JMIR Publications

ABSTRACT

Background:

Although substantial progress has been made in establishing evidence-based psychosocial clinical interventions and implementation strategies (CIs/ISs) for mental health, translating this research into practice—especially in more accessible, community settings—has been slow. We outline our protocol for the renewal of the National Institute of Mental Health-funded University of Washington ALACRITY (Advanced Laboratories for Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness) Center, which draws from human-centered design (HCD) and implementation science to improve implementation of CIs/ISs.

Objective:

UW ALACRITY Center’s second iteration of funding (2023-2028) focuses on using the Discover, Design/Build, Test (DDBT) framework to address three priority CI/IS mechanisms (usability, engagement, and appropriateness), which we identified as challenges to implementation and scalability of CIs/ISs during the first iteration of center funding. Local redesign teams work collaboratively and share decision-making to carry out DDBT. We expect DDBT to result in changes to the CI/IS mechanisms, proximal implementation outcomes (adoption, fidelity, reach, adaptation), and clinical outcomes.

Methods:

We will provide research infrastructure to one large effectiveness study and three exploratory pilot studies as part of the center grant. At least four additional small pilot studies will be solicited and funded by the center. All studies will explore the use of DDBT to: (1) Identify CI/IS modification targets to improve usability, engagement, and appropriateness in accessible non-specialty settings (Discover phase); (2) Develop redesign solutions with local teams to address CI/IS modification targets (Design/Build phase); and (3) Determine if redesign improves usability, engagement, and appropriateness (Test phase), as well as implementation outcomes. Center staff will collaborate with local redesign teams to develop and test CIs/ISs for community settings. We will collaborate with teams on the use of methods and center-wide measures that facilitate cross-project analysis of the effects of DDBT-driven redesign on outcomes of interest.

Results:

All four core studies received institutional review board (IRB) approval in February 2023, and each pilot project will pursue IRB approval when awarded.

Conclusions:

During the first iteration of the center, we established that DDBT is a useful approach to systematically identify and address chronic challenges of implementing CIs/ISs. In this subsequent grant, we expect to increase evidence of DDBT impact by expanding: (1) a list of common challenges of CIs/ISs that could benefit from modification, (2) a list of exemplary solutions to address these challenges; and (3) guidance on using the DDBT framework. These resources will contribute to broader discourse on how to enhance implementation of CIs/ISs that integrate HCD and implementation science. Clinical Trial: Individual studies are registered upon initiation. At the time of publication, there are two studies registered: ClinicalTrials.gov NCT06494384 and NCT06508515.