Introduction The RAISE Connection Program Implementation and Evaluation study (RAISE-IES) developed tools necessary to implement and disseminate an innovative team-based intervention designed to promote engagement and treatment participation, foster recovery, and minimize disability among individuals experiencing early psychosis. This paper presents the treatment model and reports on service utilization and outcomes. Using a within-group analysis, it was hypothesized that individuals’ symptoms and functioning would improve over time. Methods A total of 65 individuals in RAISE Connection Program treatment across two sites, (Baltimore, MD and Manhattan, NY) were enrolled and received services for up to two years. Primary outcomes included social and occupational functioning as well as symptoms. Trajectories for individuals’ outcomes over time were examined using linear and quadratic mixed-effects models with repeated measures. Results Measures of occupational and social functioning improved significantly over time; symptoms declined, and rates of remission improved. Visits were most frequent during the first 3 months, with a mean of 23.1± 11.5 unduplicated staff encounters per quarter, decreasing to 8.8±5.2 such encounters in the final quarter of year 2. Conclusions The overall project was successful in that the treatment program was delivered and tools useful to other clinical settings were produced. The strengths of this study lie in the demonstrated feasibility of delivering the coordinated specialty care model and the associated high rates of engagement among individuals who are typically difficult to engage in treatment. Notwithstanding the lack of a built-in comparison group, participant outcomes were promising, with improvements comparable to those seen with other successful interventions.

Mixed methods research—i.e., research that draws on both qualitative and qualitative methods in varying configurations—is well suited to address the increasing complexity of public health problems and their solutions. This review focuses specifically on innovations in mixed methods evaluations of intervention, program or policy (i.e., practice) effectiveness and implementation. The article begins with an overview of the structure, function and process of different mixed methods designs and then provides illustrations of their use in effectiveness studies, implementation studies, and combined effectiveness-implementation hybrid studies. The article then examines four specific innovations: procedures for transforming (or “quantitizing”) qualitative data, applying rapid assessment and analysis procedures in the context of mixed methods studies, development of measures to assess implementation outcomes, and strategies for conducting both random and purposive sampling particularly in implementation-focused evaluation research. The article concludes with an assessment of challenges to integrating qualitative and quantitative data in evaluation research.

A large knowledge gap exists regarding the measurement of sustainability of evidence-based prevention programs for mental and behavioral health. We interviewed 45 representatives of 10 grantees and 9 program officers within 4 Substance Abuse and Mental Health Services Administration prevention grant initiatives to identify experiences with implementation and sustainability barriers and facilitators; what “sustainability” means and what it will take to sustain their programs; and which Consolidated Framework for Implementation Research (CFIR) elements are important for sustainability. Lists of sustainability determinants and outcomes were then compiled from each data set and compared with one another. Analysis of themes from interviews and free lists revealed considerable overlap between sustainability determinants and outcomes. Four sustainability elements were identified by all three data sets (ongoing coalitions, collaborations, and networks and partnerships; infrastructure and capacity to support sustainability; community need for program; and ongoing evaluation of performance and outcomes), and 11 elements were identified by two of three data sets (availability of funding; consistency with organizational culture; evidence of positive outcomes; development of a plan for implementation and sustainment; presence of a champion; institutionalization and integration of program; institutional support and commitment; community buy-in and support; program continuity; supportive leadership; and opportunities for staff training). All but one of the CFIR domain elements (pressure from other states, tribes, or communities) were endorsed as important to sustainability by 50% or more of participants. It may be more important to implement a standardized process of eliciting determinants and outcomes of sustainability than to implement a single standardized instrument.

Objective This study describes clients’ reports of factors that facilitated or impeded engagement in services offered by the Recovery After an Initial Schizophrenia Episode (RAISE) Connection Program for youth and young adults experiencing early psychosis and was part of the larger RAISE Implementation and Engagement Study (RAISE-IES). Method Semi-structured interviews with 32 clients and thematic qualitative analyses were used to examine participants’ experiences of program services, staff practices, their own engagement behaviors, and related factors such as expectations, family, illness, and setting. Results Clients’ statements indicated that central engagement factors include: services and staff interactions that are highly individualized, respectful, warm, and flexible; clients’ life goals being the center of services; family member engagement; personal attributes and program location and setting factors. Conclusions These interviews help explain the Connection Program’s effectiveness regarding client engagement and deepen our understanding of treatment engagement for youth and young adults experiencing early psychosis. The individualized, flexible, recovery-focused and assertive model of services and client-staff interaction, incorporating shared decision making and focus on client life goals should be implemented and sustained in services for this population.

Mental health programs can address many components of fidelity with routinely available data. Information from client interviews can be used to corroborate these administrative data. In an application of this approach, data from these sources indicated that a team-based intervention for people experiencing early psychosis was implemented as intended, including program elements related to shared decision-making as well as a range of evidence-based clinical interventions.