Refining a Compilation of Discrete Implementation Strategies and Determining Their Importance and Feasibility

Friday 1:00 – 2:15 Breakout B4

Presentor: Byron J. Powell

 

Byron J. Powell, Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Thomas J. Waltz, Eastern Michigan University; VA Center for Clinical Management Research; Matthew J. Chinman, VISN 4 MIRECC; RAND Corporation; Laura J. Damschroder, VA Center for Clinical Management Research and Diabetes Quality Enhancement Research Initiative (QUERI); Jeffrey L. Smith, Central Arkansas Veterans Healthcare System, VA Mental Health Quality Enhancement Research Initiative (QUERI), HSR&D Center for Mental Healthcare and Outcomes Research; Monica M. Matthieu, Central Arkansas VA Healthcare System and Saint Louis University ; Enola K Proctor, Brown School, Washington University in St. Louis; JoAnn E Kirchner, Central Arkansas Veterans Healthcare System, HSR&D and Mental Health Quality Enhancement Research Initiative (QUERI), Department of Veterans Affairs Medical Center, Li

Identifying feasible and effective implementation strategies remains a significant challenge. This is partly due to a lack of conceptual clarity in the field, and insufficient guidance about how to select appropriate strategies. The Expert Recommendations for Implementing Change (ERIC) project aimed to 1) establish expert consensus on implementation strategy terms, definitions, and categories, and 2) develop recommendations for strategies likely to be effective in integrating EBPs into VA mental health service settings. Findings from Aim 1 will be presented. Purposive sampling was used to recruit a panel of implementation science and clinical experts (n=71). The expert panel was engaged in a three-round modified Delphi process to generate consensus on strategies and definitions. Rounds 1 and 2 involved web-based surveys that prompted edits and additions to the strategy terms and definitions from Powell et al (2012). The third round involved a live, web-based polling and consensus process that yielded a final compilation of 73 strategies and definitions (Powell et al., 2015). Experts were subsequently engaged in a concept mapping process that organized implementation strategies into nine clusters and provided ratings of the importance of each strategy and cluster. Implications for research and practice will be discussed.

Structuring Complex Recommendations: Methods and General Findings

Friday 1:00 – 2:15 Breakout B4

Presentor: Thomas Waltz

 

Thomas Waltz, Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA; Byron Powell, Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Matthew Chinman, VISN 4 MIRECC; RAND Corporation; Laura Damschroder, VA Center for Clinical Management Research and Diabetes Quality Enhancement Research Initiative (QUERI); Jeffrey Smith, Central Arkansas Veterans Healthcare System, VA Mental Health Quality Enhancement Research Initiative (QUERI), HSR&D Center for Mental Healthcare and Outcomes Research; Monica Mathieu, Central Arkansas VA Healthcare System and Saint Louis University ; Enola Procto, Brown School, Washington University in St. Louis; JoAnn Kirchner, Central Arkansas Veterans Healthcare System, VA Mental Health Quality Enhancement Research Initiative (QUERI), HSR&D Center for Mental Healthcare and Outcomes Research

The ERIC project’s penultimate activity involved a menu-based choice (MBC) task.  MBC was used to facilitate building multi-strategy implementation approaches for a clinical practice change by providing ratings for each of 73 implementation strategies in terms of how essential they would be for implementing that practice change while taking care not to overburden staff with unnecessary activities.  Recommendations were obtained for three high priority practice changes in the VA: improving safety for patients taking antipsychotic medications, depression outcome monitoring in primary care-mental health, and Prolonged Exposure therapy for treating post-traumatic stress disorder.  Twenty or more experts provided recommendations for each of the practice changes, each of which presented three different scenarios that reflected varying contextual strengths and weaknesses.  In addition to describing how the ERIC project used MBC to structure complex practice-change-specific recommendations, recommendations that were consistent across all three practice changes will be presented.  The discussion will also highlight how the MBC ratings of the strategies relate to the more generic ratings obtained in the Concept Mapping task.

Implementing Prolonged Exposure for PTSD in the VA: Expert Recommendations from the ERIC Project

Friday 1:00 – 2:15 Breakout B4

Presentor: Monica Matthieu

 

Monica Matthieu, Central Arkansas VA Healthcare System and Saint Louis University; Craig Rosen, National Center for PTSD, VA Palo Alto Healthcare System and Department of Psychiatry & Behavioral Sciences, Stanford University; Thomas Waltz, Department of Psychology, Eastern Michigan University, HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System; Byron Powell, Center for Mental Health Policy and Services Research, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania; Matthew Chinman, VISN 4 MIRECC, RAND Corporation; Laura Damschroder, VA Center for Clinical Management Research and Diabetes Quality Enhancement Research Initiative (QUERI) ; Jeffrey Smith, Central Arkansas Veterans Healthcare System, VA Mental Health Quality Enhancement Research Initiative (QUERI), HSR&D Center for Mental Healthcare and Outcomes Research; Enola Proctor, Brown School, Washington University in St. Louis

The Expert Recommendations for Implementing Change (ERIC) project utilized rigorous methods to support a highly structured and transparent recommendation process that actively engaged key stakeholders throughout the project’s execution.  This presentation will first provide a brief overview of how stakeholders at the National Center for PTSD were engaged in an iterative process of evaluating the Prolonged Exposure for PTSD implementation scenarios for reliability, credibility, and transferability.  Second, this presentation will describe the ERIC recommendations for this practice change focusing on high consensus strategies. Finally, a discussant from the National Center for PTSD will compare and contrast the implementation strategies used in the actual VA rollout for Prolonged Exposure (past, present, and future) with the strategies recommended by the ERIC project.