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Implementation Science
Published in: Implementation Science 1/2017

Open Access 01-12-2017 | Research

Non-participants in policy efforts to promote evidence-based practices in a large behavioral health system

Authors: Rebecca E. Stewart, Danielle R. Adams, David S. Mandell, Gayatri Nangia, Lauren Shaffer, Arthur C. Evans, Ronnie Rubin, Shawna Weaver, Trevor R. Hadley, Rinad S. Beidas

Published in: Implementation Science | Issue 1/2017

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Abstract

Background

System-wide training initiatives to support and implement evidence-based practices (EBPs) in behavioral health systems have become increasingly widespread. Understanding more about organizations who do not participate in EBP training initiatives is a critical piece of the dissemination and implementation puzzle if we endeavor to increase access in community settings.

Methods

We conducted 30 1-h semi-structured interviews with leaders in non-participating agencies who did not formally participate in system-wide training initiatives to implement EBPs in the City of Philadelphia, with the goal to understand why they did not participate.

Results

We found that despite not participating in training initiatives, most agencies were adopting (and self-financing) some EBP implementation. Leadership from agencies that were implementing EBPs reported relying on previously trained staff to implement EBPs and acknowledged a lack of emphasis on fidelity. Most leaders at agencies not adopting EBPs did not have a clear understanding of what EBP is. Those familiar with EBPs in agencies not adopting EBPs reported philosophical objections to EBPs. When asked about quality assurance and treatment selection, leaders reported being guided by system audits.

Conclusions

While it is highly encouraging that many agencies are adopting EBPs on their own, significant questions about fidelity and implementation success more broadly remain.
Footnotes
1
Community Behavioral Health (CBH) is a not-for-profit 501(c)(3) corporation contracted by the City of Philadelphia for provision of behavioral health coverage for the City’s over 500,000 Medicaid-enrolled individuals.
 
Literature
1.
Aarons GA, Sawitzky AC. Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychol Serv. 2006;3:61–72.CrossRefPubMedPubMedCentral
2.
Aarons GA, Wells RS, Zagursky K, Fettes DL, Palinkas LA. Implementing evidence-based practice in community mental health agencies: a multiple stakeholder analysis. Am J Public Health. 2009;99:2087–95.CrossRefPubMedPubMedCentral
3.
Aarons GA. Mental health provider attitudes toward adoption of evidence-based practice: the evidence-based practice attitude scale (EBPAS). Ment Health Serv Res. 2004;6:61–74.CrossRefPubMedPubMedCentral
4.
Ganju V. Implementation of evidence-based practices in state mental health systems: implications for research and effectiveness studies. Schizophr Bull. 2003;29:125–31.CrossRefPubMed
5.
Gotham HJ. Advancing the implementation of evidence-based practices into clinical practice: how do we get there from here? Prof Psychol Res Pract. 2006;37:606–13.CrossRef
6.
7.
Cristofalo MA. Implementation of health and mental health evidence-based practices in safety net settings. Soc Work Health Care. 2013;52:728–40.CrossRefPubMed
8.
Hemmelgarn AL, Glisson C, James LR. Organizational culture and climate: implications for services and interventions research. Clin Psychol Sci Pract. 2006;13:73–89.CrossRef
9.
Bond GR, Drake RE, McHugo GJ, Peterson AE, Jones AM, Williams J. Long-term sustainability of evidence-based practices in community mental health agencies. Adm Policy Ment Health. 2014;41:228–36.CrossRefPubMed
10.
Klein KJ, Knight AP. Innovation implementation overcoming the challenge. Curr Dir Psychol Sci. 2005;14:243–6.CrossRef
11.
Raghavan R, Bright CL, Shadoin AL. Toward a policy ecology of implementation of evidence-based practices in public mental health settings. Implement Sci IS. 2008;3:26.CrossRefPubMed
12.
Rubin RM, Hurford MO, Hadley T, Matlin S, Weaver S, Evans AC. Synchronizing watches: the challenge of aligning implementation science and public systems. Adm. Policy Ment. Health Ment. Health Serv. Res. [Internet]. 2016 [cited 2016 Sep 6]; Available from: http://​link.​springer.​com/​10.​1007/​s10488-016-0759-9
13.
Beidas RS, Stewart RE, Adams DR, Fernandez T, Lustbader S, Powell BJ, et al. A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System. Adm Policy Ment Health. 2016;43:893–908.CrossRefPubMed
14.
Olin SS, Nadeem E, Gleacher A, Weaver J, Weiss D, Hoagwood KE, et al. What predicts clinician dropout from state-sponsored managing and adapting practice training. Adm. Policy Ment. Health Ment. Health Serv. Res. [Internet]. 2015 [cited 2016 Oct 3]; Available from: http://​link.​springer.​com/​10.​1007/​s10488-015-0709-y.
15.
Skriner LC, Wolk CB, Stewart RE, Adams DR, Rubin RM, Evans AC, et al. Therapist and Organizational Factors Associated with Participation in Evidence-Based Practice Initiatives in a Large Urban Publicly-Funded Mental Health System. J Behav Health Serv Res. [Internet]. 2017 [cited 2017 May 4]; Available from: http://​link.​springer.​com/​10.​1007/​s11414-017-9552-0.
16.
Powell BJ, Beidas RS, Rubin RM, Stewart RE, Wolk CB, Matlin SL, et al. Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts. Adm Policy Ment Health. 2016;43:909–26.CrossRefPubMed
17.
Powell BJ, Proctor EK, Glass JE. A systematic review of strategies for implementing empirically supported mental health interventions. Res Soc Work Pract. 2014;24:192–212.CrossRefPubMed
18.
Creed TA, Stirman SW, Evans AC, Beck AT. A model for implementation of cognitive therapy in community mental health: the Beck initiative. Behav Ther. 2010;37:56–65.
19.
Stirman SW, Spokas M, Creed TA, Farabaugh DT, Bhar SS, Brown GK, et al. Training and consultation in evidence-based psychosocial treatments in public mental health settings: the ACCESS model. Prof Psychol Res Pract. 2010;41:48–56.CrossRef
20.
Beidas RS, Adams DR, Kratz HE, Jackson K, Berkowitz S, Zinny A, et al. Lessons learned while building a trauma-informed public behavioral health system in the City of Philadelphia. Eval Program Plann. 2016;59:21–32.CrossRefPubMed
21.
Achara-Abrahams I, Evans AC, King JK. Recovery-focused behavioral health systems transformation: a framework for change and lessons learned from Philadelphia. Addict Recovery Manag Theory Sci Pract. 2011;187–208.
22.
Glaser B, Strauss A. The discovery of grounded theory: strategies for qualitative research. New Brunswick u.a: Aldine Transaction; 1999.
23.
Bradley EH, Curry LA, Devers KJ. Qualitative data analysis for health services research: developing taxonomy, themes, and theory. Health Serv Res. 2007;42:1758–72.CrossRefPubMedPubMedCentral
24.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.CrossRefPubMed
25.
26.
Stewart RE, Adams DR, Mandell DS, Hadley TR, Evans AC, Rubin R, et al. The perfect storm: collision of the business of mental health and the implementation of evidence-based practices. Psychiatr Serv Wash DC. 2016;67:159–61.CrossRef
27.
Webb CA, DeRubeis RJ, Barber JP. Therapist adherence/competence and treatment outcome: a meta-analytic review. J Consult Clin Psychol. 2010;78:200–11.CrossRefPubMedPubMedCentral
28.
Crits-Christoph P, Frank E, Chambless DL, Brody C, Karp JF. Training in empirically validated treatments: what are clinical psychology students learning? Prof Psychol Res Pract. 1995;26:514–22.CrossRef
29.
Hoge MA, Tondora J, Marrelli AF. The fundamentals of workforce competency: implications for behavioral health. Adm Policy Ment Health Ment Health Serv Res. 2005;32:509–31.CrossRef
30.
Weissman MM, Verdeli H, Gameroff MJ, Bledsoe SE, Betts K, Mufson L, et al. National survey of psychotherapy training in psychiatry, psychology, and social work. Arch Gen Psychiatry. 2006;63:925.CrossRefPubMed
31.
Herschell AD, Kolko DJ, Baumann BL, Davis AC. The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev. 2010;30:448–66.CrossRefPubMedPubMedCentral
32.
Nakamura BJ, Selbo-Bruns A, Okamura K, Chang J, Slavin L, Shimabukuro S. Developing a systematic evaluation approach for training programs within a train-the-trainer model for youth cognitive behavior therapy. Behav Res Ther. 2014;53:10–9.CrossRefPubMed
33.
Sholomskas D, Syracuse-Siewert G, Rousanville B, Ball S, Nuro K, Carroll K. We don’t train in vain: a dissemination trial of three strategies of training clinicians in cognitive behavioral therapy. J Consult Clin Psychol. 2005;73:106–15.CrossRefPubMedPubMedCentral
34.
Aarons GA, Hurlburt M, Horwitz SM. Advancing a conceptual model of evidence-based practice implementation in public service sectors. Adm Policy Ment Health. 2011;38:4–23.CrossRefPubMed
35.
Damschroder LJ, Aron DC, Keith RE, Kirsh SR, Alexander JA, Lowery JC. Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci IS. 2009;4:50.CrossRefPubMed
36.
Nelson TD, Steele RG. Predictors of practitioner self-reported use of evidence-based practices: practitioner training, clinical setting, and attitudes toward research. Adm Policy Ment Health Ment Health Serv Res. 2007;344:319–30.CrossRef
37.
Nelson TD, Steele RG, Mize JA. Practitioner attitudes toward evidence-based practice: themes and challenges. Adm Policy Ment Health Ment Health Serv Res. 2006;33:398–409.CrossRef
38.
Pagoto SL, Spring B, Coups EJ, Mulvaney S, Coutu M-F, Ozakinci G. Barriers and facilitators of evidence-based practice perceived by behavioral science health professionals. J Clin Psychol. 2007;63:695–705.CrossRefPubMed
39.
Riley WT, Schumann MF, Forman-Hoffman VL, Mihm P, Applegate BW, Asif O. Responses of practicing psychologists to a web site developed to promote empirically supported treatments. Prof Psychol Res Pract. 2007;38:44–53.CrossRef
40.
Gallo KP, Barlow DH. Factors involved in clinician adoption and nonadoption of evidence-based interventions in mental health. Clin Psychol Sci Pract. 2012;19:93–106.CrossRef
41.
Stewart RE, Stirman SW, Chambless DL. A Qualitative Investigation of Practicing Psychologists’ Attitudes Toward Research-Informed Practice: Implications for Dissemination Strategies. Prof Psychol Res Pract. 2012;43:100–9.CrossRef
42.
Stewart RE, Chambless DL. Interesting practitioners in training in empirically supported treatments: research reviews versus case studies. J Clin Psychol. 2010;66:73–95.PubMedPubMedCentral
43.
Mandell DS, Barry CL, Marcus SC, Xie M, Shea K, Mullan K, et al. Effects of autism spectrum disorder insurance mandates on the treated prevalence of autism spectrum disorder. JAMA Pediatr. 2016;170:887–93.CrossRefPubMed
44.
Rieckmann T, Bergmann L, Rasplica C. Legislating clinical practice: counselor responses to an evidence-based practice mandate. J. Psychoactive Drugs. 2011;Suppl 7:27–39.
45.
Ziegenfuss JT, Hadley T. Understanding purposes of regulation: a case example in mental health. Adm Soc Work. 1980;4:53–60.CrossRefPubMed
46.
Creed TA, Wolk CB, Feinberg B, Evans AC, Beck AT. Beyond the label: relationship between community therapists’ self-report of a cognitive behavioral therapy orientation and observed skills. Adm Policy Ment Health. 2016;43:36–43.CrossRefPubMed
47.
Chambers DA, Glasgow RE, Stange KC. The dynamic sustainability framework: addressing the paradox of sustainment amid ongoing change. Implement. Sci. [Internet]. 2013 [cited 2016 Sep 7];8. Available from: http://​implementationsc​ience.​biomedcentral.​com/​articles/​10.​1186/​1748-5908-8-117
Metadata
Title
Non-participants in policy efforts to promote evidence-based practices in a large behavioral health system
Authors
Rebecca E. Stewart
Danielle R. Adams
David S. Mandell
Gayatri Nangia
Lauren Shaffer
Arthur C. Evans
Ronnie Rubin
Shawna Weaver
Trevor R. Hadley
Rinad S. Beidas
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2017
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/s13012-017-0598-4

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