scholarly journals Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework

2022 ◽  
Vol 3 ◽  
pp. 263348952110657
Author(s):  
Isabel Zbukvic ◽  
Demee Rheinberger ◽  
Hannah Rosebrock ◽  
Jaclyn Lim ◽  
Lauren McGillivray ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Suicide Prevention ◽  
Action Plan ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Local Health ◽  
Prevention Intervention ◽  
Tailored Implementation

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

scholarly journals Developing a Tailored Implementation Action Plan for a Suicide Prevention Clinical Intervention in an Australian Mental Health Service: A Qualitative Study Using the EPIS Framework.

2020 ◽  
Author(s):  
Isabel Zbukvic ◽  
Demee Rheinberger ◽  
Hannah Rosebrock ◽  
Jaclyn Lim ◽  
Lauren McGillivray ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Suicide Prevention ◽  
Action Plan ◽  
Implementation Strategies ◽  
Health District ◽  
Evidence Based ◽  
Local Health ◽  
Tailored Implementation

Abstract Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support implementation, sustainment and scale-up of an evidence-based suicide prevention intervention - Collaborative Assessment and Management of Suicidality (CAMS) - in an Australian public mental health service.Methods: This study took place within a larger randomised stepped-wedge design suicide prevention trial. Approximately 150 mental health staff working within a regional and remote community Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework. This was followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology.Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia.Trial registration: This study was conducted as part of the LifeSpan suicide prevention trial. Trial registration for LifeSpan in Australia New Zealand Clinical Trials Register, ID: ACTRN12617000457347. Prospectively registered on 28 March 2017.

scholarly journals Developing a Tailored Implementation Action Plan for A Suicide Prevention Clinical Intervention in an Australian Mental Health Service: A Qualitative Study Using the EPIS Framework.

2021 ◽  
Author(s):  
Isabel Zbukvic ◽  
Demee Rheinberger ◽  
Hannah Rosebrock ◽  
Jaclyn Lim ◽  
Lauren McGillivray ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Suicide Prevention ◽  
Action Plan ◽  
Implementation Strategies ◽  
Health District ◽  
Evidence Based ◽  
Local Health ◽  
Tailored Implementation

Abstract Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support implementation, sustainment and scale-up of an evidence-based suicide prevention intervention - Collaborative Assessment and Management of Suicidality (CAMS) - in an Australian public mental health service.Methods: This study took place within a larger randomised stepped-wedge design suicide prevention trial. Approximately 150 mental health staff working within a regional and remote community Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework. This was followed by stakeholder engagement to design a tailored implementation action plan based on a ‘tailored blueprint’ methodology.Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia.Trial registration: This study was conducted as part of the LifeSpan suicide prevention trial. Trial registration for LifeSpan in Australia New Zealand Clinical Trials Register, ID: ACTRN12617000457347. Prospectively registered on 28 March 2017.

Staff Training Reduces the Use of Physical Restraint in Mental Health Service, Evidence-based Reflection for China

2018 ◽  
Vol 32 (3) ◽  
pp. 488-494 ◽  
Author(s):  
Junrong Ye ◽  
Aixiang Xiao ◽  
Lin Yu ◽  
Jianxiong Guo ◽  
Huawei Lei ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Staff Training ◽  
Physical Restraint ◽  
Evidence Based

scholarly journals Patterns of Child Mental Health Service Utilization Within a Multiple EBP System of Care

2021 ◽  
Author(s):  
Joyce H. L. Lui ◽  
Lauren Brookman-Frazee ◽  
Alejandro L. Vázquez ◽  
Julia R. Cox ◽  
Debbie Innes-Gomberg ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Service Utilization ◽  
Asian American ◽  
Health Service Utilization ◽  
Service Use ◽  
Mental Health Service Utilization ◽  
Administrative Claims ◽  
Evidence Based

AbstractThe current study (1) characterizes patterns of mental health service utilization over 8 years among youth who received psychotherapy in the context of a community implementation of multiple evidence-based practices (EBPs), and (2) examined youth-, provider- and service-level predictors of service use patterns. Latent profile analyses were performed on 5,663,930 administrative claims data furnished by the county department of mental health. Multinomial logistic regression with Vermunt’s method was used to examine predictors of care patterns. Based on frequency, course, cost, and type of services, three distinct patterns of care were identified: (1) Standard EBP Care (86.3%), (2) Less EBP Care (8.5%), and (3) Repeated/Chronic Care (5.2%). Youth age, ethnicity, primary language, primary diagnosis and secondary diagnosis, provider language and provider type, and caregiver involvement and service setting were significant predictors of utilization patterns. Although the majority of youth received care aligned with common child EBP protocols, a significant portion of youth (13.7%) received no evidence-based care or repeated, costly episodes of care. Findings highlight opportunities to improve and optimize services, particularly for youth who are adolescents or transition-aged, Asian-American/Pacific Islander, Spanish-speaking, or presenting with comorbidities.

scholarly journals TeamSTEPPS to Improve Collaboration in School Mental Health: Protocol for a Mixed-Method Hybrid Effectiveness-Implementation Study (Preprint)

2020 ◽  
Author(s):  
Aparajita Kuriyan ◽  
Grace Kinkler ◽  
Zuleyha Cidav ◽  
Christina Kang-Yi ◽  
Ricardo Eiraldi ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Administrative Data ◽  
School Mental Health ◽  
Implementation Strategies ◽  
Evidence Based ◽  
Team Science ◽  
Implementation Study ◽  
Tailored Implementation

BACKGROUND Public schools in the United States are the main provider of mental health services to children but are often ill-equipped to provide quality mental health care, especially in low-income, urban communities. Schools often rely on partnerships with community organizations to provide mental health services to students. However, collaboration and communication challenges often hinder implementation of evidence-based mental health strategies. Interventions informed by team science, such as Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) have the potential to improve treatment implementation and collaboration within schools. OBJECTIVE The objective of the study is to improve communication and collaboration strategies among mental health and school staff by adapting an evidence-based team science intervention for school settings. We present a protocol for a hybrid effectiveness-implementation study to adapt TeamSTEPPS using stakeholder feedback, develop a tailored implementation plan, and pilot the adapted content in eight schools. METHODS Study participants will be recruited from public and charter schools and agencies overseeing school mental health services in the local metro area. We will characterize current services by conducting a needs assessment including stakeholder interviews, observations, and review of administrative data. Then, we will establish an advisory board to understand challenges and develop possible solutions to guide additional TeamSTEPPS adaptations along with a complementary implementation plan. In Aim 3, we will implement the adapted TeamSTEPPS plus tailored implementation strategies in eight schools using a pre-post design. Primary outcome measures include feasibility and acceptability of the adapted TeamSTEPPS. In addition, self-report measures of inter-professional collaboration and teamwork will be collected from 80 participating mental health and school personnel. School observations will be conducted prior to and at 3 time-points following the intervention along with stakeholder interviews. The analysis plan includes qualitative, quantitative, and mixed-methods analysis of feasibility and acceptability, school observations, stakeholder interviews, and administrative data of behavioral health and school outcomes for students receiving mental health services. RESULTS Recruitment for the study has begun. Goals for Aim 1 are expected to be completed in Spring 2021. CONCLUSIONS The current study utilizes team science to improve interprofessional collaboration among school and mental health staff and contributes broadly to the team science literature by developing and specifying implementation strategies to promote sustainability. Results from this study will provide knowledge about whether interventions to improve school culture and climate may ready both mental health and school systems for implementation of evidence-based mental health practices. CLINICALTRIAL This project has been registered with ClinicalTrials.gov (ID NCT04440228)

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (07) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and Method To compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis. Results Five-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001). Clinical Implications Prescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

scholarly journals File audit to assess sustained fidelity to a recovery and wellbeing oriented mental health service model: an Australian case study

2019 ◽  
Vol 77 (1) ◽  
Author(s):  
Cara L. Jones ◽  
Frank P. Deane ◽  
Keren Wolstencroft ◽  
Adam Zimmermann
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Action Plan ◽  
Audit Tool ◽  
Recovery Model ◽  
Australian Community ◽  
Australian Case ◽  
Practice Framework ◽  
Over Time

Abstract Background Over the past decade there has been increasing attention to implementing recovery-oriented approaches within mental health service practice and enhancing fidelity to such approaches. However, as is often the case with evidence-based practices, less attention has been paid to the sustainability of recovery-oriented approaches over time. This study sought to investigate whether fidelity to a recovery-oriented practice framework – the Collaborative Recovery Model could be sustained over time. Method The study setting was an Australian community managed mental health organisation. A file audit of consumer support plans was undertaken using the Goal and Action Plan Instrument for Quality audit tool (GAP-IQ). The audit tool assessed 17 areas for quality. Consumers (n = 116) from a large community managed mental health organisation participated in the study. Sustained fidelity to the Collaborative Recovery Model (CRM) was determined by comparing results from the file audit to a similar audit conducted 3 years earlier. Results The file audit revealed a significant increase in fidelity to CRM practices between 2011 and 2014. Fidelity to individual audit items that comprise the GAP-IQ was also found to significantly increase across 16 of the 17 GAP-IQ audit items, with the exception of the ‘Action Plan Review’ audit item. Conclusions A comparison of file audit data across different time points within the same setting can provide useful feedback about whether or not a practice is being sustained over time. Although fidelity increased overtime the study design does not allow conclusions that training and coaching practices implemented by the organisation were responsible.

scholarly journals Sub-optimal prescribing in an adult community mental health service: prevalence and determinants

2003 ◽  
Vol 27 (7) ◽  
pp. 266-270 ◽  
Author(s):  
David Meagher ◽  
Maria Moran
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Quality Score ◽  
Evidence Based ◽  
Community Mental Health Service ◽  
Prescribing Practice ◽  
Quality Of Prescribing ◽  
Evidence Based Guidelines

Aims and MethodTo compare prescribing practice in a community mental health service with evidence-based guidelines and identify factors related to sub-optimal prescribing. All current patients (n=640) were assessed regarding six key aspects of prescribing (polypharmacy, high-dose treatment, use of thioridazine/maintenance benzodiazepine/maintenance hypnotic or routine anticholinergic treatment). The relationship of quality of prescribing practice to demographic, illness and service variables was examined by regression analysis.ResultsFive-hundred and five (79%) patients were receiving psychotropic medication. Of these, 232 (46%) had evidence of sub-optimal prescribing practice. Mean prescribing practice quality score was 0.75 ± 0.99. Maintenance benzodiazepine/ hypnotic (31%) and anticholinergic (30%) use were particularly common. Prescribing practice quality score was higher in those receiving depot antipsychotic treatment (P < 0.01) and in older patients (P < 0.01). Scores were significantly lower in patients whose principal medical contacts were with a consultant rather than a junior doctor (P < 0.001).Clinical ImplicationsPrescribing practices in real-world settings frequently deviate from evidence-based guidelines. The quality of prescribing is related to patient, illness and service variables. In particular, greater contact with consultant staff is linked to better practices. Patients receiving depot antipsychotics are especially liable to less judicious prescribing practice.

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