Longitudinal Remote Consultation for Implementing Collaborative Care for Depression
Saturday 1:00 – 2:15 Breakout E1
Presentor: Ian M. Bennett
Ian Bennett, University of Pennsylvania; Jurgen Unutzer, University of Washington; Rinad Beidas, University of Pennsylvania; Diane Powers, University of Washington; Rachel Gold, Oregon Health Sciences University
A major obstacle to achieving the benefits to patients observed in effectiveness trials of complex interventions in large scale implementation efforts is the limit of resources available to support the training to mastery of staff carrying out the intervention. Although ongoing support in the form of training, technical assistance, quality improvement, and tools improves both implementation and patient outcomes through longitudinal consultation by content experts, most large implementation efforts rely primarily on brief intensive training for staff because of cost limitations. We conceptualize consultants as intervention-specific practice facilitators. We have developed an innovative and pragmatic remote model of longitudinal consultation for implementation of the team based collaborative care intervention for treatment of adult depression in primary care. Targeting key elements of the intervention we make use of video conferencing technologies to allow consult liaison psychiatrists to deliver this consultation to many sites simultaneously in an efficient manner. Key elements of this implementation strategy, measurement tools, and our experience with the model used in an ongoing multi-state implementation effort will be presented.
Efficient Methodologies for Monitoring Fidelity in Routine Implementation: Lessons from the Allentown Social Emotional Learning Initiative
Saturday 1:00 – 2:15 Breakout E1
Presentor: B.K. Elizabeth Kim
B.K. Elizabeth Kim, University of California, Berkeley; Valerie B. Shapiro, University of California; Berkeley, Jennifer L. Fleming, Devereux Center for Resilient Children; Paul LeBuffe, Devereux Center for Resilient Children
Monitoring implementation fidelity is essential to implementation success and intervention effectiveness. Ongoing monitoring, however, is challenging. The Promoting Alternative Thinking Strategies (PATHS) Curriculum is a school-based prevention program. Implementation guidelines suggest hiring PATHS coaches to monitor implementation fidelity of 20% of PATHS lessons (8-10 observations in grades K-2). In addition to self-monitoring of teacher fidelity, the district-wide Social Emotional Learning Initiative hired two Coaches to conduct observations in 170 classrooms across 15 schools. Coaches attempted to observe each classroom 8 times. Observations of teacher fidelity to PATHS were significantly correlated across time (e.g., r=.58-.80), but observations were not uniformly completed. 94% of classrooms were observed at Time 1. Only 35% of classrooms were observed at Time 8. Teacher fidelity to PATHS at Time 1, as observed by Coaches, was unrelated to the number of observations ultimately completed. However, the more the Coach at Time 1 perceived the teacher to be “committed to a high level of implementation of PATHS in their classroom???, the greater number of observations were ultimately completed (ES=.16). Findings suggest 1) fewer/briefer observations and 2) that teacher “buy-in???, detectable in the first month of implementation, is likely a requisite to implementation fidelity monitoring by technical assistance providers.
Efficient Sustainability: Existing Community Based Supervisors as EBT Supports
Saturday 1:00 – 2:15 Breakout E1
Presentor: Shannon Dorsey
First author (first & last name), University of Washington; Michael D. Pullmann, University of Washington; Suzanne E.U.Kerns, University of Washington; Nathaniel Jungbluth, University of Washington; Lucy Berliner, University of Washington; Kelly Thompson, University of Washington ; Eliza Segell, University of Washington
Existing community-based supervisors (CBS) are an underutilized resource for supporting EBP in community mental health, despite the fact that CBS offer an efficient and affordable mechanism for strengthening the implementation of EBPs. We present data from a study of CBS involved in a state-supported EBT effort—the Washington State Trauma-focused CBT Initiative. This study provides the only examination, to our knowledge, of how supervision time is spent by CBS and clinicians trained in EBT.
Supervisors (N = 42) and clinicians (N=167) report a high concordance of time spent on a variety of supervision topics, many of which are not clinically focused. Time spent on two EBT-critical activities—case conceptualization and treatment intervention—make up less than half of the supervision time. How much time was spent on these activities was associated with organizational climate—clinicians reporting higher stress and lower cohesion at their organization reported less time dedicated to these two activities. Notably, both supervisors (76.2%) and clinicians (74.8%) overwhelmingly report a desire for more time on case conceptualization and treatment intervention. We discuss implications of multiple demands on CBS for EBT implementation and present preliminary findings from a RCT designed to better integrate these two activities into supervision.