Background/Overview: This proposal requests full, 3-year funding for the Behavioral Health (BH) QUERI Implementation Facilitation Training Hub. Implementation facilitation (IF) is a multifaceted strategy involving interactive problem-solving and support that occurs in a context of a recognized need for improvement and supportive interpersonal relationships. IF bundles an integrated set of activities to support uptake of effective practices, including but not limited to: engaging stakeholders, identifying champions, action planning, staff training, problem-solving, providing technical support, audit/feedback and marketing. An increasing volume of literature supports IF as an evidence-based strategy for implementing evidence-based practices (EBPs) and other clinical innovations. Systematic reviews have found that primary care practices were almost 3 times more likely to adopt evidence-based guidelines through use of facilitation; and multiple studies inside and outside VA show IF to be an effective strategy for implementing new clinical programs/practices. As the evidence for effectiveness of IF grows, so has the demand for IF training from VA operations leaders and research staff. Guided by the integrated?Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, BH QUERI leaders have developed substantial experience and expertise in applying and testing the impact of IF strategies to support implementation of EBPs and other clinical innovations. Over the past 8+ years, we have systematically transferred this knowledge to VACO leaders, frontline clinical managers, other QUERI/VA researchers, and non-VA researchers through development and ongoing refinement of our IF Training Program. To date, this work has been done as an ?add-on? to project-specific work in our QUERI programs, which we have accommodated despite limited resources because we know first-hand the value and impact of IF. Training Hub funding will allow us to expand and sustain our IF Training Program, affording us the opportunity to enhance our efforts to increase training capacity and efficiency to meet ever-increasing demand.
Specific Aims and Methods: 1) Provide Implementation Facilitation (IF) training to VA and non-VA trainees to improve knowledge of and confidence in using IF to implement EBPs and other clinical innovations. Components of the 2-day in-person IF Training Program include preparatory work, didactic sessions, instruction on key IF roles/activities, interactive role-plays and group exercises. Post-training mentoring and consultation is provided to trainees, and our IF Learning Collaborative is also available to trainees for ongoing learning. 2) Conduct independent evaluation to assess impact on trainee?s IF knowledge/skills and identify training strategies/resources that work well and areas for improvement. Fundamental to our IF Training Program is an ongoing independent evaluation conducted by our South Central MIRECC partners, with rapid PDSA cycles (incorporating collection/analysis of quantitative and qualitative data) around each training for continuous quality improvement. Findings from this evaluation will directly inform incremental ?real-time? changes in the training program, as well as efforts to address Specific Aims 3 and 4. 3) Develop, pilot and evaluate virtual IF training components. To expand reach and impact of our IF Training program, we will continue to develop and evaluate (based on Aim 2 data) new tools/resources for providing IF training and mentoring through virtual platforms (e.g., V-Tel and online platforms). 4) Revise and update the IF training program to integrate new knowledge. In Year 3, we will revise and update the IF Training Program based on (a) results from the ongoing evaluation (Aim 2); (b) findings from applying IF in BH QUERI projects and other VA/non-VA projects/initiatives; (c) the updated IF Training Manual to be completed in Year 2 of the Training Hub as part of BH QUERI Implementation Core activities; and (d) consultation with a Healthcare Professional Education expert on best practices in adult learning.
The proposed Behavioral Health QUERI Implementation Facilitation (IF) Training Hub holds great promise for helping to address VA and QUERI priorities. For example, as the evidence for impact of IF strategies in supporting implementation of EBPs and other best practices becomes increasingly robust, the Behavioral Health QUERI IF Training Program continues to prepare cadres of VA personnel to apply IF strategies in support of high priority clinical initiatives (e.g., REACH-Vet for suicide prevention, medication-assisted treatment for opioid use disorders, Diffusion of Excellence Gold Status Practices) and other VA quality improvement and research efforts. Further, the application of IF strategies involves a direct focus on engaging VA staff in self-determining the focus and process of quality improvement activities in their own settings, potentially resulting in increased morale.
