Depression remains among the nation's top 10 chronic illnesses, costing over $80 billion annually. Depression has been called the Common Cold of mental illness, but one with serious risk of morbidity and mortality. There are now many evidence-based practices for the treatment of depression, but unfortunately these practices remain largely unavailable to clients receiving services in community mental health centers. Measurement Based Care (MBC) is a relatively simple evidence-based intervention framework. MBC, by definition, is the practice of using symptom measurement to inform mental health care. Physicians who routinely measure the patient's blood pressure when the treatment target is high blood pressure demonstrate the medical corollary of MBC. When MBC is used in the treatment of depressed adults, it has been shown to improve outcomes by identifying clients who are not making progress and reducing the likelihood that clients will deteriorate in treatment. However, despite the demonstrated effectiveness of MBC, the majority of community mental health counselors (i.e., clinicians) do not regularly assess target problem symptoms to guide their work over the course of treatment. To our knowledge, no studies to date have focused on the process of implementing MBC in community mental health settings. The long-term goal of this research project is to provide generalizable and practical recommendations about implementation approaches that promote MBC use and fidelity in community mental health centers. Specifically, this study will test a standardized versus a tailored approach to implementing MBC in one of the nation's largest not-for-profit providers of behavioral health services. Although touted as superior, tailored implementations have rarely been compared to standardized approaches. Moreover, recent research has demonstrated an apparent need to adapt evidence- based practices to fit the specific context in which they are being implemented, particularly if they are to be sustained. This proposal reflects a movement in the field of implementation science in which planned adaptations are being tested and compared to standardized versions. The proposed research is a three-phase, mixed methods (quantitative/qualitative) study to investigate the effect of these two different approaches to MBC implementation on both clinician-level (e.g., MBC fidelity) and client-level (depression symptom change) outcomes. We will focus on contextual factors (e.g., attitudes, resources, process, etc.) that may influence the implementation process with the goal of identifying a generalizable and practical way of bringing MBC to community mental health centers treating depressed adults.

Public Health Relevance

Depression remains among the nation's top 10 chronic illnesses, costing over $80 billion annually; however, Measurement Based Care (MBC) is a relatively simple evidence-based intervention framework that has been shown to improve outcomes for depressed clients by identifying those who are not making progress and reducing the likelihood that clients will deteriorate in treatment. Despite the demonstrated effectiveness o MBC, the majority of community mental health counselors do not regularly assess target problem symptoms to guide their work. This study will test a standardized versus a tailored approach to implementing MBC that will include the integration of symptom monitoring capacities into the electronic health record system of one of the nation's largest not-for-profit providers of behavioral health services.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Research Project (R01)
Project #
3R01MH103310-02S1
Application #
9117156
Study Section
Dissemination and Implementation Research in Health Study Section (DIRH)
Program Officer
Rupp, Agnes
Project Start
2014-09-10
Project End
2018-07-31
Budget Start
2015-08-01
Budget End
2016-07-31
Support Year
2
Fiscal Year
2015
Total Cost
$22,464
Indirect Cost
$8,064
Name
Indiana University Bloomington
Department
Psychology
Type
Schools of Arts and Sciences
DUNS #
006046700
City
Bloomington
State
IN
Country
United States
Zip Code
47401
Lewis, Cara C; Puspitasari, Ajeng; Boyd, Meredith R et al. (2018) Implementing measurement based care in community mental health: a description of tailored and standardized methods. BMC Res Notes 11:76
Boyd, Meredith R; Powell, Byron J; Endicott, David et al. (2018) A Method for Tracking Implementation Strategies: An Exemplar Implementing Measurement-Based Care in Community Behavioral Health Clinics. Behav Ther 49:525-537
Jensen-Doss, Amanda; Haimes, Emily M Becker; Smith, Ashley M et al. (2018) Monitoring Treatment Progress and Providing Feedback is Viewed Favorably but Rarely Used in Practice. Adm Policy Ment Health 45:48-61
Jacinto, Sofia B; Lewis, Cara C; Braga, João N et al. (2018) A conceptual model for generating and validating in-session clinical judgments. Psychother Res 28:91-105
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
Boyd, Meredith R; Lewis, Cara C; Scott, Kelli et al. (2017) The creation and validation of the Measure of Effective Attributes of Trainers (MEAT). Implement Sci 12:73
Lewis, Cara C; Marti, C Nathan; Marriott, Brigid R et al. (2017) Patterns of practice in community mental health treatment of adult depression. Psychother Res :1-8
Lyon, Aaron R; Lewis, Cara C (2016) Designing Health Information Technologies for Uptake: Development and Implementation of Measurement Feedback Systems in Mental Health Service Delivery. Introduction to the Special Section. Adm Policy Ment Health 43:344-9
Lyon, Aaron R; Lewis, Cara C; Boyd, Meredith R et al. (2016) Capabilities and Characteristics of Digital Measurement Feedback Systems: Results from a Comprehensive Review. Adm Policy Ment Health 43:441-66
Scott, Kelli; Klech, David; Lewis, Cara C et al. (2016) What Did They Learn? Effects of a Brief Cognitive Behavioral Therapy Workshop on Community Therapists' Knowledge. Community Ment Health J 52:998-1003

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