Validation of the Implementation Climate Scale (ICS) in substance use disorder treatment organizations.

BackgroundOne critical factor in the implementation of evidence-based practice (EBP) in substance use disorder treatment organizations is an inner organizational context that clearly supports implementation efforts. The Implementation Climate Scale (ICS) has been developed to allow researchers and organizations to assess climate for EBP implementation in health and allied health service organizations. The ICS consists of 18 items and measures six dimensions of implementation climate: focus on EBP, educational support for EBP, recognition for EBP, rewards for EBP, selection for EBP, and selection for openness. The ICS was initially developed in a mental health context; thus, the goal of this study was to provide initial validation of the ICS in substance use disorder (SUD) treatment settings.MethodsConfirmatory factor analysis (CFA) was used to assess the psychometric functioning of the ICS using survey data from 326 providers in 65 teams in SUD treatment programs. Cronbach's alpha was examined to assess internal consistency of the ICS, and individual and team level construct-based validity was examined by comparing its correlations with service climate, molar climate, and organizational change.ResultsWe found evidence for the reliability, factor structure, and validity of the ICS in SUD services. The psychometric functioning of the ICS in SUD treatment settings was comparable to that found in mental health contexts.ConclusionsThe ICS is a brief and pragmatic tool for researchers to better understand a critical antecedent for implementation effectiveness in SUD treatment and for organizational leaders in SUD treatment organizations to evaluate the extent to which providers perceive that their organization supports EBP implementation

The Role of Leadership in Creating a Strategic Climate for Evidence-Based Practice Implementation and Sustainment in Systems and Organizations

There is a growing impetus to effectively implement evidence-based practices (EBPs) in health and allied health settings in order to improve the public health impact of such practices. To support implementation and sustainment of EBPs, it is important to consider that health care is delivered within the outer context of public health systems and the inner context of health care organizations and work groups (3). This article identifies two relevant types of leadership for implementation and recommends steps that leaders can take in developing a strategic climate for EBP implementation and sustainment within the outer and inner contexts of health and allied health care systems and organizations

Evaluating a Measure of Social Health Derived from Two Mental Health Recovery Measures: The California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program Consumer Survey (MHSIP)

Social health is important to measure when assessing outcomes in community mental health. Our objective was to validate social health scales using items from two broader commonly used measures that assess mental health outcomes. Participants were 609 adults receiving psychological treatment services. Items were identified from the California Quality of Life (CA-QOL) and Mental Health Statistics Improvement Program (MHSIP) outcome measures by their conceptual correspondence with social health and compared to the Social Functioning Questionnaire (SFQ) using correlational analyses. Pearson correlations for the identified CA-QOL and MSHIP items with the SFQ ranged from .42 to .62, and the identified scale scores produced Pearson correlation coefficients of .56, .70, and, .70 with the SFQ. Concurrent validity with social health was supported for the identified scales. The current inclusion of these assessment tools allows community mental health programs to include social health in their assessments

Mental Health Recovery in the Patient-Centered Medical Home

Background : The current United States (US) healthcare system focuses primarily on acute needs. As a result, the US ranks poorly in preventable mortality, and the incidence and prevalence of chronic conditions has increased. The "patient-centered medical home" (PCMH), a facility wherein patients' comprehensive healthcare needs may be met, is posited as an innovation for improving the healthcare system at lower costs. However, evidence regarding the effectiveness of the PCMH in improving health outcomes is limited. Additionally, a healthcare system that fails to address mental health will be incomplete and minimally effective. Consequently, an assessment of the effectiveness of the PCMH in improving the health, including mental health, of its patients is necessary. Objectives : This study examined the impact of transitioning clients from a Mental Health (MH) clinic to a patient-centered medical home (PCMH) on MH recovery). Methods : Data were drawn from a large US County Behavioral Health Services administrative data set. Propensity score analysis and multilevel modeling were used to assess the impact of the PCMH on MH recovery by comparing PCMH participants (n = 215) to clients receiving service as usual (SAU) (n = 22394). MH recovery is repeatedly assessed over time (days since baseline assessment range: 0-1,639, M = 186) by the Illness Management and Recovery (IMR) scale and the Recovery Markers Questionnaire (RMQ) Results : For total IMR (LR[chi]² (1) = 4696.97, p < .0001) and IMR Factor 2 Management scores (LR[chi]² (1) = 7.9, p = .005), increases in MH recovery over time were greater for PCMH participants than SAU participants. Increases on all other measures over time were similar for PCMH and SAU participants. Conclusions : Greater increases in MH recovery over time can be expected when patients with severe mental illness are provided treatment through the PCMH. Evaluative efforts should be taken to inform more wide-spread adoption of the PCM

Applying after-action reviews to child and family teams to improve mental health service linkage within child welfare services: a study protocol.

BACKGROUND: Half of child-welfare-involved children and adolescents meet the criteria for at least one mental health diagnosis. This project proposes to improve successful mental health service linkage in child welfare services (CWS) by adapting and testing the after-action review (AAR) team effectiveness intervention to augment the child and family team (CFT) services intervention. Despite being both required and a collaborative approach to service planning, CFT meetings are implemented with questionable fidelity and consistency, rarely including the voice of children and families as intended. METHODS: Using a parallel group trial design, with non-equivalent comparison groups, and qualitative and quantitative methodology, this study will tailor and assess the impact of the AAR on enhancing CFT outcomes. The authors will conduct a qualitative needs assessment targeting the ongoing implementation of the CFT services intervention in a large, publicly funded, CWS system. A qualitative inquiry consisting of interviews and focus groups with key stakeholders will result in the preparation of an action plan to address identified gaps between the current and desired CFT services intervention outcomes. The AAR implementation strategy will be adapted and tailored to address the CFT services intervention needs. To test the effectiveness of the AAR on improving outcomes associated with the CFT services intervention, we will utilize blocked randomization of four CWS caseworkers from two CWS system regions to either the intervention condition (CFT + AAR) or standard implementation (CFT as usual). The authors will collect data from the CWS caseworkers and additional CFT members via web-based surveys. Mechanisms of the AAR team effectiveness intervention for CFT implementation will be assessed. DISCUSSION: By inclusion of child and family voice, the AAR-enhanced CFT should lead to increased fidelity to the CFT intervention and greater levels of parental satisfaction with the service and shared decision-making, thus resulting in enhanced follow-through with service plans and linkage to mental health treatment services for children. The knowledge gained by this randomized clinical trial has the potential to benefit service delivery and integration for CWS leaders, caseworkers, formal and informal CFT member support persons, parents/caregivers, and children with open cases. Improving intervention effectiveness, both at the system and family levels, is crucial for practice efficiencies and improved child and family outcomes. TRIAL REGISTRATION: NCT05629013. Approval date: November 28, 2022 (version 1). TRIAL SPONSOR: University of California, San Diego. RESPONSIBLE PARTY: Danielle Fettes

COVID-Related Work Changes, Burnout, and Turnover Intentions in Mental Health Providers: A Moderated Mediation Analysis

Objective: The novel coronavirus disease (COVID-19) has drastically impacted the provision of mental health services. Changes required of providers were substantial and could lead to increased burnout and, subsequently, increased turnover intentions. This study examined burnout experienced by mental health services providers in the context of COVID-19 and through the lens of the job demands-resources (JD-R) model. We examined the effects of work changes on burnout and subsequent turnover intentions, and how job and personal resources may have buffered the extent to which work changes due to COVID-19 impacted burnout. Methods: Service providers (n = 93) from six community mental health centers (CMHCs) in one Midwestern state in the United States completed surveys as part of service contracts to implement evidence-based practices. Path analysis tested the unconditional indirect relations between work changes and turnover intentions through burnout. Moderated mediation determined whether the indirect effect of work changes on turnover intentions via burnout varied in strength by job and personal resources. Results: Work changes had a significant indirect effect on turnover intentions through burnout ( β ^ = .140, 95% CI = .072, .217). This indirect effect varied as a function of two job resources, organizational trust and perceived organizational support. Conclusions and Implications for Practice: Burnout was relatively low only when work changes were low and job resources levels high. When work changes were high, burnout was similarly high across levels of job resources. To minimize burnout, organizations should limit task, setting, and team-related work changes to the extent possible. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Creating CHOIS: A Recovery-Oriented PROMIS-Based Measure for Mental Health Screening and Outcomes

The National Institutes of Health Patient Reported Outcomes Medical Information System (PROMIS) measures a few important domains of mental health, but does not yet measure some other important psychiatric symptoms, nor does it include recovery factors and strengths such as social connectedness, self-esteem, and coping ability. The CHOIS is a recovery-oriented PROMIS-based instrument designed to supplement traditional PROMIS administration by attempting to fill in these gaps in mental health assessment. It was created for settings that do not primarily focus on mental health issues such as primary care, non-psychiatric hospitals, and substance abuse services. It adds specific symptoms of mental disorders based on DSM-IV-TR, positive recovery factors that were drawn from focus groups of people with mental illnesses, andresponse inconsistency indicators. We first implemented the measure across 13 Alcohol and Drug Services programs as a screening measure and outcomes tool, and measured internal consistency of the scales among a wide variety of participants. Among the 3,712 people who completed the measure, the internal consistency of the scales was as follows: Depression .93, Anxiety .89, Anger .87, Psychosis .79, Cognition .71, and Recovery Factors .90. All of the scales were significantly correlated with functional limitations and wanting help for mental health issues. The CHOIS could become an important tool for allowing valid and comprehensive immediate use of the still-developing PROMIS in a variety of settings as a mental health screening and outcomes instrument. It works seamlessly as a supplement to the entire PROMIS outcomes system that measures other important health constructs, and creates a more recovery-oriented focus for healthcare systems, even in non-psychiatric settings