Conducting a Community Engagement Studio to Adapt Enhanced Milieu Teaching

2022 ◽  
pp. 1-19
Author(s):  
Emily D. Quinn ◽  
Kathleen Cotter ◽  
Kim Kurin ◽  
Kim Brown
Keyword(s):  
Service Delivery ◽  
Community Engagement ◽  
Performance Feedback ◽  
Text Message ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Language Delays ◽  
Milieu Teaching ◽  
Rural Counties ◽  
Enhanced Milieu Teaching

Purpose: Barriers to implementing evidence-based practices occur at various levels. Stakeholder input is required to identify challenges specific to clinical practice settings, client populations, and service delivery approaches. The purpose of this project was to solicit feedback from stakeholders on the telepractice service delivery and implementation strategies proposed for a future study of enhanced milieu teaching (EMT) in rural counties. Method: A Community Engagement Studio was conducted with 11 caregivers of children with language delays living in rural counties. Caregivers and the researchers discussed early intervention service delivery for children with language delays in rural Oregon and the proposed telepractice EMT procedures. Researchers gathered feedback on three intervention components: session frequency and schedule, implementation strategies to encourage caregivers' use of EMT, and performance feedback techniques to teach caregivers. Results: Findings from the Community Engagement Studio led to four primary modifications to the telepractice EMT study protocol. The principal investigator increased available days and times for intervention sessions and added text-message reminders for parents. A survey was also added for caregivers to identify their preferences for additional implementation strategies (e.g., tip sheets, checklist, e-mailed session summaries) and graphic representations of performance feedback (e.g., bar graph, radial graph, mountain climber infographic). Conclusion: Community Engagement Studios are a promising method for increasing community engagement in clinical research and soliciting stakeholder feedback on evidence-based intervention adaptations. Supplemental Material: https://doi.org/10.23641/asha.17774819

Generalized Effects of Enhanced Milieu Teaching

1994 ◽  
Vol 37 (6) ◽  
pp. 1320-1340 ◽  
Author(s):  
Ann P. Kaiser ◽  
Peggy P. Hester
Keyword(s):  
Preschool Children ◽  
Language Skills ◽  
Language Intervention ◽  
Multiple Baseline ◽  
Language Delays ◽  
Multiple Baseline Design ◽  
Baseline Design ◽  
Preschool Classrooms ◽  
Milieu Teaching ◽  
Enhanced Milieu Teaching

The primary and generalized effects of Enhanced Milieu Teaching were examined with six preschool children with significant language delays. In a multiple baseline design across children, trainers implemented the naturalistic language intervention during play-based interaction sessions in the children's preschool classrooms. Children systematically increased their use of targeted language skills during the intervention sessions, and these changes were maintained when the treatment was discontinued. Generalized changes in children's communication resulting from the intervention were examined with untrained teachers, peers, and parents. Some generalization to untrained partners was observed for all children. Correlational analyses indicated that greater numbers of child utterances and greater diversity in vocabulary were associated with increased talking and mands for verbalization presented by partners.

scholarly journals Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: A best-worst scaling choice experiment

2020 ◽  
Author(s):  
Nathaniel Williams ◽  
Molly Candon ◽  
Rebecca Stewart ◽  
Y. Vivian Byeon ◽  
Meenakshi Bewtra ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Behavioral Health ◽  
Performance Feedback ◽  
Choice Experiment ◽  
Latent Class ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Clinical Consultation ◽  
Best Worst Scaling ◽  
Stakeholder Preferences

Abstract Background: Community behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders’ values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify these stakeholders’ preferences for implementation strategies and to identify segments of stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling. Methods: A total of 240 clinicians, 74 clinical supervisors, and 29 administrators employed within clinics delivering publicly-funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles. Results: On average, stakeholders preferred two strategies significantly more than all others—compensation for use of EBP per session and compensation for preparation time to use the EBP (P<.05); two strategies were preferred significantly less than all others—performance feedback via email and performance feedback via leaderboard (P<.05). However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n = 121, 35%) strongly preferred financial incentives over all other approaches and included more administrators; Segment 2 (n = 80, 23%) preferred technology-based strategies and was younger, on average; Segment 3 (n = 52, 15%) preferred an improved waiting room to enhance client readiness, strongly disliked any type of clinical consultation, and had the lowest participation in local EBP training initiatives; Segment 4 (n = 90, 26%) strongly preferred clinical consultation strategies and included more clinicians in substance use clinics. Conclusions: The presence of four heterogeneous subpopulations within this large group of clinicians, supervisors, and administrators suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible and rigorous method for eliciting stakeholders’ implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.

Hybrid Telepractice Delivery of Enhanced Milieu Teaching: Effects on Caregiver Implementation and Child Communication

2021 ◽  
pp. 1-26
Author(s):  
Emily D. Quinn ◽  
Ann P. Kaiser ◽  
Jennifer Ledford
Keyword(s):  
Service Delivery ◽  
Functional Relation ◽  
Implementation Fidelity ◽  
Strategy Use ◽  
Service Delivery Model ◽  
Delivery Model ◽  
Language Support ◽  
Milieu Teaching ◽  
Support Strategies ◽  
Enhanced Milieu Teaching

Purpose This study investigated the effects of enhanced milieu teaching (EMT) on caregiver implementation of language support strategies and child communication skills using a hybrid telepractice service delivery model. Method Four caregivers and children with language delays aged 18–27 months participated in a multiple baseline across behaviors single-case research design. The therapist provided EMT to each caregiver–child dyad using a hybrid telepractice service delivery model with approximately 40% in-person and 60% telepractice sessions. Caregivers were taught to use five EMT language support strategies: matched turns, target talk, expansions, time delays, and milieu teaching episodes. Caregiver instruction followed the Teach–Model–Coach–Review approach. Caregiver outcomes were two measures of EMT implementation fidelity, accuracy, and frequency of EMT strategy use. Accuracy was measured by the percentage of spoken turns in which caregivers used each strategy correctly. Frequency was measured by the number of spoken turns in which caregivers used each strategy correctly. Child outcomes were number of communication acts, weighted count of communication acts, and number of different words. Results There was a functional relation between the intervention and the accuracy of EMT strategy use for all four dyads, and the frequency of strategy use for three dyads. Caregiver use of EMT strategies maintained for 6 weeks post-intervention. After caregivers learned EMT strategies, gradual increases in the number of communication acts, weighted count of communication acts, and number of different words occurred for three children. Conclusion Results demonstrate the preliminary efficacy of using a hybrid telepractice service delivery model to teach caregivers EMT language support strategies. Supplemental Material https://doi.org/10.23641/asha.14977605

scholarly journals Community stakeholder preferences for evidence-based practice implementation strategies in behavioral health: a best-worst scaling choice experiment

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Nathaniel J. Williams ◽  
Molly Candon ◽  
Rebecca E. Stewart ◽  
Y. Vivian Byeon ◽  
Meenakshi Bewtra ◽  
...  
Keyword(s):  
Latent Class Analysis ◽  
Behavioral Health ◽  
Performance Feedback ◽  
Choice Experiment ◽  
Latent Class ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Clinical Consultation ◽  
Best Worst Scaling ◽  
Stakeholder Preferences

Abstract Background Community behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders’ values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify these stakeholders’ preferences for implementation strategies and to identify segments of stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling. Methods A total of 240 clinicians, 74 clinical supervisors, and 29 administrators employed within clinics delivering publicly-funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles. Results On average, stakeholders preferred two strategies significantly more than all others—compensation for use of EBP per session and compensation for preparation time to use the EBP (P < .05); two strategies were preferred significantly less than all others—performance feedback via email and performance feedback via leaderboard (P < .05). However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n = 121, 35%) strongly preferred financial incentives over all other approaches and included more administrators; Segment 2 (n = 80, 23%) preferred technology-based strategies and was younger, on average; Segment 3 (n = 52, 15%) preferred an improved waiting room to enhance client readiness, strongly disliked any type of clinical consultation, and had the lowest participation in local EBP training initiatives; Segment 4 (n = 90, 26%) strongly preferred clinical consultation strategies and included more clinicians in substance use clinics. Conclusions The presence of four heterogeneous subpopulations within this large group of clinicians, supervisors, and administrators suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible and rigorous method for eliciting stakeholders’ implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.

scholarly journals Community Stakeholder Preferences for Evidence-Based Practice Implementation Strategies in Behavioral Health: A Best-Worst Scaling Choice Experiment

2020 ◽  
Author(s):  
Nathaniel Williams ◽  
Molly Candon ◽  
Rebecca Stewart ◽  
Y. Vivian Byeon ◽  
Meenakshi Bewtra ◽  
...  
Keyword(s):  
Behavioral Health ◽  
Performance Feedback ◽  
Financial Incentives ◽  
Choice Experiment ◽  
Latent Class ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Clinical Consultation ◽  
Best Worst Scaling ◽  
Stakeholder Preferences

Abstract Background: Community behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders’ values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify clinician, supervisor, and administrator preferences for implementation strategies and to identify segments of these stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling (BWS). Methods: A total of 240 clinicians, 74 clinical supervisors, and 29 administrators delivering publicly funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles. Results: On average, clinicians, supervisors, and administrators preferred two strategies significantly more than all others—compensation for use of EBP per session and compensation for preparation time to use the EBP; two strategies were preferred significantly less than all others—performance feedback via email and performance feedback via leaderboard. However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n = 121, 35%) strongly preferred financial incentives over all other approaches; Segment 2 (n = 80, 23%) preferred technology-based strategies; Segment 3 (n = 52, 15%) preferred an improved waiting room to enhance client readiness and strongly disliked any type of clinical consultation; Segment 4 (n = 90, 26%) rejected financial incentives and strongly preferred strategies focused on clinical consultation. Conclusions: The presence of four heterogeneous subpopulations within this large group of behavioral health administrators, supervisors, and clinicians suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible, systematic, and rigorous method for eliciting stakeholders’ implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.

Tailored interventions to support the implementation of the German national guideline on screening, diagnosis and treatment of alcohol-related disorders: a project protocol

2019 ◽  
Vol 65 (6) ◽  
pp. 373-381 ◽  
Author(s):  
Bernd Schulte ◽  
Christina Lindemann ◽  
Angela Buchholz ◽  
Anke Rosahl ◽  
Martin Härter ◽  
...  
Keyword(s):  
Alcohol Use ◽  
Guideline Implementation ◽  
Implementation Strategies ◽  
Organizational Factors ◽  
Diagnosis And Treatment ◽  
Primary Data ◽  
Routine Practice ◽  
Evidence Based ◽  
Advisory Boards ◽  
Prevention And Treatment

Abstract. Background: The German Guideline on Screening, Diagnosis and Treatment of Alcohol Use Disorders aims to increase the uptake of evidence-based interventions for the early identification, diagnosis, prevention and treatment of alcohol-related disorders in relevant healthcare settings. To date, dissemination has not been accompanied by a guideline implementation strategy. The aim of this study is to develop tailored guideline implementation strategies and to field-test these in relevant medical and psycho-social settings in the city of Bremen, Germany. Methods: The study will conduct an impact and needs assessment of healthcare provision for alcohol use orders in Bremen, drawing on a range of secondary and primary data to: evaluate existing healthcare services; model the potential impact of improved care on public health outcomes; and identify potential barriers and facilitators to implementing evidence-based guidelines. Community advisory boards will be established for the selection of single-component or multi-faceted guideline implementation strategies. The tailoring approach considers guideline, provider and organizational factors shaping implementation. In field tests quality outcome indicators of the delivery of evidence-based interventions will be evaluated accompanied by a process evaluation to examine patient, provider and organizational factors. Outlook: This project will support the translation of guideline recommendations for the identification, prevention and treatment of AUD in routine practice and therefore contributes to the reduction of alcohol-related burden in Germany. The project is running since October 2017 and will provide its main outcomes by end of 2020. Project results will be published in scientific journals and presented at national and international conferences.

Implementation Strategies

2017 ◽  
Author(s):  
JoAnn E. Kirchner ◽  
Thomas J. Waltz ◽  
Byron J. Powell ◽  
Jeffrey L. Smith ◽  
Enola K. Proctor
Keyword(s):  
Implementation Science ◽  
Comparative Effectiveness ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Efficient Manner

As the field of implementation science moves beyond studying barriers to and facilitators of implementation to the comparative effectiveness of different strategies, it is essential that we create a common taxonomy to define the strategies that we study. Similarly, we must clearly document the implementation strategies that are applied, the factors that influence their selection, and any adaptation of the strategy during the course of implementation and sustainment of the innovation being implemented. By incorporating this type of rigor into our work we will be able to not only advance the science of implementation but also our ability to place evidence-based innovations into the hands of practitioners in a timely and efficient manner.

scholarly journals Implementation support for contingency management: preferences of opioid treatment program leaders and staff

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Kelli Scott ◽  
Shelly Jarman ◽  
Samantha Moul ◽  
Cara M. Murphy ◽  
Kimberly Yap ◽  
...  
Keyword(s):  
Performance Feedback ◽  
Contingency Management ◽  
Scale Up ◽  
Team Approach ◽  
Evidence Based ◽  
Implementation Support ◽  
Training Performance ◽  
Opioid Treatment ◽  
Treatment Providers ◽  
External Facilitation

Abstract Background Contingency management (CM), a behavioral intervention that provides incentives for achieving treatment goals, is an evidence-based adjunct to medication to treat opioid use disorder. Unfortunately, many front-line treatment providers do not utilize CM, likely due to contextual barriers that limit effective training and ongoing support for evidence-based practices. This study applied user-informed approaches to adapt a multi-level implementation strategy called the Science to Service Laboratory (SSL) to support CM implementation. Methods Leaders and treatment providers working in community-based opioid treatment programs (OTPs; N = 43) completed qualitative interviews inquiring about their preferences for training and support implementation strategies (didactic training, performance feedback, and external facilitation). Our team coded interviews using a reflexive team approach to identify common a priori and emergent themes. Results Leaders and providers expressed a preference for brief training that included case examples and research data, along with experiential learning strategies. They reported a desire for performance feedback from internal supervisors, patients, and clinical experts. Providers and leaders had mixed feelings about audio-recording sessions but were open to the use of rating sheets to evaluate CM performance. Finally, participants desired both on-call and regularly scheduled external facilitation to support their continued use of CM. Conclusions This study provides an exemplar of a user-informed approach to adapt the SSL implementation support strategies for CM scale-up in community OTPs. Study findings highlight the need for user-informed approaches to training, performance feedback, and facilitation to support sustained CM use in this setting.

Sign in / Sign up

Export Citation Format

Share Document