Optimizing Implementation Coaching to Support Successful EBP Delivery

University of Washington

Status: Completed

Conditions: Anxiety Depression; Mental Health Issue

Treatments: Behavioral: Supervisor-led Implementation Coaching

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05799794

1P50MH126219 (U.S. NIH Grant/Contract)

STUDY00014969

Details and patient eligibility

About

This project engages community mental health center (CMHC) clinical supervisors in the development and examination of an optimized coaching strategy for psychotherapists utilizing Cognitive Behavioral Therapy (CBT) in Washington State. The optimized coaching strategy has the potential to enhance the adoption and fidelity of evidence-based practice (EBP).

Full description

The Washington State EBP Initiative provides clinical training and consultation for Cognitive Behavioral Therapy (CBT) and some basic organizational support; however, consistent with the literature, community mental health centers (CMHCs) often need more to successfully implement CBT. To accelerate treatment quality and clinical outcomes for youth, CMHCs need practical strategies for "successfully implementing, sustaining, and improving" EBPs that can be tailored to fit their specific context. These strategies will have the greatest impact if designed and delivered by CMHC practice community members who have CMHC-specific EBP implementation experience and expertise.

Implementation facilitation, a multifaceted, dynamic strategy of interactive problem-solving and support, improves adoption and fidelity of interventions. Implementation facilitation may be a promising strategy for CMHCs, but the resources and demands of traditional facilitation may present challenges for CMHCs. Motivated by global mental health frugal innovations work, the Principal Investigator piloted a modified facilitation approach for CMHCs, Implementation Coaching (hereafter "Coaching"), delivered to CMHCs participating in the Initiative. Coaching involved 4, group-based, virtual meetings with CMHC supervisors, who are frontline leaders in CMHCs. The investigator led coaching, supporting supervisors in developing workplans for CBT implementation in their CMHCs across 3 implementation phases. Coaching recommends a limited set of implementation strategies in each phase (e.g., Implementation phase: local technical assistance) that address known, prioritized determinants. Supervisors are supported in tailoring strategies for their CMHCs. In the pilot, CMHCs that received Coaching had clinicians that engaged in CBT delivery earlier and with more youth. Qualitative interviews suggested that supervisors were engaged and found Coaching acceptable and feasible. Based on the pilots' success, Project 2 will engage CMHC supervisors in: a) co-designing an optimized version of Coaching, and b) leading Coaching for other supervisors to optimize CBT implementation in their CMHCs.

In this exploratory research project, the Investigators' goal is to extend a pilot study that included the development and implementation of Implementation Coaching (hereafter "Coaching") within the Washington State EBP Initiative. In the pilot, the Coaching involved 4, group-based, virtual meetings with CMHC supervisors, who are frontline leaders in CMHCs. The results of the pilot indicated that Coaching was acceptable and feasible. In the current study, in collaboration with CMHC supervisors, investigators aim to optimize and test the effectiveness of Coaching for improving CBT fidelity and youth outcomes for four common conditions in CMHCs. The hypothesized mechanism through which Coaching operates is implementation climate or the degree to which an organization expects, supports, and rewards an innovation. Investigators expect that Coaching can be most effective in supporting CMHCs' high-quality EBP implementation if optimized with the practice community (supervisors) for the goals of limited resource use, fit with CMHC workflow, and wider reach. Coaching reach can be improved by moving beyond delivery by University-based personnel. In the Initiative, peer CMHC supervisors with CBT experience and expertise already co-lead CBT clinical training.

The study includes the following aims: Aim 1a) Collaborating with CMHCs, investigators will identify and convene purposively sampled groups of supervisors for diverse perspectives and demographics (e.g., ethnically diverse supervisors/clientele; urban/rural) during 2 one-day, in-person Ideation workshops; Aim 1b) Up to 150 clinicians will be recruited through the Initiative listserv and CBT+ training (for clinicians who recently completed their training) to participate in an online study in which clinicians will be randomized to read up to 6 vignettes that describe different strategies developed in the ideation phase and complete a survey with relevant subscale/s of implementation climate (EBP use is expected, supported and rewarded); Aim 2) Clinicians will be randomly assigned to receive standard implementation support or standard implementation support plus Coaching by trained supervisors.

Enrollment: 213 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Supervisors in aim 1a and clinicians/supervisors in aim 2 must

  • be employed in CMHCs whose leadership has agreed to participate in the study
  • have participated or be participating in the Initiative.
  • Clinicians in aim 1b do not need to be employed in a CMHC whose leadership has agreed to participate in the study.

Exclusion criteria

• There is no exclusion criteria for supervisors in Aim 1a or clinicians in 1b.

• Supervisors who participate in Aim 1 will be excluded from participating in Aim 2 as recipients of Implementation Coaching.
• Supervisor coaches will be recruited from the supervisors that participated in Aim 2. There is no exclusion criteria for clinicians in Aim 2.

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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213 participants in 2 patient groups

Standard/As Usual CBT+/EBP Initiative Implementation

Active Comparator group

Description:

All CMHCs involved in the CBT+/EBP Initiative receive virtual clinician training, CBT-phone consultation options over 6-months, access to a supervisor monthly call, listservs (one supervisor-focused), and a yearly advanced clinical training and supervisor training. The Initiative is a program that has been ongoing since 2009.

Treatment:

Behavioral: Supervisor-led Implementation Coaching

Supervisor-led Implementation Coaching

Experimental group

Description:

The structure of this arm will depend on Aim 1. However, the investigators imagine that peer supervisors leading implementation coaching, trained in Aim 1, will have 3-5 virtual meetings with supervisors and email communication. Meetings focus on orientation to the theory and rationale for Coaching and supervisors' role as frontline leaders to support EBP implementation. Meetings are likely over 6 months and focus on different implementation phases. Coaches will support supervisors in developing tailored workplans for implementation in their CMHCs. In each meeting, the coach will review the strategies in the workplan, provide examples of how the strategy could be specified, and then facilitate discussion among supervisors. The coach will support supervisors in building a tailored workplan for their CMHC. Supervisors in the Coaching condition receive Coaching plus standard Initiative Implementation support.

Treatment:

Behavioral: Supervisor-led Implementation Coaching