The goal of this K23 Mentored Patient-Oriented Research Career Development Award is to support the applicant in developing the critical skills necessary for an independent research program around the implementation of evidence-based treatments (EBTs) in community settings. The NIMH Strategic Plan states that one of the most important challenges of the next 20 years for the field of mental health is to implement effective treatments, developed in research settings, in the community (i.e., Strategy 4.1, 4.2, and 4.3). This K23 application capitalizes on a planned transformation of child mental healt services in the public sector in the City of Philadelphia. The applicant will embed herself as part of this natural experiment in community mental health clinics (CMHCs). Specific training goals for this 5-year-period, to be achieved under the mentorship of David Mandell, ScD, an expert in implementation science, and a team of expert consultants, are designed to engender applicant expertise in: (1) CMHC response to policy: understanding CMHC response to a system-level mandate of implementation of child EBTs in the public sector~ (2) organizational and leadership moderators: examining the impact of organizational- and leader-level factors on variability in EBT implementation~ and (3) intervention development: building expertise in the use of intervention mapping to lead to future implementation intervention development. The research component of this K23 includes three projects that build upon each other. The first project will use quantitative methods to answer the following question: To what extent do CMHCs (n = 30) implement child EBTs in response to a system-level policy mandate? The primary implementation outcome is fidelity at the individual provider level (n = 120) as measured by self-report and brief observation, three times over five years. One wave of data collection will occur prior to the initiation of the mandate. In project 2, the applicant will use quantitative methods to answr the following question: Do organizational- and leadership-level variables moderate implementation success? Organizational-level (i.e., organizational culture, organizational climate, implementation climate) and leader-level (i.e., knowledge of EBTs, leadership style, attitudes towards EBTs) predictors of implementation of child EBTs in CMHCs (N = 30) will be measured three times over 5 years. In project 3, beginning in the third year, the applicant wil study 6 CMHCs in depth using qualitative methods that are high- performing, average-performing, and low-performing to understand their experience around the implementation process using interviews. Findings from the proposed research will inform both future policy mandates around implementation and the support required for the success of these policies, increase the number of youth who can access quality psychosocial treatment, and reduce the research-practice gap.

Public Health Relevance

The work proposed has the potential to impact public health by increasing the implementation of evidence- based psychosocial treatments in the public sector, thus reaching traditionally underserved youth. The mentorship, training, and research activities will result in an understanding of how agencies respond to implementation mandates and organizational- and leadership-level predictors of implementation, critical steps toward developing implementation interventions around modifiable organizational- and leader-level variables. Independent investigators with the knowledge to conduct this type of work will be especially important going forward given that many counties and states are beginning to mandate implementation of evidence-based treatments (e.g., California, New York) and the health reform act of 2014 which will mandate implementation of evidence-based treatments in healthcare.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
4K23MH099179-05
Application #
9098847
Study Section
Mental Health Services Research Committee (SERV)
Program Officer
Hill, Lauren D
Project Start
2012-09-15
Project End
2017-06-30
Budget Start
2016-07-01
Budget End
2017-06-30
Support Year
5
Fiscal Year
2016
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Psychiatry
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Skriner, Laura C; Wolk, Courtney Benjamin; Stewart, Rebecca E et al. (2018) Therapist and Organizational Factors Associated with Participation in Evidence-Based Practice Initiatives in a Large Urban Publicly-Funded Mental Health System. J Behav Health Serv Res 45:174-186
Kang-Yi, Christina D; Grinker, Roy Richard; Beidas, Rinad et al. (2018) Influence of Community-Level Cultural Beliefs about Autism on Families' and Professionals' Care for Children. Transcult Psychiatry 55:623-647
Kang-Yi, Christina D; Wolk, Courtney Benjamin; Locke, Jill et al. (2018) Impact of school-based and out-of-school mental health services on reducing school absence and school suspension among children with psychiatric disorders. Eval Program Plann 67:105-112
Williams, Nathaniel J; Ehrhart, Mark G; Aarons, Gregory A et al. (2018) Linking molar organizational climate and strategic implementation climate to clinicians' use of evidence-based psychotherapy techniques: cross-sectional and lagged analyses from a 2-year observational study. Implement Sci 13:85
Torres, Elisa M; Ehrhart, Mark G; Beidas, Rinad S et al. (2018) Validation of the Implementation Leadership Scale (ILS) with Supervisors' Self-Ratings. Community Ment Health J 54:49-53
Becker-Haimes, Emily M; Okamura, Kelsie H; Wolk, Courtney Benjamin et al. (2017) Predictors of clinician use of exposure therapy in community mental health settings. J Anxiety Disord 49:88-94
Aarons, Gregory A; Ehrhart, Mark G; Torres, Elisa M et al. (2017) The Humble Leader: Association of Discrepancies in Leader and Follower Ratings of Implementation Leadership With Organizational Climate in Mental Health. Psychiatr Serv 68:115-122
Powell, Byron J; Beidas, Rinad S; Lewis, Cara C et al. (2017) Methods to Improve the Selection and Tailoring of Implementation Strategies. J Behav Health Serv Res 44:177-194
Edmunds, Julie M; Brodman, Douglas M; Ringle, Vanesa A et al. (2017) Examining adherence to components of cognitive-behavioral therapy for youth anxiety after training and consultation. Prof Psychol Res Pr 48:54-61
Okamura, Kelsie H; Benjamin Wolk, Courtney L; Kang-Yi, Christina D et al. (2017) The Price per Prospective Consumer of Providing Therapist Training and Consultation in Seven Evidence-Based Treatments within a Large Public Behavioral Health System: An Example Cost-Analysis Metric. Front Public Health 5:356

Showing the most recent 10 out of 56 publications