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Advancing implementation frameworks with a mixed methods case study in child behavioral health.

Melanie Barwick^1,2,3, Raluca Barac⁴, Melissa Kimber⁵

¹Research Institute, The Hospital for Sick Children, Toronto, Canada.

Translational Behavioral Medicine

|January 31, 2019

Summary

This summary is machine-generated.

A complementary implementation approach successfully integrated motivational interviewing (MI) in child behavioral health agencies. This method, unlike typical training, fostered sustained practice change over seven months, improving evidence-based treatment uptake.

Keywords:

Active Implementation Frameworks Child behavioral health Consolidated Framework for Implementation Research Implementation science Motivational interviewing

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Area of Science:

Child and Youth Behavioral Health
Implementation Science
Mental Health Services Research

Background:

Evidence-based treatments for youth mental health challenges show poor uptake, limiting benefits.
Implementation science frameworks guide the integration of effective interventions into practice.
Motivational interviewing (MI) is an evidence-based approach for youth behavioral health.

Purpose of the Study:

To investigate a complementary implementation approach for integrating motivational interviewing (MI) in child and youth behavioral health agencies.
To evaluate the effectiveness of a combined implementation strategy using the Active Implementation Frameworks (AIF), Consolidated Framework for Implementation Research (CFIR), and Implementation Outcomes Framework.
To identify key factors influencing the successful implementation of MI in real-world clinical settings.

Main Methods:

Mixed-methods study with embedded interrupted time series design.
Implementation of MI across four child and youth behavioral health agencies.
Data collection via focus groups, field notes, and questionnaires exploring CFIR factors and MI fidelity.

Main Results:

The complementary implementation approach successfully facilitated MI adoption and sustained practice change over a 7-month period.
Findings validated the AIF process guidance and highlighted salient CFIR factors for implementation success.
Novel CFIR factors were identified, potentially extending the framework; fidelity measurement in practice was challenging.

Conclusions:

A complementary implementation approach is effective for integrating MI in child behavioral health settings.
Sustained practice change emerged over time through consultation and practice, contrasting with immediate post-training effects.
The study demonstrates the external validity of CFIR constructs and identifies common factors for implementation planning and measurement.