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Therapist perspectives on training in a package of evidence-based practice strategies for children with autism spectrum disorders served in community mental health clinics. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 41:114-25. [PMID: 23086499 DOI: 10.1007/s10488-012-0441-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Therapist perspectives regarding delivery of evidence-based practice (EBP) strategies are needed to understand the feasibility of implementation in routine service settings. This qualitative study examined the perspectives of 13 therapists receiving training and delivering a package of EBPs to children with autism spectrum disorders (ASDs) in community mental health clinics. Therapists perceived the training and intervention delivery as effective at improving their clinical skills, the psychotherapy process, and child and family outcomes. Results expand parent pilot study findings, and add to the literature on training community providers and limited research on training providers to deliver EBPs to children with ASD.
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Robertson A, Walker CS, Stovall M, McCluskey L. Use of evidence-based substance use treatment practices in Mississippi. EVALUATION AND PROGRAM PLANNING 2015; 52:198-204. [PMID: 26151861 DOI: 10.1016/j.evalprogplan.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 06/02/2015] [Accepted: 06/07/2015] [Indexed: 06/04/2023]
Abstract
Over the past decade, substance abuse treatment professionals have begun to implement evidence-based practices (EBPs) into the treatment of substance use disorders. There is a growing body of research on the diffusion of EBP in addiction treatment; however, less is known about individual state initiatives to implement EBPs among community providers. The current study aimed to evaluate the progress of an initiative of the Mississippi Department of Mental Health (MDMH) to increase the implementation of evidence-based substance abuse treatment practices by certified providers. In addition, the study examines potential barriers to implementing these practices. To accomplish this goal, we reported the findings of two surveys of Mississippi addiction professionals conducted in 2010 and in 2013.
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Affiliation(s)
- Angela Robertson
- Social Science Research Center, Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States.
| | - Courtney S Walker
- Social Science Research Center, Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States.
| | - Mark Stovall
- Mississippi Department of Mental Health, Bureau of Alcohol and Drug Services, 801 Robert E. Lee Building, 239 North Lamar Street, Jackson, MS 39201, United States.
| | - Lee McCluskey
- Social Science Research Center, Mississippi State University, 1 Research Blvd., Suite 103, Starkville, MS 39759, United States.
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Ringle VA, Read KL, Edmunds JM, Brodman DM, Kendall PC, Barg F, Beidas RS. Barriers to and Facilitators in the Implementation of Cognitive-Behavioral Therapy for Youth Anxiety in the Community. Psychiatr Serv 2015; 66:938-45. [PMID: 25975886 PMCID: PMC4869696 DOI: 10.1176/appi.ps.201400134] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The study examined, from the perspective of therapists, the barriers to and facilitators in implementing cognitive-behavioral therapy (CBT) for anxious youths in community settings. METHODS Fifty therapists (43% of the original training sample of 115 providers) participated in a follow-up interview two years after training and consultation. They reported on barriers to and facilitators in implementation of CBT for youths with anxiety. RESULTS Qualitative analyses identified numerous barriers and facilitators, including client factors (for example, motivated clients facilitated the use of CBT, whereas clients with complex issues and numerous psychosocial stressors hindered its use), intervention factors (the structure of CBT helped facilitate its use for some providers, whereas others reported feeling constrained by such structure), and organizational factors (for example, the absence of support within one's institution served as a barrier, whereas supervision supporting the use of CBT facilitated implementation). CONCLUSIONS Findings of this implementation trial align with conceptual implementation frameworks and may guide the tailoring of future implementation efforts in order to overcome barriers and maximize facilitators.
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Affiliation(s)
- Vanesa A Ringle
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Kendra L Read
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Julie M Edmunds
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Douglas M Brodman
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Philip C Kendall
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Frances Barg
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Rinad S Beidas
- Ms. Ringle is with the Department of Psychology, University of Miami, Coral Gables, Florida (e-mail: ). Ms. Read, Mr. Brodman, and Dr. Kendall are with the Department of Psychology, Temple University, Philadelphia. Dr. Edmunds is with Judge Baker Children's Center, Boston. Dr. Barg is with the Department of Family Medicine and Community Health and Dr. Beidas is with the Department of Psychiatry, both at the University of Pennsylvania Perelman School of Medicine, Philadelphia
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Thomas R, Zimmer-Gembeck MJ, Chaffin M. Practitioners' views and use of evidence-based treatment: positive attitudes but missed opportunities in children's services. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2015; 41:368-78. [PMID: 23371263 DOI: 10.1007/s10488-013-0471-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The extent evidence-based treatments (EBTs) are used in clinical practice within the Australian therapeutic child welfare sector is unknown. In this study, we investigated practitioners' knowledge, attitudes, and use of EBT when providing interventions to children and families and how the intended outcomes of interventions are evaluated. Practitioners (N = 112) from 41 non-government organizations were surveyed and reported few barriers to implementing EBTs and positive attitudes. While just over half the practitioners surveyed provided an accurate definition of EBT, 72 % of practitioners reported using EBTs in their clinical practice. Of those, 88 % reported modifying the EBT, however interventions were rarely evaluated systematically. Implications for the use of EBTs, how they are modified, and the role of systematic evaluation are discussed.
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Affiliation(s)
- Rae Thomas
- Faculty of Health Sciences and Medicine, Centre for Research in Evidence-Based Practice, Bond University, Robina, QLD, 4229, Australia,
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Beidas RS, Marcus S, Aarons GA, Hoagwood KE, Schoenwald S, Evans AC, Hurford MO, Hadley T, Barg FK, Walsh LM, Adams DR, Mandell DS. Predictors of community therapists' use of therapy techniques in a large public mental health system. JAMA Pediatr 2015; 169:374-82. [PMID: 25686473 PMCID: PMC4420189 DOI: 10.1001/jamapediatrics.2014.3736] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. OBJECTIVE To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. DESIGN, SETTING, AND PARTICIPANTS In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. MAIN OUTCOMES AND MEASURES Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist-Family Revised. RESULTS Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques. CONCLUSIONS AND RELEVANCE This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique.
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Affiliation(s)
- Rinad S. Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, 215-746-1759
| | - Steven Marcus
- School of Social Policy and Practice, University of Pennsylvania,Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center
| | | | | | - Sonja Schoenwald
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina
| | - Arthur C. Evans
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, 215-746-1759,Department of Behavioral Health and Intellectual disAbility Services
| | - Matthew O. Hurford
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, 215-746-1759,Department of Behavioral Health and Intellectual disAbility Services,Community Behavioral Health
| | - Trevor Hadley
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, 215-746-1759
| | - Frances K. Barg
- Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine
| | - Lucia M. Walsh
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, 215-746-1759
| | - Danielle R. Adams
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, 215-746-1759
| | - David S. Mandell
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, 3015, Philadelphia, PA 19104, USA, 215-746-1759
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McMain S, Newman MG, Segal ZV, DeRubeis RJ. Cognitive behavioral therapy: Current status and future research directions. Psychother Res 2015; 25:321-9. [DOI: 10.1080/10503307.2014.1002440] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bearman SK, Wadkins M, Bailin A, Doctoroff G. Pre-Practicum Training in Professional Psychology to Close the Research-Practice Gap: Changing Attitudes Towards Evidence-Based Practice. TRAINING AND EDUCATION IN PROFESSIONAL PSYCHOLOGY 2015; 9:13-20. [PMID: 25745525 PMCID: PMC4346208 DOI: 10.1037/tep0000052] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Despite the rapid proliferation of mental health interventions with proven benefit for youth, empirically supported interventions (ESIs) are underutilized in most service settings. Treatment outcome studies in these community-based settings suggest that the majority of youth do not show improvement, underscoring the importance of addressing the gap between research and practice. Clinician attitudes toward evidence-based practice (EBP) may limit the use of ESIs, and efforts to address these attitudes with post-graduate training pose significant challenges. Pre-practicum training in EBP may address these challenges by familiarizing students with the framework of EBP as well as with the current youth treatment evidence base and the theories and strategies of well-supported interventions. We describe a required EBP course within a professional psychology doctoral program. Forty-two students in two class cohorts completed a measure of attitudes toward EBP prior to the first class and after the final class lecture. Students were predominantly Caucasian women with bachelor's degrees. As expected, over the course of the class, student attitudes became significantly more favorable toward EBP. Students who had previously received a master's degree had more favorable attitudes prior to the class, and students with a prior bachelor's degree showed the greatest change in attitude. The results support the use of pre-practicum training in EBP to improve attitudes toward EBP, which may lead to use of effective practices with clients following training.
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Affiliation(s)
- Sarah Kate Bearman
- Ferkauf Graduate School of Psychology, Department of School-Clinical Child Psychology, Yeshiva University
| | - Melanie Wadkins
- Ferkauf Graduate School of Psychology, Department of School-Clinical Child Psychology, Yeshiva University
| | - Abby Bailin
- Ferkauf Graduate School of Psychology, Department of School-Clinical Child Psychology, Yeshiva University
| | - Greta Doctoroff
- Ferkauf Graduate School of Psychology, Department of School-Clinical Child Psychology, Yeshiva University
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Chu BC, Crocco ST, Arnold CC, Brown R, Southam-Gerow MA, Weisz JR. Sustained Implementation of Cognitive-Behavioral Therapy for Youth Anxiety and Depression: Long-term Effects of Structured Training and Consultation on Therapist Practice in the Field. ACTA ACUST UNITED AC 2015; 46:70-79. [PMID: 26366037 DOI: 10.1037/a0038000] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Identifying factors that promote sustained implementation of evidence-based treatments (EBTs) after therapists receive training is critical for professional psychology. To address the field's minimal knowledge in this area, we interviewed community-based therapists (N = 23) who had completed intensive training in cognitive behavioral therapy (CBT) for either anxiety or depression as part of a randomized effectiveness trial (Southam-Gerow et al., 2010; Weisz et al., 2009). Therapists were interviewed three to five years after completion of the initial trial, representing one of the longest-term follow-ups of therapist practices after training. Therapists viewed each protocol and their individual CBT strategies as effective and appropriate for the majority of their current anxiety and depression caseloads. However, therapists used parts of each protocol much more frequently than the protocol as a whole (i.e., 78.5% used parts of the Coping Cat, and 7.5% used the whole protocol; 58.6% used parts of the PASCET, and 20% used the whole protocol). Therapists reported using problem-solving the most and exposure exercises the least for current anxious cases; they used cognitive restructuring the most and homework the least for current depression cases. Interventions that were more difficult to implement in usual care settings were less likely to be sustained. Future efforts should evaluate the characteristics and structure of EBTs that are most acceptable to therapists and should investigate which kinds of ongoing learning supports will maintain therapist skills in and continued use of EBTs.
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Higa-McMillan CK, Nakamura BJ, Morris A, Jackson DS, Slavin L. Predictors of Use of Evidence-Based Practices for Children and Adolescents in Usual Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 42:373-83. [DOI: 10.1007/s10488-014-0578-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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60
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"If it's worth my time, i will make the time": school-based providers' decision-making about participating in an evidence-based psychotherapy consultation program. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 40:467-81. [PMID: 23609107 DOI: 10.1007/s10488-013-0494-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study evaluated influences on school-based clinicians' decision-making surrounding participation in a modular psychotherapy training and consultation program lasting one academic year. Clinicians were recruited from three participation groups: those who never engaged, those who engaged and then discontinued, and those who participated fully. Qualitative interviews explored influences on initial and continued participation, as well as differences in decision-making by participation group, knowledge about evidence-based practices, and attitudes toward evidence-based practices. Eight major themes were identified: time, practice utility, intervention/training content, training process, attitudes toward training, social influences, commitment to training, and expectations. Some themes were discussed universally across all comparison groups, while others varied in frequency or content. Recommendations for increasing participation are presented, based on the findings.
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61
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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 2013; 53:10-9. [PMID: 24362360 DOI: 10.1016/j.brat.2013.12.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 10/03/2013] [Accepted: 12/03/2013] [Indexed: 01/11/2023]
Abstract
The purpose of this small pilot study was three-fold: (a) to begin development of a coding scheme for supervisor and therapist skill acquisition, (b) to preliminarily investigate a pilot train-the-trainer paradigm for skill development, and (c) to evaluate self-reported versus observed indicators of skill mastery in that pilot program. Participants included four supervisor-therapist dyads (N = 8) working with public mental health sector youth. Master trainers taught cognitive-behavioral therapy techniques to supervisors, who in turn trained therapists on these techniques. Supervisor and therapist skill acquisition and supervisor use of teaching strategies were repeatedly assessed through coding of scripted role-plays with a multiple-baseline across participants and behaviors design. The coding system, the Practice Element Train the Trainer - Supervisor/Therapist Versions of the Therapy Process Observational Coding System for Child Psychotherapy, was developed and evaluated though the course of the investigation. The coding scheme demonstrated excellent reliability (ICCs [1,2] = 0.81-0.91) across 168 video recordings. As calculated through within-subject effect sizes, supervisor and therapist participants, respectively, evidenced skill improvements related to teaching and performing therapy techniques. Self-reported indicators of skill mastery were inflated in comparison to observed skill mastery. Findings lend initial support for further developing an evaluative approach for a train-the-trainer effort focused on disseminating evidence-based practices.
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Affiliation(s)
- Brad J Nakamura
- University of Hawaii at Manoa, 2530 Dole Street, Sakamaki Hall C 400, Honolulu, HI 96822, USA.
| | - Alexandra Selbo-Bruns
- University of Hawaii at Manoa, 2530 Dole Street, Sakamaki Hall C 400, Honolulu, HI 96822, USA.
| | - Kelsie Okamura
- University of Hawaii at Manoa, 2530 Dole Street, Sakamaki Hall C 400, Honolulu, HI 96822, USA.
| | - Jaime Chang
- University of Hawaii at Manoa, 2530 Dole Street, Sakamaki Hall C 400, Honolulu, HI 96822, USA.
| | - Lesley Slavin
- Child and Adolescent Mental Health Division, Hawai'i State Department of Health, 3627 Kilauea Avenue, Room 101, Honolulu, HI 96816, USA.
| | - Scott Shimabukuro
- Child and Adolescent Mental Health Division, Hawai'i State Department of Health, 3627 Kilauea Avenue, Room 101, Honolulu, HI 96816, USA.
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Bearman SK, Weisz JR, Chorpita BF, Hoagwood K, Ward A, Ugueto AM, Bernstein A. More practice, less preach? the role of supervision processes and therapist characteristics in EBP implementation. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 40:518-29. [PMID: 23525895 PMCID: PMC4083565 DOI: 10.1007/s10488-013-0485-5] [Citation(s) in RCA: 107] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Identifying predictors of evidence-based practice (EBP) use, such as supervision processes and therapist characteristics, may support dissemination. Therapists (N = 57) received training and supervision in EBPs to treat community-based youth (N = 136). Supervision involving modeling and role-play predicted higher overall practice use than supervision involving discussion, and modeling predicted practice use in the next therapy session. No therapist characteristics predicted practice use, but therapist sex and age moderated the supervision and practice use relation. Supervision involving discussion predicted practice use for male therapists only, and modeling and role-play in supervision predicted practice use for older, not younger, therapists.
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Affiliation(s)
- Sarah Kate Bearman
- Department of School-Clinical Child Psychology, Ferkauf Graduate School of Psychology, Yeshiva University, Rousso Building, 1300 Morris Park Avenue, Bronx, NY, 10461, USA,
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Nakamura BJ, Mueller CW, Higa-McMillan C, Okamura KH, Chang JP, Slavin L, Shimabukuro S. Engineering youth service system infrastructure: Hawaii's continued efforts at large-scale implementation through knowledge management strategies. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 43:179-89. [PMID: 23819869 DOI: 10.1080/15374416.2013.812039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Hawaii's Child and Adolescent Mental Health Division provides a unique illustration of a youth public mental health system with a long and successful history of large-scale quality improvement initiatives. Many advances are linked to flexibly organizing and applying knowledge gained from the scientific literature and move beyond installing a limited number of brand-named treatment approaches that might be directly relevant only to a small handful of system youth. This article takes a knowledge-to-action perspective and outlines five knowledge management strategies currently under way in Hawaii. Each strategy represents one component of a larger coordinated effort at engineering a service system focused on delivering both brand-named treatment approaches and complimentary strategies informed by the evidence base. The five knowledge management examples are (a) a set of modular-based professional training activities for currently practicing therapists, (b) an outreach initiative for supporting youth evidence-based practices training at Hawaii's mental health-related professional programs, (c) an effort to increase consumer knowledge of and demand for youth evidence-based practices, (d) a practice and progress agency performance feedback system, and (e) a sampling of system-level research studies focused on understanding treatment as usual. We end by outlining a small set of lessons learned and a longer term vision for embedding these efforts into the system's infrastructure.
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Affiliation(s)
- Brad J Nakamura
- a Department of Psychology , The University of Hawaii at Manoa
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64
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Smith BD. Substance use treatment counselors' attitudes toward evidence-based practice: the importance of organizational context. Subst Use Misuse 2013; 48:379-90. [PMID: 23421387 DOI: 10.3109/10826084.2013.765480] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study addresses individual and organizational correlates of substance user treatment counselors' attitudes toward evidence-based practice. Counselors (n = 293) from a probability sample of outpatient treatment organizations in a northeastern US state were surveyed in 2008. Multilevel [hierarchical linear model (HLM)] models address the nested sample. Attitudes toward evidence-based practice were measured with the Evidence-Based Practice Attitude Scale (Aarons). Study limitations and implications for the implementation of evidence-based practices in routine substance user treatment organizations are addressed.
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Affiliation(s)
- Brenda D Smith
- School of Social Work, University of Alabama, Tuscaloosa, AL 35487, USA.
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65
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Garland AF, Haine-Schlagel R, Brookman-Frazee L, Baker-Ericzen M, Trask E, Fawley-King K. Improving community-based mental health care for children: translating knowledge into action. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2013; 40:6-22. [PMID: 23212902 PMCID: PMC3670677 DOI: 10.1007/s10488-012-0450-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is urgent need for improvement in community-based mental health care for children and families. Multiple studies have documented serious limitations in the effectiveness of "usual care." Fortunately, many empirically-supported strategies to improve care have been developed, and thus there is now a great deal of knowledge available to address this significant public health problem. The goal of this selective review is to highlight and synthesize that empirically-supported knowledge to stimulate and facilitate the needed translation of knowledge into action. The review provides a sound foundation for constructing improved services by consolidating descriptive data on the status quo in children's mental health care, as well as evidence for an array of promising strategies to improve (a) Service access and engagement; (b) Delivery of evidence-based practices; and (c) Outcome accountability. A multi-level framework is used to highlight recommended care improvement targets.
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Affiliation(s)
- Ann F Garland
- Department of School, Family, and Mental Health Professions, School of Leadership and Education Sciences, University of San Diego, 5998 Alcalá Park, San Diego, CA 92110, USA,
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66
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Lim A, Nakamura BJ, Higa-McMillan CK, Shimabukuro S, Slavin L. Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers. Behav Res Ther 2012; 50:397-406. [PMID: 22512869 DOI: 10.1016/j.brat.2012.03.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 01/11/2012] [Accepted: 03/19/2012] [Indexed: 11/27/2022]
Abstract
Enhancing the public health impact of evidence-based practices (EBPs) in usual care settings is a key priority of the National Institute of Mental Health. Longitudinal data from community mental health providers (N = 268) participating in a series of state-sponsored workshops in modular approaches to EBPs for youth are presented. EBP workshop attendance for youth anxiety resulted in increased knowledge for EBPs for anxiety (and not other conditions) and EBP workshop attendance for youth disruptive behaviors resulted in increased knowledge for EBPs for disruptive behaviors (and not other conditions). Providers' tendencies toward incorrectly classifying non-EBP therapies as evidence-based increased over time, suggesting that providers over-generalize the EBP label as a result of attending these types of workshops. Regarding EBP attitudes, most measures of attitudes improved when providers attended a workshop. Additionally, an overly inclusive view of what constitutes an EBP at intake was related to significant decreases in openness to trying EBPs over time, whereas more positive attitudes at intake was related to achieving a more refined view of what constitutes an EBP over the course of attending trainings. Study limitations and implications for implementation of EBPs in usual care settings are discussed.
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Affiliation(s)
- Ahnate Lim
- University of Hawai'i at Mānoa, Honolulu, 96848, USA.
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Becker KD, Stirman SW. The science of training in evidence-based treatments in the context of implementation programs: current status and prospects for the future. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2011; 38:217-22. [PMID: 21644028 PMCID: PMC3565531 DOI: 10.1007/s10488-011-0361-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Kimberly D. Becker
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, 8th Floor, Baltimore, MD 21205, USA
| | - Shannon Wiltsey Stirman
- Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System (116B-3), 150 S. Huntington Ave., Boston, MA 02130, USA
- Department of Psychiatry, Boston University, Boston, MA, USA
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