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Tag: implementation
04/18/2023

Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department

Carter PM, Cunningham RM, Eisman AB, Resnicow K, Roche JS, Cole JT, Goldstick J, Kilbourne AM, & Walton MA. (2022). Translating Violence Prevention Programs from Research to Practice: SafERteens Implementation in an Urban Emergency Department. The Journal of Emergency Medicine, 62(1), 109–124. https://doi.org/10.1016/j.jemermed.2021.09.003

This study examined the translation of SafERteens, an evidence-based violence prevention program, into clinical care. Implementation of the program was piloted in an emergency department (ED) hospital setting with youth (14-18 years old) who screened positive for recent aggression during an ED visit. Youth participants were randomized to SafERteens (delivered remotely by study therapists or in-person by hospital staff) or enhanced usual care. The SafERteens intervention is a 30–45-minute brief behavioral intervention that integrates motivational interviewing for cognitive behavioral strategies. Participants also received an optional 2-month tailored text messaging program on self-efficacy, reminders on their goals, and tools to avoid violence. Data was collected from hospital staff on implementation facilitators and barriers using the RE-AIM framework. SafERteens completion rate was found to be 77.6% for remote delivery and 49.1% for in-person delivery. The SafERteens and tailored text messaging demonstrated high acceptability among youth; 84.9% of participants found it helpful. After the intervention, participants reported increased self-efficacy to avoid fighting and decreased pro-violence attitudes compared to baseline. Hospital staff reported a number of barriers to implementation such as limited staff availability and lack of reimbursement for staff time to conduct intervention delivery. Remote delivery of SafERteens can be a promising strategy to overcome resource limitations. Results demonstrate that policymakers should continue to expand reimbursement mechanisms in hospitals for violence screening and interventions.

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04/03/2023

I-CARE: Feasibility, Acceptability, and Appropriateness of a Digital Health Intervention for Youth Experiencing Mental Health Boarding

Leyenaar JK, Arakelyan M, Acquilano SC, Gilbert TL, Craig JT, Lee CN, Kodak SG, Ignatova E, Mudge LA, House SA, Brady RE. I-CARE: Feasibility, Acceptability, and Appropriateness of a Digital Health Intervention for Youth Experiencing Mental Health Boarding. J Adolesc Health. 2023 Mar 2:S1054-139X(23)00062-9. doi: 10.1016/j.jadohealth.2023.01.015. Epub ahead of print. PMID: 36870901.

A modular digital intervention was developed to facilitate delivery of evidence-based psychosocial skills by non-mental health clinicians for youth with expressed suicidality. The paper describes pilot mixed method findings on the intervention’s effectiveness, feasibility, acceptability, and appropriateness. The intervention, I-CARE, consisted of seven modules grounded in cognitive behavior therapy and were delivered via a table computer with videos and practice activities. Licensed nursing assistants provided one-on-one supervision and facilitated the intervention. I-CARE was implemented in a pediatric hospital with 24 patients aged 12-17 years hospitalized due to suicidal ideation or attempt. Clinical outcomes were assessed by self-reported surveys at hospital admission and 24 hours before hospital discharge. Emotional distress significantly decreased after participation (6.3 points on 63-point scale). There were no significant changes in engagement readiness and illness severity. Majority of youth, caregivers and clinicians rated I-CARE as feasible (98%, N=39), acceptable (90%, N=36), and appropriate (78%, N=31). Overall, I-CARE was feasible to implement and acceptable to end-users and demonstrated preliminary positive impact on emotional distress for suicidal young people in psychiatric hospitalization.

 

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03/06/2023

Implementation fidelity of the Promoting First Relationships intervention program in a Native community

Booth-LaForce C, Oxford ML, O’Leary R, Rees J, Petras A, Buchwald DS. Implementation fidelity of the Promoting First Relationships intervention program in a Native community. Transl Behav Med. 2023 Jan 20;13(1):34-41. doi: 10.1093/tbm/ibac060. PMID: 36227860; PMCID: PMC9853091.

An evidence-based parenting intervention called Promoting First Relationship (PFR) was evaluated for implementation fidelity in a Northern Plains Native community. PFR is a preventive program for primary caregivers and their young children based on attachment theory. Ten sessions are delivered weekly for an hour through home visits conducted by trained providers who are tribal members living on the reservation with at least a relevant bachelor’s degree. Each week has a specific theme and includes a check-in, reflection time, observation of video recordings, and handouts on the child’s behaviors, feelings, and needs. This study analyzed data from a randomized controlled trial of 162 primary caregivers and their children (10-30 months old) who were assigned to the PFR intervention or the control condition (referral to local resources). PFR providers were trained in a two-day in-person workshop and then, online intensive training and pilot sessions. All trainees were required to pass fidelity checks with three families to be certified. Researchers measured implementation fidelity using a checklist on adherence to content, scoring quality of delivery in video-recorded sessions, number of PFR sessions completed, and participant satisfaction. On average, adherence to PFR content was very high (mean=0.99 out of 1.00; SD=0.02) and quality of delivery exceeded established criteria. Despite high attrition which occurred before intervention delivery (28.40%, N=23), the remaining participants completed all 10 intervention sessions. Additionally, participants reported high satisfaction with the program (mean=3.90 out of 4, SD=0.19). Overall, high implementation fidelity of the PFR intervention was achieved in a Native community using in-person and remote online training and video feedback.

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12/19/2022

Telehealth Remains Key Modality for Behavioral Healthcare Delivery

Article Excerpt: After reaching new heights during the first year of the COVID-19 pandemic, telehealth use is leveling off in several clinical care areas. But there is one prominent exception: behavioral healthcare. Healthcare stakeholders are continuing to flock to telehealth for behavioral health services. An analysis of data from January 2020 to March 2022 shows that mental health conditions were the most common telehealth diagnoses at the national level. In addition, data shows that amid a drop in overall telehealth use since 2020, telemental healthcare has grown. In the first quarter of 2019, 32.4 percent of all telehealth visits were related to behavioral healthcare, according to a market research report. That figure jumped to 59.9 percent by Q1 2022. This data, along with the ongoing mental health crisis in America, signifies the importance of providing virtual care options for behavioral healthcare.

Full Article: https://tinyurl.com/4pvbdeme

Article Source: mHealth Intelligence

Posted in: Emerging Technologies // Tagged: ; ; ; ; ; ;
09/12/2022

FAST: A Framework to Assess Speed of Translation of Health Innovations to Practice and Policy

Proctor E, Ramsey AT, Saldana L, Maddox TM, Chambers DA, Brownson RC. FAST: A Framework to Assess Speed of Translation of Health Innovations to Practice and Policy. Glob Implement Res Appl. 2022;2(2):107-119. doi:10.1007/s43477-022-00045-4

A known challenge for translational research is the gap of time from discovery to practical application into routine public health practice or clinical care. This paper offers a first step to conducting research on implementation speed and aims to understand the complexities of implementation speed, offer a framework to assess speed of translation (FAST), and provide guidance on how to measure speed in evaluating implementation efforts. First, the paper discussed different perspectives on the optimal pace of implementation processes and the balance of risks and benefits related to slower or quicker implementation. The benefits for quicker implementation are responding rapidly to health and social crises, applying an anticipatory approach to social and health service systems, and addressing healthcare and social inequities in prevention and care. The benefit of slower implementation is ensuring there is adequate evidence for safe and successful implementation. Three complex factors were identified that should be considered in studying implementation speed: (1) varying stakeholders’ priorities for speed, (2) what referent is speed being measured, and (3) observation time windows in research studies. To address these complexities and challenges, the authors proposed a Framework to Assess Speed of Translation (FAST) to guide research and inform a set of parameters and metrics for capturing speed, factors that affect speed, and the effects of speed on implementation. Future research is needed to describe speed and develop metrics, examine innovation, adopter, and contextual influences, identify specific strategies to accelerate speed, assess the effect of implementation speed on outcomes, and develop designs for testing speed.

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06/06/2022

Implementation of collaborative care for depressive disorder treatment among accountable care organizations

Newton H, Busch SH, Brunette M, Maust DT, O’Malley J, Meara ER. Implementation of collaborative care for depressive disorder treatment among accountable care organizations. Medicine 2021;100:27(e26539).

Collaborative care is a cost-effective model of primary care that combines care management, consulting behavioral health clinicians and registries to target mental health treatment. A study was conducted to determine the prevalence of collaborative care implementation in accountable care organizations (ACOs) and identify characteristics in ACOs associated with implementation. Researchers examined the association between implementation of collaborative care components and ACO characteristics. Four hundred five total respondents completed questions on collaborative care implementation in the 2017-2018 National Survey of ACOs. Only seventeen percent of ACOs implemented all collaborative care components. The most common components were care managers (71% of ACOs) and consulting mental health clinicians (58%). The least frequently implemented component was using patient registries to track and target mental health treatment (only 26%). The findings also showed ACOs responsible for mental healthcare quality measures were significantly more likely to implement collaborative care. This study demonstrates most ACOs do not have full implementation of behavioral health collaborative care. Payers interested in incentivizing integrated mental health care should address barriers to collaborative care implementation.

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05/30/2022

Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial

Hammersley M, Wyse R, Jones R, Okely A, Wolfenden L, Eckermann S, Xu J, Green A, Stacey F, Yoong S, Jackson J, Innes-Hughes C, Li V, Rissel C. Telephone and Web-Based Delivery of Healthy Eating and Active Living Interventions for Parents of Children Aged 2 to 6 Years: Mixed Methods Process Evaluation of the Time for Healthy Habits Translation Trial. J Med Internet Res 2022;24(5):e35771 DOI: 10.2196/35771

Researchers conducted a mixed methods process evaluation of a translational trial targeting the dietary habits and movement behaviors of children with 3 partially randomized arms. The Time for Healthy Habits study recruited 458 total parents of children aged 2 to 6 years. The three arms were a telephone intervention, a web-based app intervention, and an active control (written education materials). At baseline, participants were asked to indicate their preferred intervention delivery method (telephone, web, written) or if they preferred to be randomized to condition. Participants received the assigned intervention for 12 weeks. Intervention acceptability and process evaluation were assessed at 3 months post baseline using a questionnaire developed by the researchers and qualitative interviews. Data on intervention fidelity and study attrition were also collected. Thirty participants completed the qualitative interviews, and 144 (31.4%) participants completed the postintervention follow-up. Most participants preferred the web-based delivery method at baseline. Results demonstrated high acceptability of the web-based and telephone interventions. Participants reported the healthy eating content to be the most useful component of the web-based modules and telephone calls. A significantly higher proportion of participants completed the telephone intervention compared to the web-based intervention. However, study attrition was higher in the telephone intervention arm. Overall, the process evaluation showed high acceptability of all interventions, but significantly more participants preferred the web-based intervention and were retained in the study relative to the other arms. This study highlighted the strengths and weaknesses of remotely delivered interventions and can inform directions for policy makers and practitioners.

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04/11/2022

Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers

Haroz E, Grubin F, Goklish N, Pioche S, Cwik M, Barlow A, Waugh E, Usher J, Lenert MC, Walsh CG. Designing a Clinical Decision Support Tool That Leverages Machine Learning for Suicide Risk Prediction: Development Study in Partnership With Native American Care Providers. JMIR Public Health Surveill 2021;7(9):e24377. DOI: 10.2196/24377

Use of algorithms can be helpful as a method of risk detection for suicide. Researchers developed a machine learning algorithm to help identify people who are most at risk for suicide deaths or attempts in Native American reservation populations. Researchers explored how to implement the algorithm tool to inform care pathways in community-based suicide surveillance and case management systems. Researchers conducted qualitative in-depth interviews with 9 case managers from 3 communities (White Mountain Apache Tribe and two sites in Navajo Nation). Interviews included questions about staff perceptions and evaluation and response to risk as well as suggestions for implementation of risk algorithms into their care process. Participants highlighted the importance of current behavior, past history, and location to prioritize individuals. Participants agreed that algorithm-generated risk flags would be useful along with as much information as possible to respond to the flag. Researchers are now conducting an implementation pilot of the algorithm tool in the White Mountain Apache Tribe that flags people as high-risk or low-risk after an in-person follow-up.

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02/07/2022

Design and implementation of a smart home in a box to monitor the wellbeing of residents with dementia in care homes

Garcia-Constantino M, Orr C, Synnott J, Shewell C, Ennis A, Cleland I, Nugent C, Rafferty J, Morrison G, Larkham L, McIlroy S and Selby A (2021) Design and implementation of a smart home in a box to monitor the wellbeing of residents with dementia in care homes. Front. Digit. Health 3:798889. doi: 10.3389/fdgth.2021.798889

Sensor technology is a potential cost-effective option for caregivers of people with dementia as a method to monitor activity and detect abnormal behavior. Researchers investigated the challenges with design and deployment of a Smart Home In a Box (SHIB) approach to monitor the wellbeing of people with dementia in a care home. Researchers describe and evaluate a SHIB approach created by the Pervasive Computing Research Center (PCRC) at Ulster University. The PCRC SHIB has 4 types of sensors: thermal vision, contact, Passive Infrared, and audio. The SHIB has a small computer that processes and shares the data from sensors to a data platform and an Android tablet with an app. The researchers made short instructional videos about installation and how to use the SHIB. A case study was conducted to evaluate implementation of SHIB in a care home over the course of 6 months. The SHIB was installed in a care home in Belfast and the sensors were installed in the rooms of three persons with dementia. The study encountered issues with interrupted communication and incomplete transmission of the sensor data. Researchers found that most care home facilities do not have the infrastructure for installing sensors and installation of sensors should be adapted to specific care homes. Implementation findings informed recommendations for future implementations of SHIB.

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