Dr. Victoria Stanhope Spearheads Cross-Institutional Implementation Research Collaboration to Advance Person-Centered Care Planning
Through her $3 million, National Institute of Mental Health (NIMH)-funded clinical trial on Person-Centered Care Planning and Service Engagement, Associate Professor Victoria Stanhope is leading a cadre of social work researchers from a half-dozen academic institutions in testing not only the intervention’s effectiveness for people with severe mental illness but also the organizational factors that shape the intervention’s implementation. According to Dr. Stanhope, the study is an example of implementation research, a relatively new field that aims to bridge the science to services gap.
Dr. Stanhope explained that many state mental health systems have embraced the principle of person-centered care, but are looking for guidance on how best to implement it in practice. One promising approach is Person Centered Care Planning (PCCP), a recovery-oriented approach that orients care to people’s personal life goals and encourages them to take an active role in making decisions about their own treatment. With co-investigators from Yale University and University of Pennsylvania, she designed a study to test the effectiveness of PCCP in community mental health clinics (CMHCs). “Our cross-institutional team is looking at how real-world mental health organizations, with limited resources and competing demands, can bring about the wholesale transformation needed to deliver sustainable person-centered care,” said Dr. Stanhope.
The study, which was launched in September 2013 and on which field work is now complete, randomized 14 CMHCs from Connecticut and Delaware to deliver either treatment as usual or the PCCP intervention. At the seven CMHCs in the experimental arm, designated clinical supervisors and direct care personnel received intensive PCCP training and 12 months of ongoing technical assistance in delivering the intervention.
The study team surveyed agency leaders and personnel who participated in the training at each experimental site before the training began, after the technical assistance ended, and six months later to assess their PCCP competency, recovery orientation, transformational leadership, and organizational readiness for change. For comparison, they conducted the same surveys at the same time points with peers at the treatment-as-usual sites. At each agency in the intervention arm, the study team also interviewed senior leaders and conducted focus groups with staff who participated in the training to understand their perspectives on new practices and identify barriers to and facilitators of implementation. Separate focus groups were conducted at each experimental site with a sample of consumers regarding their engagement in services and how it relates to the service-planning process.
The research team is now analyzing the data collected from over 300 study participants as well as the notes, checklists and recordings kept by the consultants who conducted the trainings and technical assistance calls. The team will also review provider service plans to see if they reflect person-centered care values and principles. To measure the impact of PCCP on consumer outcomes, they will review Medicaid and state mental health data to assess service engagement, medication adherence, functioning and consumer satisfaction.
Assisting Dr. Stanhope and her highly regarded co-investigators, Dr. Janis Lee Tondora and Dr. Larry Davidson from Yale University School of Medicine, and Dr. Steven C. Marcus from University of Pennsylvania School of Social Policy & Practice, have been emerging researchers Mimi Choy-Brown and Lauren Jessell from the PhD program at NYU Silver, and Liz Matthews and Meredith Doherty from the PhD programs at Rutgers School of Social Work and Hunter College Silberman School of Social Work respectively.
The latest addition to the study team is Dr. Abigail Ross, an Assistant Professor at Fordham University Graduate School of Social Service, who was recently awarded a Fordham-NYU Research Fellowship to fund her work on the project from May 15 through August 15, 2017. The fellowship was introduced this year by Fordham’s Office of Research to promote and expand institutional research collaborations between the universities, and Dr. Ross was one of only six recipients from across the Fordham faculty. Dr. Stanhope said, “Dr. Ross is a talented researcher whose focus of interest is on prevention and public health. By collaborating on the study, she aims to learn about implementation science and strengthen her qualitative research skills.” With Dr. Stanhope’s mentorship, Dr. Ross is analyzing training data to understand the process of adopting a new practice.
Noting the breadth of information collected, Dr. Stanhope said, “We are looking at PCCP uptake and the implications for both providers and consumers from many different angles in order to deliver guidance that is truly relevant for our front line mental health systems.” She noted the data collection has been complicated by issues the study team did not anticipate including differences in the electronic health records participating CMHC’s use and the way they write their services plans, as well as high rates of employee turnover, particularly at the direct care level. However, Dr. Stanhope, said, “This is precisely why it is so important to do real-world, implementation research. We need to figure out the best way to scale up interventions that have shown efficacy in ideal conditions in disparate, often highly stressed practice settings.”