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Table 1 Standardized versus tailored protocol and focus

From: Implementing measurement-based care (iMBC) for depression in community mental health: a dynamic cluster randomized trial study protocol

Contextual factor Implementation strategies Standardized focus Tailored focus
Resources Paper-based PHQ-9 with score entered in EHR for clinician review Client completion of PHQ-9 on paper and score entered in EHR for review by the clinician Client completion of PHQ-9 on paper and score entered in EHR for review by the clinician
Networks and linkages Form implementation teams for each site consisting of the site administrator, a clinician identified as an opinion leader, a self-nominated MBC champion, an office professional staff member, and research staff using data from the initial needs assessment. Each team will meet triweekly over the course of the active implementation period Team meetings focus on monitoring and promoting MBC fidelity per the guideline Team meetings focus on identifying remaining barriers
Policies and incentives Guideline for PHQ-9 administration frequency Each session w/client Determined by site
Norms and attitudes Initial MBC training Standardized training material Tailored training material targeting identified barriers from the needs assessment
Structure and process Progress note modifications For clinician score review For clinician score review
Media and change agents Triweekly consultation with experts Consultation focuses on MBC fidelity, particularly on incorporating clinician PHQ-9 score review into sessions, encouraging discussion of scores with clients, and providing tips on targeting lack of progress Consultation focuses on targeting identified barriers in addition to MBC fidelity. However, emphasis will be placed on tailoring review, discussion, and targeting lack of progress to the site-specific PHQ-9 guidelines to address contextual and other barriers as they are identified throughout the course of implementation