Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework

Isabel Zbukvic; Demee Rheinberger; Hannah Rosebrock; Jaclyn Lim; Lauren McGillivray; Katherine Mok; Eve Stamate; Katie McGill; Fiona Shand; Joanna C Moullin

doi:10.1177/26334895211065786

Developing a tailored implementation action plan for a suicide prevention clinical intervention in an Australian mental health service: A qualitative study using the EPIS framework

Implement Res Pract. 2022 Jan 6:3:26334895211065786. doi: 10.1177/26334895211065786. eCollection 2022 Jan-Dec.

Authors

Isabel Zbukvic^{1

2

3

4}, Demee Rheinberger^{1

2}, Hannah Rosebrock^{1

2}, Jaclyn Lim^{1

2}, Lauren McGillivray^{1

2}, Katherine Mok^{1

2}, Eve Stamate¹, Katie McGill^{5

6}, Fiona Shand^{1

2}, Joanna C Moullin⁷

Affiliations

¹ Black Dog Institute, Hospital Road, Randwick, New South Wales, Australia.
² University of New South Wales, Sydney, New South Wales, Australia.
³ Orygen, Parkville, Victoria, Australia.
⁴ Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia.
⁵ MH-READ, Hunter New England Mental Health Services, Newcastle, New South Wales, Australia.
⁶ Centre for Brain and Mental Health Research, School of Medicine and Public Health, The University of Newcastle, Newcastle, New South Wales, Australia.
⁷ School of Pharmacy and Biomedical Sciences, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.

Abstract

Background: Tailoring implementation strategies to local contexts is a promising approach to supporting implementation and sustainment of evidence-based practices in health settings. While there is increasing research on tailored implementation of mental health interventions, implementation research on suicide prevention interventions is limited. This study aimed to evaluate implementation and subsequently develop a tailored action plan to support sustainment of an evidence-based suicide prevention intervention; Collaborative Assessment and Management of Suicidality (CAMS) in an Australian public mental health service. Methods: Approximately 150 mental health staff working within a regional and remote Local Health District in Australia were trained in CAMS. Semi-structured interviews and focus groups with frontline staff and clinical leaders were conducted to examine barriers and facilitators to using CAMS. Data were analysed using a reflexive thematic analysis approach and mapped to the Exploration, Preparation, Implementation and Sustainment (EPIS) framework and followed by stakeholder engagement to design a tailored implementation action plan based on a 'tailored blueprint' methodology. Results: A total of 22 barriers to implementing CAMS were identified. Based on the perceived impact on implementation fidelity and the feasibility of addressing identified barriers, six barriers were prioritised for addressing through an implementation action plan. These barriers were mapped to evidence-based implementation strategies and, in collaboration with local health district staff, goals and actionable steps for each strategy were generated. This information was combined into a tailored implementation plan to support the sustainable use of CAMS as part of routine care within this mental health service. Conclusions: This study provides an example of a collaborative approach to tailoring strategies for implementation on a large scale. Novel insights were obtained into the challenges of evaluating the implementation process and barriers to implementing an evidence-based suicide prevention treatment approach within a geographically large and varied mental health service in Australia. Plain language abstract: This study outlines the process of using a collaborative stakeholder engagement approach to develop tailored implementation plans. Using the Exploration Preparation Implementation Sustainment Framework, findings identify the barriers to and strategies for implementing a clinical suicide prevention intervention in an Australian community mental health setting. This is the first known study to use an implementation science framework to investigate the implementation of the clinical suicide prevention intervention (Collaborative Assessment and Management of Suicidality) within a community mental health setting. This work highlights the challenges of conducting implementation research in a dynamic public health service.

Keywords: Suicide prevention, tailored implementation, EPIS, CAMS, mental health workforce, qualitative methods, implementation evaluation, evaluation, evidence-based, sustainment, determinants of practice.