Category: Dissemination / Implementation


Exploring Network Interventions as a Mechanism for Measurement-Based Care Implementation

Sunday, November 19
8:30 AM - 10:00 AM
Location: Cobalt 501, Level 5, Cobalt Level

Keywords: Implementation | Assessment
Presentation Type: Symposium

Measurement-based care (MBC) is an evidence-based practice that involves the use of symptom measurement to monitor client progress and inform care. Most community mental health clinicians do not utilize MBC despite its demonstrated effectiveness. Social networks can be successfully harnessed when implementing new practices within an organization. There is a growing interest in the use of network interventions, such as opinion leaders and implementation teams, as a strategy for implementing new practices. Few studies have examined how these network interventions influence existing social networks within agencies to appreciate their effect on implementation. Two aims guide this study: (1) Determine the differential influence of advice-seeking/-giving, professional, and personal networks on MBC implementation; and (2)Investigate how the implementation team changes existing networks to influence clinician implementation of and fidelity to MBC.

Within an RCT comparing tailored versus standardized approaches for implementing MBC, clinicians (N=146) across 12 community mental health clinics completed measures assessing demographics, social networks, attitudes about MBC, and use of MBC at baseline and 5 months. From this data, opinion leaders and champions were invited to join implementation teams at the tailored condition sites. Social network analysis was used to determine the influence of each network on MBC implementation and assess how the introduction of implementation teams changed existing networks to promote MBC fidelity. MBC fidelity information was collected via a combination of self-report and objective data from the electronic health record.Preliminary analyses of 6 sites revealed that network density was higher in the advice networks at sites 2 and 9 and higher in the personal network at site 9 at 5 months, indicating that clinicians were more connected with one another and reported stronger relationships. A paired samples t-test indicated a statistically significant increase in clinicians’ self-reported MBC use at 5 months, t(68)= -7.655, p "<0.0001. Further analyses (using ERGM and contagion models) will examine how implementation teams rewire existing network structures to influence MBC adoption and how exposure to others using MBC influences clinicians’ adoption of and fidelity to MBC. Determining how implementation teams influence social networks and clinicians’ MBC use will clarify implementation mechanisms and inform the use of implementation strategies to increase implementation success.

Elena Navarro

Indiana University


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Exploring Network Interventions as a Mechanism for Measurement-Based Care Implementation

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