Breakout N – May 17, 2013
1. Overcoming Implementation Research Challenges While Studying CPT Training & Implementation Across Canada
Presenter: Shannon Wiltsey Stirman, PhD
Authors: Shannon Wiltsey Stirman, PhD,1 Candice Monson, PhD,2 Josh Deloriea, BA,2 Jennifer Belus, BA,3 Marta Maslej, BA,2 & Norman Shields, PhD4
1VA Boston Healthcare System, National Center for PTSD, & Boston University; 2Ryerson University; 3University of North Carolina; 4Operational Stress Injuries National Network, Veteran Affairs Canada
Abstract: The overall objectives of this study are 1) to compare three different post-workshop consultation strategies (technology-enhanced, standard, and independent use of resources) for the implementation of Cognitive Processing Therapy with clinicians who serve Veterans in Canada, and 2) to identify system-, site- and provider-level barriers and facilitators to implementation. Consistent with the theme of this year’s conference, we will present data relevant to our efforts to solve implementation research dilemmas that arose as we executed the study. Two grant submissions and three cycles of recruitment have allowed us to iteratively refine strategies to address a number of challenges inherent in implementation research, including considerations regarding study design, recruiting and engaging clinicians, managing over 16 separate IRB submissions, addressing problems with study technology, collecting data from clinicians based at clinics throughout the country, consenting of patient participants, ethical dilemmas, budget constraints, and fidelity monitoring (for both consultation condition fidelity at the consultant level CPT fidelity at the clinician level). We will present data gathered and analyzed from meeting minutes, data tracking logs, monthly clinician activity reports, weekly consultation reports, and interviews with clinicians and consultants to demonstrate both the decision making processes around addressing these challenges, as well as the outcomes of our implementation of these strategies.
2. Financing & Scaling Up Early Intervention Services
Presentation Slides Not Available
Presenter: Howard Goldman, MD
Authors: Howard Goldman, MD, PhD,1 Mustafa C. Karakus, PhD,2 & Kirsten Beronio, JD3
1Department of Psychiatry, University of Maryland School of Medicine; 2Westat; 3US Department of Health & Human Services, ASPE
Author: This presentation will focus on the scalability of supported employment and early intervention services in mental health care. It is based on a series of studies performed by Westat for the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the Department of Health and Human Services. ASPE has been interested in examining policies that would promote the implementation of supported employment services and early intervention services in mental disorders over the past several years. The passage of the Affordable Care Act (ACA) has improved the prospects for financing some of these services, but barriers still remain for paying for supported employment and supported education, as well as scaling up other aspects of team-based early intervention services. We will report on our discussions with policy makers, service providers and our observations from site visits across the U.S.
3. System Improvement Through Service Collaboratives: Closing Gaps & Improving Access & Coordination
Presenter: Brian Rush, PhD
Authors: Brian Rush, PhD,1 Fiona C. Thomas,2 & Heather McKee2
1Centre for Addiction & Mental Health, Department of Psychiatry, University of Toronto; 2Centre for Addiction & Mental Health, University of Toronto
Abstract: The Systems Improvement through Service Collaboratives (SISC) initiative, sponsored by the Centre for Addiction and Mental Health, aims to improve access and coordination for those with mental health and addictions problems, with priority on children and youth in regions across Ontario, Canada. This provincial initiative spans across multiple sectors and six different Ministries, including those in the health, justice and education sectors. SISC is grounded in Implementation Science (IS) frameworks, including Quality Improvement (QI), and has a strong emphasis on both developmental evaluation and more traditional performance measurement.
The presentation will focus on how this initiative embedded the National Implementation Research Network (NIRN) framework for implementing evidence-based interventions (EBI) across the province. Evaluation data will be presented, which includes performance indicators related to key transitions (e.g. hospital – community; health – justice; youth-adult) and measures of implementation progress, including those of maintaining fidelity to EBI. The evaluation is further comprised of assessments of partnership and collaboration, measures of health equity and case studies. The challenges of balancing between both provincial and local indicators will be discussed. Finally, contributions to the theoretical framework of IS, based on learnings from this initiative will be shared.