How can we help practitioners become partners when TCOM tools are mandated by the government? The mandated use of a TCOM tool does not guarantee its implementation will be effective, and that tool users will receive the support they need to be successful. As part of her doctoral dissertation in Educational Leadership at the University of Kentucky, Dr. Lauren Mergen developed the Design and Handoff Model to inform the design of an implementation guide for a behavioral health system. Together, the guide and model work to assist administrators and practitioners in their adoption of the Child and Adolescent Needs and Strengths (CANS), a TCOM tool, under a government mandate. Educational leaders bring a unique expertise in adult learning, instructional design, and understanding of organizational capacity that can make the difference between a tool that practitioners comply with and one which transforms both the system and the population it serves.
Lauren’s dissertation, “From Mandate to Meaning: Designing Implementation Supports for Organizational Readiness in Behavioral Health Service Planning,” focused on assisting a large public behavioral health system in service planning for children, youth, and families using a customized version of the CANS tool. Her methodology is rooted the Mixed Methods Action Research (MMAR) approach, type of mixed methods research that combines the use of qualitative and quantitative data. MMAR consists of six phases—Diagnosis, Reconnaissance, Planning, Acting, Evaluation and Monitoring—with results from each phase informing and guiding the decisions and actions of the subsequent phase. The MMAR approach is both democratic and empowering as it involves different partners at different levels of the system. Through this MMAR, she developed the Design and Handoff Model, a leadership strategy for creating and transferring implementation supports to system leaders. Under the model, the researcher or external leaders’ works to create implementation supports (e.g. practice tools, guides, etc.). Then the implementation supports are embedded leadership architecture. Lastly, the responsibility for implementation supports are transferred to the organization’s leadership for sustained use.
Initially, administrators and practitioners entered implementation with conceptual understanding and commitment to the CANS tool. Over time, they reported declining confidence in practical application, persistent time and workflow barriers, and softening perceptions of the tool’s value. Lauren found feasibility was the threshold condition for successful implementation, which is in contrast to other studies in the area. For policy interventions to be accepted as impactful, they must be viewed as feasible by practitioners.
To address the challenges of CANS implementation, Lauren used the MMAR and applied Design and Handoff model to create a comprehensive support package built through an iterative and evidence-informed design process, intentional involvement of leadership, and transfer of ownership to system leaders. The package included a workbook with detailed implementation support for various levels of the system. It included realistic examples of service planning activities through a case vignette, a completed CANS assessment with rationales for scoring, and a structured service planning guide for practitioners. For leadership, the package included examples of the TCOM workflow and an implementation fidelity checklist for ongoing quality monitoring.
The implementation support package helped both practitioners and administrators become more comfortable in using the CANS in their workplace. In particular, Lauren found practitioners greatly benefited from additional support to help understand the value and use of TCOM tools. In addition, Lauren surveyed leadership within the state agency to assess the support package’s readiness for wider use. Leaders reported that the practice-oriented design helped practitioners engage with the CANS more genuinely. The creation and use of a comprehensive support package can help create a harmonious and self-reinforcing implementation process for both policymakers and practitioners.
More about Dr. Lauren Mergen:
Dr. Lauren Mergen began her work with the TCOM framework and tools as a mental health Research Assistant at the Children’s Hospital of Eastern Ontario in 2012. Throughout the years, she continued to work with TCOM as the Distance Learning Director for TCOM Training and lead of the Instructional Design Educational Advances Program at a Center at the University of Kentucky. Lauren currently serves as the Deputy Director of Operations of the Innovation in Population Health Center, affiliated with the University of Chicago School of Medicine, Department of Psychiatry and Behavioral Neuroscience.
Lauren has always enjoyed having a long-term goal to work toward. Pursuing her Ed.D. at the University of Kentucky was a natural next step and challenge to push herself to keep learning while exploring what happens after training.
