Category: Dissemination / Implementation
Research suggests that middle managers (e.g., supervisors) influence the implementation of innovations. The middle manager role theory suggests that supervisors do this through four roles: providing information about the innovation, making it relevant, providing necessary implementation tools, and encouraging consistent and effective innovation use1. These roles are hypothesized to positively impact implementation climate (proposed mechanism), which, in turn, influences implementation effectiveness. While some support exists for this model in implementing healthcare innovations2,3, it has not been applied to a mental health context.
Material and Methods
The aims of this pilot study are to 1) evaluate the impact of a middle-manager-focused facilitation intervention in improving implementation climate, clinician implementation engagement, and quality of treatment delivery in the context of a state-funded CBT implementation initiative, and 2) examine acceptability and feasibility of the facilitation intervention. Supervisors from 17 public mental health agencies in WA State were randomized to receive either the facilitation intervention (N=12; supervising 29 clinicians) or control (N=12; supervising 34 clinicians). Intervention supervisors participated in 4 support calls before, during, and after implementation. Supervisors developed tailored work plans to fulfill the four middle manager roles to support clinicians’ implementation of CBT with youth in diverse settings ranging from clinics to schools and urban to rural locations. Clinician engagement in CBT delivery (e.g., use of online implementation tools, number of CBT cases during training) was measured through Toolkit, an online case tracking and training tool.
Preliminary analyses of clinician engagement indicate that clinicians supervised by supervisors who received the facilitation intervention were more actively engaged in Toolkit during the first 50 days following training (M = 5.28, SD = 3.06) compared to controls (M = 3.21, SD = 3.13) t(60) = -2.62, p = .01. Clinicians in the intervention group also had a greater number of training cases (M = 5.03, SD = 4.44) than controls (M = 2.79, SD = 1.78), t(35.7) = -2.53, p = .02. Preliminary analyses also indicate that the facilitation intervention was acceptable (M=3.95) and feasible (M=3.83) to supervisors (N=4; range 1 [Not at all] to 5 [Extremely]). At study completion, we will examine these and other engagement indicators, quality of CBT delivery (e.g., measurement use, session-by-session component delivery) and change in implementation climate (proposed mechanism) across conditions.
This brief, tailored facilitation intervention appears acceptable and feasible to community supervisors and has a potentially beneficial impact on clinician engagement. Results will inform the development of an RCT examining the impact of middle manager roles on implementation climate and effectiveness.
Rosemary Meza– Graduate research assistant, University of Washington, Seattle, Washington
Prerna Martin– University of Washington
Lucy Berliner– University of Washington
Sarah Birken– University of North Carolina, Chapel Hill
Shannon Dorsey– Associate Professor, University of Washington, Seattle, Washington