The field of youth mental health has been producing innovative research for decades, gaining enormous momentum in the past 20 years. So, with all this valuable work, why are there still so many gaps in our care systems?
It is widely reported that it takes, on average, 17 years for research to be translated into clincial practice. Although the exact number of years has been debated, there is convincing evidence that research takes a long time to be translated into practice, and that a lot of research never makes it into routine care at all. This research-to-practice gap has inspired a new field of research, called implementation science.
Implementation science is the rigorous study of ways to close the gap between evidence and practice. Implementation science aims to create genuine practice and system change, not just to raise awareness about a new treatment or understanding of mental ill-health, but to embed a new way of working and knowing into routine care and support settings. To help achieve this, implementation science has developed methods, tools, frameworks and strategies that have been shown to improve the uptake and maintenance of evidence-based practices. Importantly, implementation science recognises that practice change is not just driven by people – it is also shaped by processes, structures, and environments people work within.
As a behavioural neuroscientist by background, I like implementation science for this reason.
I know from my PhD research that our environments shape the actions we take and this is reflected in changes in the brain. Implementation science highlights that youth mental health professionals’ behaviour is equally influenced by their context – including the teams and organisations they work with, and the broader social, funding, and political landscapes they operate in
At Orygen, our knowledge translation division aims to close the gap between evidence and practice by using implementation science methods, frameworks and tools to design youth mental health workforce, service, and system development initiatives. This includes capacity-building programs aimed at building workforce capability, as well as designing strategies to overcome implementation barriers. Across multidisciplinary teams, the division combines the expertise of implementation facilitators, clinical educators, research and teaching academics, and administrators. The division has produced educational resources and initiatives on topics such as psychosis, depression, and anxiety, as well as information about digital interventions, guidance on service development, and recommendations for working with diverse groups such as trans and gender diverse young people. Online written resources have been accessed more than 85,500 times over the last four years, and online learning modules accessed more than 20,000 times over the last five years. By working together with clinicians, researchers, young people, and other experts, this work has brought together academic evidence, clinical wisdom, and lived experience to build the capacity of youth mental health systems across Australia and internationally.
But it hasn’t been easy going. Creating system change involves lots of moving parts. Mental health landscapes are complex and dynamic. On top of this, the COVID-19 pandemic has created significant changes to the way services run and the way we work with them. For our team at Orygen, this has meant a rapid pivot to online training and support, and adapting advice to telehealth service delivery contexts.
A recently published paper provides reflections from Orygen’s knowledge translation team on how implementation science has supported our work through the pandemic. By reminding us of the importance of context in practice change, working with implementation science frameworks helped the team to meet the needs of youth mental health workforces in a rapidly changing service environment. It helped us to design effective strategies for overcoming new barriers to practice brought on my new digital ways of working, increased service demands, and significant pressures on staffing. But we also observed gaps in the implementation literature, particularly around how to facilitate change in digital service contexts. With young people and providers reporting that digital interventions and environments are here to stay in mental health care, it’s essential that implementation science can help services and teams like ours to design development initiatives that align with our new digital realities.
Of course, implementation science is not the answer to everything. We still need research to develop new approaches to mental health prevention, treatment, and support where current methods aren’t working.
But where there is evidence for what works and what doesn’t, implementation science offers evidence-based strategies to help do more of what is known to be effective, appropriate, and feasible. Implementation science and knowledge translation can and should work alongside other areas of research, to help practitioners, services, and communities put their best efforts in the best places.
Dr Isabel Zbukvic, Research Fellow, Orygen.