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| Name | Class |
|---|---|
| VA Pittsburgh Healthcare System | FED |
| VA Maryland Health Care System | FED |
| Durham VA Health Care System | FED |
| Minneapolis Veterans Affairs Medical Center |
Not provided
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This multi-site project (four VA Medical Centers) will test two approaches to improving the delivery of a behavioral insomnia treatment in the Primary Care setting to Veterans. The first approach is training providers to deliver Brief Behavioral Treatment for Insomnia (BBTI). The second approach is to give providers trained in BBTI additional support and resources to enhance their ability to deliver BBTI, what we call implementation. This project will measure delivery of BBTI over four phases: (1) pre-training; (2) pre-implementation; (3) implementation; and (4) post-implementation.
The main questions to answer:
Does delivery of BBTI improve with training alone and does it improve further with the addition of implementation support?
Does delivery of BBTI remain at similar levels after implementation support is removed?
Do Veterans who engage in BBTI reduce their insomnia symptoms?
Chronic insomnia, one of the most common health problems among Veterans, significantly impacts health, function, and quality of life. Cognitive Behavioral Therapy for Insomnia (CBTI) is the first line treatment; however, despite efforts to train VA clinicians to deliver CBTI, there are still significant barriers to providing adequate access to insomnia care. Up to 44% of Veterans seen in Primary Care report insomnia, making it an optimal clinical setting for improving access to insomnia care. Furthermore, Brief Behavioral Treatment for Insomnia (BBTI), adapted from CBTI as a briefer, more flexible treatment, is easily delivered by Primary Care Mental Health Integration (PCMHI) clinicians and can greatly improve access to care for Veterans with insomnia. Yet, simply training PCMHI clinicians to deliver BBTI is not enough. Implementation strategies are needed for successful uptake, adoption, and sustainable delivery of care.
This stepped-wedge, hybrid III implementation-effectiveness trial involves four VA Medical Centers: Baltimore, Durham, Minneapolis, and Philadelphia. The hybrid design allows for testing of implementation and treatment effectiveness. The stepped-wedge design allows for fewer sites to achieve adequate power as all sites are exposed to BBTI training (BBTI) and BBTI + Implementation Strategies (BBTI+IS). The target sample are PCMHI clinicians and the impact of a bundle of strategies on the success of sustainable delivery of BBTI in Primary Care. Retrospective data collected from VA electronic health records will be used to obtain variables of interest related to Veteran treatment outcomes and data related to PCMHI clinician delivery of BBTI.
We will compare the impact PCMHI clinicians trained to deliver BBTI vs. the impact of BBTI training plus 12-months of access to an implementation strategy bundle (BBTI+IS). BBTI+IS vs. BBTI training alone is expected to result in more Veterans with access to insomnia care in PCMHI. We will also compare delivery of BBTI across all four phases, from pre-training to post-implementation. We will also measure Veteran-level outcomes for insomnia severity and PCMHI clinician fidelity on delivery of BBTI.
Outcome measures have been updated to reflect study protocol and analyses more accurately. Some of the prespecified Primary and Secondary Outcome Measures have been combined with one removed due to no data collection. The results reported reflect data that has been collected and analyzed.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Minneapolis VAMC | BBTI; ERIC strategies |
| |
| Philadelphia VAMC | BBTI; ERIC strategies |
| |
| Durham VAMC | BBTI; ERIC strategies |
| |
| Baltimore VAMC | BBTI; ERIC strategies |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Expert Recommendations for Implementing Change bundle of strategies | Behavioral |
|
| Measure | Description | Time Frame |
|---|---|---|
| Veteran Participants Who Engaged in BBTI | The number of Veterans in PCMHI who engaged in BBTI as indicated in the medical records | 54 months; All study phases (pre-training; pre-implementation; implementation; post-implementation) |
| Measure | Description | Time Frame |
|---|---|---|
| Veterans in PCMHI Identified With Insomnia | The number of Veterans with encounters in PCMHI related to insomnia, indicated by an insomnia diagnostic code and/or insomnia-related medication. | 54 months; All study phases (pre-training; pre-implementation; implementation; post-implementation) |
| Veterans in Primary Care Identified With Insomnia |
Not provided
Inclusion Criteria:
All Veterans in Primary Care and Primary Care Mental Health Integration (PCMHI) at the participating sites.
Exclusion Criteria:
Not meeting above criteria
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Four (4) VAMCs will be randomized to the order in which they will receive the intervention (stepped wedge). At each VAMC, retrospective data will be collected on Veterans who receive care in Primary Care and Primary Care Mental Health Integration (PCMHI). Our goal is to identify Veterans who engage in Brief Behavioral Treatment for Insomnia (BBTI) in a PCMHI clinic. Our goal is to collect data on at least 332 Veterans during the implementation phase (n=83 Veterans/site).
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| Name | Affiliation | Role |
|---|---|---|
| Adam D. Bramoweth, PhD | VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| VA Pittsburgh Healthcare System University Drive Division, Pittsburgh, PA | Pittsburgh | Pennsylvania | 15240 | United States |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 39745672 | Derived | Bramoweth AD, Hough CE, O'Brien EM, Klingaman EA, Deininger CJ, Ulmer CS, Boudreaux-Kelly MY, McCoy JL, Youk AO. Implementing brief behavioral treatment for insomnia in Department of Veterans Affairs Primary Care Mental Health Integration clinics: Reach outcomes from a hybrid type 3 effectiveness-implementation trial. Psychol Serv. 2025 Aug;22(3):409-422. doi: 10.1037/ser0000924. Epub 2025 Jan 2. |
| Label | URL |
|---|---|
| Brief Behavioral Treatment for Insomnia (BBTI introduction for patients and providers) | View source |
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Staff did not participate in the Pre-Training phase. Data collection for a site could have ranged from 36 to 54 months (including phases 1-4; excluding the 1-month BBTI training period January 1, 2021 - January 31, 2021).
Four (4) VA Medical Centers (VAMC) were enrolled in this project. Within each VAMC, we identified Veterans (Participants) who engaged in care within PCMHI clinics. Veterans' data was collected retrospectively starting from January 1, 2020 until July 31, 2024. PCMHI providers (Staff) at each site were also consented for feedback and intervention fidelity ratings. 277,920 unique Veteran Participants and Staff were enrolled across all phases; however, enrollment differs at each phase.
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| ID | Title | Description |
|---|---|---|
| FG000 | Minneapolis VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Implementation (Month 1-12), then Post-Implementation (Month 13-24). Note, this site was randomized to skip Pre-Implementation (phase 2). |
| FG001 | Philadelphia VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-6), Implementation (Month 7-18), then Post-Implementation (Month 19-30). |
| FG002 | Durham VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-12), Implementation (Month 13-24), then Post-Implementation (Month 25-36). |
| FG003 | Baltimore VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-18), Implementation (Month 19-30), then Post-Implementation (Month 31-42). |
| Title | Milestones | Reasons Not Completed | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pre-Training (12 Months) |
| ||||||||||||||||||||||
| Pre-Implementation (0, 6, 12, 18 Months) |
| ||||||||||||||||||||||
| Implementation (12 Months) |
| ||||||||||||||||||||||
| Post-Implementation (12 Months) |
|
Participants from all sites identified in the Implementation phase in PCMHI and Primary Care, and Staff from all sites identified among all phases.
Not provided
| ID | Title | Description |
|---|---|---|
| BG000 | Minneapolis VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Implementation (Month 1 - Month 12), then Post-Implementation (Month 13-24). Note, this site was randomized to skip Pre-Implementation (phase 2). |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Continuous | Participants from all sites identified in the Implementation phase in PCMHI and Primary Care, and Staff from all sites identified among all phases. |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Veteran Participants Who Engaged in BBTI | The number of Veterans in PCMHI who engaged in BBTI as indicated in the medical records | Veterans in PCMHI who engaged in BBTI | Posted | Count of Participants | Participants | 54 months; All study phases (pre-training; pre-implementation; implementation; post-implementation) |
|
Not Applicable; Deaths and Adverse Events were not monitored/assessed for Veteran Participants nor Staff
Not Applicable; Deaths and Adverse Events were not monitored/assessed for Veteran Participants nor Staff
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Not Applicable; Deaths and Adverse Events were not monitored/assessed for Veteran Participants nor Staff |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Adam Bramoweth, PhD | VA Pittsburgh Healthcare System | 412-360-2806 | adam.bramoweth@va.gov |
Not provided
| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Aug 11, 2021 | Sep 27, 2024 | Prot_SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Aug 11, 2021 | Sep 27, 2024 | ICF_002.pdf |
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| ID | Term |
|---|---|
| D007319 | Sleep Initiation and Maintenance Disorders |
| ID | Term |
|---|---|
| D020919 | Sleep Disorders, Intrinsic |
| D020920 | Dyssomnias |
| D012893 | Sleep Wake Disorders |
| D009422 | Nervous System Diseases |
Not provided
Not provided
| FED |
| Corporal Michael J. Crescenz VA Medical Center | FED |
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Not provided
|
|
| Brief Behavioral Treatment for Insomnia | Behavioral | An adapted version of Cognitive Behavioral Therapy for Insomnia (CBT-I) that is focused on behavioral components stimulus control and sleep restriction (the four rules):
Delivered weekly to bi-weekly over 4-6 sessions, with each session typically 30 minutes or less, consistent with other interventions delivered in PCMHI. |
|
|
The number of Veterans with encounters in Primary Care related to insomnia, indicated by an insomnia diagnostic code and/or insomnia-related medication. |
| 54 months; All study phases (pre-training; pre-implementation; implementation; post-implementation) |
| BBTI Effectiveness (Intent to Treat) | Change on the Insomnia Severity Index (ISI; 0-28, low scores indicate lower severity) from the initial score obtained (e.g., PCMHI initial evaluation, BBTI session 1) to the final score documented in medical records. Data aggregated across phases (averaged) for first session and last session. | 42 months; during the pre-implementation, implementation, and post-implementation phases. Time from BBTI first session to BBTI last session varies, but can range 1-13 weeks. |
| BBTI Effectiveness (Per Protocol) | Change on the Insomnia Severity Index (ISI; 0-28, low scores indicate lower severity) from the initial score obtained (e.g., PCMHI initial evaluation, BBTI session 1) to the final score documented in medical records. Data aggregated across phases (averaged) for first session and last session. | 42 months; during the pre-implementation, implementation, and post-implementation phases. Time from BBTI first session to BBTI last session varies, but can range 2-13 weeks. |
| PCMHI Providers (Staff) Who Delivered (Adopted) BBTI | PCMHI providers (Staff) who delivered (adopted) BBTI (adopted) to at least 1 Veteran - measured in each phase (pre-implementation, implementation, post-implementation). | 42 months; during the pre-implementation, implementation, and post-implementation phases. |
| Implementation/Treatment Fidelity (Staff) | Mean Competency Rating Score (0-36, higher scores indicate higher competency, >17 indicates competency) PCMHI providers (Staff) were measured via mock treatment sessions by site PIs/subject matter experts using the BBTI-Competency Rating Scale (BBTI-CRS) during the pre-implementation, implementation, and post-implementation phases. Overall refers to aggregate ratings (averaged) from all phases in which BBTI-CRS was delivered - providers could complete up to 5 ratings (up to 3 for pre-implementation, 1 for implementation, and 1 for post-implementation). | 42 months; the BBTI-CRS was administered during pre-implementation (up to 3 times), implementation (1 time, at the end), and post-implementation (1 time, at the end) |
| Barriers & Facilitators (CFIR Determinants) | Strength and valence rating for identified barriers and facilitators (determinants) from the Consolidated Framework for Implementation Research (CFIR) qualitative interviews. CFIR determinants, identified through qualitative interviews with PCMHI providers, were rated on strength (0, 1, 2; higher numbers indicate stronger influence) and valence (- indicates negative/harmful influence; + indicates positive/helpful influence) to determine how helpful or harmful an identified CFIR determinant is for implementing BBTI in PCMHI. Ratings were aggregated across sites and phases (consensus by 3 raters with adjudication by PI as needed). | 42 months; qualitative interviews took place at the end of the pre-implementation, implementation, and post-implementation phases. |
| Implementation Strategy Utilization Survey | Indication of implementation strategy utilization (yes/no) and rating of its importance (1 = not at all important, 5 = very important) and feasibility ((1 = not at all feasible, 5 = very feasible). | 12 months: 4 times - every 3-months during the Implementation phase. |
| The 2 Processes that Regulate Sleep and the 4 Rules to Improve Your Sleep | View source |
| PCMHI Participants |
|
| Primary Care Participants |
|
| Staff |
|
| COMPLETED |
|
| NOT COMPLETED |
|
| PCMHI Participants |
|
| Primary Care Participants |
|
| Staff |
|
| COMPLETED |
|
| NOT COMPLETED |
|
| PCMHI Participants |
|
| Primary Care Participants |
|
| Staff |
|
| COMPLETED |
|
| NOT COMPLETED |
|
| BG001 | Philadelphia VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-6), Implementation (Month 7-18), then Post-Implementation (Month 19-30). |
| BG002 | Durham VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-12), Implementation (Month 13-24), then Post-Implementation (Month 25-36). |
| BG003 | Baltimore VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-18), Implementation (Month 19-30), then Post-Implementation (Month 31-42). |
| BG004 | Staff | Staff consented from all 4 sites in the Pre-Implementation, Implementation, and Post-Implementation phases. |
| BG005 | Total | Total of all reporting groups |
Veteran and Staff participants analyzed separately |
| Mean |
| Standard Deviation |
| years |
|
| Sex: Female, Male | Participants from all sites identified in the Implementation phase in PCMHI and Primary Care, and Staff from all sites identified among all phases. | Veteran and Staff participants analyzed separately | Count of Participants | Participants | No |
|
| Race/Ethnicity, Customized | Participants from all sites identified in the Implementation phase in PCMHI and Primary Care, and Staff from all sites identified among all phases. | Veteran and Staff participants analyzed separately | Count of Participants | Participants | No |
|
| Sleep Medication | Participants from all sites identified in the Implementation phase in PCMHI and Primary Care, and Staff from all sites identified among all phases. | Staff - sleep medication not measured | Count of Participants | Participants | No |
|
| OG001 | Philadelphia VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-6), Implementation (Month 7-18), then Post-Implementation (Month 19-30). |
| OG002 | Durham VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-12), Implementation (Month 13-24), then Post-Implementation (Month 25-36). |
| OG003 | Baltimore VAMC | All sites underwent a 12-month pre-training period (phase 1) before undergoing training (month 0) for BBTI. Then sites were randomized to 0, 6, 12, or 18 months of the Pre-Implementation (phase 2), followed by 12 months of Implementation (phase 3, ERIC strategies were accessible and supported during this phase), and 12 months of Post-Implementation monitoring (phase 4). *This site was assigned to: Pre-Training, then Pre-Implementation (Month 1-18), Implementation (Month 19-30), then Post-Implementation (Month 31-42). |
|
|
|
| Secondary | Veterans in PCMHI Identified With Insomnia | The number of Veterans with encounters in PCMHI related to insomnia, indicated by an insomnia diagnostic code and/or insomnia-related medication. | Posted | Count of Participants | Participants | 54 months; All study phases (pre-training; pre-implementation; implementation; post-implementation) |
|
|
|
| Secondary | Veterans in Primary Care Identified With Insomnia | The number of Veterans with encounters in Primary Care related to insomnia, indicated by an insomnia diagnostic code and/or insomnia-related medication. | Posted | Count of Participants | Participants | 54 months; All study phases (pre-training; pre-implementation; implementation; post-implementation) |
|
|
|
| Secondary | BBTI Effectiveness (Intent to Treat) | Change on the Insomnia Severity Index (ISI; 0-28, low scores indicate lower severity) from the initial score obtained (e.g., PCMHI initial evaluation, BBTI session 1) to the final score documented in medical records. Data aggregated across phases (averaged) for first session and last session. | This is the intent to treat (ITT) analysis and all ISI data are included from participants who initiated BBTI. Results provided for all sites combined and individual sites. Data at the participant-level (Veterans in PCMHI), with data extracted from BBTI progress notes in the electronic health records, retrospectively. | Posted | Mean | Standard Deviation | score on a scale | 42 months; during the pre-implementation, implementation, and post-implementation phases. Time from BBTI first session to BBTI last session varies, but can range 1-13 weeks. |
|
|
|
|
| Secondary | BBTI Effectiveness (Per Protocol) | Change on the Insomnia Severity Index (ISI; 0-28, low scores indicate lower severity) from the initial score obtained (e.g., PCMHI initial evaluation, BBTI session 1) to the final score documented in medical records. Data aggregated across phases (averaged) for first session and last session. | This is the per protocol (PP) analysis and all ISI data are included from participants who completed at least 3 sessions of BBTI. Results provided for all sites combined and individual sites. Data at the participant-level (Veterans in PCMHI), with data extracted from BBTI progress notes in the electronic health records, retrospectively. | Posted | Mean | Standard Deviation | score on a scale | 42 months; during the pre-implementation, implementation, and post-implementation phases. Time from BBTI first session to BBTI last session varies, but can range 2-13 weeks. |
|
|
|
|
| Secondary | PCMHI Providers (Staff) Who Delivered (Adopted) BBTI | PCMHI providers (Staff) who delivered (adopted) BBTI (adopted) to at least 1 Veteran - measured in each phase (pre-implementation, implementation, post-implementation). | Number of PCMHI providers who delivered BBTI relative to providers who were eligible to deliver BBTI. Not all of these providers were considered enrolled in the study. | Posted | Number | providers | 42 months; during the pre-implementation, implementation, and post-implementation phases. |
|
|
|
| Secondary | Implementation/Treatment Fidelity (Staff) | Mean Competency Rating Score (0-36, higher scores indicate higher competency, >17 indicates competency) PCMHI providers (Staff) were measured via mock treatment sessions by site PIs/subject matter experts using the BBTI-Competency Rating Scale (BBTI-CRS) during the pre-implementation, implementation, and post-implementation phases. Overall refers to aggregate ratings (averaged) from all phases in which BBTI-CRS was delivered - providers could complete up to 5 ratings (up to 3 for pre-implementation, 1 for implementation, and 1 for post-implementation). | PCMHI providers (Staff) trained in BBTI who consented to participate in the competency ratings. Not all Staff completed ratings at all phases and there was no plan to compare between sites. Only descriptive statistics (Mean/Standard Deviation) reported. | Posted | Mean | Standard Deviation | score on a scale | 42 months; the BBTI-CRS was administered during pre-implementation (up to 3 times), implementation (1 time, at the end), and post-implementation (1 time, at the end) |
|
|
|
| Secondary | Barriers & Facilitators (CFIR Determinants) | Strength and valence rating for identified barriers and facilitators (determinants) from the Consolidated Framework for Implementation Research (CFIR) qualitative interviews. CFIR determinants, identified through qualitative interviews with PCMHI providers, were rated on strength (0, 1, 2; higher numbers indicate stronger influence) and valence (- indicates negative/harmful influence; + indicates positive/helpful influence) to determine how helpful or harmful an identified CFIR determinant is for implementing BBTI in PCMHI. Ratings were aggregated across sites and phases (consensus by 3 raters with adjudication by PI as needed). | 16 Staff participants were engaged in CFIR interviews with 3 study team members coding the interviews and conducting strength and valence ratings. Strength (0, 1, 2) and valence (- / +) ratings help to determine how helpful or harmful an identified CFIR determinant is for implementation of BBTI. | Posted | Number | rating score for each CFIR determinant | 42 months; qualitative interviews took place at the end of the pre-implementation, implementation, and post-implementation phases. |
|
|
|
| Secondary | Implementation Strategy Utilization Survey | Indication of implementation strategy utilization (yes/no) and rating of its importance (1 = not at all important, 5 = very important) and feasibility ((1 = not at all feasible, 5 = very feasible). | This measure was abandoned during the study, early on with no data collected, since much of the data intended to be collected through this survey could be captured/collected as part of the CFIR interviews and ratings (Outcome #8). | Posted | 12 months: 4 times - every 3-months during the Implementation phase. |
|
|
|
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
| 0 |
Not provided
Not provided
| D001523 |
| Mental Disorders |
|
|
| Male |
|
|
|
| Non-White |
|
| Unknown |
|
|
|
| No |
|
|
| Pre-Implementation |
|
| Implementation |
|
| Post-Implementation |
|
| Pre-Implementation |
|
| Implementation |
|
| Post-Implementation |
|
| Minneapolis VAMC |
|
|
| Philadelphia VAMC |
|
|
| Durham VAMC |
|
|
| Baltimore VAMC |
|
|
| <0.0001 |
| effect size for mixed effects model |
| 0.83 |
| Superiority |
| Philadelphia VAMC | Mixed Models Analysis | <0.0001 | effect size for mixed effects model | 0.79 | Superiority |
| Durham VAMC | Mixed Models Analysis | <0.0001 | effect size for mixed effects model | 0.60 | Superiority |
| Baltimore VAMC | Mixed Models Analysis | <0.0001 | effect size for mixed effects model | 1.01 | Superiority |
| Minneapolis VAMC |
|
|
| Philadelphia VAMC |
|
|
| Durham VAMC |
|
|
| Baltimore VAMC |
|
|
| <0.0001 |
| effect size for mixed effects model |
| 1.72 |
| 2-Sided |
| Superiority |
| Philadelphia VAMC | Mixed Models Analysis | <0.0001 | effect size for mixed effects model | 0.93 | 2-Sided | Superiority |
| Durham VAMC | Mixed Models Analysis | <0.0001 | effect size for mixed effects model | 0.82 | 2-Sided | Superiority |
| Baltimore VAMC | Mixed Models Analysis | <0.0001 | effect size for mixed effects model | 1.38 | 2-Sided | Superiority |
|
| Implementation |
|
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| Post-Implementation |
|
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| Implementation (phase 3) |
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| Post-Implementation (phase 4) |
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| Innovation: Relative Advantage |
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| Innovation: Design |
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| Outer: Partnerships & Connections |
|
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| Inner: Work Infrastructure |
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| Inner: Communications |
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| Inner: Compatibility |
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| Inner: Mission Alignment |
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| Inner: Available Resources |
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| Inner: Access to Knowledge & Information |
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| Inner: Relative Priority |
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| Individuals: Innovation Deliverers - Capability |
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| Individuals: Innovation Recipients - Need |
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| Individuals: Innovation Recipients - Motivation |
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| Process: Teaming |
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| Process: Tailoring Strategies |
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| Process: Engaging Recipients |
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| Process: Adapting |
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| Obtain formal commitments from leadership |
| Develop academic partnerships |
| Increase demand (if capacity allows) |