Psychological Services最新文献

Often in implementation science efforts, an intervention originated by research funding does not continue in clinical practice after funding ends, or if it does, the process by which it was sustained remains known only to the implementation research or clinical teams. From 2018 to 2020, we implemented a complex telehealth interdisciplinary behavioral health program supported by research funding. The intervention was Primary Care Mental Health Integration (PCMHI) delivered via televideo from a large parent medical facility to rural satellite clinics (tele-PCMHI) within the Veterans Health Administration. Two implementation facilitators worked closely with clinical leaders and staff to plan, launch, and sustain tele-PCMHI across four sites. The intervention is still maintained by the clinical service and has spread to eight sites. Based on ethnographic and qualitative data collected weekly over 2 years, we categorized sustainment strategies across distinct time periods for this complex program, theoretically grounded in the Dynamic Sustainability Framework, emphasizing changes to adapt intervention fit to rapidly changing context. To contextualize, we identified barriers and strengths, such as difficulty training staff to use new equipment, restructuring clinic workflow, and determining suicide risk management remotely. New barriers arose, and, thus, new strategies were needed to continue implementing at the onset of the COVID-19 pandemic in 2020. Different strategies at different stages of implementation allowed sustainment to be a dynamic and evolving process. Plus, proactive and persistent planning for sustainment early in the effort, along with alignment with performance metrics and national policy, supported continued delivery in real-world organized care. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

A primary goal of implementation science (IS) is to promote access to evidence-based practice; however, without careful attention to equity, IS may inadvertently reify inequities for priority populations who are most affected by access barriers and health inequities. Recently, there has been a push to integrate health equity concepts into IS frameworks. Yet, empirical examples are limited. This study sought to fill that gap by providing an example application of the RE-AIM framework extension for health equity in the evaluation of a family-based preventive intervention implemented in primary care for our priority population: Latinx, Black/African American, and Native American children. The Family Check-Up 4 Health (FCU4Health) is an individually tailored preventive intervention, adapted from the evidence-based Family Check-Up, for delivery in primary care settings. Data came from a Type 2 effectiveness-implementation hybrid study conducted with multiple primary care organizations in the Phoenix area, with 240 children (85% in the priority population) and their parents/caregivers. We present descriptive data guided by the RE-AIM framework's extension for health equity. Quantitative details about adoption and maintenance are supplemented with descriptions of implementation determinants, provided by partners at each site who coauthored this article. Concerning adoption, three of six organizations approached went on to implement the FCU4Health during the trial. Adoption appeared to be driven by perceived appropriateness, relative advantage, and research-related constraints. Reach: Across multiple stages from initial approach to initiation of services, reach was higher for our priority population, although differences were not statistically significant. Implementation: There were no significant differences in fidelity, active participation, and the completion or quality of home practice between our priority and nonpriority populations. Concerning dosage, coordinators spent more time working with families in our priority population on referrals to resources. Maintenance: None of the organizations continued to implement beyond the trial, which was primarily driven by feasibility. The results provide an exemplar of how the RE-AIM equity extension can be applied to assess the ability of preventive interventions to promote equitable implementation in routine primary care settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

A religious lifestyle can be a powerful factor in predicting and promoting healthy functioning following trauma exposure. Previous research has demonstrated that higher levels of religiosity significantly predict posttraumatic growth following exposure to trauma. Firefighters are a population associated with routine exposure to potentially traumatic events, as well as high levels of occupational stress. While the relationship between religiosity and posttraumatic growth is well documented, the interaction of religious belief, occupational stress, and posttraumatic growth is less clear. The objective of this secondary analysis was to determine if religious belief moderates the relationship between occupational stress and posttraumatic growth in a sample of firefighters. The sample for this analysis was comprised of 109 firefighters who were assessed at various time points before fire service and throughout their first 3 years of fire service. A religious lifestyle did moderate the relationship between occupational stress and overall posttraumatic growth. However, a religious lifestyle and occupational stress were not significantly related. A religious lifestyle did moderate the relationship between occupational stress and the subdomains of spiritual enhancement and appreciation of life. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The Practical, Robust Implementation and SustainabilityModel (PRISM) is an implementation science framework that incorporates multilevel contextual considerations and key implementation outcomes that can be used to support program planning, implementation, and sustainment. The PRISM has been applied to diverse populations, settings, and implementation strategies. Tools to rapidly assess the PRISM's contextual determinants of implementation success are needed to support implementation efforts. The objectives of this study were to describe the development and preliminary psychometric and pragmatic properties of the PRISM Contextual Survey Instrument (PCSI) and to demonstrate its use to inform implementation and sustainment in health care settings. The 29-item survey was developed based on refinement of existing questions, expert feedback, and pilot testing. Three to six items were included for each of the six PRISM context domains, each rated on a 5-point Likert scale. Implementors completed the PRISM survey and quantitative measures of implementation outcomes (acceptability, feasibility, and appropriateness; Weiner et al., 2017) to establish concurrent validity. Survey results were used to tailor subsequent implementation efforts. The PCSI took 14 min on average to complete. The mean overall score across participants and sites was 3.95 (SD = 0.42). The PCSI exhibited good psychometric and pragmatic properties. Internal consistency for the subscales ranged from 0.53 to 0.82, and concurrent validity with the other implementation outcomes varied from r = 0.70 (p < .001) for feasibility to r = 0.80 (p < .001) for appropriateness. Pragmatic ratings ranged from the "minimal/emerging" to "excellent" category (Lewis et al., 2021), and provided examples illustrate the practical application of the survey results for implementation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Detecting depression in primary care patients is suboptimal, especially among historically excluded populations. To improve depression screening rates, a primary care clinic integrated the Patient Health Questionnaire (PHQ) in the Electronic Health Record (EHR) and clinical workflow. Patients completed the PHQ on a tablet in the waiting room, and responses were available in real time for staff to review with patients. This study examined implementation science outcomes using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework 3.0. First, we calculated the percentage of patients who completed a PHQ ("Reach"). Second, we examined "Inequitable Reach" by determining if demographic characteristics were associated with the probability of not completing a PHQ. Third, we conducted 13 interviews with care team members (three physicians, five staff) and the health system's implementation team (two practice coaches, three EHR analysts) to identify barriers to Reach. Of the 8,765 patients seen in the clinic between November 2019 through September 2021, Reach was satisfactory at 71% (6,261/8,765 completed a PHQ) but inequitable because patients who did not complete PHQ screening (n = 2,502, 29%) had higher odds of being age 65+ (OR = 1.40), Black (OR = 1.37), or had Medicaid or no insurance (OR = 1.90; all p < .001). In interviews, barriers to Reach included inefficient EHR workflow, time constraints to help patients use the tablet and check if a PHQ was completed, and lack of clarity on how to talk with patients about PHQ responses. Our findings provide a roadmap for health systems to examine whether they have Inequitable Reach in depression screening. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This explanatory sequential mixed methods hybrid Type 1 study examined the efficacy and implementation of Connect2Test, a brief motivational enhancement intervention to increase SARS-CoV-2 testing among people experiencing houselessness and people who inject drugs. We conducted a randomized controlled trial with participants randomly assigned to Connect2Test (n = 105) or services as usual (n = 100). Most participants self-identified as male (65%), White (72%), and not Hispanic (87%). There were no intervention effects on immediate testing rates, χ²(1, n = 205) = 0.23, p = .6298, OR [95% CI] = 1.18 [0.61, 2.27], or at 1-month, χ²(1, n = 205) = 0.05, p = .8263, OR [95% CI] = 0.93 [0.51, 1.72], or 2-month follow-ups, χ²(1, n = 205) = 0.04, p = .8368, OR [95% CI] = 1.08 [0.52, 2.22]. We interviewed staff and volunteers (n = 17) affiliated with our community partner to examine implementation barriers and facilitators. Barriers included (a) intervention complexity, (b) no established relationship between the interventionist and participants, (c) Connect2Test's misalignment with priorities of people experiencing houselessness, and (d) incompatibility with community partner resources. Facilitators included (a) congruency between motivational interviewing and harm reduction values, (b) collaboration with a trusted community partner, and (c) intervention alignment with the community partner's mission. Although Connect2Test did not increase testing rates, our qualitative assessment highlighted barriers reflecting intervention and implementation failure. Facilitators highlighted Connect2Test adaptations to enhance efficacy. Juxtaposing qualitative implementation assessments with randomized controlled trials can discern implementation and intervention factors impacting efficacy to inform redesign. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Within mental health services, persons in recovery from their own experiences of mental health challenges (peers) are increasingly being trained to provide peer support. This study describes individual and organizational outcomes related to engaging peers in a multisite demonstration project in California that sought to integrate them as cocreators throughout planning and implementation of digital mental health interventions. We collected data from key informants across 11 sites. Quarterly online surveys invited key informants to report perceived outcomes of the peer component. Biannual interviews elicited details regarding survey-reported outcomes. Quantitative data provided indications of outcome prevalence and consistency, and quotes from the interviews illustrated the complex realities underlying survey responses. One hundred three quarterly surveys and 39 biannual interviews were completed between Summer 2020 and Fall 2022. Key informants reported diverse outcomes, including integration of peer input into local decision making, mental health benefits to peers and community members, reduced workplace mental health stigma, and new cross-site collaborations. Five sites reported outcomes with greater consistency compared to the other six sites. Reports of increased peer visibility in the workplace coincided with reports of reduced stigma and increased value of peer input by mental health professionals. This study offers encouragement for the potential positive impact of engaging peers as cocreators of mental health interventions. Data suggest integrating peers does not increase mental health stigma and may instead result in various positive outcomes. The degree to which these outcomes manifest in a specific setting, however, may vary. Future research should seek to identify contextual factors that support actualization of positive outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Research on the implementation of community gatekeeper training interventions for suicide prevention in Spanish-speaking countries is limited. Gatekeepers identify warning signs of suicidal behavior in at-risk population and refer them to specialized mental health care. To identify factors that influence the implementation of evidence-based practices, standardized measures are needed in Spanish. We culturally adapted and evaluated the factor structure and reliability of two measures for use in the Mexican population: the final version of Acceptability, Appropriateness, and Feasibility of the Intervention (Weiner et al., 2017), and the Organizational Readiness for Implementing Change (ORIC; Shea et al., 2014). Our study consisted of two consecutive phases. The first addressed the cross-cultural adaptation. In the second phase, we administered an online survey to a nonrandom sample of 453 middle school personnel and performed a confirmatory factor analysis (CFA). Participants were 73.95% female, 25.17% male, and 0.88% nonbinary/other and came from the 32 Mexican states. CFA indices for the Mexican Spanish version of the acceptability, appropriateness, and feasibility measure yielded values of comparative fit index (CFI) = 0.96, Tucker-Lewis fit index (TLI) = 0.94, root-mean-square error of approximation (RMSEA) = 0.05, and standardized root-mean-square residual (SRMR) = 0.03. Internal consistency was Ω = 0.95. CFA indices of the Mexican Spanish version of the ORIC were CFI = 0.95, TLI = 0.93, RMSEA = 0.08, and SRMR = 0.03, and internal consistency was Ω = 0.94. We conclude that both instruments show preliminary psychometric properties that support their validity and reliability in the Mexican Spanish-speaking context. These findings promise to drive research on the implementation of gatekeeper interventions and other evidence-based practices in Spanish-speaking school settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The Individualized Positive Psychosocial Interaction (IPPI) is an evidence-based program that supports engaging people living with dementia and their care partners in the nursing home (NH). IPPIs are brief, one-to-one, preference-based activities to improve well-being and decrease behavioral and psychological symptoms of dementia. The purpose of this study was to understand barriers and facilitators to implementing the IPPI program from the perspective of NH provider champions. Semistructured interviews (n = 62) were completed with implementation champions (n = 20) who led a quality improvement project to implement the IPPI with three to five residents per NH. Interviews were audio recorded, transcribed verbatim, and coded using the Innovation Domain of the updated Consolidated Framework for Implementation Research. Constructs coded included cost, design, complexity, adaptability, relative advantage, trialability, and evidence base. Implementation champions spoke about the IPPI program's relative advantage of effectively reducing resident's behavioral and psychological symptoms of dementia based on meaningful, personalized content. Champions voiced that the IPPI program was cost-effective, adaptable to their local contexts, and provided training to staff to support residents experiencing distress. Champions acknowledged the complexity of identifying implementation team members and completing initial education and training. In addition, they appreciated the chance to build capacity by trialing IPPIs with a small number of residents for initial efforts (e.g., trialability). Utilizing the Consolidated Framework for Implementation Research allowed for the systematic identification of facilitators and barriers to IPPI implementation. Overall, the IPPI program goals are aligned with nursing home organization goals, supporting staff in providing comfort to residents communicating distress, and can be feasibly implemented. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Although jails are the largest provider of mental health care nationally, access to treatment in U.S. jails is limited. Limited empirical information on factors impacting the implementation of mental health services in jail may be contributing to low treatment rates. We documented potential barriers impacting the provision of a brief cognitive-behavioral group-based intervention for people with serious mental illness in jail, including the rates of participants' recruitment, as well as starting and completing the intervention; time required for each group from recruitment to completion; and the types and frequencies of obstacles encountered during treatment sessions. We organized the barriers according to the Consolidated Framework for Implementation Research. All potential treatment recipients' questions prior to treatment, and reasons provided for not starting the treatment, were also logged and analyzed using content analysis and frequency counts; tables of the themes, frequencies, and examples of participant concerns are presented. These results suggest that although many participants were interested in and incarcerated for sufficient time to complete the intervention, relatively few participants were able to begin the groups (44%). Over 150 obstacles to treatment were encountered during treatment provision (including recurring issues with client transportation within the facility and facility lockdown). Understanding participants' progression through the study (recruitment, start, completion), their questions and reasons for not participating, and interruptions to the sessions provide important information for increasing the usability of mental health care in jails. The current findings can improve the implementation of needed evidence-based treatment in this carceral setting. (PsycInfo Database Record (c) 2025 APA, all rights reserved).