Approximately 15 million American children suffer from psychiatric disorders at an estimated treatment cost of $8.9 billion annually. During the last 30 years several effective evidence-based treatments (EBTs) have been developed to treat these conditions. However, EBTs are rarely implemented successfully in usual care practice settings. Given the typically poor outcomes of usual care services, the National Institute of Mental Health recently prioritized research that develops and tests implementation strategies to effectively integrate EBTs within community settings. Implementation researchers have tested a range of implementation strategies in mental health settings but two key knowledge gaps limit the field. First, researchers have yet to identify the specific change processes (i.e., the require "active ingredients" of implementation interventions), or the specific change mechanisms (i.e., the intermediate changes that occur during the course of the intervention and serve as the basis for the effect) that explain how and why implementation strategies generate desired changes. Identification of change processes and mechanisms is critical to developing the most effective and efficient implementation strategies for targeted settings. Second, although most mental health services are provided within complex organizations and decades of research suggest organizational social context is vital to successful innovation implementation, few implementation strategies target social context. The next steps in advancing the development of effective implementation strategies involve understanding how successful implementation strategies generate their effects, and specifically addressing the role of social context in the cross-level organizational change that characterizes successful EBT implementation. The proposed research training plan enables the PI to develop an independent program of research focused on identifying the organizational change processes and mechanisms that contribute to effective integration of EBTs into routine clinical settings. The research training plan includes advanced training activities that develop the PI's competency across three core areas: implementation science, organizational interventions, and organizational change mechanisms. The plan includes specialized didactic learning activities (elective coursework, workshops, and conferences), collaboration with three expert implementation scientists who are each directing NIMH-funded R01 implementation studies, and completion of an independent research project. The research project is the first to directly test organizational change processes and change mechanisms in the context of a randomized controlled trial of an organizational implementation strategy. The training plan prepares the PI for an independent research career focused on improving the implementation of effective mental health treatments in usual care settings. The likely benefits of this research include enhanced quality of life for children with psychiatric disorders and their families and reduced costs of mental health treatment through greater efficiency and effectiveness of service systems.

Public Health Relevance

The proposed research training plan is relevant to public health because it improves our understanding of how to increase the use of effective practices in routine mental health systems, thereby increasing the proportion of children and families who receive effective services and increasing the nation's return on its investment in biomedical and behavioral research. The plan advances the NIMH's strategic goal of closing the gap between the development of new, research-based mental health interventions and their widespread availability to those most in need.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Predoctoral Individual National Research Service Award (F31)
Project #
5F31MH099846-02
Application #
8551405
Study Section
Special Emphasis Panel (ZMH1-ERB-M (07))
Program Officer
Hill, Lauren D
Project Start
2012-09-13
Project End
2015-09-12
Budget Start
2013-09-13
Budget End
2014-09-12
Support Year
2
Fiscal Year
2013
Total Cost
$33,413
Indirect Cost
Name
University of Tennessee Knoxville
Department
None
Type
Schools of Social Work
DUNS #
003387891
City
Knoxville
State
TN
Country
United States
Zip Code
37996
Williams, Nathaniel J; Glisson, Charles (2014) Testing a theory of organizational culture, climate and youth outcomes in child welfare systems: a United States national study. Child Abuse Negl 38:757-67
Olin, S Serene; Williams, Nate; Pollock, Michele et al. (2014) Quality indicators for family support services and their relationship to organizational social context. Adm Policy Ment Health 41:43-54
Glisson, Charles; Hemmelgarn, Anthony; Green, Philip et al. (2013) Randomized trial of the Availability, Responsiveness and Continuity (ARC) organizational intervention for improving youth outcomes in community mental health programs. J Am Acad Child Adolesc Psychiatry 52:493-500
Williams, Nathaniel J; Glisson, Charles (2013) Reducing turnover is not enough: The need for proficient organizational cultures to support positive youth outcomes in child welfare. Child Youth Serv Rev 35: