Implementation Coaching for Mental Health Improvement

Overseen By Celine Lu

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Washington

Disqualifiers: Aim 1 supervisors in Aim 2

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to enhance how clinical supervisors in community mental health centers support therapists using Cognitive Behavioral Therapy (CBT). It tests a new coaching strategy, Supervisor-led Implementation Coaching, to help therapists adhere more effectively to evidence-based practices. Supervisors in Washington State mental health centers, already part of a specific training initiative, are ideal candidates for this trial. This approach could improve mental health care by ensuring therapists use proven techniques.

As an unphased trial, this study provides a unique opportunity to contribute to the advancement of mental health care practices.

Do I have to stop taking my current medications?

The trial protocol does not specify whether you need to stop taking your current medications.

What prior data suggests that this coaching strategy is safe for mental health improvement?

Studies have shown that supervisors coaching therapists can safely and effectively enhance the use of Cognitive Behavioral Therapy (CBT). Research indicates that this method involves no direct medical treatments. Instead, it trains and supports supervisors to improve therapy techniques.

Because this approach centers on coaching and guidance, it lacks typical medical side effects associated with medications. No reports suggest any harm from this type of coaching. It primarily aims to improve therapy delivery, making it a low-risk option for participants. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Supervisor-led Implementation Coaching because it offers a fresh approach to improving mental health care delivery. Unlike traditional methods that rely solely on clinician training, this method focuses on empowering supervisors as frontline leaders. By involving peer supervisors in coaching and providing them with tools and strategies, this approach aims to enhance the implementation of evidence-based practices in community mental health centers. This could lead to more tailored and effective mental health services, ultimately benefiting both practitioners and patients.

What evidence suggests that Supervisor-led Implementation Coaching is effective for improving mental health through CBT?

Research has shown that coaching for supervisors enhances therapists' use of Cognitive Behavioral Therapy (CBT). In this trial, one group of participants will receive Supervisor-led Implementation Coaching, where peer supervisors lead implementation through virtual meetings and email. A study found that this coaching enables supervisors to better support their therapists, improving mental health services. This method uses proven practices to ensure correct and consistent application of therapy techniques. By involving supervisors as leaders, the aim is to enhance therapy effectiveness. The coaching helps supervisors develop specific plans for their mental health centers, leading to better therapy use and improved outcomes. ^{1 4 6 7 8}

Who Is on the Research Team?

Shannon Dorsey, PhD

Principal Investigator

University of Washington

Are You a Good Fit for This Trial?

This trial is for clinical supervisors and psychotherapists working in community mental health centers (CMHCs) in Washington State. Supervisors must be part of a CMHC that's agreed to join the study and have been involved in the Initiative. Clinicians don't need their CMHC leadership's agreement to participate. However, supervisors from Aim 1 can't be coached in Aim 2.

Inclusion Criteria

Clinicians in aim 1b do not need to be employed in a CMHC whose leadership has agreed to participate in the study

Supervisors in aim 1a and clinicians/supervisors in aim 2 must be employed in CMHCs whose leadership has agreed to participate in the study and have participated or be participating in the Initiative

Exclusion Criteria

Supervisor coaches will be recruited from the supervisors that participated in Aim 2

Supervisors who participate in Aim 1 will be excluded from participating in Aim 2 as recipients of Implementation Coaching

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Ideation Workshops

Supervisors participate in 2 one-day, in-person ideation workshops to develop strategies for CBT implementation

2 days

2 visits (in-person)

Implementation Coaching

Supervisors receive 3-5 virtual meetings for coaching, focusing on developing tailored workplans for CBT implementation

6 months

3-5 visits (virtual)

Follow-up

Participants are monitored for CBT fidelity and client outcomes through study completion

7 months

What Are the Treatments Tested in This Trial?

Interventions

• Supervisor-led Implementation Coaching

Trial Overview

The study is testing an optimized supervisor-led coaching strategy designed to improve how therapists use Cognitive Behavioral Therapy (CBT). It aims to better adoption and correct application of this evidence-based practice within CMHCs through enhanced coaching methods.

How Is the Trial Designed?

Group I: Supervisor-led Implementation Coaching Experimental Treatment 1 Intervention

The structure of this arm will depend on Aim 1. However, the investigators imagine that peer supervisors leading implementation coaching, trained in Aim 1, will have 3-5 virtual meetings with supervisors and email communication. Meetings focus on orientation to the theory and rationale for Coaching and supervisors' role as frontline leaders to support EBP implementation. Meetings are likely over 6 months and focus on different implementation phases. Coaches will support supervisors in developing tailored workplans for implementation in their CMHCs. In each meeting, the coach will review the strategies in the workplan, provide examples of how the strategy could be specified, and then facilitate discussion among supervisors. The coach will support supervisors in building a tailored workplan for their CMHC. Supervisors in the Coaching condition receive Coaching plus standard Initiative Implementation support.

Group II: Standard/As Usual CBT+/EBP Initiative Implementation Active Control 1 Intervention

All CMHCs involved in the CBT+/EBP Initiative receive virtual clinician training, CBT-phone consultation options over 6-months, access to a supervisor monthly call, listservs (one supervisor-focused), and a yearly advanced clinical training and supervisor training. The Initiative is a program that has been ongoing since 2009.

Who Is Running the Clinical Trial?

University of Washington

Lead Sponsor

Trials

1,858

Recruited

2,023,000+

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Published Research Related to This Trial

High fidelity in implementing the illness management and recovery practice does not guarantee successful long-term use in mental health services, as highlighted by interviews with 26 practitioners.

Sustaining this evidence-based practice requires engaged leadership and clear goals, along with improved understanding of outcome monitoring to enhance practice improvement and avoid reliance on random patient experiences.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Significance of Leaders for Sustained Use of Evidence-Based Practices: A Qualitative Focus-Group Study with Mental Health Practitioners. Egeland, KM., Hauge, MI., Ruud, T., et al.[2020]

The study highlights the importance of using structured training, professional development portfolios, and progress monitoring systems to overcome barriers in implementing evidence-based programs in children's community mental health.

Results indicate that successful implementation requires adapting to both expected and unexpected challenges, emphasizing that these strategies can significantly enhance implementation outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing Evidence Based Practices for Children's Mental Health: A Case Study in Implementing Modular Treatments in Community Mental Health. Cheron, DM., Chiu, AAW., Stanick, CF., et al.[2020]

A practice-based implementation network involving 134 clinicians across 18 VA clinics was established to enhance the use of mental health practices, particularly focusing on PTSD treatment.

While the frequency of administering the PTSD checklist (PCL) showed mixed results, there was a consistent increase in clinicians using data to inform treatment decisions and discuss results with patients, indicating a positive shift in clinical practice.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Creating a Practice-Based Implementation Network: Facilitating Practice Change Across Health Care Systems. Ruzek, JI., Landes, SJ., McGee-Vincent, P., et al.[2021]

Despite extensive research showing effective pharmacological and psychosocial interventions for severe mental illnesses, these practices are not commonly implemented in routine mental health settings.

The authors propose an implementation plan using toolkits that include written materials, online resources, and training to promote the consistent delivery of evidence-based practices, addressing the needs of various stakeholders in mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Implementing evidence-based practices for persons with severe mental illnesses. Torrey, WC., Drake, RE., Dixon, L., et al.[2007]

Training staff in recovery-oriented mental health services, followed by coaching, significantly improved the quality of care planning over a 12-month period, indicating the effectiveness of this approach.

While both skills-based and transformational coaching were beneficial, further investigation into transformational coaching may reveal additional advantages in implementing recovery-oriented models.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A comparison of two coaching approaches to enhance implementation of a recovery-oriented service model. Deane, FP., Andresen, R., Crowe, TP., et al.[2022]

The study successfully implemented a quality improvement strategy for psychosocial care in 27 out of 28 oncology centers, achieving over 85% adherence to most recommendations, indicating high feasibility of translating evidence-based practices into clinical settings.

Involvement of all staff members, including oncologists, psychologists, and nurses, along with expert support, was crucial for overcoming barriers and enhancing the quality of psychosocial care for cancer patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Feasibility of a quality improvement strategy integrating psychosocial care into 28 medical cancer centers (HuCare project). Passalacqua, R., Annunziata, MA., Borreani, C., et al.[2022]

The TRAILS program successfully trained 86 community clinicians in Michigan to become coaches in cognitive behavioral therapy (CBT), significantly improving their knowledge and application of CBT strategies.

This coaching model, which includes in vivo support and personalized consultation, effectively addresses the shortage of mental health providers for youth by enhancing the implementation of evidence-based practices in schools.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing a statewide network of coaches to support youth access to evidence-based practices. Meyer, AE., Rodriguez-Quintana, N., Miner, K., et al.[2023]

Over the past decade, the National Institute of Mental Health and other US organizations have significantly advanced the field of implementation science in mental health, engaging hundreds of researchers through funding, workshops, and training programs.

These initiatives aim to enhance the development and execution of implementation studies, which are crucial for improving mental health care and prevention programs for those in need.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Capacity-building and training opportunities for implementation science in mental health. Chambers, DA., Pintello, D., Juliano-Bult, D.[2020]

A 3-year study across six community mental health clinics found that organizational support for implementing evidence-based practices (EBP) in schizophrenia treatment was moderate, highlighting the importance of leadership in successful implementation.

Key areas of support included access to patient information and scheduling flexibility, while challenges remained in medication availability and identifying treatment-resistant patients, suggesting areas for improvement in EBP implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Organizational fidelity to a medication management evidence-based practice in the treatment of schizophrenia. El-Mallakh, P., Howard, PB., Rayens, MK., et al.[2013]

The National Institute of Mental Health organized a workshop to address the challenges in implementing effective mental health interventions, bringing together diverse experts to enhance the knowledge base for real-world application.

Participants identified key constructs for successful implementation of evidence-based practices, emphasizing the need for further research on these constructs to improve mental health service delivery.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Advancing the science of implementation: a workshop summary. Chambers, DA.[2007]

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