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Boyd MR, Becker KD, Park AL, Pham K, Chorpita BF. Managers' Micro-Communities Matter: The Impact of Clinical Supervision Team on Therapist Perception of the Organization. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024:10.1007/s10488-024-01376-0. [PMID: 38676872 DOI: 10.1007/s10488-024-01376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2024] [Indexed: 04/29/2024]
Abstract
Positive organizational climate - employee perceptions of their work environment and the impact of this environment on well-being and functioning - is associated with desirable organizational and client-level outcomes in mental health organizations. Clinical supervisors are well-positioned to impact organizational climate, as they serve as intermediaries between higher-level administrators who drive the policies and procedures and the therapists impacted by such decisions. This cross-sectional study examined the role of clinical supervisors as drivers of therapist perceptions of organizational climate within supervisory teams. Specifically, the present study investigated: (1) shared perceptions of organizational climate among therapists on the same supervisory team; (2) predictors of therapist climate perceptions. Eighty-six therapists were supervised by 22 supervisors. Indices of interrater agreement and interrater reliability of therapists on the same supervisory team were examined to determine shared or distinct perceptions of organizational climate. Multi-level models were used to examine whether supervisor attitudes towards evidence-based practices and therapist perceptions of supervisor communication predicted perceived organizational climate. Results showed perceptions of organizational cohesion and autonomy were shared among therapists on the same supervisory team and distinct from therapists on different supervisory teams. Therapist perceptions of their supervisor's communication was positively associated with perceptions of organizational cohesion and autonomy. These findings align with emerging evidence that middle managers shape their employees' experience of their work environment through communication strategies. These findings also point to the potential for intervening at lower organizational levels to improve overall organizational climate.
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Affiliation(s)
- Meredith R Boyd
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA.
| | - Kimberly D Becker
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Alayna L Park
- Department of Psychology, University of Oregon, Eugene, OR, USA
| | - Kaitlyn Pham
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
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Nilsing Strid E, Wallin L, Nilsagård Y. Exploring expectations and readiness for healthy lifestyle promotion in Swedish primary health care: a qualitative analysis of managers, facilitators, and professionals. Scand J Prim Health Care 2024; 42:201-213. [PMID: 38241166 PMCID: PMC10851800 DOI: 10.1080/02813432.2023.2301556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 12/28/2023] [Indexed: 01/21/2024] Open
Abstract
OBJECTIVE Prior to a multifaceted implementation strategy for a healthy lifestyle-promoting practice the expectations of primary health care managers, appointed internal facilitators and health care professionals on supporting change was explored. DESIGN This study had an explorative qualitative design using data gathered from individual interviews and focus groups. Qualitative content analysis with a deductive category development was applied using the Consolidated Framework for Implementation Research. SETTING AND PARTICIPANTS The study was conducted in a primary care setting in central Sweden as a part of the Act in Time research project. Prior to a multifaceted implementation strategy, we held 16 individual interviews with managers and appointed facilitators and five focus groups with 26 health care professionals. RESULTS Managers, facilitators, and professionals held similar expectations, where their expressed need for support corresponded to three constructs: Readiness for implementation, Implementation climate, and Engaging. Our findings indicate the need for strong leadership engagement to focus on how the healthy lifestyle-promoting practice can be anchored among the professionals. Managers at all levels should communicate the vision and goals, enable facilitators and professionals to improve their competencies, build inter-professional teams, and jointly plan the new practice. CONCLUSION To change to a healthy lifestyle promoting practice professionals request support from their managers, who in turn need support from the middle and top managers. The requested support includes helping to prioritise health promotion and enabling the primary care centres to build competence and take ownership of the implementation. TRIAL REGISTRATION ClinicalTrials.gov NCT04799860.
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Affiliation(s)
- Emma Nilsing Strid
- University Health Care Research Center, Örebro University, Örebro, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ylva Nilsagård
- University Health Care Research Center, Örebro University, Örebro, Sweden
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Klein Schaarsberg RE, Ribberink AZ, Osinga B, van Dam L, Lindauer RJL, Popma A. Treatment Responsivity in Adolescents With Disruptive Behavior Problems: Co-Creation of a Virtual Reality-Based Add-On Intervention. JMIR Form Res 2023; 7:e46592. [PMID: 38015607 DOI: 10.2196/46592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 07/07/2023] [Accepted: 07/27/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND We developed Street Temptations (ST) as an add-on intervention to increase the treatment responsivity of adolescents with disruptive behavior problems. ST's primary aim is to improve adolescents' mentalizing abilities in order to help them engage in and benefit from psychotherapy. Additionally, virtual reality (VR) is used to work in a more visual, less verbal, fashion. OBJECTIVE By recapping the lessons learned while developing ST so far, we aim to design the following study on ST. Furthermore, we aim to enhance the development and study of new health care interventions in clinical practice, together with adolescents as their end users. METHODS We followed an iterative co-creation process to develop a prototype of ST, in collaboration with adolescents and professionals from a secured residential facility in Amsterdam, the Netherlands. The prototype was tested during a pilot phase, involving 2 test runs, in which 4 adolescents and 4 professionals participated. Qualitative data were collected through interviews with the adolescents and by conducting a group interview with the professionals, in order to gain first insights into ST's usability, feasibility, and its added value to clinical practice. In between the first and second test runs, the prototype was enhanced. On the basis of the complete pilot phase, we reflected on the future development and implementation of ST to design a subsequent study. RESULTS Over the course of 6 months, ST's first prototype was developed during multiple creative sessions. Included was the development of a short 360° VR video, to serve as a base for the mentalization exercises. The final version of ST consisted of 7 individual therapy sessions, incorporating both the VR video and a VR StreetView app. On the basis of the qualitative data collected during the pilot phase, we found preliminary signs of ST's potential to support adolescents' perspective-taking abilities specifically. Additionally, using VR to focus on real-life situations that adolescents encounter in their daily lives possibly helps to facilitate communication. However, several challenges and requests concerning the VR hardware and software and the implementation of ST emerged, pointing toward further development of ST as an add-on intervention. These challenges currently limit large-scale implementation, resulting in specific requirements regarding a subsequent study. CONCLUSIONS In order to gather more extensive information to shape further development and study treatment effects, a small-scale and individually oriented research design seems currently more suitable than a more standard between-subjects design. Using the reflection on the lessons learned described in this report, a research protocol for a forthcoming study on ST has been developed. By presenting our co-creation journey thus far, we hope to be of inspiration for a more co-creative mindset and in that way contribute to the mutual reinforcement of science and clinical practice.
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Affiliation(s)
- Renée E Klein Schaarsberg
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Garage2020, Dutch innovation network for societal youth challenges, Amsterdam, Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, Netherlands
| | - Amber Z Ribberink
- Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Babette Osinga
- Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Levi van Dam
- Garage2020, Dutch innovation network for societal youth challenges, Amsterdam, Netherlands
- Department of Child Development and Education, University of Amsterdam, Amsterdam, Netherlands
| | - Ramón J L Lindauer
- Mental Health, Amsterdam Public Health, Amsterdam, Netherlands
- Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, Netherlands
| | - Arne Popma
- Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Mental Health, Amsterdam Public Health, Amsterdam, Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry, Amsterdam, Netherlands
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Choy-Brown M, Williams NJ, Ramirez N, Esp S. Psychometric evaluation of a pragmatic measure of clinical supervision as an implementation strategy. Implement Sci Commun 2023; 4:39. [PMID: 37024945 PMCID: PMC10080877 DOI: 10.1186/s43058-023-00419-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 03/16/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Valid and reliable measurement of implementation strategies is essential to advancing implementation science; however, this area lags behind the measurement of implementation outcomes and determinants. Clinical supervision is a promising and highly feasible implementation strategy in behavioral healthcare for which pragmatic measures are lacking. This research aimed to develop and psychometrically evaluate a pragmatic measure of clinical supervision conceptualized in terms of two broadly applicable, discrete clinical supervision techniques shown to improve providers' implementation of evidence-based psychosocial interventions-(1) audit and feedback and (2) active learning. METHODS Items were generated based on a systematic review of the literature and administered to a sample of 154 outpatient mental health clinicians serving youth and 181 community-based mental health providers serving adults. Scores were evaluated for evidence of reliability, structural validity, construct-related validity, and measurement invariance across the two samples. RESULTS In sample 1, confirmatory factor analysis (CFA) supported the hypothesized two-factor structure of scores on the Evidence-Based Clinical Supervision Strategies (EBCSS) scale (χ2=5.89, df=4, p=0.208; RMSEA=0.055, CFI=0.988, SRMR=0.033). In sample 2, CFA replicated the EBCSS factor structure and provided discriminant validity evidence relative to an established supervisory alliance measure (χ2=36.12, df=30, p=0.204; RMSEA=0.034; CFI=0.990; SRMR=0.031). Construct-related validity evidence was provided by theoretically concordant associations between EBCSS subscale scores and agency climate for evidence-based practice implementation in sample 1 (d= .47 and .55) as well as measures of the supervision process in sample 2. Multiple group CFA supported the configural, metric, and partial scalar invariance of scores on the EBCSS across the two samples. CONCLUSIONS Scores on the EBCSS provide a valid basis for inferences regarding the extent to which behavioral health providers experience audit and feedback and active learning as part of their clinical supervision in both clinic- and community-based behavioral health settings. TRIAL REGISTRATION ClinicalTrials.gov NCT04096274 . Registered on 19 September 2019.
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Affiliation(s)
- Mimi Choy-Brown
- University of Minnesota, Twin Cities, 1404 Gortner Avenue, St. Paul, MN 55108 USA
| | - Nathaniel J. Williams
- Boise State University, 1910 University Drive, Education Suite 717, Boise, ID 83725-1940 USA
| | - Nallely Ramirez
- Boise State University, 1910 University Drive, Education Suite 717, Boise, ID 83725-1940 USA
| | - Susan Esp
- Boise State University, 1910 University Drive, Education Suite 717, Boise, ID 83725-1940 USA
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Allen P, Parks RG, Kang SJ, Dekker D, Jacob RR, Mazzucca-Ragan S, Brownson RC. Practices Among Local Public Health Agencies to Support Evidence-Based Decision Making: A Qualitative Study. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:213-225. [PMID: 36240510 PMCID: PMC9892206 DOI: 10.1097/phh.0000000000001653] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES Evidence-based decision making (EBDM) capacity in local public health departments is foundational to meeting both organizational and individual competencies and fulfilling expanded roles. In addition to on-the-job training, organizational supports are needed to prepare staff; yet, less is known in this area. This qualitative study explores supportive management practices instituted as part of a training and technical assistance intervention. DESIGN This qualitative study used a semistructured interview guide to elicit participants' descriptions and perceptions via key informant interviews. Verbatim transcripts were coded and thematic analyses were conducted. SETTING Local public health departments in a US Midwestern state participated in the project. PARTICIPANTS Seventeen middle managers and staff from 4 local health departments participated in remote, audio-recorded interviews. INTERVENTION Following delivery of a 3½-day in-person training, the study team met with health department leadership teams for department selection of supportive agency policies and procedures to revise or newly create. Periodic remote meetings included collaborative problem-solving, sharing of informational resources, and encouragement. MAIN OUTCOME MEASURES Included management practices instituted to support EBDM and impact on day-to-day work as described by the interview participants. RESULTS Leadership and middle management practices deemed most helpful included dedicating staff; creating specific guidelines; setting expectations; and providing trainings, resources, and guidance. Health departments with a preexisting supportive organizational culture and climat e were able to move more quickly and fully to integrate supportive management practices. Workforce development included creation of locally tailored overviews for all staff members and onboarding of new staff. Staff wanted additional hands-on skill-building trainings. Several worked with partners to incorporate evidence-based processes into community health improvement plans. CONCLUSIONS Ongoing on-the-job experiential learning is needed to integrate EBDM principles into day-to-day public health practice. Management practices established by leadership teams and middle managers can create supportive work environments for EBDM integration.
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Affiliation(s)
- Peg Allen
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Renee G. Parks
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Sarah J. Kang
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Debra Dekker
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Rebekah R. Jacob
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Stephanie Mazzucca-Ragan
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
| | - Ross C. Brownson
- Prevention Research Center, Brown School (Drs Allen, Mazzucca-Ragan, and Brownson and Mss Parks, Kang, and Jacob), and Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine (Dr Brownson), Washington University in St Louis, St Louis, Missouri; Fredrick S. Pardee RAND Graduate School, RAND Corporation, Santa Monica, California (Ms Kang); and National Association of County and City Officials, Washington, District of Columbia (Dr Dekker)
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Shuman CJ, Ehrhart MG, Veliz PT, Titler MG. Perceptual differences in nursing implementation leadership and climate: a cross-sectional study. Implement Sci Commun 2023; 4:9. [PMID: 36670493 PMCID: PMC9854059 DOI: 10.1186/s43058-023-00392-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The literature on perceptual differences between managers and staff regarding social dynamic factors (e.g., leadership, climate) in nursing settings is sparse. Addressing this gap in knowledge is critical for informing implementation efforts and improving patient and organizational outcomes. The purpose of this study was to test the perceptual differences regarding implementation leadership and implementation climate between nursing staff and their managers. METHODS This study was a secondary analysis of cross-sectional survey data collected in 2016-2017. The setting included 22 adult medical-surgical units nested in 7 acute care hospitals in the Eastern and Midwestern United States. Participants were registered nurses (N = 261) and nurse managers (N = 22) who completed an electronic survey consisting of the Implementation Leadership Scale (ILS), the Implementation Climate Scale (ICS), and demographic items. Differences in perception were analyzed at the unit level using structural equation modeling to develop latent difference score models (LDS). We assessed associations of the LDSs with manager ILS and ICS scores, years of nursing experience, and years of experience working on the current unit. The association of ILS LDS with the observed nursing staff ICS scores was also analyzed. RESULTS Higher manager scores on the ILS and ICS were associated with greater perceptual differences in implementation leadership and implementation climate. Greater years of experience as a nurse were associated with greater perceptual differences in ILS and ICS scores. Greater tenure on the unit was associated with smaller differences on the ILS knowledge domain. Greater perceptual differences regarding implementation leadership were associated with worse staff ratings of implementation climate. CONCLUSIONS Although this study observed significant relationships among manager ILS and ICS scores, staff-manager perceptual differences, and staff ratings of implementation climate in nursing settings, it is still unclear why perceptual differences in implementation leadership and climate exist and how to address them. Future studies are warranted to test the effect of perceptual differences on implementation and patient outcomes.
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Affiliation(s)
- Clayton J. Shuman
- grid.214458.e0000000086837370School of Nursing, University of Michigan, 400 N. Ingalls, Room 4162, Ann Arbor, MI 48109 USA ,grid.214458.e0000000086837370Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA ,grid.214458.e0000000086837370Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, MI USA
| | - Mark G. Ehrhart
- grid.170430.10000 0001 2159 2859Department of Psychology, University of Central Florida, Orlando, FL USA
| | - Philip T. Veliz
- grid.214458.e0000000086837370School of Nursing, University of Michigan, 400 N. Ingalls, Room 4162, Ann Arbor, MI 48109 USA ,grid.214458.e0000000086837370Center for the Study of Drugs, Alcohol, Smoking, and Health, University of Michigan School of Nursing, Ann Arbor, MI USA
| | - Marita G. Titler
- grid.214458.e0000000086837370School of Nursing, University of Michigan, 400 N. Ingalls, Room 4162, Ann Arbor, MI 48109 USA ,grid.214458.e0000000086837370Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI USA
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Lewis CC, Boyd MR, Marti CN, Albright K. Mediators of measurement-based care implementation in community mental health settings: results from a mixed-methods evaluation. Implement Sci 2022; 17:71. [PMID: 36271404 PMCID: PMC9587549 DOI: 10.1186/s13012-022-01244-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/05/2022] [Indexed: 12/01/2022] Open
Abstract
Background Tailored implementation approaches are touted as superior to standardized ones with the reasoning that tailored approaches afford opportunities to select strategies to resolve determinants of the local context. However, results from implementation trials on this topic are equivocal. Therefore, it is important to explore relevant contextual factors that function as determinants to evaluate if they are improved by tailoring and subsequently associated with changes in implementation outcomes (i.e., via statistical mediation) to better understand how tailoring achieves (or does not achieve) its effects. The present study examined the association between a tailored and standardized implementation approach, contextual factors that might mediate change, and a target implementation outcome in an initiative to implement measurement-based care (specifically the clinical integration of the Patient Health Questionnaire [PHQ-9] for depression) in a community mental health organization. Methods Using a cluster randomized control design, twelve community-based mental health clinics were assigned to a tailored or standardized implementation group. Clinicians completed a self-report battery assessing contextual factors that served as candidate mediators informed by the Framework for Dissemination at three time points: baseline, 5 months after active implementation support, and 10 months after sustainment monitoring. A subset of clinicians also participated in focus groups at 5 months. The routine use of the PHQ-9 (implementation outcome) was monitored during the 10-month sustainment period. Multi-level mediation analyses assessed the association between the implementation group and contextual factors and the association between contextual factors and PHQ-9 completion. Quantitative results were then elaborated by analyzing qualitative data from exemplar sites. Results Although tailored clinics outperformed standard clinics in terms of PHQ-9 completion at the end of active implementation, these group differences disappeared post sustainment monitoring. Perhaps related to this, no significant mediators emerged from our quantitative analyses. Exploratory qualitative analyses of focus group content emphasized the importance of support from colleagues, supervisors, and leadership when implementing clinical innovations in practice. Conclusions Although rates of PHQ-9 completion improved across the study, their sustained levels were roughly equivalent across groups and low overall. No mediators were established using quantitative methods; however, several partial quantitative pathways, as well as themes from the qualitative data, reveal fruitful areas for future research. Trial registration Standardized
versus tailored implementation of measurement-based care for depression. ClinicalTrials.gov
NCT02266134, first posted on October
16, 2014
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Affiliation(s)
- Cara C Lewis
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Suite 1600, WA, 98101, Seattle, USA. .,Department of Psychiatry and Behavioral Sciences, School of Medicine, & Department of Health Systems and Population Health, School of Public Health, University of Washington, 325 Ninth Street, Seattle, WA, 98104, USA.
| | - Meredith R Boyd
- Department of Psychology, University of California Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, USA
| | | | - Karen Albright
- Division of General Internal Medicine, University of Colorado School of Medicine, 1635 Aurora Court, Aurora, CO, 80045, USA.,Denver-Seattle Center of Innovation, Department of Veterans Affairs, 1700 N. Wheeling ST, CO, P1-15180045, Aurora, USA
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Bunger AC, Maguire-Jack K, Yoon S, Mooney D, West KY, Hammond GC, Kranich C. Does mental health screening and assessment in child welfare improve mental health service receipt, child safety, and permanence for children in out-of-home care? An evaluation of the Gateway CALL demonstration. CHILD ABUSE & NEGLECT 2021; 122:105351. [PMID: 34628151 DOI: 10.1016/j.chiabu.2021.105351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Unmet mental health service needs among children in out-of-home care are sometimes attributed to poor assessments and referrals in child welfare. The Gateway CALL project implemented mental health screening, diagnostic assessment, and referral to treatment practices. OBJECTIVE We examined the effectiveness of Gateway CALL for improving children's mental health service receipt, safety, and permanency outcomes. PARTICIPANTS AND SETTING Participants included 538 children (birth to 18 years) in out-of-home placements through a county-based child welfare agency over a 17-month period. METHODS We compared the mental health service receipt, safety, and permanency outcomes for 175 children who received Gateway CALL with 175 children who received "services as usual" identified through propensity score matching. Participant demographics, safety, and permanency outcomes were drawn from child welfare administrative records, and mental health service visits and diagnoses were drawn from Medicaid billing records. RESULTS Gateway CALL appeared to increase the number of mental health service visits children received (z = 2.14, p = 0.032), although not the likelihood of receiving services. In terms of child safety, children in Gateway CALL had a greater number of screened-in calls after the intervention than those in the comparison group [t(348) = -1.92, p = 0.03]; there were no differences in substantiations. There were also no observed effects on permanency. CONCLUSIONS Despite systematic efforts to identify, assess, and refer children to mental health services through the Gateway CALL intervention, substantial unmet mental health service needs among children persisted. Results have implications for designing interventions that promote cross-system service access.
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Affiliation(s)
- Alicia C Bunger
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA.
| | - Kathryn Maguire-Jack
- School of Social Work, University of Michigan, 1080 S. University Avenue, Ann Arbor, MI 48109, USA
| | - Susan Yoon
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA
| | | | - Kristopher Y West
- Nationwide Children's Hospital, 495 East Main Street, Columbus, OH 43215, USA
| | | | - Christiana Kranich
- College of Social Work, The Ohio State University, 1947 College Road, Columbus, OH 43210, USA
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"I see your punitive measure and I raise you a person-centered bar": Supervisory Strategies to Promote Adoption of Person-Centered Care. Community Ment Health J 2021; 57:1595-1603. [PMID: 33566270 PMCID: PMC8353014 DOI: 10.1007/s10597-021-00783-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Person-centered care remains a high priority within community mental health services. Clinical supervision is an embedded resource for professional development and promotion of high quality care. This study examined supervisory strategies during the implementation of person-centered care planning (PCCP) across two northeastern US States. A criterion sample of supervisor-provider teams participated in qualitative interviews (N = 34) and direct observation from 2016 to 2017. Modified grounded theory analyses were conducted and three supervisory strategies were identified. Supervisory attunement to providers (knowing their audience), active collaborative engagement with providers (practicing together), and infusing reminders and opportunities for feedback (chipping away) were critical strategies to engage providers in adopting PCCP. These strategies changed providers' practice patterns by improving supervisors' calibration to dynamic contextual and individual needs during implementation and communicating supervisors' expectations of PCCP enactment. Workplace-based clinical supervision holds promise as a key intervention point to embed high quality care.
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Meza RD, Triplett NS, Woodard GS, Martin P, Khairuzzaman AN, Jamora G, Dorsey S. The relationship between first-level leadership and inner-context and implementation outcomes in behavioral health: a scoping review. Implement Sci 2021; 16:69. [PMID: 34229706 PMCID: PMC8259113 DOI: 10.1186/s13012-021-01104-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/19/2021] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND First-level leadership is uniquely positioned to support evidence-based practice (EBP) implementation for behavioral health due to first-level leaders' access to and relationship with service providers. First-level leaders are individuals who directly supervise and manage frontline employees who do not manage others. However, first-level leadership is underrepresented in existing reviews of the impact of leadership on EBP implementation. This review describes the relationship between first-level leadership and implementation determinants and outcomes. METHODS A scoping review was performed to synthesize the literature on the relationship between first-level leadership and inner-context and implementation outcomes. A literature search was conducted in PubMed, Eric, PsycINFO, CINAHL, Scopus, and Web of Science. To be eligible, studies had to examine first-level leadership, be conducted in settings providing behavioral health services, and examine the relationship between first-level leadership and an implementation or inner-context outcome. Data extraction and synthesis were performed to describe study characteristics, leader-outcome relationships, and overlap in leadership frameworks. RESULTS Twenty-one records met our inclusion criteria. Studies primarily relied on observational designs and were often cross-sectional. Studies more often examined general leadership rather than leadership strategically focused on EBP implementation (i.e., strategic implementation leadership). Our findings suggest that several forms of first-level leadership are inconsistently related to a broad set of implementation determinants, with infrequent examination of specific implementation outcomes. The broad set of implementation determinants studied, limited number of replications, and inconsistent findings have resulted in sparse evidence for any specific leadership-outcome relationship. The greatest accumulation of evidence exists for general leadership's positive relationship with providers' EBP attitudes, most notably in the form of transformational leadership. This was followed by evidence for strategic implementation leadership facilitating general implementation. Our synthesis revealed moderate conceptual overlap of strategic implementation leadership behaviors described in the theory of implementation leadership and theory of middle managers' role in implementation. CONCLUSIONS Our findings suggest that first-level leadership may play an important role in shaping implementation determinants and outcomes, but consistent empirical support is sparse and confidence dampened by methodological issues. To advance the field, we need studies that adopt stronger methodological rigor, address the conceptual overlap in leadership frameworks, examine a broader set of implementation outcomes, and examine conditions under which leadership impacts implementation. TRIAL REGISTRATION This review was not registered.
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Affiliation(s)
- Rosemary D. Meza
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Noah S. Triplett
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Grace S. Woodard
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Prerna Martin
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Alya N. Khairuzzaman
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Gabrielle Jamora
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
| | - Shannon Dorsey
- Department of Psychology, University of Washington, Guthrie Hall 119A, Box 351525, Seattle, WA 98195 USA
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Affiliation(s)
- Robert L Anders
- Robert L. Anders is a professor emeritus at the University of Texas at El Paso
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Gopalan G, Kerns SEU, Horen MJ, Lowe J. Partnering for Success: Factors Impacting Implementation of a Cross-Systems Collaborative model Between Behavioral Health and Child Welfare. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:839-856. [PMID: 33861385 DOI: 10.1007/s10488-021-01135-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
Cross-system implementation efforts can support needed mental health (MH) service utilization among children involved in the child welfare (CW) system. The Partnering for Success (PfS) initiative is one such effort that promotes greater collaboration between the CW and MH providers by building capacity within and across each system. Frontline CW providers learn to accurately identify child MH treatment targets, link families to locally-provided evidence-based treatments (EBTs), and monitor treatment progress. Concurrently, local MH providers are trained along with CW workers to utilize Cognitive Behavioral Therapy plus Trauma-Focused CBT (CBT +), a common elements training and consultation approach focusing on typical MH issues for CW-involved children: Anxiety, Depression, Behavioral Problems, and Traumatic Stress. Finally, agency leadership receive support around promoting implementation and sustainment. This paper examines factors identified by participating CW and MH staff which impacted PfS implementation. Twenty-nine frontline, supervisory, and executive CW and MH providers were interviewed via audio-recorded web-based calls in six focus groups and 10 individual interviews. Factors facilitating implementation success included training/consultation, support from supervisors and agency leadership, improved referral processes, high quality relationships and communication between CW and MH frontline staff, PfS tools and resources, opportunities to use PfS, as well as buy-in from providers and families. Implementation barriers included poor communication between CW and MH providers, conflicts over role expectations, workload and turnover challenges, lack of buy-in, as well as provider (e.g., not aligned with CBT +) and client characteristics (e.g., frequent crises).
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Affiliation(s)
- Geetha Gopalan
- Silberman School of Social Work, Hunter College, City University of NewYork, 2180 3rd Avenue, New York, NY, 10035, USA.
| | | | | | - Jennie Lowe
- Mid-Atlantic Behavioral Health, Wilmington, DE, USA
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Wagner GJ, Wanyenze RK, Beyeza-Kashesya J, Gwokyalya V, Hurley E, Mindry D, Finocchario-Kessler S, Nanfuka M, Tebeka MG, Saya U, Booth M, Ghosh-Dastidar B, Linnemayr S, Staggs VS, Goggin K. "Our Choice" improves use of safer conception methods among HIV serodiscordant couples in Uganda: a cluster randomized controlled trial evaluating two implementation approaches. Implement Sci 2021; 16:41. [PMID: 33858462 PMCID: PMC8048255 DOI: 10.1186/s13012-021-01109-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/01/2021] [Indexed: 11/10/2022] Open
Abstract
Background Safer conception counseling (SCC) to promote the use of safer conception methods (SCM) is not yet part of routine family planning or HIV care. Guidelines for the use of SCM have been published, but to date there are no published controlled evaluations of SCC. Furthermore, it is unknown whether standard methods commonly used in resource constrained settings to integrate new services would be sufficient, or if enhanced training and supervision would result in a more efficacious approach to implementing SCC. Methods In a hybrid, cluster randomized controlled trial, six HIV clinics were randomly assigned to implement the SCC intervention Our Choice using either a high (SCC1) or low intensity (SCC2) approach (differentiated by amount of training and supervision), or existing family planning services (usual care). Three hundred eighty-nine HIV clients considering childbearing with an HIV-negative partner enrolled. The primary outcome was self-reported use of appropriate reproductive method (SCM if trying to conceive; modern contraceptives if not) over 12 months or until pregnancy. Results The combined intervention groups used appropriate reproductive methods more than usual care [20.8% vs. 6.9%; adjusted OR (95% CI)=10.63 (2.79, 40.49)], and SCC1 reported a higher rate than SCC2 [27.1% vs. 14.6%; OR (95% CI)=4.50 (1.44, 14.01)]. Among those trying to conceive, the intervention arms reported greater accurate use of SCM compared to usual care [24.1% vs. 0%; OR (95% CI)=91.84 (4.94, 1709.0)], and SCC1 performed better than SCC2 [34.6% vs. 11.5%; OR (95% CI)=6.43 (1.90, 21.73)]. The arms did not vary on modern contraception use among those not trying to conceive. A cost of $631 per person was estimated to obtain accurate use of SCM in SCC1, compared to $1014 in SCC2. Conclusions More intensive provider training and more frequent supervision leads to greater adoption of complex SCM behaviors and is more cost-effective than the standard low intensity implementation approach. Trial registration Clinicaltrials.gov, NCT03167879; date registered May 23, 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s13012-021-01109-z.
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Affiliation(s)
- Glenn J Wagner
- RAND Corporation, 1776 Main St., Santa Monica, CA, 91105, USA.
| | - Rhoda K Wanyenze
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jolly Beyeza-Kashesya
- Department of Reproductive Medicine, Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | - Violet Gwokyalya
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Emily Hurley
- Children's Mercy Research Institute, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Deborah Mindry
- University of California Global Health Institute, Center for Women's Health and Empowerment, 1234 Sunny Oaks Circle, Altadena, CA, 91001, USA
| | - Sarah Finocchario-Kessler
- Department of Family Medicine & Community Health, University of Kansas Medical Center, Kansas City, KS, 66160, USA
| | | | - Mahlet G Tebeka
- Pardee RAND Graduate School, 1776 Main St., Santa Monica, CA, 91105, USA
| | - Uzaib Saya
- Pardee RAND Graduate School, 1776 Main St., Santa Monica, CA, 91105, USA
| | - Marika Booth
- RAND Corporation, 1776 Main St., Santa Monica, CA, 91105, USA
| | | | | | - Vincent S Staggs
- Children's Mercy Research Institute, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - Kathy Goggin
- Children's Mercy Research Institute, Children's Mercy Kansas City, University of Missouri - Kansas City School of Medicine, 2401 Gillham Road, Kansas City, MO, 64108, USA
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Bustos TE, Sridhar A, Drahota A. Community-based implementation strategy use and satisfaction: A mixed-methods approach to using the ERIC compilation for organizations serving children on the autism spectrum. IMPLEMENTATION RESEARCH AND PRACTICE 2021; 2:26334895211058086. [PMID: 37089983 PMCID: PMC9978663 DOI: 10.1177/26334895211058086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Despite efforts to use standardized taxonomy and research reporting, documenting implementation strategies utilized in community settings remains challenging. This case study demonstrates a practical approach to gather use of and satisfaction with implementation strategies utilized within community-based sites to understand community providers' perspectives of implementing an early intensive behavioral intervention (EIBI) for children on the autism spectrum across different settings. Methods Using a sequential explanatory mixed-methods design, survey and interview data were collected from directors/supervisors and direct providers (n = 26) across three sites (one university and two community-based replication sites). The Implementation Strategies and Satisfaction Survey (ISSS) was administered to identify staff-reported implementation strategy use and satisfaction. Informed by quantitative results, follow-up semi-structured interviews were conducted with a subsample (n = 13) to further understand staff experiences with endorsed implementation strategies and elicit recommendations for future efforts. Results Survey results were used to demonstrate frequencies of implementation strategies endorsed by site and role. Overall, staff felt satisfied with implementation strategies used within their agencies. Content analysis of qualitative data revealed three salient themes related to implementation strategy use-context, communication, and successes and challenges-providing in-depth detail on how strategies were utilized, and strategy effectiveness based on community providers' experiences. Recommendations were also elicited to improve strategy use within "broader" community settings. Conclusions The project demonstrated a practical approach to identifying and evaluating implementation strategies used within sites delivering autism services. Reporting implementation strategies using the ISSS can provide insight into community providers' perspectives and satisfaction with agency implementation strategy use that can generate more relevant and responsive strategies to address barriers in community settings. Plain language abstract Examining community providers' preferences and experiences with implementation strategies used to facilitate evidence-based practice uptake can broaden our understanding of what, how, and why implementation strategies work in community-based settings ( Chaudoir et al., 2013; Leeman et al., 2017; Proctor et al., 2013). Such efforts have great potential to tailor implementation strategies to address barriers/facilitators typically found in community-based settings.This case study demonstrates a practical approach using mixed methodology to: (a) gather self-reported use of and satisfaction with implementation strategies to understand community providers' perspectives of implementation strategy success. Using a new survey, the Implementation Strategies and Satisfaction Survey (ISSS) conjoined with interviews, the study demonstrated a practical approach using standardized language to report strategies used in one university-based site and two community-based replication sites that deliver an early intensive behavioral intervention (EIBI) for children on the autism spectrum. This paper contributes to one of the five priorities to enhance public health impact-improve tracking and reporting of implementation strategies utilized when translating research into practice ( Dingfelder & Mandell, 2011; Powell et al., 2019; Stahmer et al., 2019). This approach emphasizes the importance of understanding context (e.g., community organizations providing services to children on the autism spectrum) to develop strategies that work better for EIBI implementation and scale-up. Understanding community provider's preferences and experiences with implementation strategies can support use of implementation strategies that better fit usual care contexts, with the ultimate goal of improving implementation practice in community-based settings.
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Affiliation(s)
| | - Aksheya Sridhar
- Department of Psychology, Michigan State
University, East Lansing, MI, USA
| | - Amy Drahota
- Department of Psychology, Michigan State
University, East Lansing, MI, USA
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Dolezal D, Cullen L. Evidence Into Practice: Starting in Your Own Backyard. J Perianesth Nurs 2020; 36:86-89. [PMID: 33268221 DOI: 10.1016/j.jopan.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Donna Dolezal
- Perioperative Nursing Division, Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Laura Cullen
- Office of Nursing Research, Evidence-Based Practice & Quality Department of Nursing Services and Patient Care, University of Iowa Hospitals & Clinics, Iowa City, IA.
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Lindholm LH, Laitila M, Lassila A, Kampman O. Importance of congruence between communicating and executing implementation programmes: a qualitative study of focus group interviews. Implement Sci Commun 2020; 1:94. [PMID: 33292835 PMCID: PMC7594330 DOI: 10.1186/s43058-020-00090-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 10/19/2020] [Indexed: 11/29/2022] Open
Abstract
Background The Ostrobothnia Depression Programme (ODP) in Finland was intended to implement two evidence-based brief psychotherapy interventions, namely motivational interview and behavioural activation, in several regional psychiatric teams. A simultaneous effectiveness study was conducted. Considerable tension was encountered between these two arms, causing resistance to change. We conducted a qualitative case study to better understand this tension and to discuss how managerial and executive practices may ensure the successful running of a hybrid design programme. Methods We conducted focus group interviews to evaluate the phases of preparation and practical execution of the ODP from the perspectives of management and the programme executives. To gather the data, we applied the revised Socratic approach for health technology assessment and focus group interviews. We analysed the data deductively according to the Normalization Process Theory. Results We identified two main critical issues: (1) The ODP programme plan ignored the team leaders’ crucial role in influencing the implementation climate and mobilizing organizational strategies. The ODP had a simplistic top-down design with minimal and delayed collaboration with its target groups in the preparation phase. (2) Incongruence occurred between what the project group had explicitly communicated about being the spearhead of the ODP and what they then actually enacted. These two issues caused tension between the implementation efforts and the effectiveness study as well as resistance to change among the staff. Conclusion Early, open collaboration with all prospective stakeholders towards a shared understanding about the programme is the first action the programme administrators should take. Agreement on goals and the means to achieve them would lower tension between the two arms of a hybrid design programme, thereby reducing resistance to change. Congruence between the goals communicated and the actual managerial and executive actions is of paramount importance in getting the programme recipients on board. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-020-00090-w.
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Affiliation(s)
- Lars H Lindholm
- Department of Psychiatry, South Ostrobothnia Hospital District, Hanneksenrinne 7, FI-60220, Seinäjoki, Finland. .,Faculty of Medicine and Health Technology, Tampere University, PO Box 100, FI-33014, Tampere, Finland.
| | - Minna Laitila
- Department of Psychiatry, South Ostrobothnia Hospital District, Hanneksenrinne 7, FI-60220, Seinäjoki, Finland
| | - Antero Lassila
- Department of Psychiatry, South Ostrobothnia Hospital District, Hanneksenrinne 7, FI-60220, Seinäjoki, Finland
| | - Olli Kampman
- Department of Psychiatry, South Ostrobothnia Hospital District, Hanneksenrinne 7, FI-60220, Seinäjoki, Finland.,Faculty of Medicine and Health Technology, Tampere University, PO Box 100, FI-33014, Tampere, Finland.,Department of Psychiatry, Pirkanmaa Hospital District, PO Box 2000, FI-33521, Tampere, Finland
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Bagonza A, Peterson S, Mårtensson A, Mutto M, Awor P, Kitutu F, Gibson L, Wamani H. 'I know those people will be approachable and not mistreat us': a qualitative study of inspectors and private drug sellers' views on peer supervision in rural Uganda. Global Health 2020; 16:106. [PMID: 33109214 PMCID: PMC7590471 DOI: 10.1186/s12992-020-00636-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Peer supervision improves health care delivery by health workers. However, in rural Uganda, self-supervision is what is prescribed for licensed private drug sellers by statutory guidelines. Evidence shows that self-supervision encourages inappropriate treatment of children less than 5 years of age by private drug sellers. This study constructed a model for an appropriate peer supervisor to augment the self-supervision currently practiced by drug sellers at district level in rural Uganda. METHODS In this qualitative study, six Key informant interviews were held with inspectors while ten focus group discussions were conducted with 130 drug sellers. Data analysis was informed by the Kathy Charmaz constructive approach to grounded theory. Atlas ti.7 software package was used for data management. RESULTS A model with four dimensions defining an appropriate peer supervisor was developed. The dimensions included; incentives, clearly defined roles, mediation and role model peer supervisor. While all dimensions were regarded as being important, all participants interviewed agreed that incentives for peer supervisors were the most crucial. Overall, an appropriate peer supervisor was described as being exemplary to other drug sellers, operated within a defined framework, well facilitated to do their role and a good go-between drug sellers and government inspectors. CONCLUSION Four central contributions advance literature by the model developed by our study. First, the model fills a supervision gap for rural private drug sellers. Second, it highlights the need for terms of reference for peer supervisors. Third, it describes who an appropriate peer supervisor should be. Lastly, it elucidates the kind of resources needed for peer supervision.
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Affiliation(s)
- Arthur Bagonza
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda.
| | - Stefan Peterson
- Department of Health Policy Planning and Management, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
- Department of Women's and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
| | - Andreas Mårtensson
- Department of Women's and Children's Health, International Maternal and Child Health Unit, Uppsala University, Uppsala, Sweden
| | - Milton Mutto
- Department of Disease Control and Environmental Health, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
| | - Freddy Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Henry Wamani
- Department of Community Health and Behavioural Sciences, Makerere University College of Health Sciences, School of Public Health, Kampala, Uganda
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Doherty M, Bond L, Jessell L, Tennille J, Stanhope V. Transitioning to Person-Centered Care: a Qualitative Study of Provider Perspectives. J Behav Health Serv Res 2019; 47:399-408. [PMID: 31820326 PMCID: PMC9017674 DOI: 10.1007/s11414-019-09684-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Meredith Doherty
- LCSW CUNY Graduate Center/Silberman School of Social Work, Hunter College, 2180 Third Avenue, New York, NY, 10035, USA.
| | - Lynden Bond
- Silver School of Social Work, New York University, New York, USA
| | - Lauren Jessell
- Silver School of Social Work, New York University, New York, USA
| | - Julie Tennille
- Graduate Social Work Department, West Chester University of Pennsylvania, West Chester, USA
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