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Implementation Research in Mental Health Services: an Emerging Science with Conceptual, Methodological, and Training challenges
Open accessAbstract
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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“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
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe check wasn’t confident either way, so it gives no verdict — never disputed.
In the citing paper
“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
Experimental — accuracy not yet measuredIn the citing paper
“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]
In the citing paper
“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.”
In the citing paper
“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].”
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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]
In the citing paper
“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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Weber, M. B., Rhodes, E., Ranjani, H., Jeemon, P., Ali, M. K., Hennink, M. M., Anjana, R. M., Mohan, V., Narayan, K. M. V., & Prabhakaran, D. (2023) · Implementation Science Communications · doi:10.1186/s43058-023-00516-1 · Cited by 7
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Taxman, F. S., & Belenko, S. R. (2025) · Health & Justice · doi:10.1186/s40352-025-00323-x · Cited by 7
Zhai, S., Yuwen, W., Zyniewicz, T. L., Sonney, J., Hash, J. B., Chen, M., & Ward, T. M. (2025) · Digital Health · doi:10.1177/20552076251348579 · Cited by 7
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Peer-Mediated Pivotal Response Treatment at School for Children With Autism Spectrum Disorder
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Evaluation of Behavior Change Interventions
Matthews, L., & Simpson, S. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108677318.022 · Cited by 8
Garner, B. R., Patel, S. V., & Kirk, M. A. (2020) · Systematic Reviews · doi:10.1186/s13643-020-01535-y · Cited by 8
Gonzalez, L. F., Namías, M. R., & Bravo, P. (2021) · ecancermedicalscience · doi:10.3332/ecancer.2021.1256 · Cited by 7
Whiteside, L., Huynh, L., Morse, S. C., Hall, J. P., Meurer, W. J., Banta‐Green, C. J., Scheuer, H., Cunningham, R. J., McGovern, M. P., & Zatzick, D. (2021) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2021.108666 · Cited by 7
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Special Issue of Child Maltreatment on Implementation
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Metadata
- 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.
- Venue
- Administration and Policy in Mental Health and Mental Health Services Research
- Published
- 2008-12-23
- Volume
- 36
- Issue
- 1
- Pages
- 24-34
- ISSN
- 0894-587X (ISSN-L)
- 1573-3289
- 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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