Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges

Proctor, Enola K.; Landsverk, John; Aarons, Gregory; Chambers, David; Glisson, Charles; Mittman, Brian

doi:10.1007/s10488-008-0197-4

Cited by 1,894Health Policy Implementation SciencePsychiatric care and mental health servicesMental Health and Patient Involvement

Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges

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Proctor, Enola K., Landsverk, John, Aarons, Gregory, Chambers, David, Glisson, Charles, Mittman, Brian·2009·Administration and Policy in Mental Health and Mental Health Services Research

DOI 10.1007/s10488-008-0197-4PMC PMC3808121

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Abstract

One of the most critical issues in mental health services research is the gap between what is known about effective treatment and what is provided to consumers in routine care. Concerted efforts are required to advance implementation science and produce skilled implementation researchers. This paper seeks to advance implementation science in mental health services by over viewing the emergence of implementation as an issue for research, by addressing key issues of language and conceptualization, by presenting a heuristic skeleton model for the study of implementation processes, and by identifying the implications for research and training in this emerging field.

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If a program lacks acceptability and feasibility, its efficacy in controlled clinical trials is unlikely to translate to effectiveness in real-world settings.
“These are all important considerations, because if the program lacks acceptability and feasibility, its efficacy in controlled clinical trials is unlikely to translate to effectiveness in diverse real-world settings (health care, education, etc.; Proctor et al., 2009).”
From Acceptability and Feasibility of an Intervention to Enhance Social Group Belonging: Evidence From Three Trials of Groups 4 Health (2022) · cites this paper as Proctor et al., 2009
The ‘Dissemination Versus Implementation’ section says that efficacy-study results may need adaptation to improve feasibility and that creating evidence-based treatments does not ensure their use in practice. ‘The Challenge of Implementation Research Methods’ identifies acceptability and feasibility as implementation outcomes. The paper supports the concern about translation into routine mental health care, but does not establish the claim for education settings or say that lacking those qualities makes a program’s real-world treatment effectiveness unlikely. (LLM, conf=0.82)
Experimental — accuracy not yet measured
The time lag between research discovery and routine uptake is inflated by the dominant developmental approach that encourages delimited, step-wise progressions through clinical efficacy research, clinical effectiveness research, and implementation research.
“Glasgow et al4 and others17–20 argue that the time lag between research discovery and routine uptake is also inflated by the dominant developmental approach; that is, one that encourages delimited, step-wise progressions of research through clinical efficacy research, then clinical effectiveness research, and finally implementation research.”
From Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact (2012) · cites this paper as [20]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Equity is a key service system outcome.
“Equity is a key service system outcome [1, 62].”
From Ten years of implementation outcomes research: a scoping review (2023) · cites this paper as [62]
The Challenge of Implementation Research Methods (page unavailable) identifies consumer well-being and several implementation outcomes, but does not identify equity as a service-system outcome. Searches for “equity service system outcome” and “equitable access disparities outcomes services” found no passage addressing that point. (LLM, conf=0.72)
Experimental — accuracy not yet measured
Mixed qualitative and quantitative approaches can yield richer information than either method alone for studying implementation outcomes.
“To study implementation outcomes, mixed qualitative and quantitative approaches can yield richer information than either method alone (Landsverk et al., 2012;Palinkas et al., 2011;Proctor et al., 2009).”
From Perceived acceptability and appropriateness of a web-based program targeting risk for anxiety in young children and their parents (2025) · cites this paper as Proctor et al., 2009
“The Challenge of Implementation Research Methods” discusses measuring implementation outcomes and using multilevel designs, while “Multi-level Models of Change” mentions qualitative studies and statistical approaches separately. Our copy does not say that combining qualitative and quantitative methods yields richer information than either alone (searched: mixed methods, qualitative quantitative). (LLM, conf=0.76)
Experimental — accuracy not yet measured
Proctor et al. have proposed a model that informs evaluation by differentiating implementation, service system, and clinical outcomes, and identifying a range of implementation outcomes that can be assessed.
“Similarly, Proctor et al.[46] have proposed a model that informs evaluation by differentiating implementation, service system, and clinical outcomes, and identifying a range of implementation outcomes that can be assessed [24].”
From Writing implementation research grant proposals: ten key ingredients (2012) · cites this paper as [46]

Implementation outcomes are a function of multiple types of broad factors that can be hierarchically organized to represent micro-, meso-, and macro-level factors.
“These frameworks propose that implementation outcomes are a function of multiple types of broad factors that can be hierarchically organized to represent micro-, meso-, and macro-level factors.”
From Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures (2013) · cites this paper as [17]
In order to ensure enough statistical power to test the effect of structural-level constructs on implementation outcomes, researchers must typically utilize exceptionally large samples that are typically difficult to obtain.
“In order to ensure enough statistical power to test the effect of structural-level constructs on implementation outcomes, researchers must typically utilize exceptionally large samples that are typically difficult to obtain [17].”
From Measuring factors affecting implementation of health innovations: a systematic review of structural, organizational, provider, patient, and innovation level measures (2013) · cites this paper as [17]
Sustainability and penetration constructs typically require very large sample sizes that are hard to obtain.
“sustainability and penetration constructs typically require very large sample sizes that are hard to obtain [102]”
From eMental Healthcare Technologies for Anxiety and Depression in Childhood and Adolescence: Systematic Review of Studies Reporting Implementation Outcomes (2018) · cites this paper as [102]
Proctor et al. articulated a research agenda for DIS outcome evaluations that appears to have positively influenced instrument development.
“Proctor et al. articulated a research agenda for DIS outcome evaluations that appears to have positively influenced instrument development.”
From The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote rigorous evaluation (2016) · cites this paper as [8]
Implementation outcomes are typically measured in implementation activities, can advance understanding of implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies.
“Implementation outcomes are typically measured in implementation activities, can advance understanding of the implementation processes, enhance efficiency in implementation research, and pave the way for studies of the comparative effectiveness of implementation strategies [8].”
From The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote rigorous evaluation (2016) · cites this paper as [8]
Over one third (34.90%) of instruments for implementation outcomes have been developed since the seminal paper by Proctor et al. was published.
“over one third (34.90%) of instruments for implementation outcomes have been developed since the seminal paper by Proctor et al. was published [8].”
From The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote rigorous evaluation (2016) · cites this paper as [8]
The isolation and concrete operationalization of implementation outcomes, separate from service and client outcomes, was a unique and important addition to the literature.
“The isolation and concrete operationalization of implementation outcomes, separate from service and client outcomes, was a unique and important addition to the literature (Table 1).”
From The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote rigorous evaluation (2016) · cites this paper as [8]
Basing the work on the CFIR and Implementation Outcomes Framework provides a comprehensive conceptual framework, yet DIS investigators employ diverse frameworks delineating unique constructs not included in the SIRC IRP.
“Basing our work on the CFIR [7] and Implementation Outcomes Framework [8] provides a comprehensive conceptual framework, yet it is clear that DIS investigators employ diverse frameworks delineating unique constructs not included in the SIRC IRP [2].”
From The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote rigorous evaluation (2016) · cites this paper as [8]

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Grimshaw J 2007 Improving the scientific basis of health care research dissemination and implementation Paper presented at NIH Conference on Building the Sciences of Dissemination and Implementation in the Service of Public Health Washington, DC
Proctor EK Landsverk J 2005 Challenges of translating evidence-based treatments into practice contexts and service sectors Paper presented at The Mental Health Services Research Conference Washington, DC

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Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research
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“method designs in implementation research (Proctor et al. 2009; Landsverk et al. 2012; Palinkas et al. 2011a; Aarons et al. 2011).”
Outcomes for Implementation Research: Conceptual Distinctions, Measurement Challenges, and Research Agenda
Proctor, E., Silmere, H., Raghavan, R., Hovmand, P., Aarons, G., Bunger, A., Griffey, R., & Hensley, M. (2011) · Administration and Policy in Mental Health and Mental Health Services Research · doi:10.1007/s10488-010-0319-7 · Cited by 8,721 · see citing works
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Effectiveness-implementation Hybrid Designs: Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact
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Acceptability of healthcare interventions: an overview of reviews and development of a theoretical framework
Sekhon, M., Cartwright, M., & Francis, J. J. (2017) · BMC Health Services Research · doi:10.1186/s12913-017-2031-8 · Cited by 3,938 · see citing works
Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors
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Implementation strategies: recommendations for specifying and reporting
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Bridging Research and Practice
Tabak, R. G., Khoong, E. C., Chambers, D. A., & Brownson, R. C. (2012) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2012.05.024 · Cited by 1,386 · see citing works
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The sustainability of new programs and innovations: a review of the empirical literature and recommendations for future research
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Mixed method designs in implementation research
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The Quality Implementation Framework: A Synthesis of Critical Steps in the Implementation Process
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A compilation of strategies for implementing clinical innovations in health and mental health
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Methods to Improve the Selection and Tailoring of Implementation Strategies
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Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies
Fernandez, M. E., ten Hoor, G. A., van Lieshout, S., Rodriguez, S. A., Beidas, R. S., Parcel, G., Ruiter, R. A. C., Markham, C. M., & Kok, G. (2019) · Frontiers in Public Health · doi:10.3389/fpubh.2019.00158 · Cited by 914 · see citing works
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“Finally, consider the implementation scientists (e.g., Proctor et al., 2009).”
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The Adaptome
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Accelerating digital mental health research from early design and creation to successful implementation and sustainment
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Reframing implementation science to address inequities in healthcare delivery
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Outcomes for implementation science: an enhanced systematic review of instruments using evidence-based rating criteria
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“Equity is a key service system outcome [1, 62].”
BackgroundSelf-citation
The Handbook of Behavior Change
Hagger, M. S., Cameron, L. D., Hamilton, K., Hankonen, N. E., & Lintunen, T. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318 · Cited by 420 · see citing works
A PRACTICAL IMPLEMENTATION SCIENCE HEURISTIC FOR ORGANIZATIONAL READINESS: R = MC 2
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The WPA-Lancet psychiatry commission on the future of psychiatry
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The Program Sustainability Assessment Tool: A New Instrument for Public Health Programs
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Adapting a Compilation of Implementation Strategies to Advance School-Based Implementation Research and Practice
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Standards for Reporting Implementation Studies (StaRI): explanation and elaboration document
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Psychometric properties and U.S. National norms of the Evidence-Based Practice Attitude Scale (EBPAS).
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Self-citation
Trauma-informed mental healthcare in the UK: what is it and how can we further its development?
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Implementation Science
Ogden, T., & Fixsen, D. L. (2014) · Zeitschrift für Psychologie · doi:10.1027/2151-2604/a000160 · Cited by 304 · see citing works
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International Atherosclerosis Society guidance for implementing best practice in the care of familial hypercholesterolaemia
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Best practices for addressing missing data through multiple imputation
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Approaches to mixed methods dissemination and implementation research: methods, strengths, caveats, and opportunities
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Psychology's Replication Crisis and Clinical Psychological Science
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Strategies for implementing implementation science: a methodological overview
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Context and implementation: A concept analysis towards conceptual maturity
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Delivery Of Cascade Screening For Hereditary Conditions: A Scoping Review Of The Literature
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Improving Implementation of eMental Health for Mood Disorders in Routine Practice: Systematic Review of Barriers and Facilitating Factors
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Consultation as an Implementation Strategy for Evidence-Based Practices Across Multiple Contexts: Unpacking the Black Box
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Self-citation
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Letting Go: Conceptualizing Intervention De‐implementation in Public Health and Social Service Settings
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The Juvenile Justice Behavioral Health Services Cascade: A new framework for measuring unmet substance use treatment services needs among adolescent offenders
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Measuring implementation outcomes: An updated systematic review of measures’ psychometric properties
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Barriers to Implementing the DSM-5 Cultural Formulation Interview: A Qualitative Study
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The role of treatment fidelity on outcomes during a randomized field trial of an autism intervention
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Implementation science: understanding the translation of evidence into practice
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The Society for Implementation Research Collaboration Instrument Review Project: A methodology to promote rigorous evaluation
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Looking Forward
Forgatch, M. S., Patterson, G. R., & Gewirtz, A. H. (2013) · Perspectives on Psychological Science · doi:10.1177/1745691613503478 · Cited by 149 · see citing works
Predicting program start-up using the stages of implementation measure
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Importance of Mixed Methods in Pragmatic Trials and Dissemination and Implementation Research
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Scoping implementation science for the beginner: locating yourself on the “subway line” of translational research
Lane-Fall, M. B., Curran, G. M., & Beidas, R. S. (2019) · BMC Medical Research Methodology · doi:10.1186/s12874-019-0783-z · Cited by 144 · see citing works
Severe Mental Illness in LGBT Populations: A Scoping Review
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Web-based behavioral treatment for substance use disorders as a partial replacement of standard methadone maintenance treatment
Marsch, L. A., Guarino, H., Acosta, M., Aponte-Melendez, Y., Cleland, C., Grabinski, M., Brady, R., & Edwards, J. (2014) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2013.08.012 · Cited by 139 · see citing works
Attitude theory and measurement in implementation science: a secondary review of empirical studies and opportunities for advancement
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A scoping review of de-implementation frameworks and models
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Informant discrepancies in assessments of psychosocial functioning in school-based services and research: Review and directions for future research
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Protocol: Adaptive Implementation of Effective Programs Trial (ADEPT): cluster randomized SMART trial comparing a standard versus enhanced implementation strategy to improve outcomes of a mood disorders program
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Feasibility, acceptability and clinical utility of the Cultural Formulation Interview: Mixed-methods results from the DSM-5 international field trial
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Scaling Up Evidence-Based Practices for Children and Families in New York State: Toward Evidence-based Policies on Implementation for State Mental Health Systems
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Authors: Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B.
Affiliations: Washington University in St. Louis (US)
University of California System (US)
National Institute of Mental Health (US)
University of Tennessee at Knoxville (US)
United States Department of Veterans Affairs (US)
Corresponding author: Proctor, Enola K.
ORCID: Proctor, Enola K.
Aarons, Gregory
Chambers, David
Mittman, Brian
Venue: Administration and Policy in Mental Health and Mental Health Services Research
Publisher: Springer Science and Business Media LLC
Published: 2008-12-23
Volume: 36
Issue: 1
Pages: 24-34
ISSN: 0894-587X (ISSN-L)
1573-3289
DOI: 10.1007/s10488-008-0197-4
PMC: PMC3808121
OpenAlex: W2097206783
Semantic Scholar: 1506bf0903ba73ff708619e3fbec077844c446f5
Cited by: 1,894
References: 85
Citations by year: 2026: 100 · 2025: 98 · 2024: 142 · 2023: 155 · 2022: 143 · 2021: 227 · 2020: 213 · 2019: 139 · 2018: 112 · 2017: 95 · 2016: 77 · 2015: 88 · 2014: 95 · 2013: 83 · 2012: 46
FWCI: 50.78
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.springer.com/tdm (tdm)
Locations: Administration and Policy in Mental Health and Mental Health Services Research (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (5p30mh068579-05)
National Institute of Mental Health (5 P30 MH068579, P30-MH-068579, R21MH082731, R25MH080916)
Topics: Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Health Sciences › Health Professions › General Health Professions › Mental Health and Patient Involvement
Keywords: implementation research, mental health services, implementation process, knowledge-practice gap
MeSH terms: Diffusion of Innovation, Health Services Research, Humans, Mental Health Services, Models, Theoretical, Information Dissemination, Evidence-Based Practice

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Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges

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