Over the past several decades, a large number of mental health (MH) practices and interventions have been rigorously tested through randomized control trials and shown efficacious. However, despite availability, evidence-based interventions (EBIs) are rarely adopted in everyday practice within community MH service settings. Further, even when adopted, MH EBIs are seldom implemented with strong adherence to the original design and often fail to be sustained over time. A growing body of literature demonstrates how implementation quality is directly related to the likelihood an EBI will be embedded into everyday clinical practice as well as the likelihood that EBI achieves its intended treatment outcomes. As outlined in NIMH's Strategic Plan, innovative methods to help close the gap between development of research-tested interventions and their widespread use are critically needed. This Phase II SBIR project will continue research and development of the Web- Based Dissemination Tool for Community Mental Health (WDT-C), a flexible technology infrastructure specifically designed to foster quality implementation of MH EBIs within community MH service settings on a broad scale. WDT-C will offer a suite of customizable online tools and services, including cost-efficient high quality training and supervision resources, ongoing implementation assistance for providers, adherence monitoring, and outcomes tracking. Prototype development and feasibility testing with key stakeholders were successfully completed in Phase I, providing substantial support for the product as well as specific recommendations for Phase II development.
Three specific aims will be accomplished through this Phase II project.
The first aim i s to develop the full technology infrastructure utilizing Phase I feedback, and apply it to a third, independent MH EBI. To ensure maximal quality and make any needed adjustments prior to product testing, usability of this new WDT-C application will be assessed by community MH administrators and providers.
The second aim i s to conduct a scientific evaluation of WDT-C. Each of the three WDT-C supported EBIs will be implemented by community MH providers randomly assigned to either Implementation-As-Usual (no WDT-C support) or Enhanced Implementation (WDT-C supported implementation) conditions. Differences between conditions will be tested in five implementation outcome areas: (a) organizational readiness for intervention implementation, (b) adherence to intervention protocol, (c) satisfaction with intervention and implementation support, (d) sustainability of intervention, and (e) treatment benefits.
The final aim i s to finalize all product components based on Phase II findings and evaluations in preparation for Phase III commercialization. This SBIR project will yield a flexible, scalable technology infrastructure that can be applied to any community MH EBI to effectively decrease costs (time, financial, personnel) to both providers and intervention developers, enhance the quality with which EBIs are implemented in community settings, and increase dissemination of EBIs into "real world" everyday practice.
Each year in the U.S., about 6 percent of youth and 13 percent of adults receive some form of mental health (MH) care, at an annual cost of more than $112 billion [1, 2]. In addition, each year NIMH and other foundations fund more than $785 million for MH research, much of it devoted to treatment studies . Unfortunately, it currently takes an average of 17 years for clinical research findings, such as those generated by randomized control trials, to be used regularly in clinical practice . As a result, the current state of MH care in the United States lags far behind the current state of its research knowledge base. As the mental health research-practice gap has become increasingly evident, numerous federal reports have called for action to better connect research findings to clinical practice (e.., The President's New Freedom Commission Report ;Reports of the Surgeon General on Mental Health , Youth Violence , and Culture, Race, and Ethnicity ;Institute of Medicine  and the National Children's Call to Action ). Building on the recommendations of clinical and research community members during the "Enhancing the Discipline of Clinical and Translational Sciences" meeting (May, 2005), the National Institutes of Health (NIH) identified research efforts to bridge science and practice as the primary objective of NIH's roadmap. The proposed research directly addresses this NIH Roadmap priority as well as these federal calls for action. The findings from the proposed research will advance our understanding of how to successfully integrate MH evidence-based interventions (EBIs) into everyday practice within community MH service settings. Increasing the likelihood that EBIs will be adopted, used as intended, and sustained in everyday practice, in turn, will increase the likelihood that society at large will benefit from evidence-based practices.