Statewide dissemination of an evidence-based practice using Breakthrough Series Collaboratives

Lang, Jason M.; Franks, Robert P.; Epstein, Carrie; Stover, Carla Smith; Oliver, Jason A.

doi:10.1016/j.childyouth.2015.06.005

Cited by 40 publications

(24 citation statements)

References 49 publications

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“…Our measures also did not capture friendship ties, which influence clinicians’ attitudes toward an EBT, but are more stable than advice ties (and less likely to change in response to learning collaboratives) [ 4 ]. Third, the size of our learning collaborative cohorts (about 30 participants) is both larger and smaller [ 55 , 56 ] than cohorts reported in other learning collaborative studies. Large groups may experience more growth in social networks than small groups [ 11 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

Advice-seeking during implementation: a network study of clinicians participating in a learning collaborative

et al. 2018

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BackgroundSuccessful implementation depends on the transfer of knowledge and expertise among clinicians, which can occur when professionals seek advice from one another. This study examines advice-seeking patterns among mental health clinicians participating in learning collaboratives (a multi-component implementation and quality improvement strategy) to implement trauma-focused cognitive behavioral therapy (TF-CBT). We apply transactive memory system theory, which explains how professionals access and retrieve knowledge, to examine factors associated with the evolution of advice-seeking relationships during implementation. Our aim is to unpack learning collaboratives’ mechanisms by investigating how and why advice-seeking networks change, which may help us understand how implementation strategies can best target networks.MethodsUsing social network analysis and a pretest-post-test design, we examined patterns in general and treatment-specific advice-seeking among 146 participants (including five clinical experts) from 27 agencies participating in a regional scale-up of TF-CBT. Surveys were administered in-person at the first and last of three in-person learning sessions (10 months apart) that comprise a core component of learning collaboratives. Participants nominated up to five individuals from whom they seek general and treatment-specific advice. Exponential random graph models (ERGMs) tested the likelihood of maintaining or forming advice-seeking relationships based on indicators of expertise quality, accessibility, need, and prior advice-seeking relationships.ResultsParticipants formed or maintained advice-seeking relationships with those who possess perceived expertise (e.g., learning collaborative faculty experts, supervisors, and those with greater field experience than themselves). Participants also tended to seek advice from those within the same organization and with similar disciplinary training, highlighting the importance of expertise accessibility. Prior relationships and network structural features were associated with advice-seeking, indicating that participants built on existing social ties. Advice-seeking did not vary based on participants’ role or experience.ConclusionsGiven the importance of accessible clinical expertise and ongoing supervision for delivering treatment with fidelity, learning collaboratives may support implementation by promoting clinicians’ awareness of and access to others’ expertise, especially those with substantial expertise to share (e.g., faculty experts and supervisors). Future controlled studies are needed to verify the effectiveness of learning collaboratives for building networks that connect clinicians and experts and for improving implementation.Electronic supplementary materialThe online version of this article (10.1186/s13012-018-0797-7) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Advice-seeking during implementation: a network study of clinicians participating in a learning collaborative

et al. 2018

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“…Studies of Learning Collaboratives focused on client outcomes have found that this method is associated with improved engagement in behavioral health services (Cavaleri et al, 2006(Cavaleri et al, , 2007(Cavaleri et al, , 2010Rutkowski et al, 2010), including initiating (Cavaleri et al, 2006) and sustaining (Cavaleri et al, 2007) gains in initial appointment attendance rates. It also has been associated with improvements in children's behavioral support services in schools (Stephan, Connors, Arora, & Brey, 2013) and trauma-focused service providers (Dopp, Hanson, Saunders, Dismuke, & Moreland, 2017;Lang, Franks, Epstein, Stover, & Oliver, 2015).…”

Section: Consultation and Supervision Strategiesmentioning

confidence: 99%

Proposing a mechanistic model of clinician training and consultation.

McLeod

Cox

Jensen‐Doss

et al. 2018

Clinical Psychology: Science and Practice

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To make evidence-based treatments deliverable, effective, and scalable in community settings, it is critical to develop a workforce that can deliver evidence-based treatments as designed with skill. However, the science and practice of clinician training and consultation lags behind other areas of implementation science. In this paper, we present the Longitudinal Education for Advancing Practice (LEAP) model designed to help span this gap. The LEAP model is a mechanistic model of clinician training and consultation that details how training inputs, training and consultation strategies, and mechanisms of learning influence training outcomes. We first describe the LEAP model and then discuss how key implications of the model can be used to develop effective training and consultation strategies.

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“…For example, over half of community‐based agency staff (including administrators, clinical supervisors, and clinicians) participating in a learning collaborative identified the use of FPSAs as very or extremely useful in their implementation of Trauma‐focused Cognitive Behavioural Therapy (TF‐CBT) 5 . Conversely, community‐based participants in a separate learning collaborative for TF‐CBT from sixteen agencies across a northeastern state perceived that training in the Model for Improvement, of which FPSAs were utilized, was the least helpful component of the learning collaborative 18 . Other than these studies, the importance of FPSAs in implementation has been largely unexamined.…”

Section: Introductionmentioning

confidence: 99%

“…5 Conversely, communitybased participants in a separate learning collaborative for TF-CBT from sixteen agencies across a northeastern state perceived that training in the Model for Improvement, of which FPSAs were utilized, was the least helpful component of the learning collaborative. 18 Other than these studies, the importance of FPSAs in implementation has been largely unexamined.…”

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confidence: 99%

Disseminating TF‐CBT: A Mixed Methods Investigation of Clinician Perspectives and the Impact of Training Format and Formalized Problem‐Solving Approaches on Implementation Outcomes

Ascienzo

Sprang

Eslinger

2020

Evaluation Clinical Practice

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Background: Trauma Focused-Cognitive Behavioural Therapy (TF-CBT) has been established as an evidence-based treatment for youth with traumatic stress symptoms. The versatility of TF-CBT in conjunction with its established effectiveness has led to its widespread dissemination. However, dissemination efforts have not always translated into sustainability, which has prompted a more thorough investigation into those factors that impact implementation and encouraged the development of strategies that promote sustainability. Toward this end, the aims of this study were to: (1) determine which components of TF-CBT clinicians found the most difficult to implement; (2) explore clinicians' perceptions as to why these components were challenging; and (3) examine whether the use of formalized problem-solving approaches (FPSAs) or training format was associated with implementation outcomes. Methods: A mixed methods design was utilized to analyse survey data from mental health professionals (N = 85) who received TF-CBT training. Thematic analysis explored responses to questions concerning those TF-CBT components respondents found most difficult to implement, while bivariate analyses helped determine whether training format or the use of FPSAs was associated with training engagement, confidence in delivering TF-CBT, fidelity or sustainability. Results: Clinicians perceived the same three components of TF-CBT as most difficult regardless of the type of training they received, and provider, youth, caregiver, and organizational-related themes emerged from thematic analysis. Bivariate analyses indicated more extended training formats and the use of FPSAs were associated with greater implementation success. Conclusion: Findings suggest that perceived difficulty of TF-CBT components did not vary by training format, but more extended formats and the use of FPSAs were associated with more favourable implementation outcomes. Implementers should consider ways to utilize FPSAs within training programs, as well as focus on content identified by clinicians as difficult, as this may assist clinicians in developing skills and managing implementation barriers.

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Statewide dissemination of an evidence-based practice using Breakthrough Series Collaboratives

Cited by 40 publications

References 49 publications

Advice-seeking during implementation: a network study of clinicians participating in a learning collaborative

Advice-seeking during implementation: a network study of clinicians participating in a learning collaborative

Proposing a mechanistic model of clinician training and consultation.

Disseminating TF‐CBT: A Mixed Methods Investigation of Clinician Perspectives and the Impact of Training Format and Formalized Problem‐Solving Approaches on Implementation Outcomes

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