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  • Meeting abstract
  • Open Access

Cluster randomized trial comparing standard versus enhanced implementation strategies for improving outreach to persons with SMI: 12-month results

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Implementation Science201510 (Suppl 1) :A26

  • Published:


  • Mental Illness
  • Mental Health Provider
  • Outreach Program
  • National Expert
  • Outpatient Facility


This study compared the effectiveness of an enhanced versus standard implementation strategy (Replicating Effective Programs-REP) for providers at VA outpatient facilities on improving uptake of a national outreach program for Veterans with serious mental illness (Re-Engage) among sites not initially responding to a standard implementation strategy.


Initially, Re-Engage was implemented at 158 VA facilities by mental health providers who received the standard REP strategy to support uptake (implementation manual, training, and technical assistance). Re-Engage involved giving providers a list of patients with serious mental illness who had not been seen at their facility for at least a year, requesting that providers contact these patients, assess their clinical status, and where appropriate, expedite VA healthcare appointments. At month 6, facilities considered non-responsive(N = 88, total of 3,200 patients), defined as <80% of patients on providers' lists with updated assessment of clinical status, were randomized to receive either Enhanced REP (REP+Facilitation; N = 39 practices) for 6 months followed by standard REP for 6 months; or continued standard REP (N = 49 practices) for 6 months followed by 6 months of Enhanced REP for facilities still not responding. Enhanced REP consisted of monthly phone-based coaching by national experts in Re-Engage on overcoming adoption barriers. Quantitative outcomes included attempted contacts and subsequent receipt of outpatient care.


Patients from facilities randomized to receive Enhanced compared to standard REP were more likely to have an attempted contact (30% vs. 13%, p < .001). Sites that received Enhanced REP six months after randomization (delayed implementation of Facilitation) were no more likely to have increased contacts. There were no differences in patient-level utilization between Enhanced and standard REP sites 12 months post-randomization.


Adaptive implementation intervention strategies like Enhanced REP when applied immediately to address implementation non-response, offer a means to augment implementation efforts.

Funding Source

VA HSR&D (SDR 11-232).

Authors’ Affiliations

VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 49109-2800, USA
Institute for Social Research, University of Michigan, Ann Arbor, MI 48104-2321, USA
School of Public Health, University of Michigan, Ann Arbor, MI 48109-5425, USA
University of Detroit Mercy, Detroit, MI 48221-3038, USA


© Goodrich et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.