Evaluating Clinical Outcomes in Practice Settings: Beyond the Limits of Grant-Funded Clinical Research

Effectiveness trials of manualized interventions in real-world contexts are critical to promote high-quality clinical care and to advance the field of health service psychology. However, conducting research in real-world clinic settings is challenging due to many practical constraints, such as limited research funding and personnel for the completion of research tasks. The current article describes how clinicians and researchers at 3 outpatient clinics affiliated with an academic medical center overcame practical and financial constraints to adopt and evaluate a child emotion regulation and social skills training intervention with minimal research funding. We provide an overview of challenges encountered, including adopting a new intervention, balancing the competing demands of program fidelity and flexibility, selecting and administering assessment measures, staffing for research tasks, ethical considerations for choosing a comparison control group and randomizing patients to conditions, and addressing patient concerns about research involvement. Potential solutions that may be of use to other community clinic settings or underresourced clinical research programs are suggested. These include using free, psychometrically sound measures to gather program outcome data, applying for philanthropic and nongovernment grants, dedicating a fixed portion of a clinic's income to research-related activities, working collaboratively with affiliated or nearby research institutions, engaging volunteers and trainees to support research efforts, and using a treatment-as-usual comparison condition. Public Significance Statement Integrating research into applied clinical practice is essential to advancing mental health. This article describes the challenges encountered, solutions generated, and recommendations for future research after clinicians and researchers at an academic medical center conducted a study at three outpatient clinics. This article describes adopting a new intervention, designing a study that is feasible given financial and human resource constraints, selecting and using assessment measures, and addressing patients' concerns about research participation.