While implementation scientists are documenting an increasing number of implementation strategies that support the uptake of evidence-based practices and other clinical innovations, little is known about how to transfer this knowledge to those who conduct implementation efforts in the frontline clinical practice settings. We developed, implemented, and conducted a preliminary evaluation of a training program for one strategy, implementation facilitation (IF). The training program targets facilitation practitioners, clinical managers, and researchers. This paper describes the development of the training program, the program components, and the results from an evaluation of IF knowledge and skills reported by a subset of people who participated in the training. Findings from the evaluation indicate that this training program significantly increased trainees' perceived knowledge of and confidence in applying IF skills. Further research is needed to examine whether ongoing mentoring helps trainees retain confidence in applying some IF skills over the longer term.

Background: Facilitation is an effective strategy to implement evidence-based practices, often involving external facilitators (EFs) bringing content expertise to implementation sites. Estimating time spent on multifaceted EF activities is complex. Furthermore, collecting continuous time-motion data for facilitation tasks is challenging. However, organizations need this information to allocate implementation resources to sites. Thus, our objectives were to conduct a time-motion analysis of external facilitation, and compare continuous versus noncontinuous approaches to collecting time-motion data. Methods: We analyzed EF time-motion data from six VA mental health clinics implementing the evidence-based Collaborative Chronic Care Model (CCM). We documented EF activities during pre-implementation (4-6 weeks) and implementation (12 months) phases. We collected continuous data during the pre-implementation phase, followed by data collection over a 2-week period (henceforth, "a two-week interval") at each of three time points (beginning/middle/end) during the implementation phase. As a validity check, we assessed how closely interval data represented continuous data collected throughout implementation for two of the sites. Results: EFs spent 21.8 ± 4.5 h/site during pre-implementation off-site, then 27.5 ± 4.6 h/site site-visiting to initiate implementation. Based on the 2-week interval data, EFs spent 2.5 ± 0.8, 1.4 ± 0.6, and 1.2 ± 0.6 h/week toward the implementation's beginning, middle, and end, respectively. Prevalent activities were preparation/planning, process monitoring, program adaptation, problem identification, and problem-solving. Across all activities, 73.6% of EF time involved email, phone, or video communication. For the two continuous data sites, computed weekly time averages toward the implementation's beginning, middle, and end differed from the interval data's averages by 1.0, 0.1, and 0.2 h, respectively. Activities inconsistently captured in the interval data included irregular assessment, stakeholder engagement, and network development. Conclusions: Time-motion analysis of CCM implementation showed initial higher-intensity EF involvement that tapered. The 2-week interval data collection approach, if accounting for its potential underestimation of irregular activities, may be promising/efficient for implementation studies collecting time-motion data.

The implementation of artificial intelligence (AI) in mental healthcare offers a potential solution to some of the problems associated with the availability, attractiveness, and accessibility of mental healthcare services. However, there are many knowledge gaps regarding how to implement and best use AI to add value to mental healthcare services, providers, and consumers. The aim of this paper is to identify challenges and opportunities for AI use in mental healthcare and to describe key insights from implementation science of potential relevance to understand and facilitate AI implementation in mental healthcare. The paper is based on a selective review of articles concerning AI in mental healthcare and implementation science. Research in implementation science has established the importance of considering and planning for implementation from the start, the progression of implementation through different stages, and the appreciation of determinants at multiple levels. Determinant frameworks and implementation theories have been developed to understand and explain how different determinants impact on implementation. AI research should explore the relevance of these determinants for AI implementation. Implementation strategies to support AI implementation must address determinants specific to AI implementation in mental health. There might also be a need to develop new theoretical approaches or augment and recontextualize existing ones. Implementation outcomes may have to be adapted to be relevant in an AI implementation context. Knowledge derived from implementation science could provide an important starting point for research on implementation of AI in mental healthcare. This field has generated many insights and provides a broad range of theories, frameworks, and concepts that are likely relevant for this research. However, when taking advantage of the existing knowledge basis, it is important to also be explorative and study AI implementation in health and mental healthcare as a new phenomenon in its own right since implementing AI may differ in various ways from implementing evidence-based practices in terms of what implementation determinants, strategies, and outcomes are most relevant.Plain Language Summary: The implementation of artificial intelligence (AI) in mental healthcare offers a potential solution to some of the problems associated with the availability, attractiveness, and accessibility of mental healthcare services. However, there are many knowledge gaps concerning how to implement and best use AI to add value to mental healthcare services, providers, and consumers. This paper is based on a selective review of articles concerning AI in mental healthcare and implementation science, with the aim to identify challenges and opportunities for the use of AI in mental healthcare and describe key insights from implementation science of potential relevance to understand and facilitate AI implementation in mental healthcare. AI offers opportunities for identifying the patients most in need of care or the interventions that might be most appropriate for a given population or individual. AI also offers opportunities for supporting a more reliable diagnosis of psychiatric disorders and ongoing monitoring and tailoring during the course of treatment. However, AI implementation challenges exist at organizational/policy, individual, and technical levels, making it relevant to draw on implementation science knowledge for understanding and facilitating implementation of AI in mental healthcare. Knowledge derived from implementation science could provide an important starting point for research on AI implementation in mental healthcare. This field has generated many insights and provides a broad range of theories, frameworks, and concepts that are likely relevant for this research.

Background:Implementation strategies used to enhance the implementation of interventions during efficacy and effectiveness studies are rarely reported. Tracking and reporting implementation strategies during these phases has potential to improve future research studies and real-world implementation. We present an exemplar of how this might be executed by specifying and reporting the implementation strategies that were used during a school-based efficacy trial, Project POWER, which tested a trauma-informed prevention program delivered by a university research team, community members, and school staff facilitators in 29 schools.Methods:Following the conclusion of the 4-year trial, core Project POWER research team members identified the implementation strategies that supported intervention delivery during the trial using an established taxonomy of school-based implementation strategies. The actors, actions, action targets, temporality, dose, and implementation outcomes were specified using established implementation strategies reporting guidelines.Results:The research team identified 37 implementation strategies that were used during the Project POWER trial. Most strategies fell within the categories of Train and Educate Stakeholders, Use Evaluative and Iterative Strategies, and Develop Stakeholder Interrelationships. Actors included members of the research team and partner schools. Strategies were used multiple times during the preparation and implementation phases. Action targets were most often characteristics of individuals, implementation process, and characteristics of the inner setting. Strategies predominantly targeted the implementation outcomes of fidelity, acceptability, feasibility, and adoption.Conclusions:This study provided evidence that implementation strategies are used and can be identified in efficacy research using a retrospective approach. Identifying and specifying implementation strategies used during the initial phases of the translational research pipeline can inform the implementation strategies that are carried forward, adapted, or discontinued in future trials and routine practice to improve implementation and effectiveness outcomes.

BackgroundTo address disparities in smoking rates, our safety-net hospital implementedan inpatient tobacco treatment intervention: an “opt-out” electronic healthrecord (EHR)-based Best Practice Alert + order-set, which triggersconsultation to a Tobacco Treatment Consult (TTC) service for allhospitalized patients who smoke cigarettes. We report on development,implementation, and adaptation of the intervention, informed by apre-implementation needs assessment and two rapid-cycle evaluations guidedby the Consolidated Framework for Implementation Research (CFIR) and ExpertRecommendations for Implementing Change (ERIC) compilation.MethodsWe identified stakeholders affected by implementation and conducted a localneeds assessment starting 6 months-pre-launch. We then conducted tworapid-cycle evaluations during the first 6 months post-implementation. TheCFIR informed survey and interview guide development, data collection,assessment of barriers and facilitators, and selection of ERIC strategies toimplement and adapt the intervention.ResultsKey themes were: (1) Understanding the hospital's priority to improvingtobacco performance metrics was critical in gaining leadership buy-in (CFIRDomain: Outer setting; Construct: External Policy and Incentives). (2)CFIR-based rapid-cycle evaluations allowed us to recognize implementationchallenges early and select ERIC strategies clustering into 3 broadcategories (conducting needs assessment; developing stakeholderrelationships; training and educating stakeholders) to make real-timeadaptations, creating an acceptable clinical workflow. (3) Minimizingclinician burden allowed the successful implementation of the TTC service.(4) Demonstrating improved 6-month quit rates and tobacco performancemetrics were key to sustaining the program.ConclusionsRapid-cycle evaluations to gather pre-implementation and early-implementationdata, focusing on modifiable barriers and facilitators, allowed us todevelop and refine the intervention to improve acceptability, adoption, andsustainability, enabling us to improve tobacco performance metrics in ashort timeline. Future directions include spreading rapid-cycle evaluationsto promote implementation of inpatient tobacco treatment programs to othersettings and assessing long-term sustainability and return on investment ofthese programs.

Background: Consultation is an implementation strategy that improves delivery and clinical outcomes for Cognitive Processing Therapy (CPT), an evidence-based practice (EBP) for posttraumatic stress disorder (PTSD). However, little is known about the specific components of consultation that influence the fidelity of treatment delivery or clinical outcomes. Methods: The current study examined whether specific activities performed during CPT consultation meetings were associated with better fidelity to the CPT protocol among 60 newly trained therapists or improved clinical outcomes among 135 clients treated by these therapists. Consultation activities that fall under three broad categories (discussion of the application of CPT to individual cases, review/feedback on fidelity, and technical difficulties) were measured by consultant checklists for each consultation session. Treatment fidelity (adherence to the protocol and competence of delivery) was rated by trained observers for a random sample of therapists' CPT sessions following consultation. The self-reported PTSD Checklist-IV assessed PTSD symptom change. Results: Multilevel regression analyses indicated that higher therapist consultation attendance predicted a greater decrease in their clients' PTSD symptoms and that attendance was not associated with observer-rated treatment fidelity. Discussion of the application of specific CPT strategies was the only consultation activity that was significantly associated with greater improvement in PTSD symptoms. Lastly, no consultation activities were significantly associated with treatment fidelity. Conclusions: Our findings suggest that specific consultation strategies such as emphasizing the discussion of the application of specific CPT strategies to individual cases during consultation meetings may be effective in improving the clinical outcomes of CPT.

BackgroundDespite efforts to use standardized taxonomy and research reporting,documenting implementation strategies utilized in community settings remainschallenging. This case study demonstrates a practical approach to gather useof and satisfaction with implementation strategies utilized withincommunity-based sites to understand community providers’ perspectives ofimplementing an early intensive behavioral intervention (EIBI) for childrenon the autism spectrum across different settings.MethodsUsing a sequential explanatory mixed-methods design, survey and interviewdata were collected from directors/supervisors and direct providers(n = 26) across three sites (one university and twocommunity-based replication sites). The Implementation Strategies andSatisfaction Survey (ISSS) was administered to identify staff-reportedimplementation strategy use and satisfaction. Informed by quantitativeresults, follow-up semi-structured interviews were conducted with asubsample (n = 13) to further understand staff experienceswith endorsed implementation strategies and elicit recommendations forfuture efforts.ResultsSurvey results were used to demonstrate frequencies of implementationstrategies endorsed by site and role. Overall, staff felt satisfied withimplementation strategies used within their agencies. Content analysis ofqualitative data revealed three salient themes related to implementationstrategy use—context, communication, and successes and challenges—providingin-depth detail on how strategies were utilized, and strategy effectivenessbased on community providers’ experiences. Recommendations were alsoelicited to improve strategy use within “broader” community settings.ConclusionsThe project demonstrated a practical approach to identifying and evaluatingimplementation strategies used within sites delivering autism services.Reporting implementation strategies using the ISSS can provide insight intocommunity providers’ perspectives and satisfaction with agencyimplementation strategy use that can generate more relevant and responsivestrategies to address barriers in community settings.Plain language abstractExamining community providers’ preferences and experiences withimplementation strategies used to facilitate evidence-based practice uptakecan broaden our understanding of what, how, and why implementationstrategies work in community-based settings ( Chaudoir et al., 2013; Leeman et al.,2017; Proctor et al., 2013). Such efforts have great potential totailor implementation strategies to address barriers/facilitators typicallyfound in community-based settings.This case study demonstrates a practical approach using mixed methodology to:(a) gather self-reported use of and satisfaction with implementationstrategies to understand community providers’ perspectives of implementationstrategy success. Using a new survey, the Implementation Strategies andSatisfaction Survey (ISSS) conjoined with interviews, the study demonstrateda practical approach using standardized language to report strategies usedin one university-based site and two community-based replication sites thatdeliver an early intensive behavioral intervention (EIBI) for children onthe autism spectrum. This paper contributes to one of the five priorities toenhance public health impact—improve tracking and reporting ofimplementation strategies utilized when translating research into practice (Dingfelder &Mandell, 2011; Powell et al., 2019; Stahmer et al.,2019). This approach emphasizes the importance of understandingcontext (e.g., community organizations providing services to children on theautism spectrum) to develop strategies that work better for EIBIimplementation and scale-up. Understanding community provider's preferencesand experiences with implementation strategies can support use ofimplementation strategies that better fit usual care contexts, with theultimate goal of improving implementation practice in community-basedsettings.

Organizational readiness for implementation (ORI) is a barrier to disseminating recovery-oriented evidence-based practices for people with severe mental illnesses. However, there is a knowledge gap regarding implementation strategies and specific actions related to those strategies that may enhance ORI across organizations. The Transtheoretical Model (TTM) is a well-established stage-based model used to support organizational change. In TTM, the first three stages-Pre-contemplation, Contemplation, and Preparation-represent the pre-implementation phase, during which ORI should be developed. This study explored ORI enhancement strategies reported as useful by different stakeholders in the field of community mental health (CMH) and tested the applicability of the TTM readiness stages as an organizing framework to direct ORI development. The study included the following two phases: (1) a qualitative exploration of ORI enhancement actions reported by various stakeholders in the CMH field (N = 16) based on their experience in successful implementation projects and (2) a consolidation process performed by the research team to create coherent groups of actions and their overarching implementation strategies per readiness stage. A comprehensive list of strategies and related actions was created. The strategies and actions correspond with each of the first three stages of the TTM. Stakeholders differed in their methods of facilitating engagement across the organization and in their level of involvement in developing ORI. This study is a first step in conceptualizing a systematic process for developing ORI using the TTM as a theoretical framework. Future studies should test the transferability and effectiveness of this repository to other implementation efforts, expend the lists per stage, and further explore differences between stakeholders' role in ORI development. Interventions that were proven effective in supporting the recovery of people with mental illnesses are not sufficiently available in the field of community mental health. One barrier to getting those interventions implemented is the lack of willingness and preparedness of organizations to change their practice, also referred to as organizational readiness for implementation (ORI). Little is known about how to enhance ORI to increase the availability of interventions. This study explored actions used to enhance ORI by people in different roles who successfully implemented new recovery-oriented interventions in community mental health settings. The actions were organized into three stages of readiness development based on the Transtheoretical Model (TTM) of behavioral change. Differences were found between administrators, consultants, supervisors, and providers in the type and number of strategies they described. The results show the applicability of the TTM as an organizing framework for ORI development and provide sets of strategies and specific actions to support different readiness needs across the organization.

Background:Decades of war, famines, natural disasters, and political upheaval have ledto the largest number of displaced persons in human history. The refugeeexperience is fraught with obstacles from preflight to resettlement, leadingto high rates of mental distress including post-traumatic stress disorder,depression, and anxiety. However, there is a paucity of mental healthservices for refugees in transit. To meet the needs of this vulnerablepopulation, researchers are experimenting with teaching lay communitymembers basic tools for the delivery of mental health and psychosocialsupport services (MHPSS). However, there are research gaps about the use ofimplementation science to inform the delivery of applicable interventions,especially within low resource settings, and even less in the humanitariancontext.Methods:This review utilizes an implementation science framework (RE-AIM) to assessthe reach, effectiveness, adoption, implementation, and maintenance of theseinterventions. Studies included varying interventions and modes of deliverywithin refugee camp and urban settings. A comprehensive search strategy ledto the inclusion and analysis of 11 unique studies.Results:While current research documents adaptation strategies, feasibility, andfidelity checks through routine monitoring, there is still a dearth ofevidence regarding capacity building of lay providers in humanitariansettings. Barriers to this data collection include a lack of homogeneity inoutcomes across studies, and a lack of comprehensive adaptation strategieswhich account for culture norms in the implementation of interventions.Furthermore, current funding prioritizes short-term solutions forindividuals who meet criteria for mental illnesses and therefore leaves gapsin sustainability, and more inclusive programming for psychosocial servicesfor individuals who do not meet threshold criteria.Conclusion:Findings contribute to the literature about task-shifting for MHPSS inhumanitarian contexts, especially illuminating gaps in knowledge about thelay counselor experiences of these interventions.Plain language summary:There is a growing number of refugees forced to make homes in temporary campsor urban centers as they await resettlement, a process that can lastdecades. These refugees are at risk of serious mental health outcomes due toongoing stress and trauma. One strategy commonly used in global mentalhealth is the training of lay providers to deliver basic mental health andpsychosocial programming to communities. While this tactic is currentlybeing tested in refugee settings, there is limited evidence about theimplementation of this strategy. The following scoping review aims to assessthe implementation of task-shifting interventions within refugee settings,through the use of a robust implementation science framework.

Background:Responding to the growing demand for scientific understanding of adoption anduptake of evidence-based interventions (EBIs), numerous dissemination andimplementation (“D&I”) models have been proposed in the extantliterature. This review aimed to identify community-specific constructs withthe potential to help researchers engage community partners in D&Istudies or deploy EBIs.Methods:We identified 74 D&I models targeting community-level changes. We builton Tabak et al.’s narrative review that identified 51 D&I modelspublished up to 2012 and identified 23 D&I models published between 2012and 2020 from the Health Research & Practice website (16 models) andPubMed database (7 models). Three coders independently examined all 74models looking for community-specific engagement constructs.Results:We identified five community engagement constructs: (1)Communication, (2) PartnershipExchange, (3) Community Capacity Building, (4)Leadership, and (5) Collaboration. Ofthe 74 models, 20% reflected all five constructs; 32%, four; 22%, three;20%, two; and 5%, only one. Few models with strong community content havebeen introduced since 2009.Conclusion:This article bridges the community-engaged and D&I research literature byidentifying community engagement constructs reflected in existing D&Imodels, targeting community-level changes. Implications for future researchand practice are discussed.Plain language summaryResponding to the growing demand for scientific understanding of adoption anduptake of evidence-based interventions (EBIs), numerous dissemination andimplementation (“D&I”) models have been proposed. This review aimed toidentify community-specific constructs with the potential to helpresearchers engage community partners in D&I studies or deploy EBIs. Weidentified 74 D&I models targeting community-level changes, publishedbetween 2012 and 2020. Three coders independently examined all 74 modelslooking for community-specific engagement constructs. We identified fivecommunity engagement constructs: (1) Communication, (2)Partnership Exchange, (3) Community CapacityBuilding, (4) Leadership, and (5)Collaboration. Of the 74 models, 20% reflected all fiveconstructs; 32%, four; 22%, three; 20%, two; and 5%, only one. This articleidentified community engagement constructs reflected in existing D&Imodels targeting community-level changes. Implications for future researchand practice are discussed.