Measures
Survey questions were developed by members of the MHAC using an
iterative, consensus-based process. Each year, the set of questions was
revised to reflect evolving challenges in implementation, such as
development of newly developed, condition-specific interventions for
depression and anxiety, use of telehealth, and sustainability of the
mental health program as the 3-year funding cycle was ending. Items that
had 100% endorsement in Year 1 (e.g., use of recommended screening
tools, ability to score them) were removed from subsequent surveys to
make room for questions related to more advanced implementation. In Year
1, the survey had 50 items, in Year 2 this was expanded to 80 items, and
in Year 3, a total of 71 items were included.
To quantify implementation success, points were assigned to survey
answers (0-1, 0-3, 0-4) based on the level of difficulty in achieving
them. Discussions among study co-authors were held to reach consensus on
level of implementation difficulty. For example, success in counseling
individuals with moderate to severe symptomatology was assigned more
points than counseling those reporting mild symptoms. See Table 1 for
example items and scoring.