For example, we reworded the question “Did you feel satisfied with the services you received? You may meet the psychiatrist one time and not see them again until a few weeks later.” Others were concerned that psychiatric treatment resulted in being registered into a database that could be used against them. For example, for appropriateness, only participants who provided responses to 7 or more items were included in the analysis of the appropriateness scale (but their data was included in analyses of other domains if they provided more complete answers to those scales). For analyses based on summary scores we pro-rated the scale scores only for participants who responded to more than 50% of each scale by replacing missing items with the individual average score across the items in each domain. We expected a large amount of missing data based on asking participants to answer hypothetically about their assessments of a program not yet in existence. We dichotomized overall domain ratings yielding an odds ratio representing the increased odds of having rated the vignette as a moderate amount or very acceptable/appropriate/feasible/accessible compared to a little bit or not at all acceptable/appropriate/feasible/accessible.
- Rather, individuals who are receiving treatment and/or medications may have stable mental health that is not impacting their compliance with supervision and could, therefore, be supervised on a standard caseload.
- Modeling the interrelationships between implementation outcomes will also inform their definitional boundaries and thus shape the taxonomy.
- We hypothesized that scores on the scales on the Implementation measure being tested would be higher for the vignette-based description of a “well”-implemented mental health program compared to the vignette-based description of a “poorly”-implemented mental health program.
- In decentralised healthcare systems, such as in South Africa, translation of national policies into strategic plans appropriate to the provincial or district level contexts seems to be a key factor for ensuring their successful implementation (Draper et al., 2009).
Critical Research Questions
One respondent argued for the provision of step-by-step guidance, while another cautioned against offering overly prescriptive guidance to LMIC-based investigators. Several respondents struggled with the tension between cost and rigor and wondered whether a minimal set of validation strategies might be feasible in most situations but ultimately insufficient for establishing validity. Respondents disagreed most about the vignette-based strategy; they did not agree on the amount of time and resources required, nor whether it was feasible to develop vignettes that could provide high-confidence results in diverse low-resource settings. Respondents identified a trade-off between the rigor of different validation approaches and their resource-intensiveness (Supplementary Material, Section 2).
Their review led these authors to conclude that “the evidence regarding the implementation of innovations was particularly complex and relative sparse” and that at the organizational level, the move from considering an adoption to successfully routinizing it is generally a nonlinear process characterized by multiple shocks, setbacks, and unanticipated events” (Greenhalgh et al. 2004, p. 610). Because of the pressing need to accelerate our understanding of successful implementation, concerted efforts https://www.nationalacademies.org/read/26809/chapter/5 are required to advance implementation science and produce skilled implementation researchers. Ensuring that effective interventions are implemented in diverse settings and populations has been identified as a priority by NIMH Director Thomas Insel (2007). The implementation gap prevents our nation from reaping the benefit of billions of US tax dollars spent on research and, more important, prolongs the suffering of millions of Americans who live with mental disorders (President’s New Freedom Commission on Mental Health 2003). Concerted efforts are required to advance implementation science and produce skilled implementation researchers.
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As these efforts continue to advance, it will be important that implementation research in school mental health—and education more generally—does not simply adopt the health-oriented conceptualization of implementation wholesale and uncritically. As school mental health implementation research continues to evolve over the next decade, we hope to see expanded emphasis on ways to promote equitable implementation. For instance, Renshaw and Phan (2023) recently proposed an expansion of implementation reporting recommendations for school-based mindfulness interventions to center equity (e.g., through explicit attention to principles that research teams might employ to center diversity, equity, and inclusion during intervention adaptation). This includes the development of multiple equity-oriented implementation frameworks (e.g., Eslava-Schmalbach et al., 2019; Woodward et al., 2019), processes to surface and address equity concerns in implementation strategies (Gaias et al., 2022), and guidance about how to incorporate equity into the evaluation of context and measurement of implementation outcomes (Brownson et al., 2021). Throughout this paper, we have attempted to underscore opportunities to advance equitable implementation in school mental health.
Methods Based on existing implementation literature, a questionnaire was designed with items on individual and team factors and on stages of change in an implementation process. This study is based on document analysis and qualitative interviews with actors at the national, regional, and local levels covering a total of five regions and 15 municipalities that participated in the program. The challenge to sustainable implementation is illustrated by the Swedish case where the government put forward a national training program that sought to introduce Assertive Community Treatment (ACT) for people with severe mental illness. The scale was based on implementation research and consisted of three subscales regarding (1) the organisational level, (2) the team level and (3) continuous support.
But, at post-test, following the intervention, these differences were no longer significant. A series of one-way ANOVAs were run to test whether there were differences between inmates in the experimental and control facilities at baseline and follow-up. Facilities in the control condition were given a directive to improve HIV services on their own. The HIV Services and Treatment Implementation in Corrections protocol of the NIDA funded Criminal Justice Drug Abuse Treatment Studies tested the efficacy of an organizational process improvement strategy on improving HIV services in correctional facilities. A brief overview is provided of a new CJ-DATS cooperative research protocol, informed by the survey findings, to test an organization-level intervention to reduce HIV service delivery …
