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Stakeholder-Generated Implementation Strategies to Promote Evidence-Based ADHD Treatment in Community Mental Health

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Abstract

Community implementation of evidence-based practices (EBPs) for Attention Deficit/Hyperactivity Disorder (ADHD) is greatly lacking. A recent randomized community-based trial of an EBP for ADHD (Supporting Teens’ Autonomy Daily; STAND) demonstrated suboptimal implementation and effectiveness outcomes. In the present study, we conducted an Innovation Tournament (IT) with agency staff stakeholders (N = 26) to identify barriers to successful implementation of STAND and implementation strategies for a revised service delivery model. We conducted member-checking of agency staff-generated ideas with parents (N = 226) and subsequent querying of additional parent (N = 226) and youth-generated (N = 205) strategies to improve care. Go-Zone plots were utilized to identify strategies with the highest feasibility and importance. Practical barriers (i.e., transportation, scheduling difficulties) and parent/youth engagement were the most commonly cited obstacles to successful implementation of STAND in community contexts. Eighteen “winning” implementation strategies were identified that survived member checking. These were classified as train and educate stakeholders (n = 5; e.g., train agency supervisors to deliver supervision, digitize treatment materials and trainings), engage consumers (n = 9; e.g., begin treatment with rapport building sessions, increase psychoeducation), provide interactive assistance (n = 2; e.g., add group supervision, increase roleplay in supervision), and use of evaluative/iterative strategies (n = 2; e.g., perform fidelity checks, supervisor review of session recordings). Parents and youth desired longer duration of treatment and increased focus on maintenance. Strategies will be developed and tested as part of a pilot effectiveness trial designed to refine STAND’s service delivery model.

Trial Registration NCT02694939 www.clinicaltrials.gov

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Funding

This trial was funded by the National Institute of Mental Health (Grant No. R01 MH106587). Dr. Sibley reports book royalties from Guilford Press for the manualized treatment described in this manuscript. This study was approved by the Florida International University Institutional Review Board and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. Informed consent was obtained from all research participants. Equator Network guidelines for reporting mixed methods research were adhered to when presenting this investigation. Drs. Sibley, Graziano, and Bickman contributed to study conceptualization and design. Drs. Sibley and Graziano, and Ms. Ortiz and Rios-Davis contributed to data coding and analysis. Drs. Sibley and Zulauf-McCurdy contributed to writing the first draft of the manuscript. All authors approved submission of the final manuscript.

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Authors and Affiliations

  1. Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

    Margaret H. Sibley & Courtney A. Zulauf-McCurdy

  2. Seattle Children’s Research Institute, Seattle, WA, USA

    Margaret H. Sibley & Mercedes Ortiz

  3. Florida International University, Miami, FL, USA

    Alexandria Rios-Davis, Paulo A. Graziano & Leonard Bickman

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  1. Margaret H. Sibley
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  2. Mercedes Ortiz
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  3. Alexandria Rios-Davis
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  4. Courtney A. Zulauf-McCurdy
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  5. Paulo A. Graziano
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  6. Leonard Bickman
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Correspondence to Margaret H. Sibley.

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Sibley, M.H., Ortiz, M., Rios-Davis, A. et al. Stakeholder-Generated Implementation Strategies to Promote Evidence-Based ADHD Treatment in Community Mental Health. Adm Policy Ment Health 49, 44–58 (2022). https://doi.org/10.1007/s10488-021-01143-5

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