Can Learning Collaboratives Support Implementation by Rewiring Professional Networks?

  • Alicia C. Bunger
  • Rochelle F. Hanson
  • Nathan J. Doogan
  • Byron J. Powell
  • Yiwen Cao
  • Jerry Dunn
Original Article
First Online:

Abstract

This study examined how a learning collaborative focusing on trauma-focused CBT (TF-CBT) impacted advice-seeking patterns between clinicians and three key learning sources: (1) training experts who share technical knowledge about TF-CBT, (2) peers from other participating organizations who share their implementation experiences, and (3) colleagues from their own agency who provide social and professional support. Based on surveys administered to 132 clinicians from 32 agencies, participants’ professional networks changed slightly over time by forming new advice-seeking relationships with training experts. While small, these changes at the clinician-level yielded substantial changes in the structure of the regional advice network.

Keywords

Learning collaborative Implementation Social networks Implementation strategies Mental health 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgments

This research was supported in part by a National Research Service Award Postdoctoral Traineeship (T32 MH019117) (AB), Individual Predoctoral Fellowship (F31MH098478) (BP) from the National Institute of Mental Health, and a Doris Duke Fellowship for the Promotion of Child Well-Being (BP). The preparation of this article was supported in part by the Implementation Research Institute (IRI), at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (R25 MH080916-01A2) and the Department of Veterans Affairs, Health Services Research & Development Service, Quality Enhancement Research Initiative (QUERI) (AB and RH). The authors also appreciate the support and collaboration of their community partners, and the participating clinicians.

References

  1. Aarons, G. A., Sommerfeld, D., Hecht, D. B., Silovsky, J. F., & Chaffin, M. J. (2009). The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect. Journal of Consulting and Clinical Psychology, 77(2), 270–280. doi: 10.1037/a0013223.PubMedPubMedCentralCrossRefGoogle Scholar
  2. Allen, I. J. D., Linnan, L. A., & Emmons, K. M. (2012). Fidelity and its relationship to implementation effectiveness, adaptation, and dissemination. In R. C. Brownson, G. A. Colditz, & E. K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (p. 281). New York: Oxford University Press.CrossRefGoogle Scholar
  3. Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically supported treatment: A randomized trial. Psychiatric Services, 63(7), 660–665. doi: 10.1176/appi.ps.201100401.PubMedPubMedCentralCrossRefGoogle Scholar
  4. Borgatti, S. P., & Cross, R. (2003). A relational view of information seeking and learning in social networks. Management Science, 49(4), 432–445. doi: 10.1287/mnsc.49.4.432.14428.CrossRefGoogle Scholar
  5. Butts, C. T. (2014). sna: Tools for social network analysis. R package version 2.3-2. Retrieved from http://cran.r-project.org/package=sna. Accessed 18 Aug 2014.
  6. Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domains framework for use in behaviour change and implementation research. Implementation Science, 7(37), 1–17. doi: 10.1186/1748-5908-7-37.Google Scholar
  7. Carter, P., Ozieranski, P., McNicol, S., Power, M., & Dixon-Woods, M. (2014). How collaborative are quality improvement collaboratives: A qualitative study in stroke care. Implementation Science, 9(1), 32. doi: 10.1186/1748-5908-9-32.PubMedPubMedCentralCrossRefGoogle Scholar
  8. Cary, C. E., & McMillen, J. C. (2012). The data behind the dissemination: A systematic review of trauma-focused cognitive behavioral therapy for use with children and youth. Children and Youth Services Review, 34(4), 748–757.CrossRefGoogle Scholar
  9. Clarke, N. (2005). Transorganization development for network building. The Journal of Applied Behavioral Science, 41(1), 30–46. doi: 10.1177/0021886304272655.CrossRefGoogle Scholar
  10. Cohen, J. A., Mannarino, A. P., & Deblinger, E. (2006). Treating trauma and traumatic grief in children and adolescents (p. 256). New York: Guilford Press.Google Scholar
  11. Cretin, S., Shortell, S. M., & Keeler, E. B. (2004). An evaluation of collaborative interventions to improve chronic illness care. Framework and study design. Evaluation Review, 28(1), 28–51. doi: 10.1177/0193841X03256298.PubMedCrossRefGoogle Scholar
  12. Csardi, G., & Nepusz, T. (2006). The igraph software package for complex network research. InterJournal. Complex Systems. Retrieved from http://igraph.org. Accessed 18 Aug 2014.
  13. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(50), 1–15.Google Scholar
  14. Dückers, M., Spreeuwenberg, P., Wagner, C., & Groenewegen, P. P. (2009). Exploring the black box of quality improvement collaboratives: Modelling relations between conditions, applied changes and outcomes. Implementation Science, 4(1), 74. doi: 10.1186/1748-5908-4-74.PubMedPubMedCentralCrossRefGoogle Scholar
  15. Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350. doi: 10.1007/s10464-008-9165-0.PubMedCrossRefGoogle Scholar
  16. Ebert, L., Amaya-Jackson, L., Markiewicz, J. M., & Fairbank, J. A. (2012). Development and application of the NCCTS learning collaborative model for the implementation of evidence-based child trauma treatment. In R. K. McHugh & D. H. Barlow (Eds.), Dissemination and implementation of evidence-based psychological interventions. New York: Oxford University Press.Google Scholar
  17. Ebert, L., Amaya-Jackson, L., Markiewicz, J. M., Kisiel, C., & Fairbank, J. A. (2011). Use of the breakthrough series collaborative to support broad and sustained use of evidence-based trauma treatment for children in community practice settings. Administration and Policy in Mental Health,. doi: 10.1007/s10488-011-0347-y.Google Scholar
  18. Farmer, A. P., Légaré, F., Turcot, L., Grimshaw, J. M., Harvey, E., McGowan, J., & Wolf, F. M. (2011). Printed educational materials: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews,. doi: 10.1002/14651858.CD004398.pub2.Google Scholar
  19. Garcia, S. K. (2007). Developing social network propositions to explain large-group intervention theory and practice. Advances in Developing Human Resources, 9(3), 341–358. doi: 10.1177/1523422307304100.CrossRefGoogle Scholar
  20. Gesell, S. B., Barkin, S. L., & Valente, T. W. (2013). Social network diagnostics: A tool for monitoring group interventions. Implementation Science, 8(1), 116. doi: 10.1186/1748-5908-8-116.PubMedPubMedCentralCrossRefGoogle Scholar
  21. 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. doi: 10.1007/s11020-005-7456-1.PubMedCrossRefGoogle Scholar
  22. Gustafson, D. H., Quanbeck, A. R., Robinson, J. M., Ford, J. H., Pulvermacher, A., French, M. T., et al. (2013). Which elements of improvement collaboratives are most effective? A cluster-randomized trial. Addiction, 108(6), 1145–1157. doi: 10.1111/add.12117.PubMedPubMedCentralCrossRefGoogle Scholar
  23. Hanf, K., & O’Toole, L. J. (1992). Revisiting old friends: Networks, implementation structures and the management of inter-organizational relations. European Journal of Political Research, 21(1–2), 163–180. doi: 10.1111/j.1475-6765.1992.tb00293.x.CrossRefGoogle Scholar
  24. Herschell, A. D., Kolko, D. J., Baumann, B. L., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30(4), 448–466. doi: 10.1016/j.cpr.2010.02.005.PubMedPubMedCentralCrossRefGoogle Scholar
  25. IHI. (2003). The breakthrough series: IHI’s collaborative model for achieving breakthrough improvement. Cambridge, MA. Retrieved from http://www.ihi.org/IHI/Results/WhitePapers/. Accessed 03 Oct 2011.
  26. Kilo, C. M. (1998). A framework for collaborative improvement: Lessons from the Institute for Healthcare Improvement’s breakthrough series. Quality Management in Health care, 8(4), 1–13.CrossRefGoogle Scholar
  27. Kossinets, G. (2006). Effects of missing data in social networks. Social Networks, 28(3), 247–268. doi: 10.1016/j.socnet.2005.07.002.CrossRefGoogle Scholar
  28. Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2(3), 105–113. doi: 10.1007/s12310-010-9038-1.PubMedPubMedCentralCrossRefGoogle Scholar
  29. Meyers, P. W., Sivakumar, K., & Nakata, C. (1999). Implementation of industrial process innovations: Factors, effects, and marketing implications. Journal of Product Innovation Management, 16(3), 295–311. doi: 10.1111/1540-5885.1630295.CrossRefGoogle Scholar
  30. Mittman, B. S. (2004). Creating the evidence base for quality improvement collaboratives. Annals of Internal Medicine, 140(11), 897–901.PubMedCrossRefGoogle Scholar
  31. Nadeem, E., Gleacher, A., & Beidas, R. S. (2013a). Consultation as an implementation strategy for evidence-based practices across multiple contexts: Unpacking the black box. Administration and Policy in Mental Health, 40(6), 439–450. doi: 10.1007/s10488-013-0502-8.PubMedPubMedCentralCrossRefGoogle Scholar
  32. Nadeem, E., Olin, S. S., Hill, L. C., Hoagwood, K. E., & Horwitz, S. M. (2013b). Understanding the components of quality improvement collaboratives: A systematic literature review. The Milbank Quarterly, 91(2), 354–394. doi: 10.1111/milq.12016.PubMedPubMedCentralCrossRefGoogle Scholar
  33. Nembhard, I. M. (2009). Learning and improving in quality improvement collaboratives: Which collaborative features do participants value most? Health Services Research, 44(2 Pt 1), 359–378. doi: 10.1111/j.1475-6773.2008.00923.x.PubMedPubMedCentralCrossRefGoogle Scholar
  34. Nembhard, I. M. (2011). All teach, all learn, all improve? The role of interorganizational learning in quality improvement collaboratives. Health Care Management Review,. doi: 10.1097/HMR.0b013e31822af831.Google Scholar
  35. Ovretveit, J. (2002). Quality collaboratives: Lessons from research. Quality and Safety in Health Care, 11(4), 345–351. doi: 10.1136/qhc.11.4.345.PubMedCrossRefGoogle Scholar
  36. Palinkas, L. A., Fuentes, D., Finno, M., Garcia, A. R., Holloway, I. W., & Chamberlain, P. (2014). Inter-organizational collaboration in the implementation of evidence-based practices among public agencies serving abused and neglected youth. Administration and Policy in Mental Health and Mental Health Services Research, 41, 74–85. doi: 10.1007/s10488-012-0437-5.PubMedCrossRefGoogle Scholar
  37. Palinkas, L. A., Holloway, I. W., Rice, E., Brown, C. H., Valente, T. W., & Chamberlain, P. (2013). Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems. Implementation Science, 8(133), 1–11. doi: 10.1186/1748-5908-8-133.Google Scholar
  38. Palinkas, L. A., Holloway, I. W., Rice, E., Fuentes, D., Wu, Q., & Chamberlain, P. C. (2011). Social networks and implementation of evidence-based practices in public youth-serving systems: A mixed-methods study. Implement Science,. doi: 10.1186/1748-5908-6-113.Google Scholar
  39. Proctor, E. K., Powell, B. J., & McMillen, J. C. (2013). Implementation strategies: Recommendations for specifying and reporting. Implementation Science, 8, 139. doi: 10.1186/1748-5908-8-139.PubMedPubMedCentralCrossRefGoogle Scholar
  40. Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., et al. (2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health, 38(2), 65–76. doi: 10.1007/s10488-010-0319-7.PubMedPubMedCentralCrossRefGoogle Scholar
  41. Saunders, B. E., & Hanson, R. F. (2014). Innovative methods for implementing evidence-supported interventions for mental health treatment of child and adolescent victims of violence. In R. Reece, R. F. Hanson, & J. Sargent (Eds.), Treatment of child abuse: Common ground for mental health, medical, and legal practitioners (2nd ed.). Baltimore, MD: Johns Hopkins University Press.Google Scholar
  42. Schoenwald, S. K., Sheidow, A. J., & Letourneau, E. J. (2004). Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity, and child outcomes. Journal of Clinical Child and Adolescent Psychology, 33(1), 94–104. doi: 10.1207/S15374424JCCP3301_10.PubMedCrossRefGoogle Scholar
  43. Schouten, L., Hulscher, M., van Everdingen, J., Huijsman, R., & Grol, R. (2008). Evidence for the impact of quality improvement collaboratives: Systematic review. BMJ (Clinical Research Ed.), 336(7659), 1491–1494. doi: 10.1136/bmj.39570.749884.BE.CrossRefGoogle Scholar
  44. StataCorp. (2013). Stata statistical software: Release 13. College Station, TX: StataCorp LP.Google Scholar
  45. Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the plan-do-study-act method to improve quality in healthcare. BMJ Quality & Safety, 23(4), 290–298. doi: 10.1136/bmjqs-2013-001862.CrossRefGoogle Scholar
  46. Tenkasi, R. V., & Chesmore, M. C. (2003). Social networks and planned organizational change: The impact of strong network ties on effective change implementation and use. Journal of Applied Behavioral Science, 39(3), 281–300. doi: 10.1177/0021886303258338.CrossRefGoogle Scholar
  47. Valente, T. W. (2010). Social networks and health: Models, methods, and applications. Oxford: Oxford University Press.CrossRefGoogle Scholar
  48. Valente, T. W., Chou, C. P., & Pentz, M. A. (2007). Community coalitions as a system: Effects of network change on adoption of evidence-based substance abuse prevention. American Journal of Public Health, 97(5), 880–886. doi: 10.2105/AJPH.2005.063644.PubMedPubMedCentralCrossRefGoogle Scholar
  49. Valente, T. W., & Davis, R. L. (1999). Accelerating the diffusion of innovations using opinion leaders. The ANNALS of the American Academy of Political and Social Science, 566(1), 55–67. doi: 10.1177/000271629956600105.CrossRefGoogle Scholar
  50. Wasserman, S., & Faust, K. (1994). Social network analysis: Methods and applications. New York: Cambridge University Press.CrossRefGoogle Scholar
  51. West, E., Barron, D., Dowsett, J., & Newton, J. (1999). Hierarchies and cliques in the social networks of health care professionals: Implications for the design of dissemination strategies. Social Science and Medicine, 48(5), 633–646. doi: 10.1016/S0277-9536(98)00361-X.PubMedCrossRefGoogle Scholar
  52. Yousefi-Nooraie, R., Dobbins, M., & Marin, A. (2014). Social and organizational factors affecting implementation of evidence-informed practice in a public health department in Ontario: A network modelling approach. Implementation Science, 9(1), 29. doi: 10.1186/1748-5908-9-29.PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Alicia C. Bunger
    • 1
  • Rochelle F. Hanson
    • 2
  • Nathan J. Doogan
    • 3
  • Byron J. Powell
    • 4
  • Yiwen Cao
    • 1
  • Jerry Dunn
    • 5
  1. 1.College of Social WorkOhio State UniversityColumbusUSA
  2. 2.National Crime Victims Research and Treatment CenterMedical University of South CarolinaCharlestonUSA
  3. 3.College of Public HealthOhio State UniversityColumbusUSA
  4. 4.Department of Psychiatry, Perelman School of Medicine, Center for Mental Health Policy and Services ResearchUniversity of PennsylvaniaPhiladelphiaUSA
  5. 5.Children’s Advocacy Services of Greater St. LouisUniversity of Missouri-St. LouisSt. LouisUSA

Personalised recommendations