Multi-method process maps: An interdisciplinary approach to investigate <i>ad hoc</i> modifications in protocol-driven interventions

Mackie, Thomas I.; Ramella, Leah; Schaefer, Ana J.; Sridhar, Monica; Carter, Alice S.; Eisenhower, Abbey; Ibitamuno, Grace; Petruccelli, Marisa; Hudson, Shawna V.; Sheldrick, R. Christopher

doi:10.1017/cts.2020.14

Cited by 13 publications

(12 citation statements)

References 40 publications

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“…Used alongside other sources of the adaptations data, process maps helped visualize changes taking place across implementation phases. Additional research is needed to understand how it impacts our understanding of adaptations and their effectiveness (16). Although we are proponents of multiple assessments methods, in this study it is questionable whether the interview and real time tracker methods were worth the incremental costs.…”

Section: Discussionmentioning

confidence: 89%

Using a longitudinal multi-method approach to document, assess, and understand adaptations in the Veterans Health Administration Advanced Care Coordination program

McCreight

Rohs²,

Lee³

et al. 2022

Front.Health Serv.

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BackgroundUnderstanding adaptations supports iterative refinement of the implementation process and informs scale out of programs. Systematic documentation of adaptations across the life course of programs is not routinely done, and efficient capture of adaptations in real world studies is not well understood.MethodsWe used a multi-method longitudinal approach to systematically document adaptations during pre-implementation, implementation, and sustainment for the Veteran Health Administration (VA) Advanced Care Coordination program. This approach included documenting adaptations through a real-time tracking instrument, process maps, Implementation and Evaluation (I&E) team meeting minutes, and adaptation interviews. Data collection was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) enhanced framework for reporting adaptations and modifications to evidence-based interventions (FRAME) model. Adaptations were evaluated across 9 categories, and analytic team consensus and member-checking were used to validate the results.ResultsA total of 144 individual adaptations were identified across two implementation sites and the four data sources; analytic team consensus and member-checking processes resulted in 50 unique adaptations. Most adaptations took place during the early implementation and mid-implementation phases and were: 1) planned; 2) made to address changes in program delivery; 3) made to extend a component; 4) related to the core component of the intervention concerning notification of the community emergency department visit; 5) initiated by the entire or most of the I&E team; 6) made on the basis of: pragmatic/practical considerations; 7) made with an intent to improve implementation domain (to make the intervention delivered more consistently; to better fit the local practice, patient flow or Electronic Health Record (EHR) and/or for practical reasons); 8) a result of internal influences; 9) perceived to impact the RE-AIM implementation dimension (consistent delivery of quality care or costs). I&E team meeting minutes and process maps captured the highest numbers of unique adaptations (n = 19 and n = 13, respectively).ConclusionOur longitudinal, multi-method approach provided a feasible way to collect adaptations data through engagement of multiple I&E team members, allowing and a broader understanding of adaptations that took place. Recommendations for future research include pragmatic assessment of the impact of adaptations and meaningful data collection without overburdening the implementing teams and front-line staff.

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Section: Discussionmentioning

confidence: 89%

Using a longitudinal multi-method approach to document, assess, and understand adaptations in the Veterans Health Administration Advanced Care Coordination program

McCreight

Rohs²,

Lee³

et al. 2022

Front.Health Serv.

View full text Add to dashboard Cite

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“…As with prior studies, the extent and frequency of modification varied substantially from therapist to therapist. While overall levels of modification are not associated with success, a more nuanced examination of modifications exploring type (e.g., fidelity-consistent modifications; Marques et al, 2019) and processes (e.g., planned versus ad hoc ; Mackie et al, 2020) may provide additional insight. For instance, modifications made on unsubstantiated clinical instinct or in contrast with core elements of the model may be less successful than planned modification of EBPs that use alternative forms to fulfill essential functions of the EBP (e.g., changing maladaptive thinking; Jolles et al, 2019; McGuire et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

A national survey of patient completion of cognitive behavioral therapy for chronic pain: The role of therapist characteristics, attempt rates, and modification.

McGuire¹,

Matthias²,

Kukla³

et al. 2021

Professional Psychology: Research and Pract

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“…Notably, our findings arrive from a community-based multi-stage screening protocol in a socially-disadvantaged community and specifically sought to reduce disparities in screening participation and outcomes (Sheldrick et al 2019;Mackie et al 2020). To examine whether disparities in screening participation and outcomes persisted in the parent study, our research team investigated the predictors of screening participation and outcomes at each stage of the process; demographic differences (race, language, public insurance) were observed only at first-stage screening and reflected higher participation for children of color and higher positive screens for publicly-insured children .…”

Section: Discussionmentioning

confidence: 99%

Understanding How Parents Make Meaning of Their Child’s Behaviors During Screening for Autism Spectrum Disorders: A Longitudinal Qualitative Investigation

Mackie

Schaefer

Ramella

et al. 2020

J Autism Dev Disord

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A family's journey in understanding their child's behaviors in relation to Autism Spectrum Disorders (ASD) frequently begins with screening. This study aimed to characterize the interpretive processes that unfold for parents. We employed longitudinal interviews with 19 families engaged in a community-based multi-stage screening protocol. Parents participated in 1-6 interviews dependent upon children's length of engagement in the screening protocol; data were analyzed through modified grounded theory. Parents who moved towards understanding their child's behaviors as ASD expressed (1) sensitization to ASD symptoms, (2) differentiation from other developmental conditions, and (3) use of the ASD diagnosis to explain the etiology of concerning behaviors. Identifying interpretive processes involved during ASD screening provides new opportunities for shared decision-making.

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Multi-method process maps: An interdisciplinary approach to investigate ad hoc modifications in protocol-driven interventions

Cited by 13 publications

References 40 publications

Using a longitudinal multi-method approach to document, assess, and understand adaptations in the Veterans Health Administration Advanced Care Coordination program

Using a longitudinal multi-method approach to document, assess, and understand adaptations in the Veterans Health Administration Advanced Care Coordination program

A national survey of patient completion of cognitive behavioral therapy for chronic pain: The role of therapist characteristics, attempt rates, and modification.

Understanding How Parents Make Meaning of Their Child’s Behaviors During Screening for Autism Spectrum Disorders: A Longitudinal Qualitative Investigation

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