Current Research and Scholarly Interests
The overarching goal of my program of research is to determine how to facilitate the high quality delivery of evidence-based psychosocial interventions (EBPs) in public sector mental health settings. Areas of emphasis include training and consultation, treatment fidelity and adaptation, and the identification of strategies that promote sustained implementation of EBPs.
I have been interested in developing and studying strategies to promote the implementation and sustained use of EBPs in public sector settings. My research group’s systematic review of research on sustainability suggested that EBPs are often fully or partially discontinued a short time after they are introduced into routine care settings. Identification of factors associated with sustained implementation is therefore an important step in promoting the long-term success of implementation efforts. Through my recently completed K99/R00 award, I used qualitative and quantitative methods to examine system, organizational, clinician, and patient-level influences on the long-term trajectory of clinicians’ use of cognitive therapy.
The degree of fidelity (adherence to the protocol and skill of delivery) with which EBPs are delivered, and adaptations to EBPs made in routine care, are key implementation outcomes. Without time- and cost-intensive direct observation, these outcomes are difficult to assess. Colleagues and I recently published studies that demonstrated that self-reported checklists of fidelity and coding of worksheets used in cognitive therapies can be used as scaleable and reliable alternatives.
As a first step toward understanding the implications of different types of adaptations to EBPs, my colleagues and I also developed a framework for identifying and classifying adaptations that are made to EBPs in routine care. This framework makes it possible to determine whether specific types of adaptations lead to different clinical or implementation outcomes. Using the framework, we have identified evidence that clinicians do make changes to EBPs in their own practice, and that certain clinician characteristics predict the use of adaptations that are inconsistent with the protocol.
While the work described above is based on observation of implementation efforts and has laid important groundwork for future research, my larger goal is to develop and test strategies to facilitate high-quality implementation of EBPs in routine care settings. Beyond the growing recognition that workshops, web-based trainings, and manuals alone are insufficient, little is known about strategies to train and prepare clinicians to deliver EBPs with fidelity in public sector mental health settings. My collaborators and I conducted a hybrid implementation/effectiveness RCT that comparing consultation alone, consultation combined with observation, and a fidelity-monitoring alone strategy for training clinicians to deliver Cognitive Processing Therapy (CPT) for PTSD. Next, we studied ways to sustain the use of EBPs after initial training and implementation, comparing a fidelity-oriented learning collaborative strategy to a continuous quality improvement-oriented learning collaborative to support the ongoing use of an EBP in three large mental health systems.
My most recent projects also employ digital mental health and artificial intelligence strategies to increase access to evidence-based interventions. I worked with a team at Stanford to develop Pause a Moment (pam.stanford.edu), a web-based program to support well-being and stress management for healthcare workers and other individuals who experience high levels of stress and/or trauma. I am also working with colleagues to develop and test large-language model-based strategies to support EBP implementation plans, therapist training and skill development, and client use of key therapy skills between sessions.
