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: Unknown

213 Participants Needed

Trial Summary

What is the purpose of this trial?

This project engages community mental health center (CMHC) clinical supervisors in the development and examination of an optimized coaching strategy for psychotherapists utilizing Cognitive Behavioral Therapy (CBT) in Washington State. The optimized coaching strategy has the potential to enhance the adoption and fidelity of evidence-based practice (EBP).

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 data supports the idea that Implementation Coaching for Mental Health Improvement is an effective treatment?

The available research shows that Implementation Coaching for Mental Health Improvement is effective in enhancing the quality of care. For example, a study found that training followed by coaching led to significant and sustained improvements in care planning quality over a 12-month period when implementing a recovery-oriented service model. This suggests that coaching helps in applying new approaches effectively in mental health services. ^{1 2 3 4 5}

What safety data exists for Implementation Coaching in mental health?

The provided research does not directly address safety data for Implementation Coaching in mental health. However, it discusses the effectiveness and feasibility of coaching strategies in implementing evidence-based practices, suggesting that coaching can improve implementation outcomes and support mental health service delivery. No specific safety concerns or adverse effects are mentioned in the studies. ^{1 4 6 7 8}

Is Supervisor-led Implementation Coaching a promising treatment for mental health improvement?

Yes, Supervisor-led Implementation Coaching is a promising treatment because it helps mental health professionals use effective practices in schools, improves their skills, and supports better mental health care for youth. ^{1 4 8 9 10}

Research Team

Shannon Dorsey, PhD

Principal Investigator

University of Washington

Eligibility Criteria

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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 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]

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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

A comparison of two coaching approaches to enhance implementation of a recovery-oriented service model. [2022]

2. Germany pubmed.ncbi.nlm.nih.gov

Feasibility of a quality improvement strategy integrating psychosocial care into 28 medical cancer centers (HuCare project). [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Organizational fidelity to a medication management evidence-based practice in the treatment of schizophrenia. [2013]

4. United States 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. [2020]

5. United States pubmed.ncbi.nlm.nih.gov

Significance of Leaders for Sustained Use of Evidence-Based Practices: A Qualitative Focus-Group Study with Mental Health Practitioners. [2020]

6. United States pubmed.ncbi.nlm.nih.gov

Implementing evidence-based practices for persons with severe mental illnesses. [2007]

7. United States pubmed.ncbi.nlm.nih.gov

Creating a Practice-Based Implementation Network: Facilitating Practice Change Across Health Care Systems. [2021]

8. United States pubmed.ncbi.nlm.nih.gov

Developing a statewide network of coaches to support youth access to evidence-based practices. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

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

10. Ireland pubmed.ncbi.nlm.nih.gov

Capacity-building and training opportunities for implementation science in mental health. [2020]