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Symposia

Dissemination & Implementation Science

Session: Advances and Innovations in Large Scale Youth Mental Health Measurement-Based Care

3 - (SYM 123) Transforming Data to Wisdom: Building a Measurement-based Care Infrastructure Within a Statewide Mental Health System

Sunday, November 19, 2023

8:30 AM – 9:30 AM PST

Location: Quinault, Level 5

Speaker(s)

PH

Puanani J. Hee, Ph.D.

Licensed Clinical Psychologist and Clinical Data Director
Child and Adolescent Mental Health Division, Department of Health, State of Hawai‘i
Lihue, Hawaii

Co-author(s)

TO

Trina E. Orimoto, Ph.D.

Licensed Clinical Psychologist and Dissemination and Implementation Specialist
University of Hawai‘i at Mānoa, Child and Adolescent Mental Health Division, Department of Health, State of Hawai‘i
Honolulu, Hawaii
DJ

David Jackson, Ph.D.

Research and Program Operations / Evaluation Specialist
Hawaii State Department of Health - Child & Adolescent Mental Health Division
Honolulu, Hawaii
AW

Ashlyn W. W. A. Wong, B.A. (she/her/hers)

Graduate Student and Clinical Data Assistant
Department of Psychology, University of Hawai‘i at Mānoa, Child and Adolescent Mental Health Division, Department of Health, State of Hawai'i
Honolulu, Hawaii
KB

Kristy Bowen, M.A.

Graduate Research Assistant
University of Hawai‘i at Mānoa
Honolulu, Hawaii
MS

Max Sender, B.S.

Research and Statistical Analyst
University of Hawai’i at Manoa
Honolulu, Hawaii
JG

Jhansi Gangineni, M.CA (she/her/hers)

Reports Specialist
Department Of Psychology, University Of Hawai‘i At Mānoa, Child And Adolescent Mental Health Division, Department Of Health, State Of Hawai‘i
Honolulu, Hawaii
DV

Derek Vale, B.A.

Health Systems Management Office Chief
Hawaiʻi State Department Of Health Child And Adolescent Mental Health Division
Honolulu, Hawaii
BN

Brad J. Nakamura, Ph.D.

Associate professor
University of Hawaii at Manoa
Honolulu, Hawaii
KO

Kelsie Okamura, Ph.D. (she/her/hers)

Implementation Researcher
The Baker Center for Children and Families
Boston, Massachusetts
SS

Scott Shimabukuro, PhD, ABPP

Practice Development Specialist
Hawaiʻi State Department of Health Child and Adolescent Mental Health Division
Honolulu, Hawaii

For the last two decades, the Hawai‘i youth mental health service system has made steady progress engineering an infrastructure supportive of measurement-based care (MBC; Bosswell et al., 2022; Scott & Lewis, 2015) and promoting a culture that values the use of evidence to inform clinical decisions (Chorpita & Daleiden, 2018; Nakamura et al., 2012). The goals of this presentation are to provide a historical review of the state’s foundational approaches and outline current efforts to implement MBC statewide.
Since 2000, the Hawai‘i system has gradually incorporated MBC into clinical service through four interrelated approaches: (1) prioritization of routine, multi-informant (Ohio Scales for the youth and family, Ogles, 2001) administration of standardized outcome measures; (2) MBC training development and execution; (3) delivery of static reports of client- and provider-reported treatment progress data to staff and providers; and (4) in 2019 deployment of an electronic practice management system with complementary work flows and role expectations. Despite these efforts, uptake of MBC practice has been lackluster, with administration rates of the youth- and caregiver-report measure remaining at about 30%.
With the advent of recent technological advances, the state embarked on a multiyear effort to implement MBC more fully and strategically for the approximately 1800 primarily multiethnic (57%) youth clients (M_age=13.8 years; 55.3% = male) served per year. This presentation details the design of several clinical dashboards that aim to aide clinical staff (N≈100 psychiatrists, psychologists, mental health supervisors, care coordinators) in prioritizing clients, visually display individual outcome measures, and provide recommendations based on local research and practice trends. Mediators, implementation, and clinical outcomes will be discussed using the updated Consolidated Framework for Implementation Research (Damschroder et al., 2022). Baseline dashboard usage metrics suggest initial differences by role group, with 89% of psychologists and 29% of psychiatrists viewing at least one dashboard within a five-month period. This unique study is situated in a publicly funded context with applied implementation specialists. Lessons learned and a longer-term vision for maintaining MBC implementation within the system’s infrastructure will be discussed. Applying implementation science in real-world settings has the potential to cultivate new meaning and joy to improving youth mental health outcomes and systems.