A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions

Abstract

Objective This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. Methods A literature search was conducted using electronic databases and a manual search. Results Eleven studies were identified that tested implementation strategies with a randomized (n = 10) or controlled clinical trial design (n = 1). The wide range of clinical interventions, implementation strategies, and outcomes evaluated precluded meta-analysis. However, the majority of studies (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome. Conclusions There is a clear need for more rigorous research on the effectiveness of implementation strategies, and we provide several suggestions that could improve this research area.

Methods to Improve the Selection and Tailoring of Implementation Strategies

“…This is particularly true in behavioral health settings, as there are far fewer randomized controlled trials and head-to-head comparisons of implementation strategies than in other medical and health service settings. 10–12 Thus, while it is well established that simply training clinicians to deliver EBPs is insufficient, 13 it is less clear which strategies are needed at the client, clinician, team, organizational, system, or policy levels to facilitate implementation and sustainment.…”

“…17,18 But researchers often fail to explicitly refer to guiding conceptual frameworks, 12,19 and when they do, they often simply borrow a subset of constructs or outcomes without framing their study within the broader context of the framework. 20 It is not always clear how to translate frameworks into implementation strategy design, 21 as many are primarily heuristic and do not indicate the direction or nature of causal mechanisms.…”

A review of diabetes prevention program translations: use of cultural adaptation and implementation research

“…We also evaluated whether a framework of adaptation was used, such as those outlined by Bernal and Domenech Rodriguez [25]. We coded studies that were empirical and designed to test an implementation strategy or set of strategies or explored issues related to implementation as implementation studies [40,41]. These studies were coded for study design, implementation strategy, implementation outcomes, and whether or not a conceptual model or framework was used to guide the study and/or implementation effort.…”

How Do Clinicians Prefer Cultural Competence Training? Findings from the DSM-5 Cultural Formulation Interview Field Trial

“…We analyze specific methods; clinician factors such as age, discipline, years of experience, hours of prior cross-cultural training, and ethnicity; and patient factors such as ethnicity and presence of a psychotic illness that have been hypothesized as correlating with training preferences [22]. We present clinician perspectives on training given the literature’s tendency to report perspectives of researchers and administrators who are not ultimately responsible for implementing clinical interventions [23, 24]. Better understanding of clinician preferences can produce more effective and efficient training programs.…”