SKIP for PA Study: Team and Leadership Level Implementation Support for Collaborative Care

NCT ID: NCT04946253

Last Updated: 2025-03-20

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

450 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-11-28

Study Completion Date

2026-11-30

Brief Summary

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In a prior application (MH064372), the investigators' treatment research program (Services for Kids In Primary-care, SKIP) developed and tested a chronic care model-based intervention, called Doctor Office Collaborative Care (DOCC), that was found to be effective in the management of childhood behavior problems and comorbid ADHD. In the "SKIP for PA Study", the investigators propose to conduct a randomized clinical trial to evaluate the effects of team- and practice leadership-level implementation strategies designed to enhance the use and uptake of DOCC in diverse pediatric primary care offices.

Detailed Description

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This study is a randomized, hybrid type 3 effectiveness-implementation trial to support the adoption of a chronic care model (CCM)-based intervention in pediatric primary care settings by testing the impact of implementation strategies directed towards the provider care team (TEAM) or practice leadership (LEAD) level. The treatment investigators seek to deliver here is called Doctor Office Collaborative Care (DOCC), an evidence-based intervention for the management of child behavior problems and comorbid ADHD. The implementation strategies being tested to enhance DOCC uptake include TEAM coaching/consultation strategies, which will be delivered to care team providers and target provider competency to deliver DOCC, and LEAD facilitation strategies, which will be delivered to practice leaders and target organizational support of DOCC delivery. These multi-level implementation strategies have not been formally evaluated to learn about their separate and combined effects in any randomized clinical trial conducted in pediatric primary care. Such information is needed to optimize our approaches to promoting the implementation of a CCM-based intervention in pediatric practice.

The sample includes up to 24 primary care practices from a statewide network and other networks or states. After standard training in the DOCC EBP, all practices will be randomized to one of four implementation conditions: 1) No TEAM or LEAD (ongoing technical support only); 2) TEAM implementation; 3) LEAD implementation, or 4) TEAM+LEAD implementation. TEAM and LEAD implementation will be delivered via videoconference on a graded schedule. Care teams will deliver DOCC to up to 25 children (or more if requested by the practice) who meet a clinical cutoff for modest behavior problems and their caregivers. Investigators will collect practice/provider measures from enrolled practice staff (0, 6, 12, 18, 24 months) and caregivers over several timepoints (0, 3, 6, 12 months) to support all analyses evaluating implementation and treatment outcomes, mediation, and moderation. By proposing one of the first large pragmatic pediatric trials of a CCM-based evidence-based intervention to address these aims in response to RFA-MH-18-701 and the NIMH's Strategic Plan (4.2), this research will advance the implementation science knowledge needed to optimize promising strategies for promoting the delivery and scale-up of DOCC in a pediatric medical home.

Conditions

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Child Behavior Problem Attention Deficit and Disruptive Behavior Disorders

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

The investigators propose a randomized trial using a factorial design to test effects of implementation support strategies on uptake of an evidence-based intervention (DOCC) in up to 24 primary care practices. Practices will receive DOCC training in accord with the Replicating Effective Programs model. Practices will be randomized to 1 of 4 implementation support conditions: 1) No TEAM/LEAD (training and technical support only); 2) provider care team consultation (TEAM); 3) practice leadership facilitation (LEAD); and 4) combination of provider care team and leadership implementation (TEAM+LEAD). Care teams in each practice will identify families and deliver DOCC to 20 caregivers and their children with externalizing behavior. Investigators will collect measures from 90 practice staff over 5 assessments (24 months) and 360 caregivers over 4 assessments (12 months) to support analyses.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Participants are not directly informed of the implementation condition to which the practice site has been randomized. All formal standardized assessments will be conducted via secure electronic web-based data collection systems, limiting the potential for assessment bias. In the event that a caregiver requests that a staff member administer an assessment via phone, the assessor would be unaware of the implementation condition assigned to the child's practice where the caregiver receives care.

Study Groups

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DOCC with standard implementation (No TEAM or LEAD)

Practices in this arm will receive DOCC materials/training and technical support, but will not receive care team coaching/consultation (TEAM) or practice leadership facilitation (LEAD) after the training phase.

Group Type ACTIVE_COMPARATOR

DOCC: Evidence-based treatment for disruptive behavior and ADHD

Intervention Type BEHAVIORAL

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. The content covers key topics related to the treatment of behavior problems (e.g., self-management, positive parenting) and ADHD (e.g., psychoeducation, medication).

DOCC with TEAM implementation

Practices in this arm will receive DOCC training and materials and one type of implementation support after the training: coaching/consultation for the provider care team (TEAM).

Group Type EXPERIMENTAL

DOCC: Evidence-based treatment for disruptive behavior and ADHD

Intervention Type BEHAVIORAL

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. The content covers key topics related to the treatment of behavior problems (e.g., self-management, positive parenting) and ADHD (e.g., psychoeducation, medication).

TEAM: Implementation support strategies at the care team level following standard implementation of DOCC

Intervention Type BEHAVIORAL

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. Coaching and consultation will be provided to the provider care team to support the use of collaborative care for behavior problems and ADHD. The TEAM intervention includes regular virtual meetings or calls with the providers (about once/month, on average) that cover core chronic care model functions, including registry use, case-finding, collaborative care team roles, and workflows outlining how DOCC is delivered in the practice.

DOCC with LEAD implementation

Practices in this arm will receive DOCC training and materials and only one type of implementation support after the training: facilitation for practice leadership (LEAD).

Group Type EXPERIMENTAL

DOCC: Evidence-based treatment for disruptive behavior and ADHD

Intervention Type BEHAVIORAL

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. The content covers key topics related to the treatment of behavior problems (e.g., self-management, positive parenting) and ADHD (e.g., psychoeducation, medication).

Implementation support strategies at the leadership level following standard implementation of DOCC

Intervention Type BEHAVIORAL

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. Practice facilitation will be provided to practice leaders to help them support the care team's use of collaborative care for behavior problems and ADHD. The LEAD intervention includes regular virtual meetings or calls with practice leaders (about once/month, on average) that cover the assessment of practice capacity/barriers, ways to overcome organizational barriers and support staff use of DOCC, promoting innovation, and leveraging practice resources to support DOCC delivery and maintenance in the practice.

DOCC with TEAM + LEAD implementation

Practices in this arm will receive DOCC training and materials and both types of implementation support after the training: coaching/consultation for the provider care team (TEAM) and facilitation for practice leadership (LEAD).

Group Type EXPERIMENTAL

DOCC: Evidence-based treatment for disruptive behavior and ADHD

Intervention Type BEHAVIORAL

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. The content covers key topics related to the treatment of behavior problems (e.g., self-management, positive parenting) and ADHD (e.g., psychoeducation, medication).

TEAM: Implementation support strategies at the care team level following standard implementation of DOCC

Intervention Type BEHAVIORAL

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. Coaching and consultation will be provided to the provider care team to support the use of collaborative care for behavior problems and ADHD. The TEAM intervention includes regular virtual meetings or calls with the providers (about once/month, on average) that cover core chronic care model functions, including registry use, case-finding, collaborative care team roles, and workflows outlining how DOCC is delivered in the practice.

Implementation support strategies at the leadership level following standard implementation of DOCC

Intervention Type BEHAVIORAL

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. Practice facilitation will be provided to practice leaders to help them support the care team's use of collaborative care for behavior problems and ADHD. The LEAD intervention includes regular virtual meetings or calls with practice leaders (about once/month, on average) that cover the assessment of practice capacity/barriers, ways to overcome organizational barriers and support staff use of DOCC, promoting innovation, and leveraging practice resources to support DOCC delivery and maintenance in the practice.

Interventions

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DOCC: Evidence-based treatment for disruptive behavior and ADHD

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. The content covers key topics related to the treatment of behavior problems (e.g., self-management, positive parenting) and ADHD (e.g., psychoeducation, medication).

Intervention Type BEHAVIORAL

TEAM: Implementation support strategies at the care team level following standard implementation of DOCC

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. Coaching and consultation will be provided to the provider care team to support the use of collaborative care for behavior problems and ADHD. The TEAM intervention includes regular virtual meetings or calls with the providers (about once/month, on average) that cover core chronic care model functions, including registry use, case-finding, collaborative care team roles, and workflows outlining how DOCC is delivered in the practice.

Intervention Type BEHAVIORAL

Implementation support strategies at the leadership level following standard implementation of DOCC

Practices will learn and then deliver DOCC in treatment sessions with caregivers and/or children. Practice facilitation will be provided to practice leaders to help them support the care team's use of collaborative care for behavior problems and ADHD. The LEAD intervention includes regular virtual meetings or calls with practice leaders (about once/month, on average) that cover the assessment of practice capacity/barriers, ways to overcome organizational barriers and support staff use of DOCC, promoting innovation, and leveraging practice resources to support DOCC delivery and maintenance in the practice.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* PCP Participants:

* Employed at one of the up to twenty-four (24) pediatric primary care practices identified by the PA Medical Home Program at the PA AAP or by the University of Pittsburgh research team.
* Identified by the practice as a Primary Care Provider
* CM Participants:

* Employed at one of the up to twenty-four (24) pediatric primary care practices identified by the PA Medical Home Program at the PA AAP or by the University of Pittsburgh research team.
* Identified by the practice as a Behavioral Health Resource who delivers and coordinates behavioral health care in the practice, who will function in the study as a care manager.
* SL Participants:

* Employed at one of the up to twenty-four (24) pediatric primary care practices identified by the PA Medical Home Program at the PA AAP or by the University of Pittsburgh research team.
* Identified by the practice as the Senior Leader.
* Have a practice-level leadership role such as Medical Director or a clinical/practice leader
* Have administrative responsibilities related to patient care and/or the operations/management of the practice
* PM Participants:

* Employed at one of the up to twenty-four (24) pediatric primary care practices identified by the PA Medical Home Program at the PA AAP or by the University of Pittsburgh research team.
* Identified by the practice as the Practice Manager or equivalent position
* Are responsible for day-to-day practice operations, such as personnel management, billing, and compliance with regulations, in the pediatric practice.
* Caregiver Participants:

* Have a child age 5-12 years old who exhibits at least a modest level of behavior problems (Caregiver Participants)
* Are at least 18 years of age (Caregiver participants)
* Have parental rights for this child (Caregiver participants)

Exclusion Criteria

* Caregivers

* Already enrolled in the study as the caregiver to a different child (e.g., sibling) (Caregiver participants)
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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American Academy of Pediatrics

OTHER

Sponsor Role collaborator

Drexel University

OTHER

Sponsor Role collaborator

NYU Langone Health

OTHER

Sponsor Role collaborator

University of Michigan

OTHER

Sponsor Role collaborator

National Institute of Mental Health (NIMH)

NIH

Sponsor Role collaborator

Pennsylvania American Academy of Pediatrics

UNKNOWN

Sponsor Role collaborator

University of Pittsburgh

OTHER

Sponsor Role lead

Responsible Party

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David Kolko

Professor of Psychiatry, Psychology, Pediatrics, and Clinical and Translational Science

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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David J Kolko, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Pittsburgh

Locations

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Drexel University

Philadelphia, Pennsylvania, United States

Site Status NOT_YET_RECRUITING

University of Pittsburgh

Pittsburgh, Pennsylvania, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Kevin M Rumbarger, BA

Role: CONTACT

4128867539

Omar Nogueras, BA

Role: CONTACT

4122665826

Facility Contacts

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Renee M Turchi, MD, MPH

Role: primary

267-359-6051

David J Kolko, PhD

Role: primary

4122465888

References

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Dikhanov GG, Mishan'kin BN. [Comparative study of ribosomal proteins from Yersinia pestis and Escherichia coli: amino acid composition and electrophoretic mobility]. Mol Gen Mikrobiol Virusol. 1988 Aug;(8):32-5. Russian.

Reference Type BACKGROUND
PMID: 3057358 (View on PubMed)

Kolko DJ, Campo JV, Kilbourne AM, Kelleher K. Doctor-office collaborative care for pediatric behavioral problems: a preliminary clinical trial. Arch Pediatr Adolesc Med. 2012 Mar;166(3):224-31. doi: 10.1001/archpediatrics.2011.201. Epub 2011 Nov 7.

Reference Type BACKGROUND
PMID: 22064876 (View on PubMed)

Tsai CC, Williamson HO, Kirkland BH, Braun JO, Lam CF. Low-dose oral contraception and blood pressure in women with a past history of elevated blood pressure. Am J Obstet Gynecol. 1985 Jan 1;151(1):28-32. doi: 10.1016/0002-9378(85)90418-1.

Reference Type BACKGROUND
PMID: 3966503 (View on PubMed)

Ballogh Z, Whaley K. Hereditary angio-oedema: its pathogenesis and management. Scott Med J. 1980 Jul;25(3):187-95. doi: 10.1177/003693308002500303.

Reference Type BACKGROUND
PMID: 7444430 (View on PubMed)

McGuier EA, Kolko DJ, Ramsook KA, Huh AS, Berkout OV, Campo JV. Effects of Primary Care Provider Characteristics on Changes in Behavioral Health Delivery During a Collaborative Care Trial. Acad Pediatr. 2020 Apr;20(3):399-404. doi: 10.1016/j.acap.2019.11.008. Epub 2019 Nov 21.

Reference Type BACKGROUND
PMID: 31760174 (View on PubMed)

Glukhen'kii TT, Gude ZZh. [The blood level of certain monosaccharides in patients with eczema]. Vestn Dermatol Venerol. 1969 Apr;43(4):33-5. No abstract available. Russian.

Reference Type BACKGROUND
PMID: 5364816 (View on PubMed)

Paoni NF, Keyt BA, Refino CJ, Chow AM, Nguyen HV, Berleau LT, Badillo J, Pena LC, Brady K, Wurm FM, et al. A slow clearing, fibrin-specific, PAI-1 resistant variant of t-PA (T103N, KHRR 296-299 AAAA). Thromb Haemost. 1993 Aug 2;70(2):307-12.

Reference Type BACKGROUND
PMID: 8236140 (View on PubMed)

Meier DA, Nagle CE. Differential diagnosis of a tender goiter. J Nucl Med. 1996 Oct;37(10):1745-7.

Reference Type BACKGROUND
PMID: 8862323 (View on PubMed)

Kolko DJ, McGuier EA, Turchi R, Thompson E, Iyengar S, Smith SN, Hoagwood K, Liebrecht C, Bennett IM, Powell BJ, Kelleher K, Silva M, Kilbourne AM. Care team and practice-level implementation strategies to optimize pediatric collaborative care: study protocol for a cluster-randomized hybrid type III trial. Implement Sci. 2022 Feb 22;17(1):20. doi: 10.1186/s13012-022-01195-7.

Reference Type DERIVED
PMID: 35193619 (View on PubMed)

Other Identifiers

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R01MH124914

Identifier Type: NIH

Identifier Source: secondary_id

View Link

STUDY20080207

Identifier Type: -

Identifier Source: org_study_id

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