John R Kimberly

Robert A. Schnoll, Mackenzie Hosie Quinn, Nathaniel Stevens, Alex Flitter, Paul Wileyto, John R Kimberly, Rinad S. Beidas, Jane Hatzell, Scott D. Siegel, Grace Crawford, Naja Hill, Teresa Deatley, Douglas Ziedonis (2023), A randomized clinical trial testing two implementation strategies to promote the treatment of tobacco dependence in community mental healthcare, Drug and Alcohol Dependence, 247 ().

Abstract: Introduction: People with serious mental illness (SMI) are more likely to smoke and less likely to receive tobacco treatment. Implementation strategies may address clinician and organizational barriers to treating tobacco in mental healthcare. Methods: A cluster-randomized trial (Clinic N=13, Client N=610, Staff N=222) tested two models to promote tobacco treatment in community mental healthcare: standard didactic training vs. Addressing Tobacco Through Organizational Change (ATTOC), an organizational model that provides clinician and leadership training and addresses system barriers to tobacco treatment. Primary outcomes were changes in tobacco treatment from clients, staff, and medical records. Secondary outcomes were changes in smoking, mental health, and quality of life (QOL), and staff skills and barriers to treat tobacco. Results: Clients at ATTOC sites reported a significant increase in receiving tobacco treatment from clinician at weeks 12 and 24 (ps<0.05) and tobacco treatments and policies from clinics at weeks 12, 24, 36, and 52 (ps<0.05), vs. standard sites. ATTOC staff reported a significant increase in skills to treat tobacco at week 36 (p=0.05), vs. standard sites. For both models, tobacco use medications, from clients (week 52) and medical records (week 36), increased (ps<0.05), while perceived barriers decreased at weeks 24 and 52 (ps<0.05); 4.3% of clients quit smoking which was not associated with model. QOL and mental health improved over 24 weeks for both models (ps<0.05). Conclusions: Standard training and ATTOC improve use of evidence-based tobacco treatments in community mental healthcare without worsening mental health, but ATTOC may more effectively address this practice gap.

Meghan B. Lane-Fall, Athena Christakos, Gina C. Russell, Elizabeth D. Dauer, Philip E. Greilich, Bommy Hong Mershon, Christopher P. Potestio, Erin W. Pukenas, John R Kimberly, Alisa J. Stephens-Shields, Rebecca L. Trotta, Rinad S. Beidas, Ellen J. Bass (2021), Handoffs and transitions in critical care-understanding scalability: study protocol for a multi- Center stepped wedge type 2 hybrid effectiveness implementation trial, Implementation Science, 16 (1).

Abstract: Background: The implementation of evidence-based practices in critical care faces specific challenges, including intense time pressure and patient acuity. These challenges result in evidence-to-practice gaps that diminish the impact of proven-effective interventions for patients requiring intensive care unit support. Research is needed to understand and address implementation determinants in critical care settings. Methods: The Handoffs and Transitions in Critical Care—Understanding Scalability (HATRICC-US) study is a Type 2 hybrid effectiveness-implementation trial of standardized operating room (OR) to intensive care unit (ICU) handoffs. This mixed methods study will use a stepped wedge design with randomized roll out to test the effectiveness of a customized protocol for structuring communication between clinicians in the OR and the ICU. The study will be conducted in twelve ICUs (10 adult, 2 pediatric) based in five United States academic health systems. Contextual inquiry incorporating implementation science, systems engineering, and human factors engineering approaches will guide both protocol customization and identification of protocol implementation determinants. Implementation mapping will be used to select appropriate implementation strategies for each setting. Human-centered design will be used to create a digital toolkit for dissemination of study findings. The primary implementation outcome will be fidelity to the customized handoff protocol (unit of analysis: handoff). The primary effectiveness outcome will be a composite measure of new-onset organ failure cases (unit of analysis: ICU). Discussion: The HATRICC-US study will customize, implement, and evaluate standardized procedures for OR to ICU handoffs in a heterogenous group of United States academic medical center intensive care units. Findings from this study have the potential to improve postsurgical communication, decrease adverse clinical outcomes, and inform the implementation of other evidence-based practices in critical care settings.

Scott D. Siegel, J.P. Laurenceau, Naja Hill, Anna-Marika Bauer, Alex Flitter, Douglas Ziedonis, Nathaniel Stevens, Mackenzie Hosie Quinn, Frank Leone, Rinad Beidas, John R Kimberly, Robert A. Schnoll (2021), Assessing barriers to providing tobacco use disorder treatment in community mental health settings with a revised version of the Smoking Knowledge, Attitudes and Practices (S-KAP) instrument, Addictive Behaviors , 114 ().

Abstract: Background: Tobacco use disorder (TUD) rates are 2–3 times higher among people with serious mental illness (SMI) than the general population. Clinicians working in outpatient community mental health clinics are well positioned to provide TUD treatment to this group, but rates of treatment provision are very low. Understanding factors associated with the provision of TUD treatment by mental health clinicians is a priority. Methods: This study used baseline data from an ongoing cluster-randomized clinical trial evaluating two approaches to training clinicians to increase TUD treatment. Following a psychometric assessment of our assessment tool, the Smoking Knowledge, Attitudes, and Practices (S-KAP) instrument, a new factor structure was evaluated utilizing confirmatory factor analysis. Structural equation modeling was then used to examine the associations between TUD treatment practices and clinician, setting, and patient characteristics in a sample of 182 mental health clinicians across 10 mental health clinics. Results: Clinician but not setting or patient characteristics emerged as significant correlates of providing TUD treatment. Specifically, clinicians’ general ethical commitment to providing TUD services and perceptions of their skills in providing this type of care were associated with providing TUD treatment. In contrast, clinician perceptions of patient motivation, anticipated quit rates, or available setting resources were not significantly associated with providing TUD treatment. Conclusions: Enhancing community mental health clinician TUD treatment skills and commitment to providing such services may reduce TUD rates among people with SMI. Future studies should evaluate interventions that target these factors.

Iestyn Williams, Jenny Harlock, Glenn Robert, John R Kimberly, Russell Mannion (2021), Is the end in sight? A study of how and why services are decommissioned in the English National Health Service, Sociology of Health and Illness , 43 (2), pp. 441-458.

Abstract: The decommissioning of a health-care service is invariably a highly complex and contentious process which faces many implementation challenges. There has been little specific theorisation of this phenomena, although insights can be transferred from wider literatures on policy implementation and change processes. In this paper, we present findings from empirical case studies of three decommissioning processes initiated in the English National Health Service. We apply Levine's (1979, Public Administration Review, 39(2), 179-183) typology of decommissioning drivers and insights from the empirical literature on pluralistic health-care contexts, complex change processes and institutional constraints. Data include interviews, non-participant observation and documents analysis. Alongside familiar patterns of pluralism and political partisanship, our results suggest the important role played by institutional factors in determining the outcome of decommissioning processes and in particular the prior requirement of political vulnerability for services to be successfully closed. Factors linked to the extent of such vulnerability include the scale of the proposed changes and extent to which they are supported at the macrolevel.

Melanie Pellecchia, Rinad S. Beidas, Gwendolyn Lawson, Nathaniel J Williams, Max Seidman, John R Kimberly, Carolyn C Cannuscio, David S Mandell (2020), Does implementing a new intervention disrupt use of existing evidence-based autism interventions?, Autism, 24 (7), pp. 1713-1725.

Abstract: This study examines how the introduction of TeachTown:Basics, a computer-assisted intervention for students with autism spectrum disorder, influenced teachers’ use of other evidence-based practices. In a randomized controlled trial that enrolled 73 teachers nested within 58 schools, we used three-level hierarchical linear models to evaluate changes in teachers’ use of evidence-based practices across the school year for those who received TeachTown:Basics versus those assigned to control. Both groups received training and implementation support to deliver three well-established evidence-based practices for autism spectrum disorder. Qualitative interviews were conducted with 25 teachers who used TeachTown:Basics to better understand their experience. Compared with teachers in the control group, teachers in the TeachTown:Basics group reported significantly less growth over the 9-month period in their use of evidence-based practices that require one-to-one instruction (ps < 0.05), but no difference in their reported use of evidence-based practices that do not involve one-to-one instruction (p = 0.637). Qualitative interviews indicated that teachers viewed TeachTown:Basics as an effective substitute for one-to-one instruction because it was less burdensome, despite the lack of support for TeachTown:Basics’ effectiveness. Before introducing new practices, education leaders should carefully consider both evidence of effectiveness and the potential impact on the use of other evidence-based practices.

Su Fen Lubitz, Alex Flitter, Paul Wileyto, Douglas Ziedonis, Frank Leone, David S Mandell, John R Kimberly, Rinad Beidas, Robert A. Schnoll (2020), History and Correlates of Smoking Cessation Behaviors Among Smokers With Serious Mental Illness, Nicotine & Tobacco Research , 22 (9), pp. 1492-1499.

Abstract: Introduction Individuals with serious mental illness (SMI) smoke at rates two to three times greater than the general population but are less likely to receive treatment. Increasing our understanding of correlates of smoking cessation behaviors in this group can guide intervention development. Aims and Methods Baseline data from an ongoing trial involving smokers with SMI (N = 482) were used to describe smoking cessation behaviors (ie, quit attempts, quit motivation, and smoking cessation treatment) and correlates of these behaviors (ie, demographics, attitudinal and systems-related variables). Results Forty-three percent of the sample did not report making a quit attempt in the last year, but 44% reported making one to six quit attempts; 43% and 20%, respectively, reported wanting to quit within the next 6 months or the next 30 days. Sixty-one percent used a smoking cessation medication during their quit attempt, while 13% utilized counseling. More quit attempts were associated with lower nicotine dependence and carbon monoxide and greater beliefs about the harms of smoking. Greater quit motivation was associated with lower carbon monoxide, minority race, benefits of cessation counseling, and importance of counseling within the clinic. A greater likelihood of using smoking cessation medications was associated with being female, smoking more cigarettes, and receiving smoking cessation advice. A greater likelihood of using smoking cessation counseling was associated with being male, greater academic achievement, and receiving smoking cessation advice. Conclusions Many smokers with SMI are engaged in efforts to quit smoking. Measures of smoking cessation behavior are associated with tobacco use indicators, beliefs about smoking, race and gender, and receiving cessation advice. Implications Consideration of factors related to cessation behaviors among smokers with SMI continues to be warranted, due to their high smoking rates compared to the general population. Increasing our understanding of these predictive characteristics can help promote higher engagement in evidence-based smoking cessation treatments among this subpopulation.

Alex Flitter, Su Fen Lubitz, Douglas Ziedonis, Nathaniel Stevens, Frank Leone, David S Mandell, John R Kimberly, Oscar Lopez, Rinad S. Beidas, Robert A. Schnoll (2019), A Cluster-Randomized Clinical Trial Testing the Effectiveness of the Addressing Tobacco Through Organizational Change Model for Improving the Treatment of Tobacco Use in Community Mental Health Care: Preliminary Study Feasibility and Baseline Findings, Nicotine & Tobacco Research , 21 (5), pp. 559-567.

Abstract: Abstract Introduction: People with mental illness are more likely to smoke and less likely to receive tobacco treatment than the general population. The Addressing Tobacco Through Organizational Change (ATTOC) approach supports organizational change to increase tobacco treatment in this population. We describe preliminary study feasibility and baseline behaviors and attitudes among clients and staff regarding tobacco treatment, and assesse correlates of treatment of smoking. Methods: Preliminary accrual, engagement, and baseline data are reported from a cluster-randomized trial comparing ATTOC to usual care. Feasibility, thus far, was the rate of site and participant accrual and engagement (eg, participants remaining in the trial). Correlates of assessing smoking, advising cessation, and providing treatment were assessed. Results: Site and participant accrual is 80% (8/10) and 86% (456/533), and engagement is 100% and 82%. “Staff asking about smoking” was reported by 63% of clients and 38% of staff; “staff advising cessation” was reported by 57% of clients and 46% of staff; staff report “assisting clients with any medication” at most 22% of the time, whereas at most 18% of clients report receiving a cessation medication; 59% of clients want tobacco treatment, but 36% of staff think that it is part of their job. “Staff assisting with medications” is related to more training, believing treating smoking is part of their job, and believing patients are concerned about smoking (ps < .05). Conclusions: This trial of training in tobacco treatment within mental health care is feasible thus far; self-reported rates of tobacco treatment are low and associated with clinician attitudes and barriers

A. Flitter, G. Crawford, N. Stevens, D. Ziedonis, F. Leone, D. Mandell, John R Kimberly, R. Schnoll (Working), Working with Community Mental Health Clinics to Test Clinician Training Programs for Treating Nicotine Dependence among Smokers with Serious Mental Illness (SMI).

Hamid Bouchikhi and John R Kimberly (2017), Paradigmatic warfare: The struggle for the soul of economics at the University of Notre Dame, Industrial and Corporate Change, 26 (6), pp. 1109-1124.

Abstract: Between 2003 and 2010, the College of Arts and Letters of the University of Notre Dame had two rival economics departments, one that was resolutely mainstream and the other that was just as resolutely heterodox. This unusual organizational arrangement was an effort to accommodate a paradigmatic conflict about the kind of economic scholarship needed to lift the university in national rankings while, at the same time, maintaining its Catholic identity, a conflict that unfolded over three decades and that resulted, ultimately, in the closure of the heterodox department in July 2010 and a full embrace of mainstream economics. This article traces the history of this conflict and documents the kind of organizational, political, and personal issues that together influenced this extended, intense, and highly divisive case of paradigmatic warfare. Our analysis shows how the goal of becoming a major research university and the use of rankings to measure the performance of academic departments created contested terrain, where existing interests and commitments struggled to maintain legitimacy in the face of the emergence of new strategic priorities and set off a variety of conflicting moves and counter moves that engaged identity and power and that required forceful leadership to resolve.

Hamid Bouchikhi and John R Kimberly (Working), Transgressive Leadership and the Common Good.