Assessing perspectives on an intervention connecting adolescents in outpatient psychiatry care to contraceptive counseling in the United States.

BACKGROUND: Adolescents with psychiatric disorders have high rates of unintended pregnancy and experience barriers to accessing sexual and reproductive health (SRH) care. Outpatient psychiatry visits are potential opportunities to connect adolescents to SRH care. This study informs the development of the Link2BC intervention which links adolescents in outpatient psychiatry care to SRH care. METHODS: We conducted group interviews with adolescents (3 groups, 7 total participants) and caregivers (3 groups, 9 total participants) and individual interviews with 8 psychiatry providers who received or provided outpatient psychiatric treatment in clinics in a pediatric hospital in a city in the Midwestern United States. We asked questions about the acceptability of Link2BC, potential implementation needs, and implementation determinants. Using consensus-building techniques, two coders analyzed transcriptions using a codebook informed by the Consolidated Framework for Implementation Research 2.0. RESULTS: Participants agreed on the need for interventions that expand access to SRH care. Adolescents emphasized that services should be confidential and accessible and were open to their psychiatrists introducing SRH topics during appointments. Providers expressed preference for training and clear workflows. Participants agreed that psychiatry providers could serve as liaisons between adolescents and their caregivers to facilitate conversations about contraception. Participants had concerns about time constraints during visits but mentioned few other barriers to the intervention. CONCLUSION: This study demonstrates the acceptability of connecting adolescents in outpatient psychiatry care to contraceptive counseling and informs the refinement and implementation of Link2BC. Integrating contraception counseling in outpatient psychiatry settings is an innovative approach to prevent unintended pregnancy among adolescents by increasing access to SRH care services.

Implementing traumatic brain injury screening in behavioral health treatment settings: results of an explanatory sequential mixed-methods investigation.

BACKGROUND: Traumatic brain injury (TBI) is a complex condition common among individuals treated in behavioral healthcare, but TBI screening has not been adopted in these settings which can affect optimal clinical decision-making. Integrating evidence-based practices that address complex health comorbidities into behavioral healthcare settings remains understudied in implementation science, limited by few studies using theory-driven hypotheses to disentangle relationships between proximal and medial indicators on distal implementation outcomes. Grounded in the Theory of Planned Behavior, we examined providers' attitudes, perceived behavioral control (PBC), subjective norms, and intentions to adopt The Ohio State University TBI Identification Method (OSU TBI-ID) in behavioral healthcare settings. METHODS: We used an explanatory sequential mixed-methods design. In Phase I, 215 providers from 25 organizations in the USA completed training introducing the OSU TBI-ID, followed by a survey assessing attitudes, PBC, norms, and intentions to screen for TBI. After 1 month, providers completed another survey assessing the number of TBI screens conducted. Data were analyzed using structural equation modeling (SEM) with logistic regressions. In Phase II, 20 providers were purposively selected for semi-structured interviews to expand on SEM results. Qualitative data were analyzed using thematic analysis, integrated with quantitative results, and combined into joint displays. RESULTS: Only 25% (55/215) of providers adopted TBI screening, which was driven by motivations to trial the intervention. Providers who reported more favorable attitudes (OR: 0.67, p < .001) and greater subjective norms (OR: 0.12, p < .001) toward TBI screening demonstrated increased odds of intention to screen, which resulted in greater TBI screening adoption (OR: 0.30; p < .01). PBC did not affect intentions or adoption. Providers explained that although TBI screening can improve diagnostic and clinical decision-making, they discussed that additional training, leadership engagement, and state-level mandates are needed to increase the widespread, systematic uptake of TBI screening. CONCLUSIONS: This study advances implementation science by using theory-driven hypothesis testing to disentangle proximal and medial indicators at the provider level on TBI screening adoption. Our mixed-methods approach added in-depth contextualization and illuminated additional multilevel determinants affecting intervention adoption, which guides a more precise selection of implementation strategies.

Psychosocial assessment in brain injury: An international social work survey.

OBJECTIVE: To survey social workers in the field of traumatic brain injury (TBI)/acquired brain injury (ABI) about their practice in conducting psychosocial assessments. Design: A cross-sectional quality assurance study. DESIGN: A cross-sectional quality assurance study. PARTICIPANTS: Social workers from professional social work rehabilitation networks spanning Sweden, the United Kingdom, North America, and Asia Pacific regions. MEASURE: Purpose-designed survey comprising closed and open items, organized into six sections and administered electronically. RESULTS: The 76 respondents were mainly female (65/76, 85.5%) from nine countries (majority from Australia, United States, Canada). Two-thirds of respondents were employed in outpatient/ community settings (51/76, 67.1%), with the balance working in inpatient/rehabilitation hospital settings. Over 80% of respondents conducted psychosocial assessments, with the assessments informed by a systemic focus, situating the individual within their broader family and societal networks. The top five issues identified in inpatient/rehabilitation settings were housing related needs, informed consent for treatment, caregiver support, financial issues and navigating the treatment system. In contrast, the leading issues identified in community settings related to emotional regulation, treatment resistance and compliance issues, depression, and self-esteem. DISCUSSION: Social workers assessed a broad range of psychosocial issues spanning individual, family, and environmental contextual factors. Findings will contribute to future development of a psychosocial assessment framework.

Development of an Implementation Blueprint to Scale-Up Contraception Care for Adolescents with Psychiatric Conditions in a Pediatric Hospital.

Implementation blueprints are comprehensive plans that describe implementation strategies, goals, timelines, and key personnel necessary for launching new interventions. Although blueprints are a foundational step in driving intervention rollout, little is known about how blueprints are developed, refined, and used in practice. The objective of this study was to describe a systematic, collaborative approach to developing, refining, and utilizing a formal implementation blueprint for scaling up the Contraception Care at Behavioral Health Pavilion (CC@BHP) intervention for adolescents hospitalized in psychiatric units within a pediatric hospital in the United States. In Stage 1 (Planning/Preparation), we assembled a Research Advisory Board (RAB) of 41 multidisciplinary members and conducted a formative evaluation to identify potential barriers to CC@BHP implementation. Barriers were mapped to implementation strategies using the Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change (ERIC) tool and used to create an initial blueprint. In Stage 2 (Development/Implementation), RAB members used activity logs to track implementation activities over the 18-month study period, which were then mapped to formal implementation strategies used to further develop the blueprint. About 30% of strategies were situated in the 'Train and Educate Stakeholders' ERIC category, 20% in 'Use Evaluative and Iterative Strategies,' and 16% in 'Develop Stakeholder Interrelationships' category. In Stage 3 (Synthesis/Refinement), the final blueprint was refined, consisting of 16 goals linked to 10 strategies for pre-implementation and 6 strategies for implementation. Feedback on the blueprint emphasized the role of the project champion in translating the blueprint into smaller, actionable steps for implementers.

Implementing traumatic brain injury screening in behavioral healthcare: protocol for a prospective mixed methods study.

BACKGROUND: Characteristics of both individuals and innovations are foundational determinants to the adoption of evidenced-based practices (EBPs). However, our understanding about what drives EBP adoption is limited by few studies examining relationships among implementation determinants and implementation outcomes through theory-driven hypothesis testing. Therefore, drawing on the Theory of Planned Behavior and Diffusion of Innovations Theory, this study will disentangle relationships between provider characteristics and innovation factors on the early adoption of the Ohio State University Traumatic Brain Injury Identification Method (OSU TBI-ID) in behavioral health settings. METHODS: This study will utilize an explanatory sequential mixed methods design. In Phase I (quantitative), Time 1, we will investigate behavioral health providers (N = 200) attitudes, perceived behavioral control, subjective norms, and intentions to screen for TBI upon completion of a video module introducing the OSU TBI-ID. At Time 2, we will examine the number of TBI screens conducted over the previous month, as well as the feasibility, appropriateness, and acceptability of using the OSU TBI-ID in practice. Structural equation modeling will be used to determine whether provider characteristics predict TBI screening intentions, and whether intentions mediate actual TBI screening behaviors. We will then test whether feasibility, appropriateness, and acceptability of the OSU TBI-ID moderates the relationship between intentions and TBI screening behaviors. In Phase II (qualitative), we will develop an interview guide using results from Phase I and will conduct semi-structured interviews with providers (N = 20) to assess contextual determinants of TBI screening adoption. Qualitative data will be thematically analyzed using sensitizing concepts from the Consolidated Framework for Implementation Research and integrated with the quantitative results using a joint display. DISCUSSION: This mixed methods study capitalizes on two theory-driven hypotheses bridging proximal (e.g., screening intent) to distal (actual behaviors) implementation outcomes and will contextualize these results qualitatively to advance our understanding about why TBI screening adoption has failed to translate to the behavioral healthcare context. Results of this study will offer insights into what is driving TBI screening adoption so that implementation strategies can be selected with greater precision to improve the adoption, sustainment, and scale-up of TBI screening in behavioral healthcare.