Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges

  • Enola K. Proctor
  • John Landsverk
  • Gregory Aarons
  • David Chambers
  • Charles Glisson
  • Brian Mittman
Original Paper

Abstract

One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.

Keywords

Implementation Evidence-based practice Mental health services Translation two research 

References

  1. Aday, L. A., & Andersen, R. (1974). A framework for the study of access to medical care. Health Services Research, 9, 208–220.PubMedGoogle Scholar
  2. Addis, M. E. (2002). Methods for disseminating research products and increasing evidence-based practice: Promises, obstacles, and future directions. Clinical Psychology Science & Practice, 9(4), 367–378.CrossRefGoogle Scholar
  3. Alavi, M., & Joachimsthaler, E. A. (1992). Revisiting DSS implementation research: A meta-analysis of the literature and suggestions for researchers. MIS Quarterly, 16(1), 95–116.CrossRefGoogle Scholar
  4. Backer, T. E., David, S. L., & Saucy, G. (Eds.). (1995). Synthesis of behavioral science learnings about technology transfer in reviewing the behavioral science knowledge base on technology transfer. Rockville, MD: US Department of Health and Human Services.Google Scholar
  5. Bammer, G. (2003). Integration and implementation sciences: Will developing a new specialization improve our effectiveness in tackling complex issues? Retrieved January 16, 1008, from http://www.anu.edu.au/ilsn/.
  6. Baydar, N., Reid, M. J., & Webster-Stratton, C. (2003). The role of mental health factors and program engagement in the effectiveness of a preventive parenting program for Head Start mothers. Child Development, 74, 1433–1453.PubMedCrossRefGoogle Scholar
  7. Bernfeld, G. A., Farrington, D. P., & Leschied, A. W. (2001). Offender rehabilitation in practice: Implementing and evaluating effective programs. New York: Wiley.Google Scholar
  8. Beutler, L. E., Williams, R. E., Wakefield, P. J., & Entwistle, S. R. (1995). Bridging scientist and practitioner perspectives in clinical psychology. American Psychologist, 50(12), 984–994.PubMedCrossRefGoogle Scholar
  9. Blasé, K. A., Fixsen, D. L., Naoom, S. F., & Wallace, F. (2005). Operationalizing implementation: Strategies and methods. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute.Google Scholar
  10. Blau, P. (1964). Exchange and power in social life. New York: Wiley.Google Scholar
  11. Boren, S. A., & Balas, E. A. (1999). Evidence-based quality measurement. Journal of Ambulatory Care Management, 22(3), 17–23.PubMedGoogle Scholar
  12. Borkovec, T. D. (2004). Research in training clinics and practice research networks: A route to the integration of science and practice. Clinical Psychology: Science and Practice, 11, 211–215.CrossRefGoogle Scholar
  13. Brown, B. S., & Flynn, P. M. (2002). The federal role in drug abuse technology transfer: A history and perspective. Journal of Substance Abuse Treatment, 22, 245–257.PubMedCrossRefGoogle Scholar
  14. Brown, S. A., Inaba, R. K., Gillin, J. C., Schuckit, M. A., Stewart, M. A., & Irwin, M. R. (1995). Alcoholism and affective disorder: Clinical course of depressive symptoms. American Journal of Psychiatry, 152, 45–52.PubMedGoogle Scholar
  15. Brown, S. A., Tapert, S. F., Tate, S. R., & Abrantes, A. M. (2000). The role of alcohol in adolescent relapse and outcome. Journal of Psychoactive Drugs, 32, 107–115.PubMedGoogle Scholar
  16. Cain, M., & Mittman, R. (2002). Diffusion of Innovation in Health Care. Oakland, CA: Institute for the Future. Retrieved September 25, 2006, from http://www.chcf.org/documents/ihealth/DiffusionofInnovation.pdf.
  17. Chamberlain, P., Price, J., Reid, J., & Landsverk, J. (in press). Cascading implementation of a foster parent intervention: Partnerships, logistics, transportability, and sustainability. Child Welfare.Google Scholar
  18. Chambers, D., Ringeisen, H., & Hickman, E. E. (2005). Federal, state, and foundation initiatives around evidence-based practices for child and adolescent mental health. Child and Adolescent Psychiatric Clinics of North America, 14, 307–327.PubMedCrossRefGoogle Scholar
  19. Clarke, G. N. (1999). Prevention of depression in at-risk samples of adolescents. In C. A. Essau & F. Petermann (Eds.), Depressive disorders in children and adolescents: Epidemiology, risk factors, and treatment (pp. 341–360). Northvale, NJ: Jason Aronson, Inc.Google Scholar
  20. Committee on Crossing the Quality Chasm: Adaption to Mental Health, Addictive Disorders. (2006). Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academies Press.Google Scholar
  21. Conrad, D. A., & Christianson, J. B. (2004). Penetrating the “Black Box”: Financial incentives for enhancing the quality of physician services. Medical Care Research and Review, 61, 37S–68S.PubMedCrossRefGoogle Scholar
  22. Cooper, R. B., & Zmud, R. W. (1990). Information technology implementation research: A technological diffusion approach. Management Science, 36, 123–139.CrossRefGoogle Scholar
  23. Corrigan, P. W., Steiner, L., McCracken, S. G., Blaser, B., & Barr, M. (2001). Strategies for disseminating evidence-based practices to staff who treat people with serious mental illness. Psychiatric Services, 52(12), 1598–1606.PubMedCrossRefGoogle Scholar
  24. Costello, J. E., Pescosolido, B. A., Angold, A., & Burns, B. (1998). A family network-based model of access to child mental health services. Research in Community and Mental Health, 9, 165–190.Google Scholar
  25. Donabedian, A. (1980). The definition of quality and approaches to its assessment. Ann Arbor, MI: Health Administration Press.Google Scholar
  26. Donabedian, A. (1988). The quality of care: How can it be assessed? Journal of the American Medical Association, 260, 1743–1748.PubMedCrossRefGoogle Scholar
  27. Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., et al. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469–476.PubMedCrossRefGoogle Scholar
  28. Eccles, M. P., & Mittman, B. S. (2006). Welcome to implementation Science. Implementation Science, 1(1). doi:10.1186/1748-5908-1-1.
  29. Ellis, P., Robinson, P., Ciliska, D., Armour, T., Raina, P., Brouwers, M., et al. (2003). Diffusion and dissemination of evidence-based cancer control interventions (summary). Evidence Report/Technology Assessment No. 79, 1–5. Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  30. Essock, S. M., Goldman, H. H., Van Tosh, L., Anthony, W. A., Appell, C. R., Bond, G. R., et al. (2003). Evidence-based practices: Setting the context and responding to concerns. Psychiatric Clinics of North America, 26, 919–938.PubMedCrossRefGoogle Scholar
  31. Ferlie, E. B., & Shortell, S. M. (2001). Improving the quality of health care in the United Kingdom and the United States: A framework for change. Milbank Quarterly, 79, 281–315.PubMedCrossRefGoogle Scholar
  32. Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature (No. FMHI Publication #231). Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, National Implementation Research Network.Google Scholar
  33. Fraser, S. W., & Greenhalgh, T. (2001). Complexity science: Coping with complexity: Educating for capability. British Medical Journal, 323(7316), 799–803.PubMedCrossRefGoogle Scholar
  34. Garland, A. F., Hough, R. L., McCabe, K. M., Yeh, M., Wood, P. A., & Aarons, G. A. (2001). Prevalence of psychiatric disorders in youth across five sectors of care. Journal of the American Academy of Child & Adolescent Psychology, 40, 409–418.CrossRefGoogle Scholar
  35. Glasgow, R. E., Green, L. W., Klesges, L. M., Abrams, D. B., Fisher, E. B., Goldstein, M. G., et al. (2006). External validity: We need to do more. Annals of Behavioral Medicine, 31(2), 105–108.PubMedCrossRefGoogle Scholar
  36. Glasgow, R. E., Orleans, C. T., Wagner, E. H., Curry, S. J., & Solberg, L. I. (2001). Does the chronic care model serve also as a template for improving prevention? Milbank Quarterly, 79, 579–612.PubMedCrossRefGoogle Scholar
  37. Glisson, C., & Schoenwald, S. K. (2005). The ARC organizational and community intervention strategy for implementing evidence-based children’s mental health treatments. Mental Health Services Research, 7(4), 243–259.PubMedCrossRefGoogle Scholar
  38. Gonzales, J. J., Ringeisen, H. L., & Chambers, D. A. (2002). The tangled and thorny path of science to practice: Tensions in interpreting and applying “evidence”. Clinical Psychology: Science and Practice, 9, 204–209.CrossRefGoogle Scholar
  39. Gray, B. (1989). Collaborating: Finding common ground for multiparty problems. San Francisco: Jossey-Bass.Google Scholar
  40. Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4), 581–629.PubMedCrossRefGoogle Scholar
  41. Grimshaw, J. (2007). Improving the scientific basis of health care research dissemination and implementation. Paper presented at NIH Conference on Building the Sciences of Dissemination and Implementation in the Service of Public Health, Washington, DC.Google Scholar
  42. Herschell, A. D., McNeil, C. B., & McNeil, D. W. (2004). Clinical child psychology’s progress in disseminating empirically supported treatments. Clinical Psychology Science & Practice, 11, 267–288.CrossRefGoogle Scholar
  43. Hohmann, A. A., & Shear, M. K. (2002). Community-based intervention research: Coping with the “noise” of real life in study design. American Journal of Psychiatry, 159, 201–207.PubMedCrossRefGoogle Scholar
  44. Insel, T. R. (2007). Devising prevention and treatment strategies for the nation’s diverse populations with mental illness. Psychiatric Services, 58(3), 395.PubMedCrossRefGoogle Scholar
  45. Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.Google Scholar
  46. Isett, K. R., Burnam, M. A., Coleman-Beattie, B., Hyde, P. S., Morrissey, J. P., Magnabosco, J., et al. (2007). The state policy context of implementation issues for evidence-based practices in mental health. Psychiatric Services, 58(7), 914–921.PubMedCrossRefGoogle Scholar
  47. Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173–202.PubMedCrossRefGoogle Scholar
  48. Johnston, D. A., & Linton, L. D. (2000). Social networks and the implementation of environmental technology. IEEE Transactions on Engineering Management, 47(4), 465–477.CrossRefGoogle Scholar
  49. Linder, S. H., & Peters, B. G. (1987). A design perspective on policy implementation: The fallacies of a misplaced prescription. Policy Studies Review, 6(3), 459–475.CrossRefGoogle Scholar
  50. Liyaker, D., Tomolo, A., Liberatore, V., Stange, K. C., & Aron, D. (2006). Using complexity theory to build interventions that improve health care delivery in primary care. Journal of General Internal Medicine, 21(2), S30–S34.CrossRefGoogle Scholar
  51. McGlynn, E. A., Norquist, G. S., Wells, K. B., Sullivan, G., & Liberman, R. P. (1988). Quality-of-care research in mental health: Responding to the challenge. Inquiry, 25, 157–170.PubMedGoogle Scholar
  52. McKay, M. (in press). Collaborative child mental health services research: theoretical perspectives and practical guidelines. In K. Hoadwood (Ed.), Collaborative research to improve child mental health services.Google Scholar
  53. National Advisory Mental Health Council. (2001). Blueprint for Change: Research on Child and Adolescent Mental Health. A Report by the National Advisory Mental Health Council’s Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment. Bethesda, MD: National Institutes of Health, National Institute of Mental Health.Google Scholar
  54. National Cancer Institute. (2004). Dialogue on dissemination: Facilitating dissemination research and implementation of evidence-based cancer prevention, early detection, and treatment practices. Retrieved September 25, 2005, from http://www.dccps.cancer.gov/d4d/dod_summ_nov-dec.pdf.
  55. National Institute of Mental Health. (1999). Bridging Science and Service: A report by the National Advisory Mental Health Council’s Clinical Treatment and Services Research Workgroup. Washington, DC: National Institutes of Health.Google Scholar
  56. National Institute of Mental Health. (2004). Advancing the science of implementation: Improving the fit between mental health intervention development and service systems. Retrieved September 25, 2006, from http://www.nimh.nih.gov/scientificmeetings/scienceofimplementation.pdf.
  57. Naylor, P. J., Wharf-Higgins, J., Blair, L., Green, L., & O’Connor, B. (2002). Evaluating the participatory process in a community-based heart health project. Social Science & Medicine, 55, 1173–1187.CrossRefGoogle Scholar
  58. Ott, E. M. (1989). Effects of the male-female ratio at work: Policewomen and male nurses. Psychology of Women Quarterly, 13, 41–57.CrossRefGoogle Scholar
  59. Pescosolido, B. A. (1991). Illness careers and network ties: A conceptual model of utilization and compliance. Advances in Medical Sociology, 2, 161–184.Google Scholar
  60. Pescosolido, B. A. (1992). Beyond rational choice: The social dynamics of how people seek help. American Journal of Sociology, 97(4), 1096–1138.CrossRefGoogle Scholar
  61. Phillips, S. D., Burns, B. J., Edgar, E. R., Mueser, K. T., Linkins, K. W., Rosenheck, R. A., et al. (2001). Moving assertive community treatment into standard practice. Psychiatric Services, 52(6), 771–779.PubMedCrossRefGoogle Scholar
  62. President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health in America. Final report. Rockville, MD: DHHS Publication.Google Scholar
  63. Proctor, E. K. (1996). Research and research training in social work: Climate, connections, and competencies. Research on Social Work Practice, 6(3), 366–378.CrossRefGoogle Scholar
  64. Proctor, E. K. (2004). Leverage points for the implementation of evidence-based practice. Brief Treatment and Crisis Intervention, 4(3), 227–242.CrossRefGoogle Scholar
  65. Proctor, E. K., Knudsen, K. J., Fedoravicius, N., Hovmand, P., Rosen, A., & Perron, B. (2007). Implementation of evidence-based practice in community behavioral health: Agency director perspectives. Administration and Policy in Mental Health, 34(5), 479–488.PubMedCrossRefGoogle Scholar
  66. Proctor, E. K., & Landsverk, J. (2005). Challenges of translating evidence-based treatments into practice contexts and service sectors. Paper presented at The Mental Health Services Research Conference, Washington, DC.Google Scholar
  67. Rogers, E. M. (1995). Diffusion of innovations. New York: Free Press.Google Scholar
  68. Rosenberg, R. N. (2003). Translating biomedical research to the bedside: A national crisis and a call to action. Journal of the American Medical Association, 289, 1305–1306.PubMedCrossRefGoogle Scholar
  69. Rubenstein, L. V., & Pugh, J. (2006). Strategies for promoting organizational and practice change by advancing implementation research. Journal of General Internal Medicine, 21, S58–S64.PubMedCrossRefGoogle Scholar
  70. Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52, 1190–1197.PubMedCrossRefGoogle Scholar
  71. Shortell, S. M. (2004). Increasing value: A research agenda for addressing the managerial and organizational challenges facing health care delivery in the United States. Medical Care Research and Review, 61(3), 12S–30S.PubMedCrossRefGoogle Scholar
  72. Stetler, C. B., Legro, M. W., Wallace, C. M., Bowman, C., Guihan, M., Hagedorn, H., et al. (2006). The role of formative evaluation in implementation research and the QUERI experience. Journal of General Internal Medicine, 21, S1–S8.PubMedCrossRefGoogle Scholar
  73. Sullivan, G., Duan, N., Mukherjee, S., Kirchner, J., Perry, D., & Henderson, K. (2005). The role of services researchers in facilitating intervention research. Psychiatric Services, 56, 537–542.PubMedCrossRefGoogle Scholar
  74. Sung, N. S., Crowley, W. F., Jr., Genel, M., Salber, P., Sandy, L., Sherwood, L. M., et al. (2003). Central challenges facing the national clinical research enterprise. Journal of the American Medical Association, 289(10), 1278–1287.PubMedCrossRefGoogle Scholar
  75. Torrey, W. C., Drake, R. E., Dixon, L., Burns, B. J., Flynn, L., Rush, A. J., et al. (2001). Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric Services, 52(1), 45–50.PubMedCrossRefGoogle Scholar
  76. Trickett, E. J., & Ryerson Espino, S. L. (2004). Collaboration and social inquiry: Multiple meanings of a construct and its role in creating useful and valid knowledge. American Journal of Community Psychology, 34(1/2), 1–69.PubMedCrossRefGoogle Scholar
  77. US Department of Health and Human Services. (1999). Mental health: A report of the Surgeon General. Washington, DC: Office of the Surgeon General, Department of Health and Human Services.Google Scholar
  78. US Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity—A supplement to Mental health: A report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, Public Health Service, Office of the Surgeon General.Google Scholar
  79. US Department of Health and Human Services. (2006).The road ahead: Research partnerships to transform services. A report by the National Advisory Mental Health Council’s Workgroup on Services and Clinical Epidemiology Research. Bethesda, MD: National Institutes of Health, National Institute of Mental Health.Google Scholar
  80. Van Meter, D. S., & Van Horn, C. E. (1975). The policy implementation process: A conceptual framework. Administration and Society, 6, 445–488.CrossRefGoogle Scholar
  81. Wells, K., Miranda, J., Bruce, M. L., Alegria, M., & Wallerstein, N. (2004). Bridging community intervention and mental health services research. American Journal of Psychiatry, 161, 955–963.PubMedCrossRefGoogle Scholar
  82. Woolston, J. L. (2005). Implementing evidence-based treatments in organizations. Journal of the American Academy of Child & Adolescent Psychology, 44(12), 1313–1316.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Enola K. Proctor
    • 1
  • John Landsverk
    • 1
    • 2
  • Gregory Aarons
    • 3
  • David Chambers
    • 4
  • Charles Glisson
    • 5
  • Brian Mittman
    • 6
  1. 1.George Warren Brown School of Social WorkWashington UniversitySt LouisUSA
  2. 2.Child and Adolescent Services Research CenterSan Diego Children’s Hospital WorkSan DeigoUSA
  3. 3.Department of PsychiatryUniversity of CaliforniaSan DiegoUSA
  4. 4.Dissemination and Implementation Research Program Division of Services and Intervention ResearchNational Institute of Mental HealthBethesdaUSA
  5. 5.Children’s Mental Health Services Research CenterUniversity of TennesseeKnoxvilleUSA
  6. 6.Department of Veterans Affairs, VA Center for Implementation Research & Improvement ScienceGreater Los Angeles Healthcare SystemLos AngelesUSA

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