Implementing measurement-based care (iMBC) for depression in community mental health: a dynamic cluster randomized trial
- PDF / 909,471 Bytes
- 14 Pages / 595.276 x 793.701 pts Page_size
- 5 Downloads / 228 Views
STUDY PROTOCOL
Open Access
Implementing measurement-based care (iMBC) for depression in community mental health: a dynamic cluster randomized trial study protocol Cara C. Lewis1,2*, Kelli Scott1, C. Nathan Marti3, Brigid R. Marriott1, Kurt Kroenke4, John W. Putz5, Peter Mendel6 and David Rutkowski7
Abstract Background: Measurement-based care is an evidence-based practice for depression that efficiently identifies treatment non-responders and those who might otherwise deteriorate [1]. However, measurement-based care is underutilized in community mental health with data suggesting fewer than 20 % of behavioral health providers using this practice to inform treatment. It remains unclear whether standardized or tailored approaches to implementation are needed to optimize measurement-based care fidelity and penetration. Moreover, there is some suggestion that prospectively tailored interventions that are designed to fit the dynamic context may optimize public health impact, though no randomized trials have yet tested this notion [2]. This study will address the following three aims: (1) To compare the effect of standardized versus tailored MBC implementation on clinician-level and client-level outcomes; (2) To identify contextual mediators of MBC fidelity; and (3) To explore the impact of MBC fidelity on client outcomes. Methods/design: This study is a dynamic cluster randomized trial of standardized versus tailored measurement-based care implementation in Centerstone, the largest provider of community-based mental health services in the USA. This prospective, mixed methods implementation-effectiveness hybrid design allows for evaluation of the two conditions on both clinician-level (e.g., MBC fidelity) and client-level (depression symptom change) outcomes. Central to this investigation is the focus on identifying contextual factors (e.g., attitudes, resources, process, etc.) that mediate MBC fidelity and optimize client outcomes. Discussion: This study will contribute generalizable and practical strategies for implementing systematic symptom monitoring to inform and enhance behavioral healthcare. Trial registration: Clinicaltrials.gov NCT02266134.
Background Depression is one of the world’s leading causes of illness burden [3], costing the United States alone over $80 billion annually due to lost work and wages [4]. There are now many evidence-based practices (EBPs) for the * Correspondence: [email protected] 1 Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St, Bloomington, IN 47405, USA 2 Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, Harborview Medical Center, School of Medicine, University of Washington 325 9th Ave, Box 359911, Seattle, WA 98104, USA Full list of author information is available at the end of the article
treatment of depression, but these practices remain largely unavailable to clients receiving services in community mental health centers (CMHCs). One reason for this paucity of EBPs is that CMHCs have few resour
Data Loading...
