How Organizational Factors Influence Training Impact Over Time - PowerPoint PPT Presentation

How Organizational Factors Influence Training Impact Over Time within Community Mental Health Clinics Victoria Stanhope, Abigail Ross, Mimi Choy-Brown, & Lauren Jessell

Acknowledgements PCCP Study Team Investigators Diane Grieder, AliPar, Inc Victoria Stanhope (PI), NYU Maria Restrepo-Toro, Yale PRCH Steven Marcus, Penn Stephanie Lanteri, Yale PRCH Larry Davidson, Yale PRCH Mimi Choy-Brown, NYU Lauren Jessell, NYU Janis Tondora, Yale PRCH Taylor Kravitz, NYU Deborah Padgett, NYU Lynden Bond, NYU Abigail Ross, Fordham University Liz Matthews, Rutgers University Meredith Doherty, Hunter College This work was supported by NIMH R01MH099012 Person-Centered Care Planning and Service Engagement The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health

Mandate to Improve Service Quality “Care that is respectful of and responsive to individual patient preferences, needs and values and ensuring those values guide all clinical decisions”

An Emerging EBP: Person-Centered Care Planning

Implementation Strategy for Person-Centered Care Planning » 2-DAY training with expert trainers Community Mental Health Clinics (N=14) with 273 providers » 12-months of follow-up technical assistance calls twice/month with expert trainers targeting supervisors as trainers and Control addressing challenges Intervention N=7 N=7 5

Implementation Readiness  Multi-dimensional concept & critical for translation  Change Commitment  Change Efficacy  Schein’s primary mechanisms for embedding a new practice  What leaders pay attention to on a regular basis shape provider priorities  How they signal their interest & support of an effort

Role of Implementation Leadership Proactive Perseverant Knowledgeable Supportive

Study Aim & Design  A longitudinal mixed-methods study examined a one-year training process across seven community mental health clinics to explore the relationship between organizational factors and implementation readiness over time  Embedded in a randomized controlled trial of Person-Centered Care Planning in community mental health clinics  Mixed-methods design  Sequential Explanatory  Focus groups utilized to explain trainer ratings of the training process and observed leadership participation in the training process

Quantitative Data Sources  Trainer Ratings:  Following the 2 monthly TA calls per site (one supervisor call, one team-based call), trainers completed assessments for each of 7 experimental sites  Proactive Leadership (single item 1-10 likert)  Implementation Readiness (single item 1-10 likert)  Observed TA Call Attendance Ratios:  Attendance recorded for each TA call (n=24)  Ratio calculated by: (# attending participants) / (# eligible participants) for leadership and supervisor subgroups

Quantitative Analyses  Pearson’s r correlation were used to examine the relationship between proactive leadership and implementation readiness  Means and standard deviations were computed for Phase 1(Months 1-6) and Phase 2 (Months 7-12) of 12 month training period  Paired sample t-tests were used to examine changes between Phases 1 and 2 of training on outcomes of proactive leadership, implementation readiness, and observed participation

Demographics Characteristic Overall (N=157) Direct Care (n=87) Supervisors (n=45) Leadership (n=25) Gender Female N=110(70.5%) N=61 (70.5%) N=33 (73.3%) N=16 (64.0%) Male N=46 (29.5%) N=25 (29.1%) N=12 (26.7%) N=9 (36.0%) Age 43.3 (SD=12.4) 40.1 (SD=11.9) 43.6 (SD=11.0) 53.73 (SD=10.7) Race/Ethnicity White N=96 (61.1%) N=47 (53.0%) 26 (57.8%) 23 (92.0%) Non-White N=61 (38.9%) N=36 (41.4%) 17 (37.8%) 2 (4.0%) Education HS/Some college/AA N=19 (12.0%) N=15 (17.2%) N=3 (6.7%) N=1 (4.0%) Undergraduate N=60 (38.2%) N=40 (46.0%) N=14 (31.1%) N=6 (24.0%) Graduate N=77 (49.0%) N=31 (35.6%) N=38 (62.2%) N=17 (72.0%) Time at agency Less than 1 year 24 (15.5%) N=17 (19.5%) N=4 (8.9%) N=3 (12.0%) 1-3 years 41 (26.1%) N=27 (31.0%) N=13 (28.9%) N=5 (20.0%) 3 or more years 92 (58.6%) N=41 (47.1%) N=28 (62.2%) N=17 (68.0%)

Proactive Leadership and Implementation Readiness By Month 10 9 8 7 Trainer Rating 6 Implementation Readiness 5 Proactive Leadership 4 3 2 1 r =0.69 0 1 2 3 4 5 6 7 8 9 10 11 12 Month of TA Call

Trainer Ratings and Observed Leadership Participation by Month 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 1 2 3 4 5 6 7 8 9 10 11 12 Implementation Readiness (Rescaled) Proactive Leadership (Rescaled) Observed Leadership Participation Ratio

Trainer Ratings and Observed Leadership Participation on Supervisor Calls by Month 1 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0 1 2 3 4 5 6 7 8 9 10 11 12 Implementation Readiness (Rescaled) Proactive Leadership (Rescaled) Supervisor Call Leadership Participation Ratio

Differences Over 12 Month Training Period Phase 1 (M1-M6): M(SD) Phase 2 (M7-M12): M(SD) P t (df) Trainer Ratings Proactive Leadership 5.39(2.21) 6.74(1.74) *0.03 2.73(6) Implementation Readiness 4.52(2.78) 5.94(2.01) *0.04 2.63(6) Observed Participation Ratios Supervisors Participation 0.51(0.15) 0.64(0.16) *0.02 3.10(6) Leadership Participation 0.45(0.32) 0.74(0.21) *0.03 2.98(6)

Qualitative Methods  Focus groups of supervisors and direct care staff were conducted at the 7 experimental sites during rolling 12-month intervention period  104 participants total, 8-12 participants per focus group  One hour groups led by two masters-level interviewers  Topical domains included: perceptions of PCCP, experiences with PCCP training, and barriers and facilitators to implementation

Qualitative Analysis  Focus groups were digitally recorded, transcribed verbatim and uploaded into Atlas TI for analysis  Using thematic analysis (Boyatzis, 1998), three researchers co-coded the 15 transcripts, generating categorical codes and an initial codebook reflecting patterns in the data  A final codebook was generated through consensus and codes specific to the training process were extracted and collapsed into key themes  Strategies for rigor included weekly team debriefings and the use of an audit trail

Qualitative Findings  Four themes emerged  Already Doing it  Resistance  Top Down  The Ah-Ha Moment

Already Doing It  I mean, we’ve just, we’ve done it, it’s just now it’s put a title to it of, okay, this is exactly what it’s called that we do. Um, I feel like it, it was very in line with how we did our jobs previously (DC/Site 2)  I mean, I feel kind of like, um — of course [pause] most of, you know, if you ask nine out of ten clinicians, of course they’re going to be, like, “I’m really happy with the way things are going in our program, we don’t need to change anything.” (SUP/Site 7)  Um, so I definitely felt the staff were open but a lot of them, again, folk who had been here a little bit longer, it was kind of like, “How is this different again? Or are we just calling it a different name ?” (SUP/Site 6 )

Resistance  I think in the overall what I have to do and juggle and balance, I don’t think—I don’t think everyone’s on the same page that that is the best method. Um, so again, it’s a lot of pushback of us to like everybody else, like, “No, this isn’t the way it should be.” So it’s a lot of fighting with—as you go up and up……You know, because if this is something that [the state] is requiring, you can resist it and you can not like it, but it’s going to happen. (DC/Site 2)  The other thing that I remember about the first email… said, “You’ve been chosen for this great opportunity,” and we’re all going, “Oh, no.” But she tried really hard to frame it as something really good. But there was moaning and groaning. (SUP/Site 3)

Top Down  No, he just told us, “Do it.” [laughter] “I want you to do it. You’re going to do it.” (SUP/Site 2)  Definitely my supervisor would have done it in supervision, kind of like, “Oh, by the way, we’re doing this thing.” (DC/Site 3)  You just, you just muscle through it. It’s just, you know, you can complain all you want but at the end of the day, it’s got to get done, so. (DC/Site 8)  But am I understanding what it —uh, the, the purpose of all of it and how it’s— no. I’m just doing it. [laughs] But I’m not really comprehending the importance of it . (DC/Site 2)