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Assessing Causal Pathways and Targets of Implementation Variability for EBP use (Project ACTIVE): a study protocol.

Emily M Becker-Haimes1,2, David S Mandell3, Jessica Fishman3,4

  • 1Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA. emily.haimes@pennmedicine.upenn.edu.

Implementation Science Communications
|December 21, 2021
PubMed
Summary

This study tests a model to improve the use of cognitive-behavioral therapy (CBT) by examining clinician intentions and behaviors in community mental health settings. Findings will guide strategies to enhance evidence-based practice (EBP) implementation.

Keywords:
Behavior change theoryCausal modelCognitive-behavioral therapyCommunity mental healthImplementation scienceOrganizational theoryTheory of planned behavior

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Area of Science:

  • Implementation Science
  • Clinical Psychology
  • Health Services Research

Background:

  • Advancing causal implementation theory is crucial for effective evidence-based practice (EBP) strategies.
  • Cognitive-behavioral therapy (CBT) is an underutilized EBP in community mental health.
  • A conceptual model integrating organizational and behavioral factors can predict CBT use.

Purpose of the Study:

  • To test the generalizability of a causal model predicting clinician use of CBT techniques.
  • To identify organizational and behavioral determinants of CBT implementation.
  • To understand the intention-behavior gap in EBP adoption.

Main Methods:

  • Recruited 300 clinicians and 600 clients across 40 organizations in two health systems.
  • Measured clinician intentions and observed use of six discrete CBT components.
  • Utilized multilevel path analysis and semi-structured interviews to analyze data.

Main Results:

  • The study will test how intentions and determinants predict CBT component use.
  • It will examine psychological, organizational, and contextual factors influencing intention and use.
  • Qualitative data will explore reasons for the intention-behavior gap.

Conclusions:

  • Project ACTIVE advances implementation theory by testing a causal model.
  • Results will inform tailored implementation strategies for modifiable factors.
  • Findings can be broadly applied across various evidence-based practices.