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Effects of an Organizational Implementation Strategy on Sustainment of Measurement-Based Care in Community Mental
Nathaniel J Williams1, Gregory A Aarons1, Mark G Ehrhart1
1School of Social Work, Boise State University, Boise, Idaho (Williams, Esp); Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla (Aarons, Sklar, Carandang, Brookman-Frazee); Department of Psychology, University of Central Florida, Orlando (Ehrhart); Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland (Vega); School of Social Policy and Practice, University of Pennsylvania, Philadelphia (Marcus).
Objective:
Little is known about how to sustain evidence-based interventions with fidelity in community mental health settings. Phase 1 of the Working to Implement and Sustain Digital Outcome Measures (WISDOM) trial showed that an organizational strategy improved the implementation of measurement-based care (MBC) in mental health services for youths 1-12 months after clinician MBC training. The authors report results from phase 2 of the trial, in which the strategy's effects on MBC sustainment 13-26 months after clinician MBC training were examined.
Methods:
Twenty-one outpatient mental health clinics were randomly assigned to MBC training and technical assistance plus the Leadership and Organizational Change for Implementation (LOCI) strategy (11 clinics) or to training and technical assistance only (10 clinics). In phase 2, the primary outcomes of MBC completion rate, youth symptom improvement, and MBC fidelity were examined for 452 youths who entered treatment 13-26 months after clinician MBC training.
Results:
No differences were found in MBC completion rate or symptom improvement between the two conditions; however, among the 81 youths who received MBC, fidelity was significantly higher at LOCI sites relative to control sites (24%, SE=11.1 vs. 1%, SE=1.0, respectively; p=0.003).
Conclusions:
During phase 2, LOCI sites (vs. control sites) sustained superior MBC fidelity when MBC was used; however, superior MBC completion rates and clinical outcomes were not sustained. Sustainment of MBC may require strategies that improve its fit with regulatory and reimbursement environments in addition to strategies that develop clinic infrastructure.
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