The IMPACT Center’s pilot grant program is an extended incubator for our methods. We seek the most innovative proposals that address stakeholder needs and draw applicants from all IMPACT institutional partners.
The first group of three IMPACT pilots were identified through a competitive process during the IMPACT Center grant development process. Investigators submitting applications for funding were encouraged to focus on implementation challenges related to developing, refining, employing, and disseminating user-friendly methods and tools to accelerate the impact of evidence-based practices for youth.
Leveraging peer support to address youth mental health disparities
Disparities in youth mental health outcomes among low-income and racial and ethnic minorities are a pervasive problem. Despite the efforts of some to address disparities in mental health care outcomes, they have worsened during the COVID-19 pandemic.
Peer support, a method in which lay individuals with shared lived experience help support the delivery of services, is a strategy that holds promise in promoting equity in mental health and implementation outcomes. However, empirical support for current models of peer support is equivocal, and there is a need for theory-informed models of peer support to underpin their testing and replicability.
This project aims to address disparities in youth mental health and implementation outcomes through leveraging peer support, a Washington State-approved and Medicaid-reimbursable service.
We work with publicly funded community mental health clinics providing peer support to youth and families in Washington State.
We do so by: 1) using a rapid evidence review to synthesize theories that inform peer support interventions in mental health to distill their hypotheses about how and why peer support works; 2) using rapid ethnography , we examine peer support in the context of Medicaid-funded community mental health clinics in Washington State to understand the current supported models of peer support and to identify areas for its optimization; and 3) using causal pathway diagrams, we develop micro-theories of peer support components to enhance Cognitive Behavioral Therapy fidelity.
This work will yield theory-driven peer support components to target cognitive behavioral therapy fidelity that can be vetted by stakeholders and tested in future studies.
Rapid Ethnography to Investigate Rural Mental Health Services
This pilot study involves partnering with rural community mental health centers across Washington State to investigate the determinants of cognitive behavioral therapy implementation.
Implementing cognitive behavioral therapy in rural settings may have dual benefits of ensuring youth receive high-quality care while also providing structure and problem-focused strategies for community-based clinicians with limited resources.
A growing body of literature has investigated determinants of cognitive behavioral therapy delivery in community mental health centers. However, much of this has focused on urban clinics or across statewide initiatives, potentially obscuring any determinants that are unique to rural settings.
Using IMPACT Stage I methods, this study will engage rural community mental health center clinicians, supervisors, and clients to investigate the determinants of cognitive behavioral therapy delivery. These determinants will be refined and prioritized in consultation with stakeholders to begin the process of developing implementation strategies to address key determinants.
Increasing Adolescent and Young Adult Engagement in Digital Mental Health
We will partner with Appa Health to examine the barriers to adolescent and young adult engagement in digital mental health resources. Appa Health is a digital mental health resource for youth aged 13-18, with evidence-based content drawn from cognitive behavioral therapy. Appa uses peer mentors to remotely engage with and support youth as they complete a mental health curriculum using digital mental health tools such as video content on cognitive behavioral therapy techniques.
By adolescence, about half of the US has been affected by a mental disorder, but access to services is limited. Digital and remote delivery of evidence-based mental health interventions hold promise for increasing accessibility and scalability, but engagement with these resources is less than ideal. We will examine the barriers to youth use of digital mental health.
Using a rapid evidence review, we will explore the research to develop a list of possible barriers to youth engagement in video clip delivery of mental health strategies. A focus group with youth served by Appa will corroborate this literature review. A series of causal pathway diagramming sessions using nominal group decision making with Appa leadership will then be used to create actionable models of youth barriers and strategies to remove barriers.
Parent and teacher engagement as an undervalued implementation determinant
This project focuses on the need for evidenced-based practices (EBPs) to address child behavioral concerns in preschool. Our goal is to understand key determinants of EBP implementation and identify feasible strategies to improve implementation.
Every day approximately 250 children are expelled from preschool in the U.S., a rate more than three times that of grades K-12. Expulsion disproportionately affects Black children, who comprise 19% of preschool enrollment but 47% of children expelled. Despite the gravity of this problem, well-established EBPs (such as behavorial interventions) for child behavioral concerns in preschool are poorly implemented. This adherence gap is problematic, and the resources invested in the development and evaluation of interventions do not translate into large-scale impact on child outcomes.
We will use IMPACT’s rapid evidence review method to map strategies and determinants of teacher implementation of EBPs with fidelity in preschool classroom. These findings will be shared through a brief report providing a roadmap of how the field of early childhood education can begin to think about implementation science to improve the adherence gap.
Implementation Strategies for Depression Management for Youth with HIV in Kenya
Our goal is to identify potential barriers in implementation of depression assessment in HIV clinics and develop implementation strategies to overcome those barriers. Stakeholders in this process include mental health and adolescent HIV practitioners, policymakers and researchers, adolescents and youth with HIV and their caregivers.
While HIV care guidelines require comprehensive psychosocial management including depression screening as part of clinical care, gaps in implementation of mental health interventions in routine care persist in low and middle income settings.
This project will use 3 IMPACT methods to identify barriers to implementation and develop strategies to overcome them:
1) Rapid evidence review focused on barriers in primary health settings with HIV clinics in lower- and middle-income countries and implementation strategies evaluated in various settings.
2) Barrier prioritization with stakeholders to validate and add to barriers identified above — creating a single prioritized list that ranks barriers across 5 domains: importance, pervasiveness, frequency, duration, and equity.
3) Causal pathway diagrams to consider all implementation strategies suggested, identify the mechanisms of action, and link them to proximal (adoption) and distal (fidelity) outcomes.
Cyrus Mugo Wachira, PhD
Pilot Program Lead Investigator
Senior Research Scientist, Kenyatta National Hospital, Nairobi, Kenya