5 - (SYM 110) Towards Implementation: Integrating Feedback from Stakeholders into Developing a Scalable STEP Intervention

The promising results from various pilot trials of STEP provided justification for a larger multi-site trial. We proposed a Hybrid Type 1 Implementation Effectiveness design with three phases: 1) Phase 1 involves qualitative assessments with clinical stakeholders; 2) Phase 2 is a fully powered 3 site RCT, that recruits adolescents from inpatient facilities; and 3) Phase 3 is a post-intervention assessment with participants and stakeholders. 

This presentation will focus on Phase 1 findings. Stakeholder interviews examined perceived usefulness of STEP including how it might be received by families, overlap with existing curriculum, how STEP fits into the existing workflows, benefits and challenges of implementation, staff roles that are best suited to deliver STEP, STEP training,, as well as other resources needed to implement STEP. We interviewed 12 clinicians including hospital administrators, psychiatrists, psychologists, social workers, and milieu staff from our three recruitment sites. 

This presentation will describe some of the challenges that were brought to light, and the concomitant changes to our protocol. For example, one theme was that recording sessions would not be feasible on any of the units. Therefore, our plan for monitoring adherence was adapted to include alternative strategies including the use of simulated sessions. Also, due to staff and scheduling limitations, training had to be consolidated and be provided on-demand. We thus created a multimedia kit of training materials that includes a manual and recordings of didactics and role-plays. With regard to staff in the best position to deliver STEP, some units believed it would be the milieu staff, others preferred to utilize trainees. We also heard about barriers to setting up or utilizing an app. Therefore,  we utilized text messaging which only requires a phone number. Finally, we learned that sessions in an inpatient cannot be reliably scheduled, and as such, the joint parent session was not feasible. Adaptations to the structure of our sessions were made. 

Adaptations to training procedures and the treatment protocol have led to a more scalable intervention and improved implementation efforts in the inpatient setting. Additional qualitative feedback will be used to enhance the sustainability of STEP over time with particular attention paid to ongoing training of unit staff delivering the intervention to address staff turnover challenges.