Background Psychotherapy implementation must contend with the task of preparing a mental health workforce to provide the highest quality services to as much of a service population as possible, in high-income as well as low-to-middle income countries.
Objective We outline general challenges and solutions and investigate how well various implementation strategies would fit a clinical population.
Methods Using a data set from a prior cluster randomised trial with a clinically diverse population and 33 intervention practices, we presented multiple illustrations comparing the ability of different implementation strategies to serve youth and families with procedures in which service providers were trained.
Findings A series of survival functions demonstrated that many common implementation strategies are unlikely to create a prepared workforce, given the large and diverse number of practices needed to be mastered by providers.
Clinical implications ‘Benchmark’ solutions that afforded superior coverage of the service population could be supported through paced learning approaches (ie, training interventions a little at a time) using extensible, modular intervention designs.
- child & adolescent psychiatry
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Contributors BFC implemented the trial and oversaw all operations, training and data collection. BFC and ED planned the analyses and set up the survival models. ED, BFC and JDV worked on the data analysis. All authors contributed to the writing.
Funding This work was supported by the John D. and Catherine T. MacArthur Foundation, award number 12-103104-000-USP.
Competing interests Dr Chorpita and Dr Daleiden are owners and partners in PracticeWise, LLC, which publishes a version of the protocol used in the illustrations in this study.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request. Data are available upon reasonable request to the first author. Permission for re-use is granted on a case by case basis.
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