7 - (IOP 1) Supervisor Perspectives and Preliminary Implementation Outcomes of a Peer-led Implementation Coaching Program Within a Community Mental Health Setting

Introduction: Community mental health (CMH) clinicians often require more than just training in evidence-based practices (EBPs) for successful implementation. Implementation facilitation, referred to here as “coaching”, is an interactive problem-solving and support strategy that can help organizations and their clinicians in successful EBP implementation by building a climate that expects, supports and rewards EBP use. Coaching is particularly important in CMH settings as it can enhance the quality-of-care delivery for underserved youth. However, most facilitation models are resource-intensive and can be difficult to implement in CMH settings. A sustainable and scalable alternative is to engage experienced CMH supervisors as coaches instead. This study presents a mixed-method evaluation of supervisor perspectives and preliminary implementation outcomes from a small, randomized control trial of peer-led coaching program in a CMH setting.

Method: Participants were 18 master's level CMH supervisors (M age=45.6 years, 67% non-Hispanic White) whose clinicians were taking part in a state-funded cognitive-behavioral therapy (CBT) training. 10 supervisors were randomized to receive coaching and attended 4–5 group virtual coaching meetings led by a peer supervisor from another CMH center, over 6 months. Meetings focused on promoting implementation climate—how to expect, support, and reward CBT delivery across implementation stages (preparation, implementation, sustainment). All supervisors rated implementation climate before and after the coaching program. Supervisors in the active condition also rated the coaching program’s acceptability, appropriateness, and feasibility (0-4 Likert scale) and evaluated the program in open-ended responses, which were coded inductively by 2 coders.

Result: A linear mixed-effects model was used to examine the interaction effect of Condition (control vs. active) X Time (pre vs. post) on supervisors' ratings of implementation climate at their agency. The model revealed a significant interaction, (β=0.45,SE=0.20,t(13.53)=2.27,p =.040) indicating that supervisors' ratings of implementation climate increased in the active condition from pre- to post- assessment, but stayed the same in the control condition. The coaching program was rated high in acceptability (M=3.36,SD=0.65), appropriateness (M=3.36,SD=0.65), and feasibility (M=3.28,SD=0.61). Qualitative coding revealed that supervisors felt the coaching program fostered a supportive environment and allowed space for collaboratively problem-solving EBP implementation challenges that arose. The main limitation reported was time constraints, hindering supervisors’ full engagement in the coaching program.

Discussion: Peer-led coaching is an acceptable, appropriate and feasible alternative to traditional implementation facilitation. This coaching program was shown to target implementation climate, a mechanism empirically linked to EBP implementation. The next step in this study is to examine whether the coaching program led to other outcomes including CBT fidelity and improved youth outcomes. Findings are promising as we work to scale up the coaching program as part of the state-wide EBP initiative.