and Mental Health , 2012, Medical care research and review : MCRR.

[82]  R. McHugh,et al.  Balancing fidelity and adaptation in the dissemination of empirically-supported treatments: The promise of transdiagnostic interventions. , 2009, Behaviour research and therapy.

[83]  D. Kolko,et al.  The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. , 2010, Clinical psychology review.

[84]  David A. Chambers,et al.  Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges , 2008, Administration and Policy in Mental Health and Mental Health Services Research.

[85]  StrategIc PlaN,et al.  National Institute of Mental Health Strategic Plan | 2008 , 2008 .

[86]  J. Grimshaw,et al.  A systematic review of the use of theory in randomized controlled trials of audit and feedback , 2013, Implementation Science.

[87]  Larry R Hearld,et al.  Methods and metrics challenges of delivery-system research , 2012, Implementation Science.

[88]  D. Berwick.  The science of improvement. , 2008, JAMA.

[89]  B. Burns,et al.  Implementing Cognitive Behavioral Therapy in the real world: A case study of two mental health centers , 2008, Implementation science : IS.

[90]  Alicia C. Bunger,et al.  Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[91]  J. Sandars,et al.  Knowledge transfer for the management of dementia: a cluster-randomised trial of blended learning in general practice , 2010, Implementation science : IS.

[92]  R. Raghavan.  The role of economic evaluation in dissemination and implementation research , 2012 .

[93]  Jaelyn R. Farris,et al.  Parent Training: Implementation Strategies for Adventures in Parenting , 2008, The Journal of Primary Prevention.

[94]  E. Proctor,et al.  Writing implementation research grant proposals: ten key ingredients , 2012, Implementation Science.

[95]  C. Sherbourne,et al.  Impact of disseminating quality improvement programs for depression in managed primary care: a randomized controlled trial. , 2000, JAMA.

[96]  R. Kessler,et al.  Recent care of common mental disorders in the united states , 2000, Journal of General Internal Medicine.

[97]  Jeremy M Grimshaw,et al.  A systematic review of the use of theory in the design of guideline dissemination and implementation strategies and interpretation of the results of rigorous evaluations , 2010, Implementation science : IS.

[98]  S. Henggeler,et al.  Transporting Efficacious Treatments to Field Settings: The Link Between Supervisory Practices and Therapist Fidelity in MST Programs , 2002, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[99]  Harold Alan Pincus,et al.  Can Psychiatry Cross the Quality Chasm? Improving the Quality of Health Care For Mental and Substance Use Conditions , 2011 .

[100]  J. Cosby,et al.  Resilience Engineering: Concepts and Precepts , 2006, Quality and Safety in Health Care.

[101]  J. Lowery,et al.  Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science , 2009, Implementation science : IS.

[102]  Lawrence Palinkas,et al.  Design Elements in Implementation Research: A Structured Review of Child Welfare and Child Mental Health Studies , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[103]  Lawrence A. Palinkas,et al.  Mixed Method Designs in Implementation Research , 2010, Administration and Policy in Mental Health and Mental Health Services Research.

[104]  C. Abraham,et al.  Making psychological theory useful for implementing evidence based practice: a consensus approach , 2005, Quality and Safety in Health Care.

[105]  Wendi Cross,et al.  Show Me, Don't Tell Me: Behavioral Rehearsal as a Training and Analogue Fidelity Tool. , 2014, Cognitive and behavioral practice.

[106]  A D Oxman,et al.  Audit and feedback: effects on professional practice and health care outcomes. , 2006, The Cochrane database of systematic reviews.

[107]  Sonja K Schoenwald,et al.  The ARC Organizational and Community Intervention Strategy for Implementing Evidence-Based Children's Mental Health Treatments , 2005, Mental health services research.

[108]  Tom Lane,et al.  Consumers and families as partners in implementing evidence-based practice. , 2003, The Psychiatric clinics of North America.

[109]  J. Grimshaw,et al.  Systematic review of economic evaluations and cost analyses of guideline implementation strategies , 2007, The European Journal of Health Economics.