Few evidence-based treatment models for mental disorders have been translated into community-based practices. A primary reason for this research-to-practice gap is the lack of tools and incentives to maintain treatment fidelity (e.g., training) while maximizing generalizability across different settings. The goal of this randomized controlled trial is to determine whether a systematic framework for implementing behavioral health treatment models leads to improved intervention fidelity and patient outcomes in community-based mental health practices. We will test components of the Replicating Effective Programs (REP) implementation framework, which includes: 1) translation of effective treatment models into culturally appropriate, non- technical components ("packaging"), 2) formal training of providers in implementing the package, and 3) supporting the transfer of the package through technical assistance (TA). Using the bipolar disorder care model (BCM) as an example of an effective intervention, we will package the BCM, and then randomize 60 community-based practices from three large behavioral health organizations to receive the BCM package along with training and TA, or the BCM package only. All practices will receive the BCM package, which includes: 1) self-management education scripts, 2) care management protocols, and 3) simplified practice guidelines. In the training/TA arm, selected staff at sites will receive standardized training in the BCM and structured TA via a specialist who will contact site representatives on a regular basis to problem-solve local barriers to BCM implementation. Primary (12-month) outcomes include patient-level fidelity to BCM core elements, clinical status (e.g., symptoms, functioning, quality of life), and REP/BCM cost-effectiveness. Translating effective treatment models from research to practice is a public health priority articulated by the NIH Roadmap. There have been no implementation frameworks applied to health care settings that have successfully demonstrated improved patient outcomes. While training and TA are designed to maximize model fidelity, they can be costly for programs. Yet training and TA may enhance fidelity and buy-in from local practices through consultations on reducing implementation barriers. Determining the marginal benefit of training and TA on improved fidelity and patient outcomes is crucial for making the business case for REP to health care stakeholders, ultimately facilitating translation of evidence-based treatment models to community- based practices.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
5R01MH079994-05
Application #
8269051
Study Section
Mental Health Services in MH Specialty Settings (SRSP)
Program Officer
Chambers, David A
Project Start
2008-09-19
Project End
2014-05-31
Budget Start
2012-06-01
Budget End
2014-05-31
Support Year
5
Fiscal Year
2012
Total Cost
$635,452
Indirect Cost
$171,385
Name
University of Michigan Ann Arbor
Department
Psychiatry
Type
Schools of Medicine
DUNS #
073133571
City
Ann Arbor
State
MI
Country
United States
Zip Code
48109
Kilbourne, Amy M; Goodrich, David E; Nord, Kristina M et al. (2015) Long-Term Clinical Outcomes from a Randomized Controlled Trial of Two Implementation Strategies to Promote Collaborative Care Attendance in Community Practices. Adm Policy Ment Health 42:642-53
Kilbourne, Amy M; Bramlet, Margretta; Barbaresso, Michelle M et al. (2014) SMI life goals: description of a randomized trial of a collaborative care model to improve outcomes for persons with serious mental illness. Contemp Clin Trials 39:74-85
Abraham, Kristen M; Miller, Christopher J; Birgenheir, Denis G et al. (2014) Self-efficacy and quality of life among people with bipolar disorder. J Nerv Ment Dis 202:583-8
Waxmonsky, Jeanette; Kilbourne, Amy M; Goodrich, David E et al. (2014) Enhanced fidelity to treatment for bipolar disorder: results from a randomized controlled implementation trial. Psychiatr Serv 65:81-90
Bajor, Laura A; Lai, Zongshan; Goodrich, David E et al. (2013) Posttraumatic stress disorder, depression, and health-related quality of life in patients with bipolar disorder: review and new data from a multi-site community clinic sample. J Affect Disord 145:232-9
Miller, Christopher J; Grogan-Kaylor, Andrew; Perron, Brian E et al. (2013) Collaborative chronic care models for mental health conditions: cumulative meta-analysis and metaregression to guide future research and implementation. Med Care 51:922-30
O'Donnell, Allison N; Williams, Brent C; Eisenberg, Daniel et al. (2013) Mental health in ACOs: missed opportunities and low-hanging fruit. Am J Manag Care 19:180-4
Miller, Christopher J; Abraham, Kristen M; Bajor, Laura A et al. (2013) Quality of life among patients with bipolar disorder in primary care versus community mental health settings. J Affect Disord 146:100-5
Goodrich, David E; Kilbourne, Amy M; Nord, Kristina M et al. (2013) Mental health collaborative care and its role in primary care settings. Curr Psychiatry Rep 15:383
O'Donnell, Allison N; Williams, Mark; Kilbourne, Amy M (2013) Overcoming roadblocks: current and emerging reimbursement strategies for integrated mental health services in primary care. J Gen Intern Med 28:1667-72

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