Psychological Services最新文献

Despite research and treatment advances in health care, the implementation of research evidence into practice remains a challenge, especially for historically marginalized populations. There have been numerous calls to action to integrate health equity into implementation science frameworks, models, and theories. Yet, progress toward better integration of these approaches has been hampered by the theoretical and aspirational nature of calls to action up to the present time, which poses a challenge as it remains unclear how to specifically move from rhetoric to action. We present three case examples from our work to illustrate how to synergize health equity research and implementation science into our approach to "equity-grounded implementation science" focused on processes and practices located at the intersection of these fields. These three distinct studies focused on reducing mental health inequities in historically marginalized communities, namely, Latino and Black individuals in mainland United States and Puerto Rico. For each study, we describe the study aim, methodology, setting in which activities were carried out, the health equity elements, and the implementation science aspects. We articulate how each study bridged implementation science and health equity research by (a) situating the study activities in community settings; (b) codesigning interventions to ensure their cultural, linguistic, and contextual relevance; and (c) weaving mixed methods and community-engaged approaches to draw community insights. Finally, we illustrate how to address key implementation outcomes in these health equity studies, representing a significant step toward turning rhetoric into actionable solutions for reducing mental health inequities in marginalized communities. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Suicide comprises nearly one third of jail deaths, but strategies for effectively supporting implementation of suicide prevention education in jails are understudied. Here, we aimed to identify and pilot strategies to promote uptake of a brief suicide prevention education program, Talk Saves Lives: Corrections (TSL-C), developed by the American Foundation for Suicide Prevention, in jails. Applying community-engaged dissemination and implementation principles, we conducted a statewide survey of jail leadership in a mid-Southern state (N = 65 jails) to (a) understand the preimplementation landscape of suicide prevention education efforts and (b) assess the perceived feasibility and helpfulness of possible strategies to promote TSL-C uptake. With continuous input from our community advisory board, we then partnered with two jails to select and tailor implementation strategies via a rigorous Evidence-Based Quality Improvement process and pilot TSL-C. Statewide survey results revealed insufficient rates of foundational (50.8%) and refresher (27.7%) suicide prevention training; however, receptivity to proposed implementation strategies was very high. Through the Evidence-Based Quality Improvement process, partnering sites selected both overlapping (i.e., identifying local champions, tailoring materials, and providing train-the-trainer training) and divergent strategies. A primary difference between the sites was their implementation teams' structure. Both sites successfully piloted the TSL-C program facility-wide by the end of the study period, though one site significantly revised their implementation plan due to staffing shortages and financial barriers. Together, our results indicate that although carceral settings face barriers to implementing and sustaining health-focused interventions, community-developed implementation strategies can help support uptake in these underresourced but high-need contexts. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

This article presents an overview of a novel process improvement project that aimed to enhance the utilization of prolonged exposure for treating posttraumatic stress disorder in behavioral health clinics within the Military Health System (MHS). The MHS is a geographically dispersed medical system encompassing diverse clinics and poses unique challenges to the adoption of evidence-based practices. To address these challenges, the Targeted Assessment and Context-Tailored Implementation of Change Strategies project was developed. Implemented across eight MHS clinics, this project involved conducting a comprehensive needs assessment to identify barriers, developing customized implementation plans for each site, and providing coaching calls and access to a clinic optimization toolkit for the clinic staff. We describe the development of Targeted Assessment and Context-Tailored Implementation of Change Strategies intervention components, including an implementation rubric that documents barriers to evidence-based practice utilization and proposes specific actions based on the underlying causes of these barriers. Additionally, a needs assessment interview tool and an implementation toolkit were developed to identify clinic-level challenges and support the implementation process, respectively. The needs assessment phase of the project involved conducting interviews with clinic staff and leadership, as well as reviewing clinic appointment data to discern trends and patterns in care. The insights gleaned from these interviews were instrumental in formulating tailored implementation plans for increasing the usage of prolonged exposure. Each plan was collaboratively developed with clinic leadership and subsequently put into practice at the site with the support of weekly coaching calls provided by an implementation science expert. Portions of this research project occurred during the COVID-19 pandemic, and we discuss the impact of the pandemic on the implementation of this study. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Complex interventions combining multiple evidence-based strategies have gained substantial traction in suicide prevention across the world. However, implementing these interventions in real-life settings is fraught with several challenges, significant resource demands, and evidence on the merits of implementing complex interventions remains a topic of debate. This study explores the real-world experiences of implementing complex interventions, including challenges, lessons learned, and the way forward. Sixteen participants (nine leaders, five implementors, and two lived experience advocates) from varied professional backgrounds and experiences were purposively recruited from six high-income countries and one low- and middle-income country. Participants were encouraged to reflect on their experiences of implementing complex suicide prevention interventions in their specific country contexts. Thematic analysis was conducted to identify, organize, and offer real-world insights into challenges, lessons learned, and what is needed as the way forward. Important themes related to challenges and lessons learned emerged: (a) stakeholder characteristics, engagement, and dynamics; (b) resources such as funding priorities and capacity; (c) contextual factors including larger sociocultural beliefs, policies, and legislation surrounding suicide and its prevention; (d) nature of lived experience engagement; (e) design and approach to interventions; (f) delivery of interventions; and (g) the scope of evaluation. The study yielded important insights into practice recommendations related to the implementation of complex suicide prevention interventions on the ground. Important pathways for designing interventions, collaboration, and stakeholder engagement for future implementation efforts were discussed. These real-life experiences and lessons learned from international experts are critical in understanding and bridging the know-do gap. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Three evidence-based psychotherapies for depression (D-EBPs)-cognitive behavioral therapy for depression, acceptance and commitment therapy for depression, and interpersonal psychotherapy-are available in Veterans Health Administration (VHA) through its training initiative. However, training initiatives are not sufficient to move effective treatments into routine practice. Patient and clinic factors can impact evidence-based psychotherapies use. As part of a larger explanatory sequential mixed methods study, we assessed D-EBP use across VHA's outpatient general mental health (GMH) clinics and examined associations between patient- and clinic-level factors and D-EBP use. We identified all patients with a depression diagnosis seen in a VHA GMH clinic in fiscal year 2022. Patient-level variables included demographics, psychiatric medication for depression, and comorbid mental health diagnoses. Clinic-level variables included patient volume, D-EBP clinician capacity, and location. 635,653 patients with a diagnosis of depression were seen in a GMH clinic. 2.8% of those patients had a D-EBP session identified in their medical record, and 77.4% received a depression medication. Being male, older, having certain comorbidities, and using depression medication was associated with lower D-EBP use. Clinics with lower psychotherapy patient volume and in the Continental and Midwest districts had higher D-EBP use. D-EBP use was strikingly lower than depression medication use. Findings suggest clinicians may be challenged by patient comorbidities and high patient volume in practice. Further research on how these factors play out in clinical practice can shed light on whether there is a need for additional implementation strategies to increase D-EBP use. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Implementation science (IS) has received increased attention as it provides a means to bridge the know-do gap to implement evidence-based interventions in real-world settings. Against this backdrop, posttraumatic stress disorder (PTSD) is a global mental health concern (Koenen et al., 2017), especially in low- and middle-income countries characterized by limited trained health professionals, infrastructure, and limited access to evidence-based mental health care (Chen et al., 2017). Over the last 3 decades, effective trauma-focused psychotherapies (TFPs) for PTSD have been developed (Hamblen et al., 2019). Prolonged exposure therapy (PE) is a first-line TFP for PTSD (Hamblen et al., 2019), yet the dissemination and implementation of PE have been limited to specialty care settings in developed or industrialized countries (Booysen & Kagee, 2020). Implementation science provides an opportunity for disseminating and implementing TFPs like PE in low- and middle-income countries. This article describes mixed-method data from a pilot implementation study of an abbreviated version of PE, known as prolonged exposure for primary care (S. A. M. Rauch, Kim, et al., 2023), in a semirural city in the Eastern Cape of South Africa. Importantly, prolonged exposure for primary care shows a significant reduction in PTSD when provided by lay counselors and good feasibility and acceptability. In addition, we reflect on the barriers and facilitators related to implementation research within a low-resourced community, namely, (a) training lay counselors, (b) cultural diversity, and (c) mental health literacy. Mental health literacy is proposed as an essential component to consider in implementation science, especially in low-resourced communities. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

The Veterans Health Administration (VHA) has committed to increasing health equity for all veterans, which is needed to address disparities in health care and outcomes experienced by Black VHA patients. In this cross-sectional retrospective observational study, we analyzed VHA operations data on all patients receiving mental health treatment at VHA in fiscal year 2021 (N = 1,602,865). Facility-level negative binomial regressions demonstrated that Black patients were disproportionately treated at large, complex, urban facilities in the Southern United States that had higher overall volumes of mental health care and staff but lower mental health staffing ratios and less care for each patient. Though they utilized facilities with lower visits and hours per patient, Black versus non-Black patients had on average more visits and hours per patient. Accounting for these gaps using patient-level Kitagawa-Oaxaca-Blinder (KOB) decomposition analyses, we found (a) negligible and small within-facility effects, (b) between-facility effects that demonstrated that Black patients would have received more treatment than non-Black patients had they utilized facilities in the same proportions as non-Black patients, and (c) excluded variables in unadjusted KOB and excluded variables and covariates (e.g., age, homeless treatment receipt) in adjusted KOB most strongly accounted for gaps. Combining facility-level analyses with novel use of patient-level KOB revealed nuance in the potential inequities experienced by Black VHA mental health patients while demonstrating the need for additional research to examine whether Black patients receive the proper treatments for their mental health conditions and at the optimum dose. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Depression can be effectively treated with internet-based computerized cognitive behavioral therapy (cCBT). The Veterans Health Administration (VHA) provided cCBT free to all veterans nationally as of 2013; however, its uptake has been limited. This study aimed to examine VHA primary care clinicians' and patients' perspectives regarding cCBT treatment for depression. We conducted semistructured interviews with 12 primary care clinicians (September-November 2020) and four focus groups involving 15 patients with depression (March-May 2021). Interview guides were developed using the Consolidated Framework for Implementation Research; questions addressed depression treatment barriers and facilitators, cCBT awareness and acceptability, target patient population for cCBT, and integration into depression management pathways. Data were analyzed for overarching themes using matrix analysis techniques. Few primary care clinicians and patients were aware of cCBT and its availability for veterans. Clinicians stressed the importance of identifying appropriate patients for cCBT use, specifically veterans with mild-to-moderate severity depression. Clinicians believed cCBT could potentially engage patients in depression treatment who may not otherwise engage and envisioned cCBT use to be guided by integrated VHA mental health personnel. Patients spoke of multiple treatment barriers (e.g., long wait times) and, correspondingly, viewed cCBT as facilitating access to mental health treatment. While patients raised some technical questions, they expressed interest in cCBT. Though relatively unknown to participants, cCBT was widely perceived to be acceptable and with the potential to increase access to depression treatment within VHA primary care settings. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

In recent years, the emergence of alternative response models (ARMs) in the United States has shifted greater responsibility to behavioral health (BH) professionals instead of police officers when responding to BH crises. Louisville (Kentucky) Metro launched the ARM Crisis Call Diversion Program in March 2022, which provides an alternative response to certain 911 calls involving a BH crisis. Overarching goals are to deflect BH-related calls from police and reduce unnecessary institutionalizations. Utilizing the Consolidated Framework for Implementation Research, semistructured interviews were conducted between December 2022 and June 2023 with 47 ARM responders (i.e., 35 first responders; 12 alternative responders). Interviews emphasized negative experiences related to program rollout, compassion fatigue, and burnout, which may impact responders' ability to fulfill their duties. Positive coping mechanisms of responders were also ascertained. First and alternative responders expressed similar sources of stressors when responding to individuals in crisis due to insufficient social support systems. All responder groups expressed a range of symptoms of compassion fatigue and burnout, but alternative responders demonstrated more awareness of the signs and a greater range of positive coping methods to address symptoms. As BH ARMs evolve, decision making related to planning, implementation, and expansion must consider responder burnout and compassion fatigue. Understanding responder burnout and compassion fatigue increases responder buy-in and can be used to improve implementation and decrease turnover. Ignoring these needs may lead to persistent barriers to implementation and negatively impact the quality of BH care individuals in crisis receive. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Though the implementation of science frameworks has recently been expanded to understand determinants of health equity (Woodward et al., 2021), the application of these frameworks in safety net hospital settings is new. We applied the health equity implementation framework to (a) understand the determinants of implementation and equity and (b) develop an institution-wide implementation facilitation plan for three evidence-based practices (EBPs) for posttraumatic stress disorder. We utilized researcher field notes from clinical case consultation gathered during posttraumatic stress disorder treatment implementation initiatives (cognitive processing therapy, written exposure therapy, brief skills training in affective and interpersonal regulation) at the same safety net hospital (N = 94 meetings total, from 2020 to 2023) to assess determinants of implementation and equity. We developed a qualitative codebook based on the health equity implementation framework to specify determinants and then built an implementation facilitation toolkit for multi-EBP implementation. Similar determinants were found across clinics and EBPs (e.g., provider training gaps and misperceptions about manualized treatments; inefficiencies in identification, triage, and referral pathways; patient engagement barriers related to stigma, literacy, and mistrust) with additional nuance per clinic and EBP. Institution-wide facilitation strategies were then utilized to enhance implementation and equity and focused on enhancing both access and quality of services (e.g., training and consultation, refining referral pathways) and patient engagement (e.g., culturally responsive training, consultation, and treatment delivery). Implementation science has an important role to play in enhancing health equity. Our findings illustrate how pooling determinants across clinics and treatments can help implementation scientists engage with hospital leadership and advocate for system-level implementation facilitation strategies. (PsycInfo Database Record (c) 2025 APA, all rights reserved).