Description of Research Initiative

We have had the pleasure of supporting governments of New Brunswick (NB), Prince Edward Island (PEI), and Newfoundland & Labrador in their efforts working towards implementing core components of provincial stepped care models for the delivery of mental health and addiction services. Provinces of NB and PEI started by implementing one-at-a-time therapy (i.e., Single Session Therapy) across the province in an attempt to facilitate rapid access to care.

In consultation with international content experts, Stepped Care Solutions created asynchronous training courses in one-at-a-time therapy and Stepped Care 2.0. Mental healthcare providers (e.g., social workers, psychologists, nurses, counselors), primary-care providers, community partners, and system administrators in partnering provinces (i.e., NL, NB & PEI) were eligible to receive training in one-at-a-time therapy and Stepped Care 2.0. Our team supported the implementation of one-at-a-time therapy and evaluated impacts

Results: Provider perceptions of implementing stepped care

We conducted a mixed-methods observational implementation study. Surveys were completed after training courses, open-ended responses were collected after completion of SC2.0 training, and a subset of providers who completed surveys were asked to participate in semi-structured interviews. 316 providers completed surveys and responded to open-ended prompts. Interviews were completed with 28 of those providers. Stepped Care 2.0 (SC2.0) was deemed to be acceptable, a suitable fit, and feasible to implement. Perceived benefits included: (1) timely access to services; (2) increased practice efficiency; and (3) increased availability of services. Perceived barriers included: (1) insufficient availability of resources to populate a SC2.0 continuum of care; (2) provider complacency with their current practice; and (3) difficulty for clients to accept and adjust to change. Conclusions Identifying the perceived benefits, facilitators, and barriers to adopting stepped care in practice can lead to targeted implementation strategies and the collection of data that can inform continuous improvement cycles.

Citation: King, A., Harris-Lane, L. M., Bérubé, S., Burke, K., Churchill, A., Cornish, P., … & Rash, J. A. (2023). Provider perceptions of the anticipated benefits, barriers, and facilitators associated with implementing a stepped care model for the delivery of addiction and mental health services in New Brunswick: a mixed-methods observational implementation study. International Journal of Mental Health Systems, 17(1), 40.

Results: Implementing One-At-A-Time Therapy in Adult Services

The process of implementing One-At-A-Time (OAAT) therapy within Community Addiction and Mental Health Clinics (CAMHCs) was documented and retrospectively aligned with the Active Implementation Frameworks-Stages of Implementation, Consolidated Framework for Implementation Research, and incorporated strategies endorsed by the Expert Recommendations for Implementing Change. Providers working in CAMHCs completed online asynchronous courses in OAAT therapy and SC2.0, and were recruited to participate in research on perceptions of organizational readiness. Initial outcomes of the implementation were evaluated through client satisfaction surveys administered in CAMHCs and system performance indicators.

Aligning with implementation stages, key strategies included: 1) continuously monitoring readiness and soliciting stakeholder feedback for iterative improvement; 2) building a representative implementation team with engaged leaders; 3) creating a comprehensive implementation plan on staff training, communication, and system changes; and 4) supporting sustainability. Providers who participated in research (N = 170, ~ 50% response rate) agreed that their organization was ready for implementation, and that OAAT therapy delivered within a SC2.0 framework was acceptable, appropriate, and feasible. More than 3,600 OAAT therapy sessions were delivered.

Citation: Harris-Lane, L. M., Keeler-Villa, N. R., Bol, A., Burke, K., Churchill, A., Cornish, P., … & Rash, J. A. (2023). Implementing One-at-a-Time Therapy in community addiction and mental health centres: a retrospective exploration of the implementation process and initial outcomes. BMC Health Services Research, 23(1), 982.

Results: Implementing One-At-A-Time Therapy in Child & Youth Services

Providers were recruited to participate in research associated with the system change, and completed surveys to assess readiness for implementation. Client satisfaction and system-outcomes were measured through surveys and system indicators, respectively. Key implementation considerations included age of consent for services, implementation within an integrated service delivery model, and mapping the client journey to conceptualize changes in service delivery. Providers (N = 214) felt that OAAT therapy was acceptable and appropriate to implement into practice, and would lead to observable short-term outcomes. During the implementation (April–December 2022), 2266 sessions were delivered, resulting in a 62% waitlist reduction. Most clients who completed the satisfaction survey (N = 518) reported benefit. This study elucidates the successful implementation of OAAT therapy for children and youth, and can serve as a heuristic for comparable practice change initiatives.

Citation: Harris-Lane, L. M., King, A. C., Bérubé, S., Burke, K., Churchill, A., Cornish, P., … & Rash, J. A. (2024). Improving access to child and youth addiction and mental health services in new Brunswick: Implementing one-at-a-time therapy within an integrated service delivery model. International Journal of Mental Health and Addiction, 1-22.

Results: Exploring Determinants of Effective Implementation from the Perspective of Champions

We conducted interviews to understand determinants of implementation from program champions. Champions of the OAAT therapy implementation (N = 19; Child/Youth n = 8, Adult n = 11) working within A&MH services and school districts were recruited through the provincial implementation team. Transcripts were synthesized using thematic analysis. Determinants were organized as facilitators and barriers in accordance with the Consolidated Framework for Implementation Research (CFIR). Thematic analysis resulted in 18 themes and 5 recommendations. Facilitators within the inner setting included: (1) need for change and perceived benefits of OAAT therapy; (2) compatibility of OAAT therapy with previous practice and service processes; and (3) support received from champions and colleagues. Insufficient resources (e.g., staff and physical infrastructure), and a culture that favored long-term therapy were barriers. Navigating age of consent, and implementation around COVID-19 were barriers within the outer setting. Facilitators within the implementation process domain included: (1) interconnected teams across sites, regions and the province; (2) collaborative implementation planning; (3) flexibility to tailor implementation at sites; and (4) mentorship provided by champions. Insufficient standardization of the implementation and limited representation among affected parties (e.g., community partners) were barriers within the implementation process.

Citation: Keeler-Villa, N. R., Beaulieu, D., Harris-Lane, L. M., Bérubé, S., Burke, K., Churchill, A., … & Rash, J. A. (2024). Exploring Determinants of Effective Implementation of an Innovation Within Health Care: Qualitative Insights from Program Champions on Implementing One-at-a-Time Therapy Within Addictions and Mental Health Services in New Brunswick. Administration and Policy in Mental Health and Mental Health Services Research, 1-23.

 

Infographics can be located for: 1) readiness to implement stepped mental healthcare in practice; and 2) initial impacts of One-at-a-time therapy services on clinics throughout New Brunswick.