Community mental health (CMH) agencies in Michigan are integral for providing services to autistic children experiencing socioeconomic disadvantage. However, CMH agencies utilize evidence based interventions, such as Project ImPACT, at a significantly lower frequency and intensity than is recommended to improve outcomes. There is a critical need to investigate methods to systematically increase the adoption and delivery of interventions such as Project ImPACT within CMH agencies. Concept mapping has been identified as an Implementation Strategy Mapping Method (ISMM) to elicit stakeholder perspectives, identify context-specific implementation determinants, and select and tailor implementation strategies that map on to each determinant, in an effort to facilitate implementation. This study aimed to evaluate (a) the impact of concept mapping on organizational readiness to change and (b) the feasibility, acceptability, appropriateness, and usability of concept mapping as an ISMM in CMH agencies. This study followed a sequential explanatory (quan QUAL) mixed methods design. Four CMH agencies across Michigan participated; 5 staff members (agency leaders, clinical supervisors, direct providers) within each agency participated in pre-concept mapping questionnaires, concept mapping, and post-concept mapping questionnaires. Questionnaire data included demographics information, implementation barriers and facilitators, organizational readiness to change, and end-user evaluations of concept mapping. The concept mapping process included brainstorming, sorting, and ranking implementation strategies on their importance and feasibility in addressing agency-specific implementation barriers. Lastly, 15 participants completed a semi-structured interview to further describe perspectives on the impact of concept mapping on organizational readiness as well as the feasibility, acceptability, appropriateness and usability of concept mapping. Paired samples t-tests did not indicate significant changes in organizational motivation or capacity to change at any of the participating agencies. Concept mapping results highlighted implementation strategies that were ranked as important and feasible at each of the participating agencies. The majority of implementation strategies were selected from the ERIC list of implementation strategies. Common strategies involved training, supervision, developing an implementation plan, and engaging patients/consumers in the process. Lastly, average ratings of end-user evaluations indicated high levels of acceptability, feasibility appropriateness, and usability of concept mapping. Qualitative findings indicated that participants most often discussed the feasibility, acceptability and usability of concept mapping. Three themes were identified: End-user Evaluations, Organizational Readiness, and Mapping Strategies. Qualitative codes explained factors that influenced perceptions of ISMM end-user evaluations, factors that impacted organizational readiness, and beliefs regarding how implementation strategies mapped on to agency-specific barriers. Quantitative and qualitative data were merged in a joint display to illustrate how perceptions of organizational readiness and ISMM end-user evaluations converged or diverged across both data strands. Overall, study findings indicate that concept mapping is a promising method for selecting and tailoring implementation strategies within CMH agencies serving autistic youth, in an effort to facilitate successful implementation and increase service equity for this population.
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