Dynamic Sustainment of Evidence-Based Health Promotion Interventions in Mental Health

NIMH, R01MH133610

9/16/2024 – 5/31/2029

Kelly Aschbrenner, PhD, AM (Contact PI/Project Director: Dartmouth Health), Stephen Bartels, MD, MS (Harvard Medical School)

Team Members:
Sarah Pratt, PhD (Dartmouth Health)
Gail Williams (Dartmouth Health)
Pablo Martinez-Camblor, PhD (Dartmouth Health)
Haiyi Xie, PhD (Dartmouth College)
Douglas Luke, PhD (Washington University in St. Louis)
Virginia McKay, PhD, MA (Washington University in St. Louis)
Ellis Ballard, MSW, MPH (Washington University in St. Louis)

Consultants:
Byron Powell, PhD, LCSW (Washington University in St. Louis)
Leopoldo Cabassa, PhD, MSW ((Washington University in St. Louis)

Community Partner:
Mental Health Center of Greater Manchester (Manchester, New Hampshire)

A team lead by Kelly Aschbrenner at the Geisel School of Medicine at Dartmouth with investigators from Harvard Medical School and Washington University in St. Louis was awarded an R01 from the National Institute of Mental Health (NIMH) building on over a decade of Dartmouth-led research to study the long-term sustainment of an evidence-based lifestyle intervention in 39 mental organizations across the U.S.

Adults with serious mental illness (SMI) including schizophrenia, bipolar disorder, and major depressive disorder experience a 15-30 year reduced life expectancy primarily due to modifiable cardiovascular risk factors that can be effectively addressed with behavioral lifestyle interventions. Lifestyle interventions have reduced obesity-related cardiovascular risk in upwards of 50% of adults with SMI in community-based effectiveness trials, even among those taking antipsychotic medications; however, these interventions are rarely sustained once research projects are completed. This later stage translational study focuses on long-term sustainment of an evidence-based lifestyle intervention (InSHAPE) implemented in U.S. mental health organizations where integrated health promotion is not necessarily part of the core mission, but is critical to stem the tide of early mortality in adults with SMI. InSHAPE is the only lifestyle intervention for adults with SMI that has been tested multiple times with health benefits replicated in two RCTs and a statewide and national implementation study. There has yet to be an investigation of long-term sustainment of InSHAPE or any other evidence-based health promotion interventions for adults with SMI in mental health organizations. From 2014-2019, the Dartmouth team led an NIMH-funded type 3 hybrid effectiveness-implementation study of InSHAPE in mental health organizations across the U.S. In 2023, 14 (36%) of 39 organizations that completed the prior implementation study continued to deliver InSHAPE. In the new study, the team evaluate long-term sustainment of InSHAPE (6-8 years post-implementation) on two dimensions: 1) sustained delivery of the InSHAPE program, and 2) sustained InSHAPE program health benefits. The team will leverage data collected in the prior trial to examine multi-level factors that predict long-term sustainment of InSHAPE at 39 implementation sites; collect new data on contextual factors, adaptations and fidelity to InSHAPE; and collaborate with an existing national network of InSHAPE teams to develop a sustainment practice guide tailored for InSHAPE. While the practice guide will be based on InSHAPE, it will be guided by the Program

Sustainability Framework and thus will include key considerations for sustaining evidence-based health promotion programs more broadly in mental health organizations.

The study has high public health and implementation science impact as one of the first studies to identify adaptations associated with sustained health promotion interventions while also addressing longstanding assumptions about the ‘voltage drop’ in individual benefits of evidence-based interventions as they move from implementation to sustainment. It is one of the first studies to use a participatory form of systems science methods to leverage a large network of implementation organizations to identify factors, including fidelity and adaptation, that influence long-term sustainment of an evidence-based intervention in mental health organizations and to build on these findings to develop, evaluate, and refine sustainment strategies for future research and practice.