DHSR’s Research Cycle
DHSR investigators strive to apply the knowledge gained during observational studies to the development of new interventions and to translate research findings into routine clinical practice. The strength of the DHSR research environment is the interaction between investigators conducting observational studies, investigators conducting intervention studies, and investigators conducting implementation studies.
Understand: DHSR investigators apply a variety of methods (qualitative interviews, surveys, chart reviews, and analyses of administrative data) to better understand the risk/protective factors for developing mental health and substance use disorders, the barriers/facilitators to help seeking behavior and service utilization, and process/quality of care factors that impact patient outcomes. We use observational research methods to determine when, where, and how to intervene effectively to improve outcomes and how to best facilitate the sustained adoption of evidence-based practices by provider organizations. DHSR observational researchers work closely with our intervention developers and implementation experts to conduct studies that inform the design of both interventions and implementation strategies.
- DHSR investigators conduct epidemiological and services research to: 1) identify unmet mental health needs, 2) understand the health beliefs and treatment preferences that drive help seeking behaviors, 3) understand how barriers to care impact patterns of service utilization, and 4) determine the patient and system factors that influence quality of care and clinical outcomes.
- DHSR investigators conduct both qualitative and quantitative observational research to better understand the organizational climate, culture and clinical capacity, as well as the administrators’ and providers’ preferences for improving quality of care and patient outcomes.
Intervene: DHSR researchers focus on designing evidence-based treatments that reach out to under-served populations in community settings (e.g., homes, schools, churches, nursing homes, etc.) and to patients in clinical service settings (e.g., VA primary care clinics, federally qualified health centers, and community mental health centers). We have a history of conducting multi-site randomized effectiveness trials that evaluate the impact of interventions on clinical outcomes and quality of life, as well as experience conducting cost-effectiveness analyses to assess value. Our intervention developers collaborate directly with our implementation experts to identify potential facilitators and barriers to future dissemination efforts.
- Meeting Consumer Needs – With observational data about preferences, barriers, patterns of service use and quality, DHSR investigators design interventions that are responsive to the needs of individuals with mental health and substance use disorders.
- Meeting Provider Needs – DHSR investigators convert efficacious clinical interventions, originally developed in highly controlled research settings, into portable, street-ready best practices that can be delivered effectively in community contexts. Our interventions are designed to be feasible, flexible, acceptable, and cost-effective.
- Technology – DHSR investigators have a growing interest in applying technologies (interactive video, web-based decision support systems, electronic medical records, PDAs, virtual reality) to reach out to people in their community and to provide support for non-specialty providers to deliver high quality mental health care.
Implement: DHSR implementation experts rely on our intervention developers to help ensure fidelity to the evidence base during our dissemination and translation efforts. In order to make sure that DHSR research addresses organizational and community needs, our implementation projects are conceived and conducted within the context of formal and informal community-based partnerships of individuals with mental health and substance use disorders, community members, informal care givers, organizational leaders, and clinical providers.
- Adaptation – Because most interventions are not originally designed or tested in real world clinical settings that serve disadvantaged populations, our implementation efforts devote considerable attention to tailoring evidence-based practices to fit local needs, cultures, and resources. Successful adaptation requires tailoring the intervention to the local context in order to promote sustained adoption while simultaneously maintaining fidelity to the core elements of the evidence base in order to preserve clinical effectiveness.
- Adoption – Our partnerships with clinical and community stakeholders help us identify the barriers and facilitators to the sustained adoption of evidence-based practices in busy clinical settings. We often use multi-faceted implementation strategies to promote adoption, including: direct to consumer advertising, academic detailing and other provider marketing strategies, performance monitoring and feedback, clinical reminders and other decision support systems, expert facilitation, as well as use of local opinion leaders and other social influence interventions.