Study Design and Population
We will initially pilot test this mental health service delivery model at a single primary care site and then refine the model based on pilot data. We will then expand implementation across 6 Colombia-based healthcare sites in urban and rural communities (including approximately 2000 participants). Consistent with a modified stepped wedge design (multiple baseline design), we will implement the model across sites on a staggered basis and expand the number of sites in which we implement over time. By conducting this multi-site implementation research project, we can assess the extent to which the implementation model and associated outcomes are replicable across sites and/or the extent to which the model needs to be modified for differing contexts.
We will evaluate the ability of our proposed approach to accelerate the translation of evidence-based mental health services into practice and expand research capacity at multiple levels. Specifically, we will measure implementation outcomes, including: (1) the ability of this model to accelerate the adoption of science-based mental health service delivery (e.g., increase provision of evidence-based resources to more individuals), (2) the acceptability of the model for healthcare service delivery (the ability of the technology-based service-delivery model to increase patient activation and engagement in their own self-management), and (3) the cost-evaluation of services in the model. We will also collect patient level data outcomes as a secondary focus to assess (4) the model’s impact on public/population health (e.g., its effects on accelerating improved behavioral health and health outcomes, and improving patient quality of life, functioning, etc.).
We will also use implementation context measures to evaluate barriers and facilitators to implementation in each of the following domains: intervention characteristics, organization characteristics (e.g., climate, readiness), individual characteristics (i.e., provider/staff attitudes, experiences; patient attitudes and experiences), and external influences (e.g., socio-political characteristics local technology infrastructure i.e., wireless in the community, state policy/regulations, and reimbursement models). Strategies related to planning, facilitating provider and patient engagement in use of the novel mental health service delivery model, and potential sustainability issues will also be explored. We will additionally conduct exploratory moderator/mediator analyses to examine how implementation context variables relate to implementation outcomes.
Detection and Integrated Care for Depression and Alcohol use in Primary Care