abstract: 'ObjectiveStudy a quality improvement approach for implementing

  evidence-based employment services at specialty mental health clinics.

  Data Sources/Study SettingSemistructured interviews with clinicians and

  administrators before, during, and after implementation. Qualitative

  field notes, structured baseline and follow-up interviews with patients,

  semistructured interviews with patients after implementation, and

  administrative data.

  Study DesignSite-level controlled trial at four implementation and four

  control sites. Hybrid implementation-effectiveness study with mixed

  methods intervention evaluation design.

  Data Collection/Extraction MethodsSite visits, in-person and telephone

  interviews, patient surveys, patient self-assessment. A total of 801

  patients completed baseline surveys and 53 clinicians and other clinical

  key stakeholders completed longitudinal qualitative interviews.

  Principal FindingsAt baseline, sites varied in the availability,

  utilization, and quality of supported employment. Each site needed

  quality improvement for this service, though for differing reasons, with

  some needing development of the service itself and others needing

  increased service capacity. Improvements in knowledge, attitudes,

  beliefs, and referral behaviors were evident in mid- and

  postimplementation interviews, though some barriers persisted. Half of

  patients expressed an interest in working at baseline. Patients at

  implementation sites were 2.3 times more likely to receive employment

  services during the study year. Those who had a service visit were more

  likely to be employed at follow-up than those who did not.

  ConclusionsStudies of implementation and effectiveness require mixed

  methods to both enhance implementation in real time and provide context

  for interpretation of complex results. In this study, a quality

  improvement approach resulted in superior patient-level outcomes and

  improved clinician knowledge, attitudes, and behaviors, in the context

  of substantial variation among sites.'
affiliation: 'Hamilton, AB (Corresponding Author), Univ Calif Los Angeles, Dept Psychiat
  \& Biobehav Sci, 11301 Wilshire Blvd 210A, Los Angeles, CA 90073 USA.

  Hamilton, Alison B.; Cohen, Amy N.; Young, Alexander S., Univ Calif Los Angeles,
  Dept Psychiat \& Biobehav Sci, Los Angeles, CA 90073 USA.

  Hamilton, Alison B.; Cohen, Amy N.; Glover, Dawn L.; Young, Alexander S., Greater
  Los Angeles VA Healthcare Ctr, Los Angeles, CA 90073 USA.

  Whelan, Fiona, Univ Calif Los Angeles, Dept Psychiat \& Biobehav Sci, Semel Inst
  Biostat Core SIStat, Los Angeles, CA 90073 USA.

  Chemerinski, Eran, James J Peters VA Med Ctr, Bronx, NY USA.

  McNagny, Kirk P.; Reist, Christopher, Long Beach VA Healthcare Syst, Long Beach,
  CA USA.

  Mullins, Deborah, Michael E DeBakey VA Med Ctr, Houston, TX USA.

  Schubert, Max, Cent Texas Vet Healthcare Syst, Waco, TX USA.'
author: Hamilton, Alison B. and Cohen, Amy N. and Glover, Dawn L. and Whelan, Fiona
  and Chemerinski, Eran and McNagny, Kirk P. and Mullins, Deborah and Reist, Christopher
  and Schubert, Max and Young, Alexander S.
author-email: alisonh@ucla.edu
author_list:
- family: Hamilton
  given: Alison B.
- family: Cohen
  given: Amy N.
- family: Glover
  given: Dawn L.
- family: Whelan
  given: Fiona
- family: Chemerinski
  given: Eran
- family: McNagny
  given: Kirk P.
- family: Mullins
  given: Deborah
- family: Reist
  given: Christopher
- family: Schubert
  given: Max
- family: Young
  given: Alexander S.
da: '2023-09-28'
doi: 10.1111/1475-6773.12115
eissn: 1475-6773
files: []
issn: 0017-9124
journal: HEALTH SERVICES RESEARCH
keywords: 'Mixed methods; implementation research; schizophrenia; supported

  employment; health services'
keywords-plus: 'SUPPORTED EMPLOYMENT; ORGANIZATIONAL READINESS; COMPETITIVE EMPLOYMENT;

  MIXED METHODS; QUALITY; DESIGNS; MANAGEMENT; ILLNESS; CARE'
language: English
month: DEC
number: 6, 2
number-of-cited-references: '37'
orcid-numbers: 'Hamilton, Alison B/0000-0003-3998-7212

  McNagny, Kelly/0000-0003-4737-3499'
pages: 2224-2244
papis_id: ff40ba377bddf2129774bba6d0eb72c7
ref: Hamilton2013implementationeviden
researcherid-numbers: 'Hamilton, Alison B/IUP-2045-2023

  McNagny, Kelly/P-5239-2014'
times-cited: '20'
title: Implementation of Evidence-Based Employment Services in Specialty Mental Health
type: article
unique-id: WOS:000327391900006
usage-count-last-180-days: '0'
usage-count-since-2013: '19'
volume: '48'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2013'