Cited by 268Health Policy Implementation SciencePsychotherapy Techniques and ApplicationsPsychiatric care and mental health services

The DOI matches its Crossref record; 118 of the 120 references it cites were found in a registry or an index; 1 of the 102 sources its claims cite were checked for support.

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

Open access
Powell, Byron J., Proctor, Enola K., Glass, Joseph E.·2014·Research on Social Work Practice

Abstract

Objective: This systematic review examines experimental studies that test the effectiveness of strategies intended to integrate empirically supported mental health interventions into routine care settings. Our goal was to characterize the state of the literature and to provide direction for future implementation studies. Method: A literature search was conducted using electronic databases and a manual search. Results: Eleven studies were identified that tested implementation strategies with a randomized ( n = 10) or controlled clinical trial design ( n = 1). The wide range of clinical interventions, implementation strategies, and outcomes evaluated precluded meta-analysis. However, the majority of studies ( n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome. Conclusion: There is a clear need for more rigorous research on the effectiveness of implementation strategies, and we provide several suggestions that could improve this research area.

Overview

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review characterizes 11 experimental studies testing strategies to implement empirically supported mental health interventions into routine care. Most included studies were randomized (10/11) and tested multifaceted strategies (10/11), but heterogeneity precluded meta-analysis; 7 of 11 studies (64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome.

Key findings

  • Eleven studies met inclusion criteria: 10 RCTs and 1 controlled clinical trial. Eight focused on child/adolescent mental health and three on adult mental health. The majority (n = 7; 64%) found a statistically significant effect in the hypothesized direction for at least one implementation or clinical outcome; all studies except Azocar et al. (2003) provided at least some support for the implementation strategies used.
  • Only one study evaluated a discrete strategy (guideline dissemination), while 10 (91%) evaluated multifaceted strategies; nine of those included training. Only Glisson et al. (2010) evaluated a blended, manualized strategy (ARC). Passive strategies in isolation—such as disseminating guidelines or manuals and using opinion leaders—were ineffective.
  • CFIR domains targeted by implementation strategies were: characteristics of individuals (100%, n = 11), inner setting (82%, n = 9), process of implementation (64%, n = 7), outer setting (55%, n = 6), and intervention characteristics (45%, n = 5). Mean domains addressed was 3.45 (range = 2–5) and mean subdomains was 9.73 (range = 4–20); there was no clear relationship between number of domains/subdomains and effectiveness.
  • Ninety-one percent of studies (n = 10) evaluated at least one implementation or service system outcome, 36% (n = 4) evaluated clinical outcomes in addition, and 9% (n = 1) evaluated only clinical outcomes. Fidelity and provider attitudes/satisfaction were most frequent; only one study assessed costs (Kauth et al., 2010: $2,458.80 total cost for approximately 28 additional hours of CBT per month per therapist). Mean implementation/service system outcomes assessed was 2.09 (SD = 1.30); mean client outcomes was .82 (SD = 1.33).

Methods

  • Systematic review searching CINAHL Plus, Medline, PubMed, PsycINFO, and SocINDEX on January 4, 2011, plus hand searches. The search identified 501 abstracts (492 database, 9 hand search), 25 full-text articles were screened, and 11 met inclusion criteria.
  • Inclusion required empirical research implementing an empirically supported psychosocial treatment or practice guideline in mental health or social service systems, with both an implementation strategy and a comparative design meeting EPOC standards (RCT, CCT, controlled before-and-after, or interrupted time series). Studies focused primarily on physical health, substance abuse, pharmacological interventions, or testing clinical intervention efficacy/effectiveness were excluded.
  • At least two reviewers independently extracted data using a modified Cochrane EPOC Data Abstraction Form, a Proctor et al. (2009)-guided outcomes checklist, and a CFIR-based checklist for strategy targets. No inter-rater reliability statistics were calculated; discrepancies were resolved through consensus meetings. Synthesis used tabulation, textual description, and vote-counting because meta-analysis was precluded.

Limitations

  • The paper states that the small number of studies and diverse clinical interventions, implementation strategies, and outcomes made firm conclusions difficult; vote-counting gives equal weight to studies of varying sample sizes, effect sizes, and significance levels. It also states that grey literature was excluded, risk of bias/study quality was not assessed, reporting bias may have led to underestimating CFIR domains/subdomains addressed, the focus on rigorous designs limits learning from other designs, and the conceptual frameworks used have not been fully established empirically.
  • Evident from the text: no meta-analysis was possible, no inter-rater reliability statistics were calculated, coding reliability was difficult particularly for CFIR domains, and only one included study evaluated implementation costs.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1177/1049731513505778

Cites

118 of 118 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

73 Not checked yet · 42 Own result · 17 Own interpretation · 14 Own method · 7 No basis given · 1 Couldn’t confirm · accuracy not yet measured

Verify all 101 references — free account

Show all 84 claims

  • It may state two separate claims as one. 36
  • Probably not a substantial claim. 40
  • The quote only partly states this claim. 1
70 of 70
  • The 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.

    “We assumed a treatment to be “empirically supported” if the authors cited evidence that supported its efficacy or effectiveness.”
  • The paper relies on this without support.

    The published trial reports included in the review adequately disclose the theories or conceptual models that guided the studies, so that the review's assessment of theory use is not substantially limited by undisclosed theoretical foundations.

    “We do acknowledge that our systematic review was focused on the discussion of theory within the published trial, yet it is possible that the theoretical foundation of the implementation intervention was discussed elsewhere.”
  • The paper relies on this without support.

    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.

    “It is also possible that counting the number of CFIR domains addressed is a limited proxy for the intensity and comprehensives of the strategies.”
  • The paper relies on this without support.

    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.

    “Third, we did not assess risk of bias/study quality of the included studies”
4 of 4

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Citations

Cites

Research works printed but not linked: 11

  1. References marked with an asterisk indicate studies included in the systematic review.
  2. *Chamberlain P., 2008, Child Welfare, 87, 27
  3. Cochrane Effective Practice and Organisation of Care Group. (2002a). Data collection checklist (pp. 1–30). Retrieved from http://epoc.cochrane.org/sites/epoc.cochrane.org/files/uploads/datacollectionchecklist.pdf
  4. Gibbs L. E., 2003, Evidence-based practice for the helping professions
  5. Goldner E. M., 2011, Healthcare Policy, 7, 83
  6. Institute of Medicine, 2007, The state of quality improvement and implementation research: Workshop summary
  7. *Kauth M. R., 2010, Implementation Science, 5, 1, 10.1186/1748-5908-5-1 · DOI · Paper page
  8. National Institute of Mental Health, 2008, National Institute of Mental Health strategic plan
  9. Oxman A. D., 1995, Canadian Medical Association Journal, 153, 1424
  10. President’s New Freedom Commission on Mental Health, 2003, Achieving the promise: Transforming mental health care in America: Final report
  11. Wensing M., 2009, Knowledge translation in health care: Moving from evidence to practice, 94

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Metadata

Authors
Powell, B. J., Proctor, E. K., & Glass, J. E.
Affiliations
  • Washington University in St. Louis (US)
  • University of Wisconsin–Madison (US)
Corresponding author
Powell, Byron J.
Venue
Research on Social Work Practice
Published
2013-10-08
Volume
24
Issue
2
Pages
192-212
ISSN
  • 1049-7315 (ISSN-L)
  • 1552-7581
OpenAlex
W2046149030
Cited by
268
References
120
Citations by year
2026: 8 · 2025: 22 · 2024: 24 · 2023: 20 · 2022: 31 · 2021: 38 · 2020: 28 · 2019: 18 · 2018: 19 · 2017: 19 · 2016: 15 · 2015: 25 · 2014: 1
FWCI
1.65
Type
journal article
Language
en
Open access
Locations
  • Research on Social Work Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health (UL1TR000448, TL1TR000449, 5p30mh068579-05)
  • National Institute on Alcohol Abuse and Alcoholism (F31AA021034)
  • National Institute of Mental Health (P30-MH-068579, F31MH098478, T32MH019960)
  • National Institute on Drug Abuse (T32DA015035)
  • National Center for Research Resources (TL1RR024995, UL1RR024992)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
implementation strategies, empirically supported treatments, mental health interventions, implementation research, intervention effectiveness, mental health services

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