A Systematic Review of Strategies for Implementing Empirically Supported Mental Health Interventions

May combine two claims.

The review identified 11 studies testing implementation strategies; 10 were randomized controlled trials and 1 was a controlled clinical trial.

“Eleven studies were identified that tested implementation strategies with a randomized (n = 10) or controlled clinical trial design (n = 1).”

• Also stated in: § Study Designs · plain

  “The majority of the studies (n = 10; 91%) were RCTs, and one study was a CCT.”

• AssumptionThe authors state this as an assumption: The authors treated a treatment as empirically supported if the included study's authors cited evidence supporting its efficacy or effectiveness.

Probably not a substantial claim: may not pass S3 (load-bearing).

Twenty-five full-text articles were identified as potentially relevant.

“Abstracts were screened for eligibility and 25 full-text articles were identified as potentially relevant.”

May combine two claims.

The mean number of CFIR domains addressed across studies was 3.45, with a range of 2 to 5.

“The mean number of domains addressed was 3.45 (range = 2–5), and the mean number of sub-domains addressed was 9.73 (range = 4–20).”

Probably not a substantial claim: may not pass S3 (load-bearing).

A total of 501 abstracts were identified through the database and hand search.

“A total of 501 abstracts were identified through the database (n = 492) and hand search (n = 9) process.”

May combine two claims.

Kauth et al. (2010) and Kramer and Burns (2008) conducted small randomized studies with 23 and 17 participants, respectively, that could be characterized as feasibility or pilot studies.

“For example, Glisson et al. (2010) and Chamberlain, Price, Reid, & Landsverk (2008) both conducted large-scale RCTs involving over 600 youth, whereas Kauth and colleagues (2010) and Kramer and Burns (2008) conducted small randomized studies (n = 23 and n = 17 respectively) that could be characterized as feasibility or pilot studies.”

• cites Kauth and colleagues (2010)Not checked yet

  Not checked in the free run.

• cites Kramer and Burns (2008)Not checked yet

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May combine two claims.

Several studies evaluated multifaceted, multi-level implementation strategies that targeted multiple domains of the implementation context, although these approaches were not technically blended because they lacked manualization.

“Though their implementation approaches would not technically be classified as blended owing to a lack of manualization, we note that several studies evaluated multifaceted, multi-level implementation strategies by targeting multiple domains of the implementation context.”

May combine two claims.

The mean number of CFIR subdomains addressed across studies was 9.73, with a range of 4 to 20.

“the mean number of sub-domains addressed was 9.73 (range = 4–20).”

May combine two claims.

Seven studies, or 64%, found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome, and about two-thirds demonstrated beneficial effects over comparison conditions.

“The majority of studies (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome”

• Also stated in: § Discussion and Applications to Social Work · boosted

  “A promising finding of this review was that approximately two-thirds (64%) of studies demonstrated beneficial effects of employing implementation strategies to improve intermediate and/or clinical outcomes over the comparison conditions.”

• AssumptionRests on an assumption: The outcome measures used in the included studies validly indicate implementation, service system, and clinical outcomes, so that the review's synthesis of their effects is meaningful.

Probably not a substantial claim: may not pass S3 (load-bearing). The quote only partly states this claim.

Kramer and Burns justified selecting cognitive behavioral therapy by drawing on innovation characteristics: relative advantage, trialability, and compatibility.

“Kramer and Burns (2008) draw upon the characteristics of innovations that may make them easier to implement as they justify their selection of cognitive behavioral therapy by noting its relative advantage (it has been demonstrated to be effective in community trials), trialability (standardized components and manuals have been developed and can”

• cites Kramer and Burns, 2008Not checked yet

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May combine two claims.

The adult mental health service settings included outpatient mental health through a managed behavioral health care organization, Department of Veterans Affairs hospitals, and psychiatric clinics in Stockholm, Sweden.

“The adult mental health service settings included: outpatient mental health (through a managed behavioral health care organization), Department of Veterans Affairs hospitals, and psychiatric clinics (in Stockholm, Sweden)”

Probably not a substantial claim: may not pass S3 (load-bearing).

Atkins and colleagues supported using opinion leaders as an implementation strategy by citing diffusion theory's proposition that novel interventions begin with a small group of key opinion leaders who influence others in their networks.

“Atkins and colleagues (2008) supported the use of opinion leaders as an implementation strategy by stating, “diffusion theory posits that novel interventions are initiated by a relatively small group of key opinion leaders (KOLs) who serve as influential models for others in their social network” (p. 905).”

• cites Atkins et al., 2008Not checked yet

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May combine two claims.

Some studies testing very comprehensive implementation strategies showed positive effects, while other studies also showed positive effects with less comprehensive strategies.

“Some studies testing very comprehensive implementation strategies demonstrated positive effects (e.g., Forsner et al., 2010; Glisson et al., 2010); however, other studies also demonstrated positive effects with less comprehensive strategies (e.g., Herschell et al., 2009; Lochman et al., 2009).”

• cites Forsner et al., 2010Not checked yet

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• cites Glisson et al., 2010Not checked yet

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• cites Herschell et al., 2009Not checked yet

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• AssumptionRests on an assumption: The outcome measures used in the included studies validly indicate implementation, service system, and clinical outcomes, so that the review's synthesis of their effects is meaningful.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One study described in Palinkas et al. (2008) lacked final data at the time of the search; the later Weisz et al. (2012) article was examined instead.

“One of the studies described in the Palinkas et al. (2008) article did not have final data published at the time of this search; however, the results have subsequently been published and the more recent article (Weisz et al., 2012) was examined in this review.”

• cites Palinkas et al. (2008)Not checked yet

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• cites Weisz et al., 2012Not checked yet

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May combine two claims.

Glisson et al. (2010) and Chamberlain, Price, Reid, & Landsverk (2008) both conducted large-scale RCTs involving over 600 youth.

“For example, Glisson et al. (2010) and Chamberlain, Price, Reid, & Landsverk (2008) both conducted large-scale RCTs involving over 600 youth, whereas Kauth and colleagues (2010) and Kramer and Burns (2008) conducted small randomized studies (n = 23 and n = 17 respectively) that could be characterized as feasibility or pilot studies.”

• cites Glisson et al. (2010)Not checked yet

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• cites Chamberlain, Price, Reid, & Landsverk (2008)Not checked yet

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May combine two claims.

External facilitation had a total cost of $2,458.80 for facilitator and therapist time and produced a benefit of about 28 additional hours of CBT per month per therapist.

“The external facilitation strategy resulted in a total cost (facilitator’s and therapists’ time) of $2,458.80 for a benefit of approximately 28 additional hours of CBT per month per therapist.”

• cites Kauth et al., 2010 sourceNot checked yet

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May combine two claims.

Client outcomes in the reviewed studies included symptom or behavioral checklists and out-of-home placements.

“Client outcomes included symptom/behavioral checklists and out-of-home placements.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The reviewers found it difficult to achieve high reliability during the first round of coding, especially when coding the theoretical domains.

“Though we did not calculate inter-rater reliability statistics (i.e., Cohen’s kappa), we found it difficult to achieve high reliability during the first round of coding, particularly when coding the theoretical domains outlined by Damschroder and colleagues (2009).”

May combine two claims.

Eight of the eleven included studies were conducted in child and adolescent mental health, and three focused on adult mental health.

“Eight of the eleven included studies were conducted in child and adolescent mental health, with the remaining three focusing on adult mental health.”

May combine two claims.

The mean number of implementation or service system outcomes assessed was 2.09, with a standard deviation of 1.30.

“The mean number of implementation or service system outcomes assessed was 2.09 (SD = 1.30)”

May combine two claims.

The present review found no difference in clinical or implementation outcome attainment between studies that targeted multiple CFIR domains or subdomains and studies that targeted fewer, which is consistent with Grimshaw and colleagues.

“In the present study, we found no difference in outcome attainment (clinical or implementation) between studies that targeted multiple theoretical domains or subdomains of the CFIR and studies that targeted fewer domains or subdomains, providing evidence that is consistent with Grimshaw and colleagues (2006).”

• cites Grimshaw et al., 2006Not checked yet

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• AssumptionRests on an assumption: The number of CFIR domains or subdomains addressed by a study is a meaningful measure of the comprehensiveness of its implementation strategy, so that comparing studies by domain counts can inform conclusions about strategy effectiveness.

May combine two claims.

In many other cases, it was difficult to determine the scope and detail of the implementation strategies used, which limits the ability to understand and replicate the implementation approach.

“In many other cases it was difficult to determine the scope and detail of the implementation strategies used, which obviously limits one’s ability to understand the implementation approach, let alone replicate it.”

May combine two claims.

Most studies effectively differentiated between clinical interventions and implementation strategies, but the description and reporting of implementation strategies could be vastly improved.

“For instance, while most studies effectively differentiated between clinical interventions and implementation strategies, the description and reporting of implementation strategies could be vastly improved.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Forsner and colleagues provided an excellent example of a study that clearly described the implementation strategies, including a separate box detailing the different strategies employed.

“Forsner et al. (2010) is one excellent example of a study that clearly describes the implementation strategies (even providing a separate box detailing the different strategies employed).”

• cites Forsner et al., 2010Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Efforts are underway to catalog and rate the quality of implementation-related measures in order to promote valid and reliable instruments and catalyze development of new measures.

“Efforts are underway to catalog and rate the quality of implementation related measures (Rabin et al., 2012) to promote the use of a wider array of valid and reliable instruments and serve to catalyze the development of new measures needed to advance the field.”

• cites Rabin et al., 2012Not checked yet

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May combine two claims.

Some studies addressed many CFIR domains and subdomains but used strategies classified as passive, while other studies addressed few domains but used relatively intensive strategies.

“For example, some studies (e.g., Atkins et al., 2008) addressed many CFIR domains and subdomains, but used implementation strategies that have been classified as passive (e.g., opinion leaders and educational meetings), whereas other studies (e.g., Lochman et al., 2009) addressed few domains but used implementation strategies that are considered relatively intensive”

• cites Atkins et al., 2008Not checked yet

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• cites Lochman et al., 2009Not checked yet

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May combine two claims.

Raghavan, Bright, and Shadoin highlighted potential change levers at the level of the policy ecology, but few if any of these strategies have been tested empirically.

“Raghavan, Bright, & Shadoin (2008) have highlighted a number of potential change levers at the level of the “policy ecology;” however, few if any of these strategies have been tested empirically.”

• cites Raghavan, Bright, & Shadoin, 2008Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Landsverk et al. (2011) concluded that mental health has lagged behind other disciplines in building an evidence base for implementation.

“has led Landsverk, Brown, Rolls Reutz, Palinkas, & Horwitz (2011) to conclude that the field of mental health has lagged behind other disciplines in building an evidence-base for implementation.”

• cites Landsverk, Brown, Rolls Reutz, Palinkas, & Horwitz (2011)Not checked yet

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Classified as probably not a substantial claim.

Implementation research has emerged as one way to address quality gaps in fields including mental health.

“Implementation research has emerged as one way of addressing the quality gaps in a variety of fields, including mental health (Brownson, Colditz, & Proctor, 2012, McMillen, 2012).”

• cites Brownson, Colditz, & Proctor, 2012Not checked yet

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• cites McMillen, 2012Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The National Institutes of Health and the Institute of Medicine have called for more research on identifying, developing, refining, and testing implementation strategies.

“It has been prioritized and supported by the National Institutes of Health (NIH; National Institute of Mental Health, 2008; National Institutes of Health, 2013) and the Institute of Medicine (IOM; Institute of Medicine, 2007, 2009b), both of which have called for more research that focuses on the identification, development, refinement, and testing of implementation strategies.”

• cites National Institute of Mental Health, 2008Not checked yet

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• cites National Institutes of Health, 2013Not checked yet

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• cites Institute of Medicine, 2007Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Conceptual models can help frame a study theoretically and provide a broad picture of hypothesized relationships among variables.

“as Proctor, Powell, Baumann, Hamilton, & Santens (2012) note, conceptual models can be “…useful in framing a study theoretically and providing a ‘big picture’ of the hypothesized relationships between variables” (p. 6)”

• cites Proctor, Powell, Baumann, Hamilton, & Santens (2012)Not checked yet

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May combine two claims.

Passive implementation approaches may increase provider knowledge and predispose providers to adopt a treatment, but they do little to change provider behavior.

“the most consistent finding from this literature is that while passive approaches to implementation (e.g., single session workshops, distribution of treatment manuals) may increase provider knowledge and even predispose providers to adopt a treatment, passive approaches do little to produce provider behavior change (Davis & Davis, 2009).”

• cites Davis & Davis, 2009Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Powell et al. (2012) identified 68 discrete implementation strategies.

“For example, the review by Powell et al. (2012) identified 68 discrete strategies that can be used to plan, educate, finance, restructure, manage quality, and attend to the policy context to facilitate implementation.”

• cites Powell et al., 2012Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Each mutable aspect of the implementation context highlighted by the CFIR is potentially amenable to targeted and tailored implementation strategies.

“Each mutable aspect of the implementation context that the CFIR highlights is potentially amenable to the application of targeted and tailored implementation strategies (Powell et al., 2012).”

• cites Powell et al., 2012Not checked yet

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Classified as probably not a substantial claim.

EPOC designates four designs as appropriate for testing implementation strategy effectiveness: randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series studies.

“EPOC designates four designs as appropriate for testing the effectiveness of implementation strategies, including: 1) randomized controlled trials (RCTs), 2) controlled clinical trials (CCTs), 3) controlled before and after studies, and 4) interrupted time series studies.”

• cites Cochrane Effective Practice and Organisation of Care Group, 2002aNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The CFIR captures the complex, multi-level nature of implementation and suggests that successful implementation may require an array of strategies acting at multiple levels of the implementation context.

“This model captures the complex, multi-level nature (Shortell, 2004) of implementation, and suggests (implicitly) that successful implementation may necessitate the use of an array of strategies that exert their effects at multiple levels of the implementation context.”

• cites Shortell, 2004Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The CFIR proposes that implementation is influenced by intervention characteristics, outer setting, inner setting, characteristics of individuals involved, and the process of implementation.

“The CFIR suggests that implementation is influenced by: 1) intervention characteristics (evidentiary support, relative advantage, adaptability, trialability, and complexity), 2) the outer setting (patient needs and resources, organizational connectedness, peer pressure, external policy and incentives), 3) the inner setting (structural characteristics, networks and communications, culture, climate,”

• Also stated in: § Overview of Implementation Models · plain

  “4) the characteristics of individuals involved (knowledge, self-efficacy, stage of change, identification with organization, etc.), and 5) the process of implementation (planning, engaging, executing, reflecting, evaluating).”

• cites Damschroder et al., 2009Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The review did not calculate inter-rater reliability statistics such as Cohen's kappa.

“Though we did not calculate inter-rater reliability statistics (i.e., Cohen’s kappa), we found it difficult to achieve high reliability during the first round of coding, particularly when coding the theoretical domains outlined by Damschroder and colleagues (2009).”

Probably not a substantial claim: may not pass S3 (load-bearing).

The classification approach used in this review was previously used to enrich understanding of implementation strategies applied to alcohol screening and brief intervention.

“This approach was previously used to enrich the understanding of implementation strategies applied to alcohol screening and brief intervention (Williams et al., 2011).”

• cites Williams et al., 2011Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Wide variations in the quality of reporting and in the justification for implementation strategies in the included studies partly caused the coding reliability difficulty.

“This is partly due to wide variations in the quality of reporting and the justification for the use of implementation strategies in the included studies, a point that we consider further in the discussion section.”

Probably not a substantial claim: may not pass S3 (load-bearing).

At least two reviewers independently reviewed and extracted data from each article.

“At least two reviewers independently reviewed and extracted data from each article.”

Classified as probably not a substantial claim.

The review tempered its interpretation of results because of the limitations of vote counting.

“thus, we temper our interpretation of results accordingly.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Coding discrepancies were discussed and resolved through consensus in face-to-face meetings.

“These challenges compelled us to hold a number of face-to-face meetings in which coding discrepancies were discussed and resolved through consensus.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The CFIR's utility as a framework to guide empirical research is not fully established.

“Indeed, while the CFIR’s utility as a framework to guide empirical research is not fully established, it is consistent with the vast majority of frameworks and conceptual models in dissemination and implementation research in its emphasis of multi-level ecological factors (Tabak et al., 2012).”

• cites Tabak et al., 2012Not checked yet

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Classified as probably not a substantial claim.

The review's design criteria required a comparative design that met EPOC standards of rigor to test the implementation strategy.

“Our study design criteria required the use of a comparative design to test the implementation strategy that met standards of rigor set forth by the Cochrane Effective Practice and Organisation of Care (EPOC) group (2002a).”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

There may be room for implementation programs that integrate protocolized adaptations, similar to how modular treatments allow clinicians to shift treatment protocols to meet client needs.

“Thus, there may be room for implementation programs that integrate protocolized adaptations, much in the same way that modular treatments (Weisz et al., 2012) allow clinicians to shift treatment protocols to meet client need.”

• cites Weisz et al., 2012Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Interpreting the results of studies that evaluated multifaceted strategies was another challenge for the review.

“Another challenge we faced was interpreting the results of studies that evaluated multifaceted strategies.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).

There may be opportunities to address the process of implementation in order to develop implementation programs that are more flexible and adaptive to the needs of the implementation context.

“Finally, there may also be opportunities to address the “process” of implementation to develop implementation programs that are more flexible and adaptive to the needs of the implementation context.”

May combine two claims.

Studies of large-scale implementation efforts have identified the importance of policy-level implementation strategies and suggested that different evidence-supported interventions may require different policy-level interventions.

“Studies of large-scale implementation efforts have identified the importance of policy level implementation strategies (e.g., aligning financial incentives, altering certification and licensing standards, state partnerships with academic institutions to develop ESI training curriculum for students), and have suggested that different ESIs may even require different policy-level interventions (Isett”

• cites Isett et al., 2007Not checked yet

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• cites Magnabosco, 2006Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

Common elements and transdiagnostic approaches may be similarly effective as approaches that design interventions for flexibility and adaptation.

“Other approaches that have been described in the literature such as the “common elements” and transdiagnostic approaches to treatment may be similarly effective.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Common elements can be systematically identified, taught to clinicians, and applied flexibly to meet clients' needs, which relieves clinicians of learning many full evidence-supported intervention protocols.

“These common elements can be systematically identified, taught to clinicians, and applied flexibly to meet clients’ needs, relieving clinicians of the burden of learning a whole host of ESI protocols (Barth et al., 2012; Chorpita, Becker, & Daleiden, 2007).”

• cites Barth et al., 2012Not checked yet

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• cites Chorpita, Becker, & Daleiden, 2007Not checked yet

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May combine two claims.

Passive strategies such as disseminating guidelines or manuals and using opinion leaders may be promising when combined with other strategies, but in isolation they may lack the intensity and comprehensiveness needed for successful implementation.

“The results from several studies seem to suggest that passive strategies (e.g., disseminating guidelines or manuals, opinion leaders) may represent promising approaches to implementation when combined with other strategies; however, in isolation, they may lack the intensity and comprehensiveness that successful implementation requires.”

May combine two claims.

The review did not formally evaluate the methodological quality of the included studies, and the need for reporting guidelines in implementation research was readily apparent.

“Although we did not formally evaluate the methodological quality of included studies, the need for reporting guidelines in implementation research were readily apparent.”

May combine two claims.

Linking implementation strategies to the CFIR allowed the review to explore implementation effectiveness at the level of the implementation context and indirectly provided insight into debates about multifaceted versus discrete strategies.

“In an effort to make meaningful comparisons between studies that had different design characteristics we linked the implementation strategies in the included studies to a conceptual framework of implementation (Damschroder et al., 2009). Doing so allowed us to explore implementation effectiveness at the level of the implementation context, which indirectly provided insight into debates regarding”

• cites Damschroder et al., 2009Not checked yet

  Not checked in the free run.

May combine two claims.

Because cost was assessed in only one of the eleven studies, the usefulness of this research to policy makers and organizational leaders deciding which implementation strategies to adopt is severely limited.

“Unfortunately, cost was assessed in only one of the eleven studies, which severely limits the usefulness of this research to policy makers and organizational leaders who are charged with making decisions about which implementation”

Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing).

Others have suggested that the reason for Grimshaw and colleagues' finding is that many multifaceted strategies focus on only one level of the implementation context.

“Others have suggested that the reason for Grimshaw and colleagues’ (2006) finding is that many multifaceted strategies focus on only one level of the implementation context (Wensing, Bosch, & Grol, 2009).”

• cites Wensing, Bosch, & Grol, 2009Not checked yet

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May combine two claims.

This review is the first systematic review to assess the effectiveness of implementation strategies across diverse mental health treatment settings and to link implementation strategies to conceptual targets considered important in the implementation literature.

“To our knowledge, this is the first systematic review that assesses the effectiveness of implementation strategies within diverse settings where mental health treatments are delivered (e.g., community mental health centers, schools, daycare centers, foster care, etc.), and that links implementation strategies to conceptual targets deemed important in the implementation literature.”

May combine two claims.

Implementation outcomes such as acceptability, appropriateness, cost, and feasibility may all directly affect whether a strategy or set of strategies will be effective in the real world.

“Implementation outcomes such as acceptability, appropriateness, cost, and feasibility may all have direct bearing on whether a strategy or set of strategies will be effective in the “real world.””

Classified as probably not a substantial claim.

These measures and frameworks can serve a practical purpose by guiding the targeted application of implementation strategies to increase the likelihood of implementation success.

“these measures and frameworks can serve a very practical purpose by guiding the targeted application of implementation strategies to increase the likelihood of implementation success (Aarons et al., 2012).”

• cites Aarons et al., 2012Not checked yet

  Not checked in the free run.

May combine two claims.

Both common elements and transdiagnostic approaches attempt to simplify evidence-based care by manipulating intervention characteristics to make them more widely applicable to clients in routine care, and they may be promising opportunities for implementation research.

“Both of these approaches attempt to simplify the provision of evidence-based care by manipulating characteristics of the intervention to make them more widely applicable to the types of clients that clinicians are likely to serve in routine care, and may represent promising opportunities for implementation research.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The common elements approach is based on the idea that evidence-supported interventions for a given disorder share many common features that contribute to their effectiveness.

“The common elements approach is predicated on the idea that ESIs for a given disorder (e.g., childhood anxiety disorders) share many common features that contribute to their effectiveness.”

• cites Barth et al., 2012Not checked yet

  Not checked in the free run.

• cites Chorpita, Becker, & Daleiden, 2007Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Grimshaw and colleagues' extensive review of guideline implementation strategies in health concluded that there was no evidence that multifaceted strategies were superior to single-component strategies.

“Grimshaw et al.’s (2006) extensive review of guideline implementation strategies in health concluded that there was no evidence that multifaceted strategies were superior to single-component strategies.”

• cites Grimshaw et al., 2006Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Transdiagnostic treatments provide unified treatment protocols for clinical disorders that have overlapping clinical features, high co-occurrence, or common maintaining mechanisms.

“Transdiagnostic treatments provide unified treatment protocols for clinical disorders that have overlapping clinical features, high levels of co-occurrence, or common maintaining mechanisms (McHugh, Murray, & Barlow, 2009).”

• cites McHugh, Murray, & Barlow, 2009Not checked yet

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Classified as probably not a substantial claim. May combine two claims.

Alexander and Hearld note that it is difficult to separate the effects of individual intervention components and to determine whether some components are more important than others.

“As Alexander and Hearld (2012) note, it is “difficult to parse out the effects of individual intervention components and determine whether some components are more important than others” (p. 4).”

• cites Alexander and Hearld, 2012Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The review did not assess risk of bias or study quality of the included studies.

“Third, we did not assess risk of bias/study quality of the included studies”

May combine two claims.

The review did not include grey literature and therefore may have missed unpublished studies that met the other inclusion criteria.

“Second, we did not include “grey literature;” thus, we may have missed unpublished studies meeting our other inclusion criteria.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A recently developed checklist based on the WIDER Recommendations may further assist implementation researchers in reporting their studies.

“A recently developed checklist based upon the WIDER Recommendations may further assist implementation researchers in reporting their studies (Albrecht, Archibald, Arseneau, & Scott, 2013).”

• cites Albrecht, Archibald, Arseneau, & Scott, 2013Not checked yet

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May combine two claims.

The review used a vote-counting approach to synthesis, which is prone to limitations but can be useful for an initial description of patterns across studies when coupled with narrative synthesis.

“We chose to use a “vote counting” approach to synthesis. This approach is prone to the limitations discussed above in the “methods of synthesis” section, but can be a useful way of providing an initial description of the patterns found across studies (Popay et al., 2006) and, coupled with the narrative approach to synthesis that we have utilized, is a useful way of summarizing included studies.”

• cites Popay et al., 2006Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The authors affirm Eccles and colleagues' call for a suite of reporting guidelines for different types of implementation research.

“Despite the utility of the WIDER Recommendations and other reporting guidelines, we also affirm Eccles et al. (2009) call for a suite of reporting guidelines for different types of implementation research.”

• cites Eccles et al., 2009Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The WIDER guidelines ask researchers to provide detailed descriptions of interventions and implementation strategies, clarify assumed change processes and design principles, provide access to manuals and protocols, and describe active control conditions in detail.

“These guidelines may be very helpful to researchers studying implementation strategies in mental health, as they implore researchers to: 1) provide detailed descriptions of interventions (and implementation strategies) in published papers, 2) clarify assumed change processes and design principles, 3) provide access to manuals and protocols that provide information about the clinical interventions”

• cites Michie et al., 2009Not checked yet

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• cites Workgroup for Intervention Development and Evaluation Research, 2008Not checked yet

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May combine two claims.

The review focused on rigorous designs that minimize threats to internal validity because its aim was to assess the effectiveness of implementation strategies.

“our focus on the effectiveness of implementation strategies compelled us to focus on rigorous designs that minimize threats to internal validity”