Background There is a fundamental gap in understanding the causal mechanisms by which strategies for implementing evidence-based practices address local barriers to effective, appropriate service delivery. Until this gap is addressed, scientific knowledge and practical guidance about which implementation strategies to use in which contexts will remain elusive. This research project aims to identify plausible strategy-mechanism linkages, develop causal models for mechanism evaluation, produce measures needed to evaluate such linkages, and make these models, methods, and measures available in a user-friendly website. The specific aims are as follows: (1) build a database of strategy-mechanism linkages and associated causal pathway diagrams, (2) develop psychometrically strong, pragmatic measures of mechanisms, and (3) develop and disseminate a website of implementation mechanisms knowledge for use by diverse stakeholders. Methods For the first aim, a combination of qualitative inquiry, expert panel methods, and causal pathway diagramming will be used to identify and confirm plausible strategy-mechanism linkages and articulate moderators, preconditions, and proximal and distal outcomes associated with those linkages. For the second aim, rapid-cycle measure development and testing methods will be employed to create reliable, valid, pragmatic measures of six mechanisms of common strategies for which no high-quality measures exist. For the third aim, we will develop a user-friendly website and searchable database that incorporates user-centered design, disseminating the final product using social marketing principles. Discussion Once strategy-mechanism linkages are identified using this multi-method approach, implementation scientists can use the searchable database to develop tailored implementation strategies and generate more robust evidence about which strategies work best in which contexts. Moreover, practitioners will be better able to select implementation strategies to address their specific implementation problems. New horizons in implementation strategy development, optimization, evaluation, and deployment are expected to be more attainable as a result of this research, which will lead to enhanced implementation of evidence-based interventions for cancer control, and ultimately improvements in patient outcomes.
We tend to overlook immigrant families in policy and program discussions related to the COVID-19 pandemic, yet they are some of the most vulnerable to the effects of this continuing crisis. This study examined the impact of the COVID-19 pandemic on immigrant families in an upper Midwest state. We interviewed 19 human and social service providers from agencies serving Somali, Latinx, and Karen (refugees from Burma/Myanmar) immigrant families between June and August 2020. Results analyzed for this paper focused on responses to questions asked about COVID-19-related financial and familial stress, and coping resources and constraints that providers were observing with their immigrant clients. Guided by the Family Adjustment and Adaptation Response Model (Patterson, 1988), we identified a pile-up of financial and relationship stressors including employment, housing, and family relationship strains, and resource access constraints. We found that job loss in already financially vulnerable immigrant families was particularly impactful. Housing insecurity soon followed. Immigrant families also faced significant constraints to resource access including lack of documentation, fear of making a mistake, language barriers, and lack of technology skills. We identified family and community resources that families used to meet demands, coping strategies, and glimmers of resilience. As we near the end of the pandemic, we urge family researchers to monitor long-term effects of the crisis on immigrant families. Findings can inform the creation of programs and policies that address immigrant family needs for resources and culturally relevant services to support their financial recovery post-COVID.
Objective: Adolescent depression is a serious behavioral health concern often seen in primary care clinics. The purpose of this study was to examine the relationship between successful implementation of integrated behavioral health (IBH) services in primary care settings and clinics' rates of screening adolescents for depression. Method: We examined clinic-level data, with screening rates obtained from a statewide reporting agency and IBH data obtained through an implementation collaborative. Using the Site Self-Assessment, we first examined global IBH integration using a simple regression, then examined specific components of integration using 2 multiple regressions. Results: While an overall level of behavioral health integration was not significantly related to screening rates, several specific components were. These included positive relationships of adolescent depression screening rates with evidence-based practice and provider/staff integrated care training; and negative relationships of adolescent depression screening rates with funding access and integration, organizational leadership for integrated care, and linking to community resources. Conclusions: Clinical implications include the importance of training providers and staff in behavioral health care and regular use and reinforcement of evidence-based practices to facilitate adolescent depression screening. In addition, clinic personnel may perceive less support for IBH implementation from organizational leadership and less financial integration between behavioral and medical services, when clinics have high screening rates. While more research is needed to examine this unexpected finding, it may be that in clinics with high screening rates a culture of valuing behavioral health care leads to a desire for more organizational support for IBH. Implications for Impact StatementThis study found that there were different valance relationships between components of integrated behavioral health and adolescent depression screening rates. It
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