The influence of a blended, theoretically-informed pre-implementation strategy on school-based clinician implementation of an evidence-based trauma intervention

Abstract

Background Individual-level implementation determinants, such as clinician attitudes, commonly influence the successful adoption of evidence-based practices, but few explicit strategies have been tested with regard to their ability to impact these key mechanisms of change. This paper reports on an initial test of a blended, theoretically informed pre-implementation strategy designed to target malleable individual-level determinants of behavior change. Beliefs and Attitudes for Successful Implementation in Schools (BASIS) is a brief and pragmatic pre-implementation strategy that uses strategic education, social influence techniques, and group-based motivational interviewing to target implementation attitudes, perceived social norms, perceived behavioral control, and behavioral intentions to implement among mental health clinicians working in the education sector. Methods As part of a pilot trial, 25 school mental health clinicians were randomized to BASIS ( n = 12) or an attention control placebo ( n = 13), with both conditions receiving training and consultation in an evidence-based intervention for youth experiencing trauma (the Cognitive Behavioral Intervention for Trauma in Schools). Theorized mechanisms of change (attitudes, perceived social norms, perceived behavioral control, and behavioral intentions) were assessed at baseline, post-training, and 4-month follow-up. Clinician participation in post-training consultation and intervention adoption were also tracked. Results A series of regression models and independent sample t tests indicated that BASIS had significant, medium to large effects on the majority of its proximal mechanisms from baseline to post-training. BASIS was also associated with a greater latency between initial training in the intervention and discontinuation of participation in post-training consultation, with clinicians in the BASIS condition persisting in consultation for an average of 134 days versus 32 days for controls, but this difference was not statistically significant. At 4-month follow-up, most differences in the theorized mechanisms had attenuated, and approximately the same small number of BASIS clinicians adopted the trauma intervention as controls. Conclusion Findings suggest that the brief BASIS pre-implementation strategy had a significant influence on its proximal mechanisms of change, but that these changes did not persist over time or translate into adoption of the trauma intervention. Implications for theory refinement, revisions to the BASIS protocol, and next steps for research surrounding individual-level implementation strategies are discussed. Trial registration ClinicalTrials.gov Identifier: NCT03791281 . Registered 31 December 2018—Retrospectively registered Electronic supplementary material The o...

Protocol for a hybrid type 2 cluster randomized trial of trauma-focused cognitive behavioral therapy and a pragmatic individual-level implementation strategy

“…The BASIS online booster is delivered at approximately 15 days post-training, a time point when clinicians’ implementation intentions and behaviors may first weaken [ 78 ]. The aim of the BASIS booster is to provide adaptive content to clinicians to either increase intentions to implement or maintain self-efficacy to implement the EBT, depending on whether or not clinicians have initiated TF-CBT implementation.…”

“…A BASIS fidelity tool [ 78 ] will be used to rate recordings of BASIS delivery by trained research assistants. Each recording will be coded independently by two different raters and disagreements resolved through consensus dialog to capture facilitator adherence and participant responsiveness via engagement [ 79 , 80 ].…”

“…Conservatively assuming 35 clinicians in each group and 12 time points, we will have sufficient power to detect a Cohen’s d of .68 for clinician implementation outcomes, which is lower than most significant effects during our pilot study [ 78 ]. We will have power to detect mediation effects when the relationship of BASIS to implementation mechanisms is d > .59 (as expected) and mechanisms to implementation outcomes has at least small/moderate effects ( d > .31) [ 111 ].…”

Preschool teachers’ selection of social communication interventions for children with autism: An application of the theory of planned behavior

“…Although sometimes these beliefs are studied separately (Ruble et al, 2018), together, they account for a substantial portion of the variance in behavioral intentions (Davis et al, 2015). Furthermore, there is evidence that these beliefs are malleable in response to intervention (Cook et al, 2015), practice-specific (Fishman et al, 2018), and associated with the EBP implementation in special education (Lyon et al, 2019). Nevertheless, theory-driven investigations of teacher beliefs as antecedents to practice selection remain rare within preschool special education (Fishman et al, 2018; Ruble et al, 2018).…”

Implementing nudges for suicide prevention in real-world environments: project INSPIRE study protocol

“…To date, a number of behavior change theories such as the theory of planned behavior [ 25 ] and self-determination theory [ 26 ] have been used to guide implementation research [ 27 , 28 ]. BE offers unique insights for the design of implementation strategies that target human decision-making constraints (i.e., cognitive heuristics) across settings.…”