Table 1 Implementation Strategies as Operationalized Within Each LGBTQ-affirmative CBT Trial
Implementation Strategies (ERIC) | LGBTQ-affirmative CBT Trial | ||||
|---|---|---|---|---|---|
ESTEEMa Young sexual minority men (in-person, individual format) | EQuIPa Gender-diverse sexual minority women (in-person, individual format) | ESTEEM ConneCTa Black and Latino gay and bisexual men (in-person, group format) | LGBTQ-affirmative ICBTa Young LGBTQ people (internet based, individual format) | China ICBTa Young Chinese gay, bisexual, and other men who have sex with men (internet based, individual format) | |
1. Use Evaluative and Iterative Strategies | |||||
Audit and provide feedback | Recorded sessions to monitor fidelity and provide feedback | Recorded sessions to monitor fidelity and provide feedback | – | – | – |
Conduct local needs assessment | – | Interviewed therapists and community to inform adaptation | Informally assessed local needs for ESTEEM ConneCT | – | – |
Develop and implement tools for quality monitoring | Developed session checklists and fidelity rating forms | Developed session checklists and fidelity rating forms | – | – | – |
Develop and organize quality monitoring systems | Developed systems to track clinical progress | Developed systems to track clinical progress | Developed systems to track clinical progress | Developed systems to track clinical progress | Developed systems to track clinical progress |
Obtain and use clients' feedback | – | – | Provided clients with opportunities to provide feedback during and after the intervention | Provided clients with opportunities to provide feedback throughout intervention | Provided clients with opportunities to provide feedback throughout intervention |
2. Provide Interactive Assistance | |||||
Centralize technical assistance | Established central technical assistance across the two sites of the trial | – | – | Made staff available to address ICBTb platform issues for therapists and clients | Centralized research staff provided technical support for the ICBTb platform |
Facilitation | Engaged in problem solving and support via team meetings and consults to implement the intervention | Engaged in problem solving and support via team meetings and consults to implement the intervention | Engaged in problem solving and support via team meetings and consults to implement the intervention | Engaged in problem solving and support via team meetings and emails to implement the intervention | Engaged in problem solving via group meetings and emails to implement the intervention |
Provide clinical supervision | Provided clinical supervision to therapists | Provided clinical supervision to therapists | Provided clinical supervision to therapists | Provided clinical supervision to therapists | Provided clinical supervision to therapists |
Provide local technical assistance | Established local technical assistance | Established local technical assistance | Established local technical assistance | – | – |
3. Adapt and Tailor to Context | |||||
Promote adaptability | Established “core” vs. adaptable components of ESTEEM for therapists | Established “core” vs. adaptable components of EQuIP for therapists | Adapted for sexual minority men of color (e.g., race-related stress/resilience, group format) | Adapted for young adults | Adapted for Chinese GBMb (translations and cultural adaptations) |
Tailor strategies | Tailored implementation strategies to reach young SMMb and engage them in the trial | – | Modified the delivery of the intervention for a group context and tailored delivery context to a non-LGBTQ specific clinic | Adapted the delivery format to be online and tailored outreach strategies for various LGBTQ communities for equitable reach | Adapted the delivery format of the intervention to be online and self-directed |
Use data experts | N/A | – | – | Worked with creators of online ICBT platform to implement EQuIP ICBT | Worked with creators of online ICBT platform to implement for Chinese GBM |
4. Develop Stakeholder Interrelationships | |||||
Build a coalition | Built relationships with LGBTQ-serving organizations for outreach and referral | – | – | – | – |
Conduct local consensus discussions | – | – | Consulted with local therapists to determine suitability of intervention and needed adaptations prior to implementation | Consulted with LGBTQ community center providers across the U.S. to gather feedback to implement ICBT | Team in China discussed needs of Chinese GBM with local organizations and community to ensure the intervention was aligned |
Develop academic partnerships | – | – | Academic institution partnered with local clinic to promote sustainment | – | – |
Identify and prepare champions | Selected team members committed to LGBTQ health | Selected team members committed to LGBTQ health | Selected team members committed to LGBTQ health and LGBTQ people of color and who were Spanish-speaking | Selected team members committed to LGBTQ health | Selected team members and leaders with a commitment to LGBTQ and Chinese GBM health |
Obtain formal commitments | Required therapists and staff to make a formalized commitment to the trial (e.g., time, duration) | Required therapists and staff to make a formalized commitment to the trial (e.g., time, duration) | Required therapists and staff, as well as implementing site, to formally commit to the trial (e.g., time, space) | Required therapists and staff to make a formalized commitment to the trial (e.g., time, duration) | Required therapists and staff to make a formalized commitment to the trial (e.g., time, duration) |
Organize clinician implementation team (i.e., all individuals involved in implementation) meetings | Held multiple types of team meetings to reflect on and improve implementation efforts | Held multiple types of team meetings to reflect on and improve implementation efforts | Held multiple types of team meetings to reflect on and improve implementation efforts | Held multiple types of team meetings to reflect on and improve implementation efforts | Held regular meetings for the full team and local team in China to organize implementation efforts |
Promote network weaving | – | – | – | – | Leveraged healthcare networks to identify ICBT implementers |
Recruit, designate, and train for leadership | Recruited team leaders with experience related to LGBTQ mental health | Recruited team leaders with experience related to LGBTQ mental health | Recruited team leaders with experience related to LGBTQ health in general and LGBTQ people of color | Recruited team leaders with experience related to LGBTQ mental health | Recruited team leaders with experience related to LGBTQ mental health and Chinese young MSM |
Visit other sites | Therapists and research staff visited the other site and shared experiences with ESTEEM | – | N/A | Developers of EQuIP ICBT visited another site that developed the original ICBT technology platform | Developers of the adaptation for Chinese young MSM visited the U.S. team with prior experience to plan local implementation |
5. Train and Educate Stakeholders | |||||
Conduct educational meetings | Educated therapists on ESTEEM, LGBTQ-affirmative therapy, and CBT and educated staff on administrative skills | Leveraged therapists’ prior training in LGBTQ-affirmative CBT and trained research staff in administrative roles | Educated therapists on ESTEEM ConneCT and LGBTQ affirmative CBT in general | Educated therapists on unique role of therapists within ICBT and leveraged therapists’ prior training in LGBTQ-affirmative CBT | Therapists completed training on prior iterations of LGBTQ-affirmative CBT from the ESTEEM and EQuIP trials to inform implementation of ICBT in China |
Conduct ongoing training | Conducted ongoing refresher training and onboarding training for new therapists/staff | Conducted ongoing refresher training and onboarding training for new therapists | Conducted ongoing clinical training between sessions on ESTEEM ConneCT | Conducted ongoing refresher training and onboarding training for new therapists/staff | Conducted ongoing training on intervention skills |
Develop educational materials | Developed training materials (e.g., ESTEEM treatment manual, training slides) | Developed training materials (e.g., EQuIP treatment manual, training slides) | Developed training materials (e.g., treatment manual, training slides) | Developed training materials (e.g., manual for ICBT platform, checklists, protocols) | Developed training and implementation materials (e.g., manual, checklists, protocols) |
Make training dynamic | Trained using various methods (e.g., didactic, role play, discussion) | Trained using various methods (e.g., didactic, role play, discussion) | Trained using various methods (e.g., didactic, role play, discussion) | – | – |
Shadow other experts | Shared ESTEEM session recordings with therapists | Shared ESTEEM session recordings with therapists | Shared ESTEEM session recordings with therapists | – | – |
Use train-the-trainer strategies | Trained therapists to train and supervise | Trained therapists to train and supervise | Trained therapists to train and supervise | – | – |
6. Support Clinicians | |||||
Create new clinical teams (i.e., all individuals involved in implementation) | Established ESTEEM clinical team | Established EQuIP clinical team | Established ESTEEM ConneCT clinical team | Established EQuIP ICBT clinical team | Established a China ICBT clinical team |
Remind clinicians | Had reminder systems to enhance fidelity | Had reminder systems to enhance fidelity | Had reminder systems to enhance fidelity | – | – |
7. Engage Consumers | |||||
Involve clients | Involved ESTEEM clients in recruitment efforts | Involved EQuIP clients in recruitment efforts | Involved ESTEEM ConneCT clients in recruitment efforts | Involved EQuIP ICBT clients in recruitment efforts | – |
Intervene with clients to enhance uptake and adherence | Used strategies to increase uptake/retention in intervention (e.g., covering transportation, motivating to return for sessions, flexible scheduling) | Used strategies to increase uptake/ retention in intervention (e.g., covering transportation, motivating to return for sessions, flexible scheduling, post-session handouts) | Used strategies to increase uptake/ retention in intervention (e.g., covering transportation, motivating to return for sessions, implementing in an accessible clinic, post-session handouts) | Used strategies to increase uptake/ retention in intervention (e.g., welcome/check in calls, simplifying modules, reminders, motivating to complete modules, compensating for completed modules) | Used strategies to increase uptake/retention in intervention (e.g., motivational interviewing, local assistance with recruitment, made intervention materials more engaging) |
Prepare clients to be active participants in the intervention | Explained the need for clients to be actively engaged in treatment in order to benefit | Explained the need for clients to be actively engaged in treatment in order to benefit | Explained the need for clients to be actively engaged in treatment in order to benefit | Explained the need for clients to be actively engaged in treatment in order to benefit | Explained the need for clients to be actively engaged in treatment in order to benefit |
Use mass media | Developed culturally tailored outreach campaigns and disseminated on social and sexual networking apps, listservs, etc | Developed culturally tailored outreach campaigns and disseminated on social networking apps, listservs, etc | Developed culturally tailored outreach campaigns and disseminated on social and sexual networking apps, listservs, etc | Developed culturally tailored outreach campaigns and disseminated on social and sexual networking apps, listservs, etc | Used mass media (e.g., WeChat) to distribute culturally tailored outreach campaigns for the intervention |
8. Change Infrastructure | |||||
Change physical structure and equipment | Added visual indicators of LGBTQ affirmation and cultural relevance to intervention setting | Added visual indicators of LGBTQ affirmation and cultural relevance to intervention setting | Added visual indicators of LGBTQ affirmation and cultural relevance to intervention setting and reduced physical hierarchy | – | – |