Statewide System and Organizational Strategy for Evidence-Based Practice Implementation and Sustainment in Substance Use Disorder Treatment
Principal Investigator(s): Gregory Aarons, Ph.D. UC San Diego
Co-Investigators(s): Mark Ehrhart, Ph.D. Univeristy of Central Florida, Marisa Sklar, Ph.D. UC San Diego
This project will test an implementation strategy that seeks to align system, organization, and clinic leadership and strategies to implement and sustain an evidence-based practice (EBP) for substance use disorders. The Leadership and Organizational Change for Implementation - System Level (LOCI-SL) seeks to improve implementation leadership, climate, provider attitudes and behaviors, and EBP fidelity for enhanced client engagement in services and outcomes. LOCI-SL will be tested in integrated mental health and substance use disorder treatment clinics across the state of Oregon while engaging the Oregon Health Authority, the Alcohol and Drug Policy Commission, and managed care organizations.
Funding Information: NIH/NIDA, R01, DA049891
Study time period: 2020 - 2025
System of Care Evaluation
Principal Investigator(s): Gregory Aarons, Ph.D. UC San Diego, Todd Gilmer, Ph.D. UC San Diego
Co-Investigator(s): Emily Trask, Ph.D. UC San Diego and Kate McDonald, DrPH, UC San Diego
The SOCE contract focuses on data management and program evaluation for publicly-funded mental health services provided by Children, Youth & Families Behavioral Health Services (CYFBHS). SOCE works in tandem with the Health Services Research Center (HSRC), which is responsible for data management and evaluation of the Adult/Older Adult Behavioral Health Services (AOABHS) system. As part of this contract, SOCE and HSRC collaborated to develop and maintain a web-based outcomes data collection system: CYF Mental Health Outcomes Management System (CYF mHOMS). We provide ongoing training, technical support, data management, and evaluation services for CYF mHOMS. CYF mHOMS allows each contractor to generate outcomes reports for their own reporting needs, and also allows SOCE to report at the system, unit and subunit level. Outcomes measures are also linked to administrative data from Cerner, the County’s billing system, for additional reporting on systemwide service use, demographics, outcomes, and compliance. These data are also linked to information on clients involved in other public systems of care (Probation, Child Welfare, Substance Use Disorder, and Special Education) in order to examine the overlap and collaboration between these sectors.
In addition to overseeing outcomes, SOCE also supports BHS quality assurance efforts, and provides consultation to BHS leadership on program and client outcome measures and standards. Other research consultation services include development and ongoing support for the Community Experience Partnership (CEP), State-mandated Performance Improvement Projects (PIPs), Full Service Partnership (FSP) support and evaluation, disparities reporting, TAY reporting, client satisfaction focus groups, distribution and processing of the biennial Youth Services Survey (YSS), and myriad regular and ad hoc reporting requests.
Funding Information: County of San Diego Behavioral Health Services, Contract
Study time period: established 1996
Adapting an ASD Executive Functioning Intervention for Implementation in Children’s Mental Health Services
Principal Investigator(s): Kelsey Dickson, Ph.D. University of Oregon
Co-Investigator(s): Lauren Brookman-Frazee, Ph.D. UC San Diego, Gregory Aarons, Ph.D. UC San Diego, Lauren Kenworthy, Children's National, Laura Anthony, Ph.D. University of Colorado, Scott Roesch, Ph.D. San Diego State University
The aims of the current project are to use an implementation science framework to: 1) conduct a needs and context assessment to inform the systematic adaptation of an ASD EF intervention (Unstuck and on Target [UOT]) for implementation in child mental health services; 2) systematically adapt UOT and develop a corresponding plan; and 3) conduct a feasibility pilot test of the adapted intervention and corresponding implementation plan in community mental health settings.
Funding Information: NIMH, K23, K23MH115100
Study time period: 2018-2023
Hybrid Effectiveness-Implementation Trial of an Executive Functioning Intervention for Children's Mental Health Services
Principal Investigator: Kelsey Dickson, Ph.D. University of Oregon
Co-Investigator(s): Lauren Brookman-Frazee, Ph.D. UC San Diego, Laura Anthony, Ph.D. University of Colorado, Sarah Kennedy, Ph.D. University of Colorado, Scott Roesch, Ph.D. San Diego State University
Autism is a highly prevalent neurodevelopmental condition, affecting 1 in 36 youth. The annual cost in the U.S. of autism was $223 billion in 2020 and is estimated to rise to $589 billion by 2030. Outcomes are poor and care disparities and high rates of unmet service needs are common. Mental health services play a key role in caring for autistic youth. There have been efforts to develop evidence-based interventions (EBIs) with the potential to lessen the public health burden of autism. Yet, research indicates limited community EBI penetration. There is an urgent need to focus on EBIs that improve mental health services for autism and optimize outcomes for this priority, complex population. Executive functioning (EF) is a potent mechanism underlying autism and commonly co-occurring mental health conditions. EF impairments (e.g., inflexibility, poor goal setting, poor planning) contribute to negative outcomes spanning multiple areas (e.g., academic, vocational, health). Our work underscores the impact of EF deficits on mental health services, including its transdiagnostic impact on the majority of children served in this setting and its role as a barrier to psychotherapy engagement and progress. EF is responsive to treatment, and mental health therapists cite a significant need and motivation for EF treatments, making EF EBIs highly relevant for community mental health settings. However, EF EBIs have not been widely used and tested in such settings. Autism EBIs, or those developed or adapted for autistic youth, have the potential to enhance mental health services, in addition to improving service quality for the populations targeted (e.g., autism). This is due to the specific components and strategies incorporated into the EBI to enhance its impact and fit. We propose a Hybrid Type 2 randomized trial examining the effectiveness and implementation of an autism EF EBI (Unstuck and On Target) in community mental health settings. Unstuck and On Target is a cognitive-behavioral EF intervention effective for autism. With NIMH funding (K23MH115100;), Unstuck and On Target was systematically adapted for and tested in mental health settings, with a pilot test suggesting its preliminary effectiveness, high fidelity, and use beyond autism. Findings have the potential to transform implementation and service quality for the high priority population of autistic youth as well as youth generally. Aim 1. Evaluate the effectiveness and implementation of an autism EBI (Unstuck and On Target), relative to a non-autism transdiagnostic intervention (Unified Protocol for Children) for autistic youth. Aim 2. Evaluate mediators of EBI training effects to confirm engaged change mechanisms of clinical and implementation outcomes. Aim 3. Explore the generalized effects of EBI training on reach and improved psychotherapy quality with non-autistic youth.
Funding Information: NIMH, R01, R01MH137179
Study time period: 2024 – 2029
Personalizing Parent Training Interventions for Culturally Diverse Families
Principal Investigator(s): Kristen McCabe, Ph.D. University of San Diego, May Yeh, Ph.D. San Diego State University
Co-Investigator(s): Argero Zerr, Ph.D. California State University Channel Islands
Behavioral Parent Training (BPT) interventions have been shown to be effective treatments for young children with behavior problems. However, not all families benefit, and ethnic minority families in particular are less likely to enroll, engage, and improve in BPT, in part because some aspects of these treatments may not fit with culturally influenced beliefs and attitudes about child mental health and its treatment. One way of improving engagement and outcomes in BPT for culturally diverse families may be to personalize the delivery of treatments by enhancing or modifying aspects of their delivery to increase the cultural fit of the treatment to the family when research suggests this might be helpful. In this project, we developed a personalization approach (PersIn) that utilizes cultural assessment results to tailor a BPT called Parent-Child Interaction Therapy (PCIT) to individual families in order maximize cultural responsiveness to a specific family while still being deliverable to a culturally diverse population. We then pilot tested this intervention, called MY PCIT, with 32 families from a range of racial/ethnic groups (African American, Asian American, Latinx, and Non-Hispanic White) that were seeking treatment for their child’s clinically significant behavior problems.
Funding Information: NIMH, R34, R34MH109561
Study time period: 2016 - 2021
Policy Implementation Research on Earmarked Taxes for Mental Health Services
Principal Investigator(s): Jonathan Purtle, DrPH New York University, Nicole Stadnick, Ph.D., MPH UC San Diego
The goal of this study is to generate knowledge about how to enhance the ability of earmarked taxes for mental health to increase the reach of evidence-based practices that improve population mental health.
Funding Information: NIMH, R21, MH125261
Study time period: 2020 - 2023
Adapting and Implementing an Integrated Care Model for Youth with Autism Spectrum Disorder and Psychiatric Comorbidity
Principal Investigator(s): Nicole Stadnick, Ph.D., MPH UC San Diego
The study used implementation science theory and methods and a research-community partnership approach to: 1) identify targets to improve mental health screening and linkage to mental health services in primary care for children with autism, 2) adapt integrated care procedures into “Access To Tailored Autism INtegrated Care,” ATTAIN, to facilitate identification of mental health problems and linkage to evidence-based care for youth with autism, and 3) conduct an open trial feasibility pilot test of ATTAIN in pediatric primary care.
Funding Information: NIMH, K23
Study time period: 2017 - 2022
Refining and Implementing Technology-Enhanced Family Navigation to Promote Early Access and Engagement with Mental Health Services for Youth with Autism
Principal Investigator(s): Nicole Stadnick, Ph.D., MPH UC San Diego
Other Collaborator(s): Kaiser Permanente
This proposal aims to test the effectiveness and implementation of technology-enhanced family navigation to promote early access to, and engagement in evidence-based mental health care for children with autism plus mental health comorbidity.
Funding Information: NIMH, R34, MH120190
Study time period: 2020 - 2024
Mental Health Innovation Program Evaluation
Principal Investigator(s): David Sommerfeld, Ph.D. UC San Diego, Gregory Aarons, Ph.D. UC San Diego, Todd Gilmer, Ph.D. UC San Diego
Since 2015 a team of investigators from UC San Diego has conducted outcome and process evaluations for each San Diego County Behavioral Health Service (BHS) “Innovation” initiative funded through the State of California, Mental Health Services Act. These community-based behavioral health programs are typically pilot projects that test out new strategies to increase access to behavioral health services tailored to meet the needs of specific populations that have been underserved/poorly served by existing BHS treatment programs. As of 2023, the UCSD evaluation team has worked on 15 separate Innovation initiatives. These initiatives have utilized many different service strategies and targeted a wide range of populations including: transitional age youth with serious mental illness, postpartum mothers with depression, parents of children receiving BHS services, rural American Indian communities with limited access to behavioral health services, education and outreach partnerships between faith-based communities and behavioral health service providers, persons transitioning from acute/crisis care services to outpatient care, and older adults with hoarding disorder.
Each evaluation is a collaborative endeavor in which the UCSD team partners with the relevant community-based service provider(s) and BHS representatives to develop approaches that are both feasible to implement in community settings and will result in actionable findings regarding program continuation and/or expansion after the pilot project phase. Where relevant to the target population and/or specific service modality utilized, additional subject matter experts from the Department of Psychiatry or San Diego State University supplement the core UCSD evaluation team to guide evaluation design and interpret findings for key stakeholders (i.e., program administrators, front-line service providers, and public sector decision makers at BHS and the County Board of Supervisors). In this manner the UCSD Innovations evaluation team is able to develop comprehensive evaluation approaches that are uniquely tailored to the objectives of the specific Innovation initiative, responsive to the needs and capabilities of the community-based service providers, and informative to relevant public sector entities.
Funding Information: County of San Diego Behavioral Health Services, Evaluation contract
Study time period: 2015 - 2024
Wraparound Fidelity Assessment
Principal Investigator(s): David Sommerfeld, Ph.D. UC San DiegoThe Wraparound Fidelity Assessment (WFA) initiative seeks to develop and implement a fidelity assessment plan for County of San Diego Behavioral Health Services (BHS) funded Wraparound programs to determine the extent to which they are operating as high quality and high-fidelity Wraparound programs. The primary assessment tool used for the WFA will be the Wraparound Fidelity Index-Short Version (WFI-EZ), a structured survey instrument that is administered to each youth, caregiver, Wraparound Service Care Coordinator, and an affiliated "natural support" who is part of the Wraparound care team for the youth and family. Deviations from high fidelity Wraparound standards will be identified and the UCSD team leading the WFA will work with BHS and the relevant Wraparound program(s) to develop quality improvement and data monitoring plans. The WFI-EZ will be administered 1-2 times per year over multiple years to detect changes over time related to the program improvement activities.
Funding Information: County of San Diego Behavioral Health Services, Evaluation contract
Study time period: 2022 - 2024
Team Effectiveness Factors in the Implementation of Autism Evidence-Based Practices
Principal Investigator(s): Allison Jobin, Ph.D. California State Univeristy San Marcos, Lauren Brookman-Frazee, Ph.D. UC San Diego, Aubyn Stahmer, Ph.D. UC DavisCo-Investigator(s): Elizabeth Rangel, Ph.D. UC Davus, Patricia Schetter, M.Ed. Placer County Office of Education, Katherine Williams, Ph.D., Rady Children's Hospital-San Diego
The purpose of this R03 is to identify specific team-based inputs and processes of evidence-based practice (EBP) leadership teams associated with effective implementation of autism EBPs in community settings. Despite the importance of leadership teams in children’s mental health and education services, there is minimal research on effective teams for autism EBP implementation. Team effectiveness research (TER) specifies team-level factors as key levers impacting outcomes. Little research has attempted to understand these factors and how they are involved within EBP leadership teams, which has potential to improve their impact and scalability. Applying a community-partnered approach, this project capitalizes on existing data from statewide implementation trials to improve understanding of the role of teams in EBP implementation outcomes and has the potential to inform development of team-based implementation strategies to further promote effective autism EBP implementation efforts. We will apply secondary coding and analysis of team characteristics and in-group process data from a team-based EBP implementation strategy across two service systems to: (1) Identify team inputs associated with implementation outcomes, and (2) Identify team processes associated with implementation outcomes. Together, findings related to potent team-based factors (i.e. team inputs, key processes) will support a larger-scale project to develop and test an EBP implementation team toolkit for school and youth mental health services in collaboration with community partners.
Funding Information: NIMH, P50, MH126231
Study time period: 2023 - 2024