Translating clinical training into practice in complex mental health systems: Toward opening the 'Black Box' of implementation

Greer Sullivan¹^,2^,3 , Dean Blevins¹^,2^,3 and Michael R Kauth¹^,4^,5

¹South Central Mental Illness Research, Education, and Clinical Center (SC-MIRECC), Central Arkansas Veterans Healthcare System, North Little Rock, USA

²Central Arkansas Veterans Healthcare System, HSR&D, Center for Mental Healthcare and Outcomes Research (CeMHOR), North Little Rock, USA

³University of Arkansas for Medical Sciences, Department of Psychiatry, Division of Health Services Research, Little Rock, USA

⁴Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA

⁵Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, USA

author email corresponding author email

Implementation Science 2008, 3:33doi:10.1186/1748-5908-3-33


Published:	3 June 2008

Abstract

Background

Implementing clinical training in a complex health care system is challenging. This report describes two successive trainings programs in one Veterans Affairs healthcare network and the lessons we drew from their success and failures. The first training experience led us to appreciate the value of careful implementation planning while the second suggested that use of an external facilitator might be an especially effective implementation component. We also describe a third training intervention in which we expect to more rigorously test our hypothesis regarding the value of external facilitation.

Results

Our experiences appear to be consonant with the implementation model proposed by Fixsen. In this paper we offer a modified version of the Fixsen model with separate components related to training and implementation.

Conclusion

This report further reinforces what others have noted, namely that educational interventions intended to change clinical practice should employ a multilevel approach if patients are to truly benefit from new skills gained by clinicians. We utilize an implementation research model to illustrate how the aims of the second intervention were realized and sustained over the 12-month follow-up period, and to suggest directions for future implementation research. The present report attests to the validity of, and contributes to, the emerging literature on implementation research.