It’s the time of year when backyard gardeners start to think about transplanting tomato seedlings from that tray in the sunny part of the kitchen to the real garden outside. Moving outdoors too soon is risky. Those little seedlings could get beaten down by the cold rain, nibbled by the escaped Easter bunnies running wild in my neighborhood, or decimated by cutworms. Gardeners in the Northeast and Midwest even need to worry about late-season snow. But you don’t want to wait too long, or you’ll end up with root-bound, leggy plants and a disappointing tomato crop.
Those of us who develop mental health interventions often keep them indoors too long. When I look back on the history of Collaborative Care for depression, I think we waited too long before moving that intervention to the outdoor garden. We completed four trials of Collaborative Care within Group Health Cooperative (now Kaiser Permanente Washington) before the large, multi-site IMPACT trial-tested Collaborative Care across the great outdoors of eight health systems. Perhaps IMPACT could have happened five years (and two randomized trials) earlier.
For those who develop new treatments or programs, it’s only natural to want to keep those delicate young plants indoors. Spring weather is unpredictable, and a promising new treatment or program might fail for random reasons. We might relax our over-protectiveness if we could learn more from those “failures”. I’ll again cite the IMPACT trial as an example to follow. Collaborative Care for depression proved effective across a variety of health systems, patient populations, and enrollment strategies. But that consistency was not a presumption or even a goal. If Collaborative Care had “failed” in some settings, we could have learned valuable lessons for future implementation. If we intentionally plant our tomato seedlings in all sorts of conditions, some might not flourish. But we might learn things we can implement next spring.
Greg Simon