Implementing measurement-based care (iMBC) for depression in community mental health: a dynamic cluster randomized trial study protocol.
BACKGROUND
Measurement-based care is an evidence-based practice for depression that efficiently identifies treatment non-responders and those who might otherwise deteriorate [1]. However, measurement-based care is underutilized in community mental health with data suggesting fewer than 20 % of behavioral health providers using this practice to inform treatment. It remains unclear whether standardized or tailored approaches to implementation are needed to optimize measurement-based care fidelity and penetration. Moreover, there is some suggestion that prospectively tailored interventions that are designed to fit the dynamic context may optimize public health impact, though no randomized trials have yet tested this notion [2]. This study will address the following three aims: (1) To compare the effect of standardized versus tailored MBC implementation on clinician-level and client-level outcomes; (2) To identify contextual mediators of MBC fidelity; and (3) To explore the impact of MBC fidelity on client outcomes.


METHODS
This study is a dynamic cluster randomized trial of standardized versus tailored measurement-based care implementation in Centerstone, the largest provider of community-based mental health services in the USA. This prospective, mixed methods implementation-effectiveness hybrid design allows for evaluation of the two conditions on both clinician-level (e.g., MBC fidelity) and client-level (depression symptom change) outcomes. Central to this investigation is the focus on identifying contextual factors (e.g., attitudes, resources, process, etc.) that mediate MBC fidelity and optimize client outcomes.


CONCLUSIONS
This study will contribute generalizable and practical strategies for implementing systematic symptom monitoring to inform and enhance behavioral healthcare.


BACKGROUND
Clinicaltrials.gov NCT02266134 .
Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St, Bloomington, IN, 47405, USA. lewiscc@indiana.edu.|Department of Psychiatry and Behavioral Sciences, University of Washington, School of Medicine, Harborview Medical Center, School of Medicine, University of Washington, 325 9th Ave, Box 359911, Seattle, WA, 98104, USA. lewiscc@indiana.edu.
Cara C
CC
Lewis
Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St, Bloomington, IN, 47405, USA. scottks@indiana.edu.
Kelli
K
Scott
Abacist Analytics, PO Box 11581, Austin, TX, 78711, USA. nmarti@abacist-analytics.com.
C Nathan
CN
Marti
Department of Psychological and Brain Sciences, Indiana University, 1101 E. 10th St, Bloomington, IN, 47405, USA. brmarrio@indiana.edu.
Brigid R
BR
Marriott
Regenstrief Institute for Health Care, RG-6, 1050 Wishard Blvd., Indianapolis, IN, 46202, USA. kkroenke@indiana.edu.
Kurt
K
Kroenke
Centerstone Research Institute, 645 S. Rogers Street, Bloomington, IN, 47403, USA. john.putz@centerstone.org.
John W
JW
Putz
, 1776 Main Street Santa Monica, Box 359911, California, 90401, USA. mendel@rand.org.
Peter
P
Mendel
W.W. Wright Education Building Indiana University, Bloomington, IN, 47405, USA. drutkows@indiana.edu.
David
D
Rutkowski
D000328:Adult; D002985:Clinical Protocols; D003156:Community Mental Health Services / Q000379:methods*; D003863:Depression / Q000628:therapy*; D006801:Humans; D016730:Program Development; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome