scholarly journals Case Report: Implementation of a Multi-Component Behavioral Health Integration Program in Obstetrics for Perinatal Behavioral Health

2021 ◽  
Vol 12 ◽  
Author(s):  
Heather Flynn ◽  
Megan Deichen Hansen ◽  
Amandla Shabaka-Haynes ◽  
Shay Chapman ◽  
Kay Roussos Ross
Keyword(s):  
Behavioral Health ◽  
Program Implementation ◽  
Geographic Area ◽  
Evidence Based ◽  
Improvement Program ◽  
Initial Development ◽  
Implementation Phase ◽  
Behavioral Health Integration ◽  
The Us ◽  
Component Approach

Despite growing research and policy attention, perinatal behavioral health conditions (i.e., mental health and substance use disorders) remain prevalent, burdensome for families, and largely untreated in the US. Researchers have documented an array of barriers to accurate detection, linkage with effective treatment, and improved outcomes for perinatal women with behavioral health disorders. It is clear that a multi-component approach that integrates evidence-based detection and management of perinatal behavioral health in the context of obstetrics care can be effective. This paper presents the initial development of a clinical quality improvement program that includes evidence-based components of behavioral health integration in obstetrics in the state of Florida in the US. The FL BH Impact (Improving Maternal and Pediatric Access, Care and Treatment for Behavioral Health) program, guided by the RE-AIM model for program implementation, has been developed over the past 2 years. Program components, initial implementation, and preliminary findings are presented. Following the implementation phase, the program has enrolled 12 obstetrics practices and 122 obstetrics providers in program engagement and training activities. The primary program component allows for obstetrics clinician telephone access to a statewide listing of behavioral health referral resources for patients and access to consultation with psychiatry. Since program implementation, the program has received a total of 122 calls to this line, with an expected increasing trajectory of calls over time. Results suggest this program is feasible to implement across a large geographic area. Challenges to implementation and future directions are discussed. These types of multi-component approaches to improved management and outcomes for perinatal behavioral health are promising and must be expanded and sustained in the US.

Adapting and Evaluating Implementation of a Tobacco-Free Workplace Program in Behavioral Health Centers

2020 ◽  
Vol 44 (6) ◽  
pp. 820-839
Author(s):  
Isabel Martinez Leal ◽  
Tzu-An Chen ◽  
Virmarie Correa-Fernández ◽  
Kathy Le ◽  
Daniel P. O'Connor ◽  
...  
Keyword(s):  
Behavioral Health ◽  
Program Implementation ◽  
Behavioral Interventions ◽  
Organizational Capacity ◽  
Tobacco Dependence ◽  
Health Centers ◽  
Routine Practice ◽  
Evidence Based ◽  
Evidence Based Practices ◽  
Key Stakeholders

Objectives: State-administered community behavioral health centers (CBHCs) rarely treat tobacco dependence, despite high client tobacco use. Using a mixed-methods approach we examine the adaptation and implementation of an evidence-based tobacco-free workplace (TFW) program in 2 CBHCs (17 individual clinics). Methods: Varied data collection included pre- and post-implementation leader, clinician, and staff surveys; pre-, mid-, and post-implementation staff and client focus groups; and monthly implementation logs. The RE-AIM framework guided translation of behavioral interventions into sustainable practice. Results: Pre- to post-implementation increases were seen in training receipt among clinicians and employees. Both CBHCs adopted a 100% TFW policy, integrated tobacco screenings into routine practice, and delivered evidence-based practices (EBPs). Qualitative methods enlisted key stakeholders contributing towards adapting program strategies to local contexts, addressing barriers, adjusting tobacco screening administration, and understanding reasons for success or failure to implement specific components. Conclusions: Program implementation at both CBHCs increased organizational capacity in the provision of EBPs to treat tobacco dependence through successfully meeting the majority of our RE-AIM targets. Findings contribute to the development of flexible strategies and interventions responsive to variable implementation contexts and barriers; enhancing the effectiveness and sustainability of a TFW program.

scholarly journals Using Mixed Methods to Adapt and Evaluate the Implementation of a Multicomponent Tobacco-Free Workplace Program within Behavioral Health Centers

2020 ◽  
Author(s):  
Isabel Martinez Leal ◽  
Tzu-An Chen ◽  
Virmarie Correa-Fernández ◽  
Kathy Le ◽  
Daniel P. O’Connor ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Behavioral Health ◽  
Program Implementation ◽  
Organizational Capacity ◽  
Tobacco Dependence ◽  
Routine Practice ◽  
Evidence Based ◽  
Program Outcomes ◽  
Evidence Based Practices ◽  
Local Contexts

Abstract Background: Behavioral health treatment centers (BHTCs) rarely implement existing evidence-based practices for treating tobacco dependence, despite high rates of tobacco use among their clients. Taking Texas Tobacco Free (TTTF) has successfully targeted this disparity by delivering an evidence-based, multilevel, tobacco-free workplace program providing policy implementation and enforcement, education, provider training in tobacco screenings and treatments, and nicotine replacement therapies (NRT) to BHTCs across Texas. We describe a mixed methods design used to conduct a formative evaluation process to adapt implementation strategies to local contexts, evaluate program outcomes and characterize processes influencing program implementation in two BHTCs serving 17 clinics.Methods: Varied data collection included pre and post-implementation leader, provider, and staff surveys; and pre, mid, and post-implementation provider, staff and consumer focus groups. During implementation, data were collected via various logs (tobacco screenings, NRT delivery) to monitor program content delivery. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework guided translation of behavioral interventions into sustainable practice.Results: While program implementation varied between each BHTC, all clinics adopted a 100% tobacco-free workplace policy, integrated tobacco screenings into routine practice, delivered evidence-based interventions, dispensed NRT to consumers and staff, and increased provider knowledge on how to address tobacco dependence. Pre, mid, and post-implementation qualitative findings served to: 1) develop program strategies and materials adapted to local contexts and populations and address barriers; 2) adjust delivery systems of key components to enhance implementation; 3) understand reasons for success or failure to implement specific practices; and 4) reveal program integration into clinic culture, enhancing sustainability.Conclusions: Implementation of TTTF at both BHTCs increased organizational capacity in the provision of evidence-based practices to treat tobacco dependence through successfully meeting most of our RE-AIM targets. Mixing methods involved program adopters and recipients as collaborators directly shaping core interventions to their individual context and needs, thus increasing program fit, ownership, adoption and sustainability; closing the gap between research and practice. These findings contribute to the development of flexible strategies and interventions capable of addressing variable implementation contexts and barriers, thus enhancing the effectiveness and sustainability of a tobacco-free workplace program.

Systematic review methodology for development: An example from microfinance

2018 ◽  
Vol 43 (1) ◽  
pp. 65-77 ◽  
Author(s):  
Carina Van Rooyen ◽  
Ruth Stewart ◽  
Thea De Wet
Keyword(s):  
Systematic Review ◽  
International Development ◽  
Health Sector ◽  
Evidence Based ◽  
Systematic Review Methodology ◽  
Development Interventions ◽  
The Us ◽  
Sub Saharan ◽  
The Impact ◽  
Evidence Based Decision Making

Big international development donors such as the UK’s Department for International Development and USAID have recently started using systematic review as a methodology to assess the effectiveness of various development interventions to help them decide what is the ‘best’ intervention to spend money on. Such an approach to evidence-based decision-making has long been practiced in the health sector in the US, UK, and elsewhere but it is relatively new in the development field. In this article we use the case of a systematic review of the impact of microfinance on the poor in sub-Saharan African to indicate how systematic review as a methodology can be used to assess the impact of specific development interventions.

The Great Recession, behavioral health, and self-rated health: An examination of racial/ethnic differences in the US

2021 ◽  
Vol 118 ◽  
pp. 106873
Author(s):  
Nina Mulia ◽  
Yu Ye ◽  
Katherine J. Karriker-Jaffe ◽  
Libo Li ◽  
William C. Kerr ◽  
...  
Keyword(s):  
Behavioral Health ◽  
Ethnic Differences ◽  
Great Recession ◽  
The Great Recession ◽  
Self Rated Health ◽  
The Us ◽  
Racial Ethnic

scholarly journals Measures of organizational culture, organizational climate, and implementation climate in behavioral health: A systematic review

2021 ◽  
Vol 2 ◽  
pp. 263348952110188
Author(s):  
Byron J Powell ◽  
Kayne D Mettert ◽  
Caitlin N Dorsey ◽  
Bryan J Weiner ◽  
Cameo F Stanick ◽  
...  
Keyword(s):  
Organizational Culture ◽  
Organizational Climate ◽  
Psychometric Properties ◽  
Behavioral Health ◽  
Implementation Research ◽  
Learning Climate ◽  
Evidence Based ◽  
Implementation Climate ◽  
Relative Priority ◽  
Evidence Based Practices

Background: Organizational culture, organizational climate, and implementation climate are key organizational constructs that influence the implementation of evidence-based practices. However, there has been little systematic investigation of the availability of psychometrically strong measures that can be used to assess these constructs in behavioral health. This systematic review identified and assessed the psychometric properties of measures of organizational culture, organizational climate, implementation climate, and related subconstructs as defined by the Consolidated Framework for Implementation Research (CFIR) and Ehrhart and colleagues. Methods: Data collection involved search string generation, title and abstract screening, full-text review, construct assignment, and citation searches for all known empirical uses. Data relevant to nine psychometric criteria from the Psychometric and Pragmatic Evidence Rating Scale (PAPERS) were extracted: internal consistency, convergent validity, discriminant validity, known-groups validity, predictive validity, concurrent validity, structural validity, responsiveness, and norms. Extracted data for each criterion were rated on a scale from −1 (“poor”) to 4 (“excellent”), and each measure was assigned a total score (highest possible score = 36) that formed the basis for head-to-head comparisons of measures for each focal construct. Results: We identified full measures or relevant subscales of broader measures for organizational culture ( n = 21), organizational climate ( n = 36), implementation climate ( n = 2), tension for change ( n = 2), compatibility ( n = 6), relative priority ( n = 2), organizational incentives and rewards ( n = 3), goals and feedback ( n = 3), and learning climate ( n = 2). Psychometric evidence was most frequently available for internal consistency and norms. Information about other psychometric properties was less available. Median ratings for psychometric properties across categories of measures ranged from “poor” to “good.” There was limited evidence of responsiveness or predictive validity. Conclusion: While several promising measures were identified, the overall state of measurement related to these constructs is poor. To enhance understanding of how these constructs influence implementation research and practice, measures that are sensitive to change and predictive of key implementation and clinical outcomes are required. There is a need for further testing of the most promising measures, and ample opportunity to develop additional psychometrically strong measures of these important constructs. Plain Language Summary Organizational culture, organizational climate, and implementation climate can play a critical role in facilitating or impeding the successful implementation and sustainment of evidence-based practices. Advancing our understanding of how these contextual factors independently or collectively influence implementation and clinical outcomes requires measures that are reliable and valid. Previous systematic reviews identified measures of organizational factors that influence implementation, but none focused explicitly on behavioral health; focused solely on organizational culture, organizational climate, and implementation climate; or assessed the evidence base of all known uses of a measure within a given area, such as behavioral health–focused implementation efforts. The purpose of this study was to identify and assess the psychometric properties of measures of organizational culture, organizational climate, implementation climate, and related subconstructs that have been used in behavioral health-focused implementation research. We identified 21 measures of organizational culture, 36 measures of organizational climate, 2 measures of implementation climate, 2 measures of tension for change, 6 measures of compatibility, 2 measures of relative priority, 3 measures of organizational incentives and rewards, 3 measures of goals and feedback, and 2 measures of learning climate. Some promising measures were identified; however, the overall state of measurement across these constructs is poor. This review highlights specific areas for improvement and suggests the need to rigorously evaluate existing measures and develop new measures.

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