Adapting on-the-go in NYC: Ongoing implementation strategy and cultural adaptations of Problem Management Plus (PM+), a non-clinician delivered mental health intervention

Abstract Introduction: Mental health service utilization remains disproportionately low among racial and ethnic minority populations, due to structural barriers and a lack of culturally responsive mental health programming in community settings. Adapting both intervention content and implementation strategies is essential to improving the fit and effectiveness of task-shared mental health interventions, yet most adaptation research focuses on pre-implementation changes rather than ongoing adjustments throughout a program's lifecycle. This paper examines adaptations to Problem Management Plus (PM+), a task-shared intervention delivered by non-clinicians across 19 community-based organizations in New York City as part of a cluster randomized controlled trial, drawing on implementation science and cultural adaptation frameworks to guide documentation of adaptations before, during, and after implementation. Methods Three implementation science and two cultural adaptation frameworks were used to guide the documentation, analysis, and reporting of implementation strategy and cultural adaptations. A seven-step adaptation process was conducted before, during, and after intervention implementation and data was collected throughout each of these steps. Qualitative methods and descriptive statistics were used to characterize and summarize implementation strategy and cultural adaptations. Results Of the 139 adaptations documented, most (63%, n = 88) occurred during implementation, and most concerned program delivery (69%, n = 96) rather than training/supervision (10%, n = 14) or recruitment and CBO integration (21%, n = 29). Adaptations were made mainly at the individual level (43%, n = 59), followed by across all CBO sites (38%, n = 53) and select sites (19%, n = 27). Priority adaptations included adjusting the training model to increase trainee retention, integration of implementation strategy-related topics such as participant reach within clinical supervision, delivering the intervention in community settings such as parks and cafes, and integration of culturally appropriate practices such as meditation and prayer within the intervention. Conclusion This paper offers guidance on documenting implementation strategies and cultural adaptations throughout program delivery in real-world settings—specifically, how to conduct and document adaptations pre-, during, and post-implementation, and what to adapt. By consolidating implementation science and cultural adaptation frameworks, this study aims to bridge dialogue between the two disciplines and serve as a guiding example for documenting adaptations across the program lifecycle. Trial Registration: NCT04913766; Clinicaltrials.gov; Registration date 06/03/2021