# Project 1

> **NIH NIH P50** · KAISER FOUNDATION RESEARCH INSTITUTE · 2021 · $203,408

## Abstract

PROJECT 1 SUMMARY
For youth receiving care in community mental health centers (CMHCs), comorbidities are the rule rather than
the exception.1,2 Using measurement-based care (MBC) as the foundation of treatment for youth with comorbid
problems significantly improves the therapeutic impact as it can help define the treatment focus. MBC is the
systematic, routine evaluation of symptoms to inform care decisions. Especially in youth, MBC increases the
rate of symptom improvement,3 detects clients who would otherwise deteriorate,4 and alerts clinicians to non-
responders.4,5 Implementing MBC with fidelity requires 3 elements: (a) routine administration of measures for
symptoms, outcomes, and processes before therapy sessions, (b) therapist and client score review, and (c)
collaborative reevaluation of the treatment plan. But MBC is rarely implemented with fidelity; less than 15% of
providers report using MBC per recommendations.6 Previous efforts to support MBC implementation have
yielded suboptimal outcomes because CMHC leaders are challenged to identify and prioritize barriers and select
strategies to overcome them. New methods are needed for identifying and prioritizing determinants, and
matching strategies to determinants, to optimize MBC implementation and treatment quality to improve youth
mental health outcomes in community settings. Project 1's optimization goals are to increase impact of MBC and
align methods with preferences of practice partners. IMPACT Center methods will be piloted in six diverse CMHC
clinics (three of six serve primarily Latinx populations). IMPACT methods we focus on include (a) rapid evidence
reviews to uncover empirical data regarding MBC determinants; (b) rapid ethnography to identify and describe
local determinants and situate them in specific organizational, social, and task contexts; and (c) design probes
(e.g., kits with disposable camera, journals, maps) to allow practice partners and youth to capture and reflect on
aspects of their context that are salient for MBC. These activities will result in a list of determinants that will be
rated by partners from each clinic for criticality, chronicity, and ubiquity to generate priority scores. Subsequently,
we will use facilitated group processes to develop causal pathway diagrams to match strategies to the top three
determinants and clarify their preconditions, moderators, mechanisms, and proximal and outcomes (definitions in
Methods Core) at each of the six clinics to yield a plan to optimize MBC implementation (Aim 1). We will check
back with clinic-specific implementation teams to track strategy deployment for six months. We will then compare
MBC treatment quality for another six months post implementation with data from two years of historical controls
(Aim 2). Finally, we will co-design toolkits for each of the five IMPACT Methods for the practice and scientific
communities (Aim 3). Results from Aims 1 & 2 will support an R01 testing practice partner-led efforts, u...

## Key facts

- **NIH application ID:** 10202084
- **Project number:** 1P50MH126219-01
- **Recipient organization:** KAISER FOUNDATION RESEARCH INSTITUTE
- **Principal Investigator:** Cara Charissa Lewis
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $203,408
- **Award type:** 1
- **Project period:** 2021-09-01 → 2025-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10202084

## Citation

> US National Institutes of Health, RePORTER application 10202084, Project 1 (1P50MH126219-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10202084. Licensed CC0.

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