An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER)
Abstract Background Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2023-11-01
|
Series: | Implementation Science Communications |
Subjects: | |
Online Access: | https://doi.org/10.1186/s43058-023-00530-3 |
_version_ | 1797452546740060160 |
---|---|
author | Emily M. Becker-Haimes Megan Brady Jesslyn Jamison Shari Jager-Hyman Megan E. Reilly Esha Patel Gregory K. Brown David S. Mandell Maria A. Oquendo |
author_facet | Emily M. Becker-Haimes Megan Brady Jesslyn Jamison Shari Jager-Hyman Megan E. Reilly Esha Patel Gregory K. Brown David S. Mandell Maria A. Oquendo |
author_sort | Emily M. Becker-Haimes |
collection | DOAJ |
description | Abstract Background Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use is a compelling but untested approach to improving the implementation of suicide prevention evidence-based practices (EBPs). This project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot test an exposure-based implementation strategy (EBIS) to target clinician anxiety to improve suicide prevention EBP implementation. Methods We will develop, iteratively refine, and pilot test an EBIS paired with implementation as usual (IAU; didactic training and consultation) in preparation for a larger study of the effect of this strategy on reducing clinician anxiety, improving self-efficacy, and increasing use of the Columbia Suicide Severity Rating Scale and the Safety Planning Intervention in outpatient mental health settings. Aim 1 of this study is to use participatory design methods to develop and refine the EBIS in collaboration with a stakeholder advisory board. Aim 2 is to iteratively refine the EBIS with up to 15 clinicians in a pilot field test using rapid cycle prototyping. Aim 3 is to test the refined EBIS in a pilot implementation trial. Forty community mental health clinicians will be randomized 1:1 to receive either IAU or IAU + EBIS for 12 weeks. Our primary outcomes are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics. Secondary outcomes are the engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to implementation) and preliminary effectiveness of EBIS on implementation outcomes (adoption and fidelity) assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). Discussion Outcomes from this study will yield insight into the feasibility and utility of directly targeting clinician anxiety and self-efficacy as mechanistic processes informing the implementation of suicide prevention EBPs. Results will inform a fully powered hybrid effectiveness-implementation trial to test EBIS’ effect on implementation and patient outcomes. Trial registration Clinical Trials Registration Number: NCT05172609 . Registered on 12/29/2021. |
first_indexed | 2024-03-09T15:09:15Z |
format | Article |
id | doaj.art-d4f4d26ae3124a77b504fce2049bb8df |
institution | Directory Open Access Journal |
issn | 2662-2211 |
language | English |
last_indexed | 2024-03-09T15:09:15Z |
publishDate | 2023-11-01 |
publisher | BMC |
record_format | Article |
series | Implementation Science Communications |
spelling | doaj.art-d4f4d26ae3124a77b504fce2049bb8df2023-11-26T13:28:55ZengBMCImplementation Science Communications2662-22112023-11-014111310.1186/s43058-023-00530-3An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER)Emily M. Becker-Haimes0Megan Brady1Jesslyn Jamison2Shari Jager-Hyman3Megan E. Reilly4Esha Patel5Gregory K. Brown6David S. Mandell7Maria A. Oquendo8Department of Psychiatry, University of Pennsylvania Perelman School of MedicineDepartment of Psychiatry, University of Pennsylvania Perelman School of MedicineDepartment of Psychiatry, University of Pennsylvania Perelman School of MedicineDepartment of Psychiatry, University of Pennsylvania Perelman School of MedicineDepartment of Psychiatry, University of Pennsylvania Perelman School of MedicineDepartment of Psychiatry, University of Pennsylvania Perelman School of MedicineDepartment of Psychiatry, University of Pennsylvania Perelman School of MedicineDepartment of Psychiatry, University of Pennsylvania Perelman School of MedicineDepartment of Psychiatry, University of Pennsylvania Perelman School of MedicineAbstract Background Clinicians often report that their own anxiety and low self-efficacy inhibit their use of evidence-based suicide prevention practices, including gold-standard screening and brief interventions. Exposure therapy to reduce clinician maladaptive anxiety and bolster self-efficacy use is a compelling but untested approach to improving the implementation of suicide prevention evidence-based practices (EBPs). This project brings together an interdisciplinary team to leverage decades of research on behavior change from exposure theory to design and pilot test an exposure-based implementation strategy (EBIS) to target clinician anxiety to improve suicide prevention EBP implementation. Methods We will develop, iteratively refine, and pilot test an EBIS paired with implementation as usual (IAU; didactic training and consultation) in preparation for a larger study of the effect of this strategy on reducing clinician anxiety, improving self-efficacy, and increasing use of the Columbia Suicide Severity Rating Scale and the Safety Planning Intervention in outpatient mental health settings. Aim 1 of this study is to use participatory design methods to develop and refine the EBIS in collaboration with a stakeholder advisory board. Aim 2 is to iteratively refine the EBIS with up to 15 clinicians in a pilot field test using rapid cycle prototyping. Aim 3 is to test the refined EBIS in a pilot implementation trial. Forty community mental health clinicians will be randomized 1:1 to receive either IAU or IAU + EBIS for 12 weeks. Our primary outcomes are EBIS acceptability and feasibility, measured through questionnaires, interviews, and recruitment and retention statistics. Secondary outcomes are the engagement of target implementation mechanisms (clinician anxiety and self-efficacy related to implementation) and preliminary effectiveness of EBIS on implementation outcomes (adoption and fidelity) assessed via mixed methods (questionnaires, chart-stimulated recall, observer-coded role plays, and interviews). Discussion Outcomes from this study will yield insight into the feasibility and utility of directly targeting clinician anxiety and self-efficacy as mechanistic processes informing the implementation of suicide prevention EBPs. Results will inform a fully powered hybrid effectiveness-implementation trial to test EBIS’ effect on implementation and patient outcomes. Trial registration Clinical Trials Registration Number: NCT05172609 . Registered on 12/29/2021.https://doi.org/10.1186/s43058-023-00530-3Clinician anxietyImplementationEvidence-based implementation strategyExposure therapySuicide prevention |
spellingShingle | Emily M. Becker-Haimes Megan Brady Jesslyn Jamison Shari Jager-Hyman Megan E. Reilly Esha Patel Gregory K. Brown David S. Mandell Maria A. Oquendo An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER) Implementation Science Communications Clinician anxiety Implementation Evidence-based implementation strategy Exposure therapy Suicide prevention |
title | An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER) |
title_full | An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER) |
title_fullStr | An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER) |
title_full_unstemmed | An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER) |
title_short | An exposure-based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence-based practices: protocol for development and pilot testing (Project CALMER) |
title_sort | exposure based implementation strategy to decrease clinician anxiety about implementing suicide prevention evidence based practices protocol for development and pilot testing project calmer |
topic | Clinician anxiety Implementation Evidence-based implementation strategy Exposure therapy Suicide prevention |
url | https://doi.org/10.1186/s43058-023-00530-3 |
work_keys_str_mv | AT emilymbeckerhaimes anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT meganbrady anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT jesslynjamison anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT sharijagerhyman anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT meganereilly anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT eshapatel anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT gregorykbrown anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT davidsmandell anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT mariaaoquendo anexposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT emilymbeckerhaimes exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT meganbrady exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT jesslynjamison exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT sharijagerhyman exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT meganereilly exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT eshapatel exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT gregorykbrown exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT davidsmandell exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer AT mariaaoquendo exposurebasedimplementationstrategytodecreasecliniciananxietyaboutimplementingsuicidepreventionevidencebasedpracticesprotocolfordevelopmentandpilottestingprojectcalmer |