ACTS Model

The Center for Behavioral Intervention Technologies is a pioneer in the development of research and evaluation methods that fit the digital mental health context. Current research methods have resulted in hundreds of trials that have demonstrated efficacy, yet this enormous evidence base has not translated into successful or sustainable implementation in real-world healthcare settings. Indeed, many value-based healthcare organizations have attempted to implement commercially available digital mental health settings interventions. Unfortunately, these implementations have failed because patients do not use them and they are not well-accepted by providers.

Our solution-focused approach has been articulated in a number of papers listed at the bottom of this page. The overarching framework is our Accelerated Creation-to-Sustainment (ACTS) model. In contrast to traditional research methods, which aim to generate generalizable evidence of efficacy or effectiveness, the end goal of solution-focused research is to create a sustainable implementation in one setting. From there, the intervention can be scaled out to other settings.

There are three stages in the ACTS model:

• Create Stage: This phase employs user-centered design methods to deeply engage with all stakeholders to understand their needs, preferences and limitations in an iterative design process. Importantly, we begin simultaneously designing the service protocol (the goals and specific actions on a provider), the technologies that support that service and the implementation plan. Therefore, we don’t just focus first on the technology design but rather view all components as equally important.
• Optimization-Effectiveness-Implementation (OEI) Hybrid Trial Stage: We move away from a phase-based research model in which interventions are moved sequentially through pilot, efficacy, effectiveness and implementation trials, to a model that can produce rapid results in one trial.  Effectiveness and implementation are evaluated simultaneously. Using our Trials of Intervention Principles method, we integrate optimization into the trial. Thus, we encourage learning and improvement in service protocol, technologies and implementation plan throughout the course of the trial.
• Sustainment Stage: To ensure sustainment, we continue past the OEI Hybrid Trial, turning over essential implementation functions normally provided by research staff to staff in the healthcare system. These functions include training, supervision and continuous quality improvement methods. 

References

Mohr DC, Lyon AR, Lattie EG, Reddy M, Schueller SM. Accelerating Digital Mental Health Research From Early Design and Creation to Successful Implementation and Sustainment. 2017;19(5):e153.

Mohr DC, Schueller SM, Riley WT, et al. Trials of Intervention Principles: Evaluation Methods for Evolving Behavioral Intervention Technologies. J Med Internet Res. 2015;17(7):e166.

Mohr DC, Cheung K, Schueller SM, Hendricks Brown C, Duan N. Continuous evaluation of evolving behavioral intervention technologies. Am J Prev Med. 2013;45(4):517-523.

Mohr DC, Schueller SM, Montague E, Burns MN, Rashidi P. The behavioral intervention technology model: an integrated conceptual and technological framework for eHealth and mHealth interventions. J Med Internet Res. 2014;16(6):e146.