Category: Dissemination / Implementation

Symposium

Outer and Inner Context Factors Affecting Implementation of Cognitive-Behavioral Social Skills Training on ACT Teams

Friday, November 17
4:15 PM - 5:45 PM
Location: Indigo Ballroom A, Level 2, Indigo Level

Keywords: Implementation | Community-Based Assessment / Intervention
Presentation Type: Symposium

Background: It is critical to address factors affecting implementation and sustainment of evidence-based interventions (EBIs) for severe mental illness (SMI) in community settings as a large proportion of implementation efforts fail. This study uses data from a Hybrid Type 1 effectiveness/implementation trial examining implementation of a cognitive-behavioral social skills training (CBSST) intervention implemented on Assertive Community Treatment (ACT) teams. This study is framed in the Exploration, Preparation, Implementation, Sustainment (EPIS) framework that highlights the roles of both outer (system) context and inner (organizational context).


Methods: Fourteen semi-structured focus groups were conducted: 2 ACT client groups (n=8), 6 ACT team provider groups (n=54), 3 ACT team supervisor groups (n=11), 1 agency administrator group (n=5), 1 public sector/policy group (n=5), and 1 intervention developer/trainer group (n=4). Focus group prompts were consistent with a “concept-mapping” approach using the focus question: “What are the factors that influenced the implementation and use of CBSST on the ACT teams?” Focus groups leaders facilitated discussion by asking clarifying questions/probes. Once a subtopic was exhausted, another open-ended probe was utilized. Focus groups were audio recorded and transcribed. Data analysis involved open and then focused coding. 


Results: Results indicated perceived client and provider benefits for integrating CBSST within the inner context of ACT teams while highlighting the importance of purposeful adaptation, training, implementation tools and supports in the outer context to facilitate structural and values fit.


Discussion: This study identified a number of inner and outer context issues likely to impact effective implementation and sustainment of CBSST on ACT teams. When placed within the EPIS implementation framework, these results provide guidance on the development of strategies to facilitate and support effective implementation. Such strategies should be tested in future studies to improve implementation outcomes that will promote better treatment outcomes for those with SMI.  

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