Guideline evaluation and implementation mechanisms in school health services (GuideMe): protocol for a hybrid randomized factorial trial.

BACKGROUND: Norwegian school health services received a national best-practice guideline in 2017. To promote healthy life skills and identify adolescents needing support, the guideline includes strong recommendations for individual consultations with all 8th graders and increased collaboration with schools. To help implement the recommendations, a blended implementation strategy (SchoolHealth) was co-created with school nurses, students, and stakeholders. SchoolHealth consists of three implementation elements: Digital dialog and administration tool (audit and feedback +), Dialog support (external consultation), and Collaboration materials (targeted dissemination). This hybrid study will test the main and combined effects of the elements on guideline fidelity and effectiveness. METHODS: The GuideMe study is a factorial cluster randomized controlled trial examining SchoolHealth's effectiveness on guideline fidelity and guideline effectiveness goals. Forty Norwegian secondary schools will be randomized to eight different combinations of the elements in SchoolHealth. Participants will include school nurses and school personnel from these schools, and 8th grade students (n = 1200). Primary outcomes are school nurses' fidelity to the guidelines and student's ability to cope with their life (i.e., health literacy, positive health behaviors and self-efficacy). Quantitative methods will be used to test effects and mechanisms, while mixed- and qualitative methods will be used to explore mechanisms, experiences, and other phenomena in depth. Participants will complete digital questionnaires at the start and end of the schoolyear, and after the consultation during the schoolyear. The study will run in two waves, each lasting for one school year. The multifactorial design allows testing of interactions and main effects due to equal distribution of all factors within each main effect. Sustainment and scale-up of optimized SchoolHealth elements using national infrastructure are simultaneously prepared. DISCUSSION: The study will investigate possible effects of the implementation elements in isolation and in combination, and hypothesized implementation mechanisms. In-depth study of user experiences will inform improvements to elements in SchoolHealth. The results will yield causal knowledge about implementation strategies and the mechanisms through which they assert effects. Mixed-methods will provide insights into how and when the elements work. Optimizing guideline implementation elements can support adolescents in a crucial life phase. TRAIL REGISTRATION: ISRCTN24173836. Registration date 8 August 2022.

Process and Implementation Elements of Measurement Feedback Systems: A Systematic Review.

Measurement feedback systems (MFS) can help guide treatment and improve clinical outcomes. Studies of MFS are heterogeneous both in execution and results, and the effects of MFS seem restricted by limited attention to process and implementation elements and by limited adoption by health professionals. The current systematic review mapped the use of process and implementation elements in MFS studies. An overview of therapists' use of and attitudes toward MFS is provided. Three-level meta-analyses were used to test theoretically informed process and implementation elements as moderators of the effects of MFS. Hypotheses and general propositions from Clinical Performance Feedback Intervention Theory (CP-FIT) were used to organize the elements of the studies and were used as moderator variables. Previous studies on MFS interventions have had a limited focus on implementation efforts and process elements that may increase the effects of MFS and their use among therapists. Efforts have sparsely been made to reduce barriers to MFS use, and several studies have reported limited engagement with MFS among therapists. Therapists' attitudes toward MFS, feedback, or standardized measures were heterogeneously reported, making data synthesis challenging. Identified process and implementation elements were not significantly associated with effect sizes in the studies and the results did not support the propositions of CP-FIT. The lack of statistically significant associations may be due to limited reporting of details about process and implementation aspects. More research designed to test hypotheses regarding process and implementation elements is needed to improve the use and effects of MFS. Future studies should aspire to report findings in a manner that allows for an understanding of the implementation process and therapists' adoption of these systems.

Common Elements of Practice, Process and Implementation in Out-of-School-Time Academic Interventions for At-risk Children: a Systematic Review.

Academic achievement is a strong preventive factor against marginalization. Children at risk of academic failure and drop out can benefit from out-of-school-time academic (OSTA) interventions. Wide-scaled implementation and sustainment of effective interventions remain a struggle across education, welfare, and health. The need for approaches to increase implementability, effectiveness, and efficiency of interventions is pressing. Advancements in the field of education and mental health suggest identifying and studying discrete elements that are common across interventions for the purpose of hypothesis generation, intervention optimization, design improvement, and implementation. This review identified OSTA interventions for primary school children at risk of academic failure. Common elements methodology was used to code practice elements (n = 62), process elements (n = 49), and implementation elements (n = 36) in 30 effective and six ineffective OSTA interventions in matrices. Based on frequency counts, common practice, process, and implementation elements across the interventions were identified, and given frequency count values (FV) reflecting how often elements were included in effective studies as opposed to in ineffective studies. The five common practice elements with the highest FVs were homework support, training in positive parental school involvement, positive reinforcement, structured tutoring, and psychoeducation. The most common process element was regular support to intervention receiver, and the most common implementation element was quality monitoring. Common combinations of elements were also identified and given FVs. Results from this review can inform efforts to design or optimize OSTA interventions, and inform education, implementation, and practice to improve academic achievement for children at risk.

Common Elements Approaches to Implementation Research and Practice: Methods and Integration with Intervention Science.

We propose that common elements approaches can advance implementation research and practice and facilitate pragmatic use of intervention and implementation evidence. Common elements are practices or processes frequently shared by interventions or implementations. Traditional common elements methodologies use synthesis, distillation, and statistics to describe and evaluate the merit of common ingredients in effective interventions. Recent developments include identifying and testing common configurations of elements, processes, and context variables across the literature of effective interventions and implementations. While common elements thinking has grown popular in intervention science, it has rarely been utilized in implementation science, and specifically, combined with the intervention literature. The goals of this conceptual methodology paper are to (1) provide an overview of the common elements concept and how it may advance implementation research and usability for practice, (2) give a step-by-step guide to systematic common elements reviews that synthesizes and distills the intervention and implementation literature together, and (3) offer recommendations for advancing element-level evidence in implementation science. A narrative review of the common elements literature was conducted with attention to applications to implementation research. A six-step guide to using an advanced common elements methodology was provided. Examples of potential results are presented, along with a review of the implications for implementation research and practice. Finally, we reviewed methodological limitations in current common elements approaches, and identified steps towards realizing their potential. Common elements methodologies can (a) synthesize and distill the implementation science literature into practical applications, (b) generate evidence-informed hypotheses about key elements and determinants in implementation and intervention processes and mechanisms, and (c) promote evidence-informed precision tailoring of intervention and implementation to context. To realize this potential, common elements approaches need improved reporting of details from both successful and unsuccessful intervention and implementation research, more data availability, and more testing and investigation of causal processes and mechanisms of change from diverse theories. Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-023-00077-4.

Proceedings from the Second Annual Conference of the Norwegian Network for Implementation Research.

In 2019, Norwegian implementation researchers formed a network to promote implementation research and practice in the Norwegian context. On November 19th, 2021, the second annual Norwegian implementation conference was held in Oslo. Ninety participants from all regions of the country gathered to showcase the frontiers of Norwegian implementation research. The conference also hosted a panel discussion about critical next steps for implementation science in Norway. The conference included 17 presentations from diverse disciplines within health and welfare services, including schools. The themes presented included stakeholder engagement, implementation mechanisms, evaluations of the implementation of specific interventions, the use of implementation guidelines and frameworks, the development and validation of implementation measurements, and barriers and facilitators for implementation. The panel discussion highlighted several critical challenges with the implementation of evidence-informed practices in Norway, including limited implementation competence and capacity among practice leaders and workforces, few opportunities for education in implementation science, limited implementation research in the Norwegian context, scarce funding possibilities for implementation research, and a lack of long-term perspectives on implementation processes. Overall, the 2021 Norwegian implementation conference showed an encouraging sign of a maturing field of science in Norway. The more voluminous proceedings from the 2020 conference called for several important advancements to improve implementation science and practice in Norway, and the 2021 conference indicates that steps have already been taken in favorable directions in terms of, for instance, research designs and measurements. However, there are still unexploited potentials for improvements in implementation research, funding, policies, and practice. Norwegian implementation researcher should be mindful of the challenges and potential pitfalls implementation science currently face as a scientific discipline. Supplementary Information: The online version contains supplementary material available at 10.1007/s43477-022-00069-w.

Leveraging implementation science to reduce inequities in Children's mental health care: highlights from a multidisciplinary international colloquium.

BACKGROUND AND PURPOSE: Access to evidence-based mental health care for children is an international priority. However, there are significant challenges to advancing this public health priority in an efficient and equitable manner. The purpose of this international colloquium was to convene a multidisciplinary group of health researchers to build an agenda for addressing disparities in mental health care access and treatment for children and families through collaboration among scholars from the United States and Europe engaged in innovative implementation science and mental health services research. KEY HIGHLIGHTS: Guided by the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework, presentations related to inner, outer, and bridging context factors that impact the accessibility and quality of mental health evidence-based practices (EBPs) for children and families. Three common topics emerged from the presentations and discussions from colloquium participants, which included: 1) the impact of inner and outer context factors that limit accessibility to EBPs across countries, 2) strategies to adapt EBPs to improve their fit in different settings, 3) the potential for implementation science to address emerging clinical and public health concerns. IMPLICATIONS: The common topics discussed underscored that disparities in access to evidence-based mental health care are prevalent across countries. Opportunities for cross-country and cross-discipline learnings and collaborations can help drive solutions to address these inequities, which relate to the availability of a trained and culturally appropriate workforce, insurance reimbursement policies, and designing interventions and implementation strategies to support sustained use of evidence-based practices.

Knowledge translation in child welfare-improving educational outcomes for children at risk: study protocol for a hybrid randomized controlled pragmatic trial.

BACKGROUND: In Norway, a disproportionately high number of children receiving Child Welfare Services (CWS) struggle academically and drop out of school. Academic attainment is one of the strongest protective factors against societal marginalization. The present study is part of a knowledge translation project in collaboration with local CWS with the aim to develop, implement, and evaluate Enhanced Academic Support (EAS) for primary school children in CWS. METHODS/DESIGN: The study is a mixed-methods hybrid type 2 randomized, controlled pragmatic trial. The participants are approximately 120 children whose families receive support measures from three child welfare agencies in and around Oslo, Norway, and practitioners from these agencies. Families are randomly assigned to either the EAS condition or "business as usual" support. Primary outcomes are math and reading skills, parental involvement in school, and intervention fidelity. Questionnaires and academic tests are administered at baseline, post-intervention (after 6 months), and at follow-up (after 12 months). Implementation drivers are assessed before and after the trial period, and intervention fidelity is monitored during the trial through checklists and structured telephone interviews. Semi-structured interviews and focus groups are conducted after the trial. DISCUSSION: This hybrid study has two implications. (1) The effects of providing EAS to children in child welfare will be investigated. The study also explores how each core component of the intervention and the use of specific adaptations, implementation drivers, and other important child-level covariates moderate the overall effects. The results can provide valuable knowledge about how to deliver precise and effective academic support to increase academic skills and prevent dropout. In turn, this can promote academic completion and well-being, outcomes that are beneficial for both children and society at large. (2) The study also evaluates the feasibility of applying an Integrated Knowledge Translation model designed to develop, implement, and evaluate research-supported practice in health, care, and welfare services in less time than is usually the case. If deemed successful, this model will provide an efficient collaborative approach to translate the best available evidence into effective evidence-based practice, applicable in effectiveness research and quality improvement efforts. TRIAL REGISTRATION: ISRCTN, ISRCTN38968073 . Registered on 18 September 2017. https://doi.org/10.1186/ISRCTN38968073 .