# Validation of a Causal Model of Implementation

> **NIH NIH R01** · UNIVERSITY OF PENNSYLVANIA · 2024 · $585,807

## Abstract

PROJECT SUMMARY
Advancing causal implementation theory is critical for designing tailored implementation strategies to facilitate
clinician behavior change that target specific mechanisms associated with evidence-based practice (EBP) use.
Such strategies may be more successful and more efficient than general implementation strategies. The
overall goal of this study is to test the generalizability of a conceptual model that posits the causal relationship
among variables from organizational and social psychology to predict clinician evidence-based practice (EBP)
use. Broadly, the model proposes that organizational factors like climate and culture influence attitudes, norms
and self-efficacy, while other organizational factors like workload, resources and organizational friction
moderate the pathway between intentions and the use of an EBP. Our recently completed NIMH-funded R21
demonstrated that this model accounted for up to 75% of variance in implementation of three EBPs in
community settings. While promising, we were limited by a small sample, and a focus on special education
teachers' use of autism interventions. This R01 will test the generalizability of the causal model in a much
larger sample from a new group of practitioners, for a different and more widely-used EBP, cognitive-
behavioral therapy (CBT). Successful completion would further validate the model, advancing our
understanding of the causal pathways in EBP implementation. We will leverage ongoing CBT implementation
efforts to recruit approximately 300 mental health clinicians across 40 organizations in two large public health
systems (Philadelphia and Texas). After completing training in CBT, clinicians will complete measures of all
constructs delineated in the model. Clinicians also will be observed via audio recording delivering CBT with a
client on their caseload on two occasions. Following each observation, data on theorized moderators of the
intention to behavior gap will be collected via survey. A subset of clinicians who report high intentions and
demonstrate low EBP use will be purposively recruited to complete brief semi-structured interviews further
assessing reasons for the intention to behavior gap. Our primary dependent variables and implementation
outcomes of interest are clinician intentions to use CBT and direct observation of clinician use of CBT.
However, as CBT comprises many discrete components that vary in complexity, each discrete component of
CBT use will be measured separately. Data will be analyzed via multilevel modeling to test the extent to which
intentions and determinants of intention predict each discrete CBT component (Aim 1) and the extent to which
organizational and other contextual factors highlighted in the implementation literature predict factors related to
intention formation and moderate the association between intentions and CBT use (Aim 2). Results will inform
the development of implementation strategies that target modifiable factors expla...

## Key facts

- **NIH application ID:** 10798306
- **Project number:** 5R01MH124897-04
- **Recipient organization:** UNIVERSITY OF PENNSYLVANIA
- **Principal Investigator:** Emily Michele Becker Haimes
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $585,807
- **Award type:** 5
- **Project period:** 2021-05-07 → 2026-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10798306

## Citation

> US National Institutes of Health, RePORTER application 10798306, Validation of a Causal Model of Implementation (5R01MH124897-04). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10798306. Licensed CC0.

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