Multilevel Implementation SMARTs (MI-SMART) are a type of experimental study design used to construct an optimized Multilevel Adaptive Implementation Strategy (MAISY). In a MI-SMART, there are multiple levels—for example, schools and school practitioners, or clinic and providers within clinic—and multiple time points of randomization. These randomizations help us answer scientific questions about how best to sequence and adapt different strategies across multiple levels of implementation.
EXAMPLE. Consider optimizing a two-stage MAISY for implementing cognitive behavioral therapy (CBT) at high schools across Michigan, which often have multiple school psychologists (SPs) on staff. A MI-SMART may randomize: (i) schools to understand the effect of a school-wide CBT skills coaching strategy in the first stage, and (ii) SPs within schools to understand the effect of a self-efficacy promotion strategy in the second stage.