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Szota K, van der Meer AS, Bourdeau T, Chorpita BF, Chavanon ML, Christiansen H. Pilot study of implementing Managing and Adapting Practice in a German psychotherapy master's program. Sci Rep 2024; 14:16466. [PMID: 39014099 PMCID: PMC11252301 DOI: 10.1038/s41598-024-67407-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 07/10/2024] [Indexed: 07/18/2024] Open
Abstract
Despite a significant accumulation of research, there has been little systemic implementation of evidence-based practices (EBP) in youth mental health care. The fragmentation of the evidence base complicates implementation efforts. In light of this challenge, we sought to pilot a system that consolidates and coordinates the entire evidence base in a single direct service model (i.e., Managing and Adapting Practice; MAP) in the context of a legal reform of psychotherapy training in Germany. This pilot study aimed to evaluate the feasibility of the implementation of MAP into the curriculum of the reformed German master's program. Eligible participants were students in the master's program at Philipps-University Marburg during the winter-term 2022/2023. Students first learned about MAP through introductions and role plays (seminar 1), followed by actively planning and conducting interventions using MAP resources for patients in a case seminar under supervision (seminar 2). A repeated-measures survey was conducted to investigate students' knowledge gains, perception of MAP and changes in their self-rated confidence to use EBP. Results indicated that students perceive MAP to be manageable to learn. Positive progress was achieved with regard to their knowledge and self-reported confidence to use EBP, although interpretation and generalization of the results are limited by small and homogeneous samples, lack of statistical power and missing comparison groups. The feasibility of the implementation and suitability of measures are discussed. Important implications could be drawn with regard to future investigations.
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Affiliation(s)
- Katharina Szota
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany.
- Department of Psychology, Goethe-University Frankfurt, Varrentrappstr. 40-42, 60486, Frankfurt am Main, Germany.
| | - Anna S van der Meer
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Teri Bourdeau
- PracticeWise, PO Box 372657, Satellite Beach, FL, 32937, USA
| | - Bruce F Chorpita
- UCLA Department of Psychology, 1285 Franz Hall, Los Angeles, CA, 90095, USA
| | - Mira-Lynn Chavanon
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
| | - Hanna Christiansen
- Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, 35032, Marburg, Germany
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Mora Ringle VA, Calloway A, Reich D, Oziel R, Walzer A, O'Connor S, Venti A, Comeau C, Williams T, Creed TA. What Really Matters in the Implementation of Evidence-based Practices in Community Mental Health? Insight and Recommendations from Experts, Providers, and Clients. Community Ment Health J 2024:10.1007/s10597-024-01307-1. [PMID: 38907842 DOI: 10.1007/s10597-024-01307-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/02/2024] [Indexed: 06/24/2024]
Abstract
Perceptions of evidence-based practices (EBPs) and implementation are inherent drivers of implementation outcomes. Most studies on implementation perceptions have focused on direct service providers, but clients and EBP experts may offer additional meaningful information about implementing EBPs in community settings. EBP providers (n = 21), EBP experts (n = 12), and clients who received EBPs (n = 6) participated in focus groups to ascertain their perceptions of and experiences with EBP implementation, as part of a program evaluation. Thematic analysis indicated that provider and expert perceptions of EBP implementation in community settings converged around themes of implementation supports and training and client outcomes, along with several subthemes. Client perceptions centered on themes regarding the importance of their personal experiences, their impressions of EBPs, as well as their recommendation for increasing public awareness and use of EBPs. Findings suggest that the perspectives of EBP providers and experts are closely aligned, focusing on system-level, individual-level, and training issues that impact EBP implementation within a public mental health system. The themes that were important to clients were primarily related to their experiences as recipients of an EBP which produced insightful recommendations for promoting EBPs in the community.
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Affiliation(s)
| | - Amber Calloway
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Danielle Reich
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Rebecca Oziel
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- King's College London, London, UK
| | - Arielle Walzer
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sydne O'Connor
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Neuro-Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Amberlee Venti
- Community Behavioral Health (a division of Department of Behavioral Health and Intellectual disAbility Services), Philadelphia, PA, USA
| | - Carrie Comeau
- Community Behavioral Health (a division of Department of Behavioral Health and Intellectual disAbility Services), Philadelphia, PA, USA
| | - Tamra Williams
- Community Behavioral Health (a division of Department of Behavioral Health and Intellectual disAbility Services), Philadelphia, PA, USA
| | - Torrey A Creed
- Penn Collaborative for CBT and Implementation Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Klein CC, Salem H, Becker-Haimes EM, Barnett ML. Therapist Anxious Distress and Avoidance of Implementing Time-Out. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01706-1. [PMID: 38819665 DOI: 10.1007/s10578-024-01706-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2024] [Indexed: 06/01/2024]
Abstract
Therapist anxious distress when delivering child mental health treatment has been understudied as a factor that contributes to the underuse of some evidence-based interventions (EBIs), such as time-out for children with disruptive behaviors. This study investigated therapist anxious avoidance of time-out using a three-part, vignette-based survey design. Therapists (n = 198) read a vignette of an in-session time-out and reported on their personal anxious distress and likelihood of discontinuing the implementation of time-out. Therapists also provided open-ended descriptions of challenges to delivering time-out. Therapists reported moderate anxious distress at time points 1 and 2 and lower anxious distress at time 3 when the time-out had resolved. Most therapists endorsed some avoidance of time-out. Binomial logistic regression analyses indicated that increased anxious distress corresponded with an increased probability of avoiding time-out delivery in the future. Qualitative reports expanded on challenges to implementing time-out. Findings suggest the importance of addressing therapist anxious distress when implementing children's mental health treatments.
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Affiliation(s)
- Corinna C Klein
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA.
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA.
| | - Hanan Salem
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Miya L Barnett
- Department of Counseling, Clinical, & School Psychology, University of California, Santa Barbara, Santa Barbara, CA, USA
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Motamedi M, Lau AS, Byeon YV, Yu SH, Brookman-Frazee L. Supporting Emotionally Exhausted Community Mental Health Therapists in Appropriately Adapting EBPs for Children and Adolescents. J Behav Health Serv Res 2023; 50:468-485. [PMID: 37430134 DOI: 10.1007/s11414-023-09844-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/12/2023]
Abstract
Evidence-based practices (EBPs) are often adapted during community implementation to improve EBP fit for clients and the service context. Augmenting EBPs with additional dosing and content may improve fit. However, reducing EBP content can reduce EBP effectiveness. Using multilevel regression models, this study examined whether supportive program climate and program-furnished EBP-specific implementation strategies (e.g., materials, ongoing training, in-house experts) are associated with augmenting and reducing adaptations, and whether therapist emotional exhaustion moderated these associations. Data were collected from surveys completed by 439 therapists from 102 programs 9 years after a system-driven EBP implementation initiative. Supportive program climate was associated with more augmenting adaptations. Emotional exhaustion was a significant moderator. When organizations used more EBP-specific implementation strategies, more emotionally exhausted therapists reduced EBPs less and less emotionally exhausted therapists augmented EBPs more. Findings provide guidance on how organizations can support appropriate EBP adaptations in spite of therapist emotional exhaustion.
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Affiliation(s)
- Mojdeh Motamedi
- University of California San Diego, La Jolla, USA.
- Child and Adolescent Services Research Center, San Diego, USA.
| | - Anna S Lau
- University of California Los Angeles, Los Angeles, USA
| | | | | | - Lauren Brookman-Frazee
- University of California San Diego, La Jolla, USA
- Child and Adolescent Services Research Center, San Diego, USA
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Merle JL, Cook CR, Locke JJ, Ehrhart MG, Brown EC, Davis CJ, Lyon AR. Teacher attitudes toward evidence-based practices: Exploratory and confirmatory analyses of the school-adapted evidence-based practice attitude scale. IMPLEMENTATION RESEARCH AND PRACTICE 2023; 4:26334895221151026. [PMID: 37091537 PMCID: PMC9924278 DOI: 10.1177/26334895221151026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Background The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral health services. Method School-based stakeholders and a research team comprised of experts in the implementation of evidence-based practices in schools adapted the EBPAS for teachers (the S-EBPAS). The adapted instrument was administered to a representative sample ( n = 441) of general education teachers (grades K—5) to assess the reliability and internal consistency via factor analyses. The S-EBPAS included two forms (i.e., EBP-agnostic and EBP-specific item referents), therefore, a multiple-group confirmatory factor analysis (CFA) was also performed to establish measurement invariance between the two forms. Results After adaptation and refinement, a 9-item, 3-factor structure was confirmed, with the final model supporting three first-order factors that load onto a second-order factor capturing attitudes toward adopting evidence-based practices. Multiple-group CFA analyses of measurement invariance indicated there were no significant differences between the two forms. Conclusions Overall, this study provides a brief, flexible instrument capturing attitudes toward adopting EBPs that has high reliability and internal consistency, which support its use among general education teachers in school settings implementing evidence-based practices. Plain Language Summary The Evidence-Based Practice Attitudes Scale (EBPAS) is a popular instrument for measuring attitudes toward evidence-based practices (EBPs). This instrument provides valuable information during implementation initiatives, such as whether providers or front-line implementers have favorable attitudes toward a given practice. The EBPAS has been used in many different settings, such as in community-based mental health clinics, medical hospitals, and in child welfare. However, it's use in schools has been limited, and it has not yet been tested with general education teachers, who are key implementers of evidence-based practices in schools. In order to trust that the scores from an instrument are accurate, it needs to be evaluated when scaling it out to new populations and settings. One popular method to determine this is to use factor analysis, which was employed in this study. This study fills the identified gap by assessing the reliability (i.e., accuracy) and internal consistency of the EBPAS among a representative sample of general education teachers. Findings from this study indicate that the school-adapted EBPAS (S-EBPAS) is a brief, nine-item instrument that provides a reliable estimate of teachers’ attitudes toward evidence-based practices. Our results also provide evidence that the S-EBPAS can be used to capture attitudes toward specific EBPs as well as attitudes toward EBP -agnostic. This study provides a flexible instrument that can be used by school-based implementation researchers, practitioners, and intermediaries at multiple phases of implementation projects, such as when exploring a new EBP to adopt.
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Affiliation(s)
- James L. Merle
- Department of Population Health Science, University of Utah, Salt Lake City, UT, USA
| | - Clayton R. Cook
- Department of Organizational Leadership, Policy, and Development, University of Minnesota, Minneapolis, MN, USA
| | - Jill J. Locke
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
| | - Mark G. Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Eric C. Brown
- Department of Public Health Science, University of Miami, Coral Gables, FL, USA
| | - Chayna J. Davis
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
| | - Aaron R. Lyon
- Department of Psychiatry and Behavior Science, University of Washington, Seattle, WA, USA
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Nirisha PL, Malathesh BC, Kulal N, Harshithaa NR, Ibrahim FA, Suhas S, Manjunatha N, Kumar CN, Parthasarathy R, Manjappa AA, Thirthalli J, Chand PK, Arora S, Math SB. Impact of Technology Driven Mental Health Task-shifting for Accredited Social Health Activists (ASHAs): Results from a Randomised Controlled Trial of Two Methods of Training. Community Ment Health J 2023; 59:175-184. [PMID: 35779139 PMCID: PMC10290774 DOI: 10.1007/s10597-022-00996-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 06/11/2022] [Indexed: 01/07/2023]
Abstract
Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness. Easily available and accessible digital technology can be utilised to continuously engage grassroot level health workers (for example, Accredited Social Health Activists (ASHAs). However, the impact of such a strategy is not yet systematically evaluated. In this randomised controlled trial, longitudinal hybrid training of ASHAs [1 day in-person classroom training and seven online sessions (ECHO model), aimed to screen and refer to commonly prevalent mental health issues in communities] was compared with traditional one-day in-person classroom training. ASHAs (n = 75) from six Primary Health Centres in Ramanagara district, Karnataka, India were randomized into study (SG-ASHAs) and control (CG-ASHAs) groups. After excluding drop-outs, 26 ASHAs in each group were included in the final analysis of the scores on their Knowledge, attitude, and practices (KAP) in mental health. Two house-to-house surveys were conducted by both groups to identify and refer possible cases. The number of screen positives (potential persons with mental illnesses) and the KAP scores formed the outcome measures. Online sessions for SG-ASHAs were completed over 18 months, the COVID-19 pandemic being the main disruptor. SG-ASHAs identified significantly higher number of persons with potential alcohol use disorders [n = 873 (83%); p ≤ 0.001] and common mental disorders [n = 96(4%); p = 0.018], while CG-ASHAs identified significantly higher number of those with potential severe mental disorders [n = 61(61.61%); p ≤ 0.001]. As regards KAP, after controlling for baseline scores, the time effect in RMANOVA favoured SG-ASHAs. Mean total KAP score increased from 16.76 to18.57 (p < 0·01) in SG-ASHAs and from 18.65 to 18.84 (p = 0.76) in CG-ASHAs. However, the Time-group interaction effect did not favour either (F = 0.105; p = 0.748). Compared to traditional training, mentoring ASHAs for extended periods is more impactful. Easily accessible digital technology makes the latter feasible. Scaling up such initiatives carry the potential to considerably improve treatment access for those in need.
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Affiliation(s)
- P Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Barikar C Malathesh
- Department of Psychiatry, All India Institute of Medical Sciences, Bibinagar, India
| | - Nithesh Kulal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Nisha R Harshithaa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - N Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Adarsha Alur Manjappa
- DMHP Psychiatrist, Department of Health and Family Welfare, Government of Karnataka Office of the District Health Officer, Ramanagara District, Ramanagara, Karnataka, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Sanjeev Arora
- University of New Mexico Health Sciences Center, Albuquerque, USA
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Sichel CE, Connors EH. Measurement feedback system implementation in public youth mental health treatment services: a mixed methods analysis. Implement Sci Commun 2022; 3:119. [PMID: 36415009 PMCID: PMC9682849 DOI: 10.1186/s43058-022-00356-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/28/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Prior studies indicate the effectiveness of measurement-based care (MBC), an evidence-based practice, in improving and accelerating positive outcomes for youth receiving behavioral health services. MBC is the routine collection and use of client-reported progress measures to inform shared decision-making and collaborative treatment adjustments and is a relatively feasible and scalable clinical practice, particularly well-suited for under-resourced community mental health settings. However, uptake of MBC remains low, so information on determinants related to MBC practice patterns is needed. METHODS Quantitative and qualitative data from N = 80 clinicians who implemented MBC using a measurement feedback system (MFS) were merged to understand and describe determinants of practice over three study phases. Quantitative, latent class analysis identified clinician groups based on participants' ratings of MFS acceptability, appropriateness, and feasibility and describes similarities/differences between classes in clinician-level characteristics (e.g., age; perceptions of implementation climate; reported MFS use; phase I). Qualitative analyses of clinicians' responses to open-ended questions about their MFS use and feedback about the MFS and implementation supports were conducted separately to understand multi-level barriers and facilitators to MFS implementation (phase II). Mixing occurred during interpretation, examining clinician experiences and opinions across groups to understand the needs of different classes of clinicians, describe class differences, and inform selection of implementation strategies in future research (phase III). RESULTS We identified two classes of clinicians: "Higher MFS" and "Lower MFS," and found similarities and differences in MFS use across groups. Compared to Lower MFS participants, clinicians in the Higher MFS group reported facilitators at a higher rate. Four determinants of practice were associated with the uptake of MBC and MFS in youth-serving community mental health settings for all clinicians: clarity, appropriateness, and feasibility of the MFS and its measures; clinician knowledge and skills; client preferences and behaviors; and incentives and resources (e.g., time; continuing educational support). Findings also highlighted the need for individual-level implementation strategies to target clinician needs, skills, and perceptions for future MBC and MFS implementation efforts. CONCLUSION This study has implications for the adoption of evidence-based practices, such as MBC, in the context of community-based mental health services for youth.
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Affiliation(s)
- Corianna E Sichel
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Mail Unit 78, New York, NY, 10032, USA.
| | - Elizabeth H Connors
- Division of Prevention and Community Research, Department of Psychiatry, Yale University School of Medicine, 389 Whitney Avenue, New Haven, CT, 06511, USA
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Aranbarri A, Stahmer AC, Talbott MR, Miller ME, Drahota A, Pellecchia M, Barber AB, Griffith EM, Morgan EH, Rogers SJ. Examining US Public Early Intervention for Toddlers With Autism: Characterizing Services and Readiness for Evidence-Based Practice Implementation. Front Psychiatry 2021; 12:786138. [PMID: 34975582 PMCID: PMC8716593 DOI: 10.3389/fpsyt.2021.786138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/24/2021] [Indexed: 12/15/2022] Open
Abstract
As the rates of Autism Spectrum Disorder (ASD) increase and early screening efforts intensify, more toddlers with high likelihood of ASD are entering the United States' (US') publicly funded early intervention system. Early intervention service delivery for toddlers with ASD varies greatly based on state resources and regulations. Research recommends beginning ASD-specific evidence-based practices (EBP), especially caregiver-implemented intervention, as early as possible to facilitate the development of social-communication skills and general learning. Translating EBP into practice has been challenging, especially in low-resourced areas. The main goal of this study was to obtain a more comprehensive understanding of public early intervention system structure, service delivery practices, and factors influencing EBP use for children with ASD in the US. Participants (N = 133) included 8 early intervention state coordinators in 7 states, 29 agency administrators in those states, 57 early intervention providers from those agencies, and 39 caregivers of children with ASD receiving services from those providers. Online surveys gathered stakeholder and caregiver perspectives on early intervention services as well as organizational factors related to EBP implementation climate and culture. Stakeholders identified key intervention needs for young children with ASD. In general, both agency administrators and direct providers reported feeling somewhat effective or very effective in addressing most needs of children with ASD. They reported the most difficulty addressing eating, sleeping, family stress, and stereotyped behaviors. Data indicate that children from families with higher income received significantly higher service intensity. While administrators and providers reported high rates of high-quality caregiver coaching (>60%), caregivers reported low rates (23%). Direct providers with more favorable attitudes toward EBP had greater EBP use. In turn, provider attitudes toward EBP were significantly associated with implementation leadership and culture at their agency. Results suggest that publicly funded early intervention programs in the US require additional resources and training for providers and leaders to support improved implementation climate and attitudes toward ASD EBPs. Results also suggest that more state system support is needed to increase use of ASD-specific EBP use, including high-quality caregiver coaching, to better serve toddlers with ASD. Recommendations for implementation strategies are addressed.
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Affiliation(s)
- Aritz Aranbarri
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- Child and Adolescent Mental Health Area, Psychiatry and Psychology, Hospital Sant Joan de Déu Barcelona, Esplugues de Llobregat, Spain
- Child and Adolescent Mental Health Research Group, Psychiatry and Psychology, Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
| | - Aubyn C. Stahmer
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Meagan R. Talbott
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Marykate E. Miller
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, United States
| | - Melanie Pellecchia
- Center for Mental Health, Psychiatry Department, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, United States
| | - Angela B. Barber
- Department of Communicative Disorders, University of Alabama, Tuscaloosa, AL, United States
| | | | - Elizabeth H. Morgan
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
- College of Education, California State University, Sacramento, CA, United States
| | - Sally J. Rogers
- Collaborative START Lab, The MIND Institute, Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, United States
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Barnett ML, Lau AS, Lind T, Wright B, Stadnick N, Innes-Gomberg D, Pesanti K, Brookman-Frazee L. Caregiver Attendance as a Quality Indicator in the Implementation of Multiple Evidence-Based Practices for Children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:868-882. [PMID: 31799862 PMCID: PMC7269837 DOI: 10.1080/15374416.2019.1683851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This study investigated a quality indicator for children's mental health, caregiver attendance in youth psychotherapy sessions, within a system-driven implementation of multiple evidence-based practices (EBPs) in children's community mental health services. METHOD Administrative claims from nine fiscal years were analyzed to characterize and predict caregiver attendance. Data included characteristics of therapists (n = 8,626), youth clients (n = 134,368), sessions (e.g., individual, family), and the EBP delivered. Clients were primarily Latinx (63%), male (54%) and mean age was 11; they presented with a range of mental health problems. Three-level mixed models were conducted to examine the association between therapist, youth, service, EBP characteristics and caregiver attendance. RESULTS Caregivers attended, on average, 46.0% of sessions per client for the full sample and 59.6% of sessions for clients who were clinically indicated, based on age and presenting problem, to receive caregiver-focused treatment. Following initial EBP implementation, the proportion of caregiver attendance in sessions increased over time. Caregivers attended a higher proportion of youth psychotherapy sessions when clients were younger, had an externalizing disorder, were non-Hispanic White, and were male. Further, higher proportions of caregiver attendance occurred when services were delivered in a clinic setting (compared with school and other settings), by bilingual therapists, and the EBP prescribed caregiver attendance in all sessions. CONCLUSIONS Overall, the patterns of caregiver attendance appear consistent with evidence-informed practice parameters of client presenting problem and age. Yet, several improvement targets emerged such as client racial/ethnic background and service setting. Potential reasons for these disparities are discussed.
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Affiliation(s)
- Miya L. Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical, & School Psychology, Santa Barbara, CA
| | - Anna S. Lau
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Teresa Lind
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
| | - Blanche Wright
- University of California, Los Angeles, Department of Psychology, Los Angeles, CA
| | - Nicole Stadnick
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
| | | | - Keri Pesanti
- Los Angeles County Department of Mental Health, Los Angeles, CA
| | - Lauren Brookman-Frazee
- University of California, San Diego, Department of Psychiatry; Child and Adolescent Services Research Center, San Diego, CA
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Drahota A, Sadler R, Hippensteel C, Ingersoll B, Bishop L. Service deserts and service oases: Utilizing geographic information systems to evaluate service availability for individuals with autism spectrum disorder. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2008-2020. [PMID: 32564619 DOI: 10.1177/1362361320931265] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
LAY ABSTRACT Autism spectrum disorder and co-occurring symptoms often require lifelong services. However, access to autism spectrum disorder services is hindered by a lack of available autism spectrum disorder providers. We utilized geographic information systems methods to map autism spectrum disorder provider locations in Michigan. We hypothesized that (1) fewer providers would be located in less versus more populated areas; (2) neighborhoods with low versus high socioeconomic status would have fewer autism spectrum disorder providers; and (3) an interaction would be found between population and socioeconomic status such that neighborhoods with low socioeconomic status and high population would have few available autism spectrum disorder providers. We compiled a list of autism spectrum disorder providers in Michigan, geocoded the location of providers, and used network analysis to assess autism spectrum disorder service availability in relation to population distribution, socioeconomic disadvantage, urbanicity, and immobility. Individuals in rural neighborhoods had fewer available autism spectrum disorder providers than individuals in suburban and urban neighborhoods. In addition, neighborhoods with greater socioeconomic status disadvantage had fewer autism spectrum disorder providers available. Finally, wealthier suburbs had good provider availability while few providers were available in poorer, urban neighborhoods. Knowing autism spectrum disorder providers' availability, and neighborhoods that are particularly poorly serviced, presents the opportunity to utilize evidence-based dissemination and implementation strategies that promote increased autism spectrum disorder providers for underserved individuals.
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Affiliation(s)
- Amy Drahota
- Michigan State University, USA.,Child and Adolescent Services Research Center, USA
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11
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Palmer Molina A, Palinkas LA, Monro W, Mennen FE. Barriers to Implementing a Group Treatment for Maternal Depression in Head Start: Comparing Staff Perspectives. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 47:545-554. [PMID: 31933218 DOI: 10.1007/s10488-020-01012-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Although providing depression treatment for Head Start mothers may improve child wellbeing, interventions have not been widely used for this purpose. This failure may be due to the characteristics of clients, interventions, or the systems of care in which services are delivered. This study explored barriers to implementing Interpersonal Psychotherapy-Group with ethnic minority Head Start mothers, including differences in the level of staff consensus regarding barriers, which may predict implementation success. Barriers included resource challenges, cultural and linguistic differences, and participant concerns, and staff demonstrated low to moderate consensus. Results emphasize the importance of engaging diverse stakeholders in implementation.
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Affiliation(s)
- Abigail Palmer Molina
- University of Southern California Suzanne Dworak-Peck School of Social Work, 669 W. 34th Street, Los Angeles, CA, 90089, USA.
| | - Lawrence A Palinkas
- Chair of the Department of Children, Youth, and Families, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, USA
| | - William Monro
- University of Southern California Suzanne Dworak-Peck School of Social Work, 669 W. 34th Street, Los Angeles, CA, 90089, USA
| | - Ferol E Mennen
- Department of Children, Youth, and Families, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, USA
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12
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Acri MC, Bornheimer LA, Hamovitch EK, Lambert K. Outcomes Associated With Adapting a Research-Supported Treatment for Children With Behavior Disorders. RESEARCH ON SOCIAL WORK PRACTICE 2020; 30:74-83. [PMID: 32855587 PMCID: PMC7449371 DOI: 10.1177/1049731519841439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The aims of this study are to describe an adaptation process of a research-supported treatment (RST) for children with oppositional defiant disorder and to examine provider attitudes toward RSTs prior to and following this process. METHOD Providers from 14 agencies in New York State delivered the adapted RST, following training. Attitudes toward RSTs were measured by the Evidence-Based Practice Attitude Scale at baseline and posttest. RESULTS Openness toward RSTs decreased from baseline to posttest. The majority of providers reported modifications to the structure and process of the intervention. DISCUSSION To improve the uptake and usability of RSTs in practice, future research must further address adaptation processes and their relationships to attitudes toward RSTs.
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Affiliation(s)
- Mary C. Acri
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
| | | | - Emily K. Hamovitch
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
| | - Kate Lambert
- McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA
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13
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Li H, Yuan B, Meng Q, Kawachi I. Contextual Factors Associated with Burnout among Chinese Primary Care Providers: A Multilevel Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193555. [PMID: 31547533 PMCID: PMC6801650 DOI: 10.3390/ijerph16193555] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/12/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
Burnout is a common and growing phenomenon in the health care setting. The objective of the present study is to examine contextual factors in the workplace associated with burnout among primary care providers (PCPs) in Shandong Province, China. A cross-sectional survey was conducted among 951 PCPs nested within 48 primary health institutions (PHIs). Burnout was measured using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). We used two-level random intercept linear regression models to examine individual- versus workplace-level risk factors for burnout. The result revealed that 33.12%, 8.83% and 41.43% PCPs were experiencing a high degree of emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PA). In multilevel analysis, the most significant and common individual-level predictors of burnout were lack of perceived work support and autonomy. At the institutional level, workload was positively related to EE (odds ratio (OR): 6.59; 95% confidence interval (CI): 3.46-9.72), while work support was related to higher PA (OR: 3.49; 95% CI: 0.81-6.17). Greater attention should be paid to the influence of the work environment factors (workload and work support) to prevent burnout. Strategies such as increasing human resources allocated to PHIs and establishing a supportive work environment are encouraged to prevent and reduce burnout among PCPs in China.
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Affiliation(s)
- Huiwen Li
- School of Public Health, Peking University, Beijing 100191, China.
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
| | - Qingyue Meng
- School of Public Health, Peking University, Beijing 100191, China.
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
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14
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Wright B, Lau AS, Brookman-Frazee L. Factors Associated With Caregiver Attendance in Implementation of Multiple Evidence-Based Practices in Youth Mental Health Services. Psychiatr Serv 2019; 70:808-815. [PMID: 31159663 PMCID: PMC6718317 DOI: 10.1176/appi.ps.201800443] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The implementation of evidence-based practices (EBPs) in community mental health settings for youths has consistently yielded weakened effects compared with controlled trials. There is a need to feasibly measure the quality of large-scale implementation efforts to inform improvement targets. This study used therapist-reported caregiver attendance in treatment sessions as a quality indicator in the community implementation of EBPs. METHODS Data were collected from therapists practicing in agencies contracted to provide publicly funded children's mental health services following a system-driven implementation of multiple EBPs. Community therapists (N=101) provided information about youth clients (N=267) and psychotherapy sessions (N=685). Multivariable binomial logistic regressions were conducted to examine associations between caregiver attendance and therapist factors (e.g., licensure status, education), youth factors (e.g., gender, age), and the type of EBP delivered. RESULTS Caregiver attendance occurred in 42% of sessions. The following factors were associated with increased odds of caregiver attendance: younger client age, male sex of client, externalizing presenting problem, and delivery of an EBP that prescribes caregiver attendance at all sessions. Caregiver attendance at sessions targeting trauma or externalizing disorders appeared to explain the differences between boys and girls in levels of caregiver engagement. CONCLUSIONS Overall, the patterns of actual caregiver attendance appeared consistent with empirically informed practice parameters for involvement of caregivers in treatment. Still, the rates of caregiver attendance in externalizing-focused sessions were suboptimal, and the gender difference in these rates-which clearly disfavored girls-suggests targeted areas for quality improvement. Potential reasons for these quality gaps are discussed.
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Affiliation(s)
- Blanche Wright
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
| | - Lauren Brookman-Frazee
- Department of Psychology, University of California, Los Angeles (Wright, Lau); Child and Adolescent Services Research Center, Department of Psychiatry, University of California, San Diego (Brookman-Frazee)
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15
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Attitudes of mental health providers towards adoption of evidence-based interventions: relationship to workplace, staff roles and social and psychological factors at work. BMC Health Serv Res 2019; 19:110. [PMID: 30736786 PMCID: PMC6368721 DOI: 10.1186/s12913-019-3933-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 01/28/2019] [Indexed: 12/02/2022] Open
Abstract
Background Gaining insight into factors influencing the adoption of evidence-based interventions (EBI) is essential to ensuring their sustainability in the mental healthcare setting. This article describes 1) differences between professional staff roles in attitudes towards EBI and 2) individual and organizational predictors of attitudes towards adopting EBI. Methods The participants were psychologists and psychiatric nurses (N = 792). Student t-tests were used to investigate group differences of global attitude scores on the Evidence-based Practice Attitude Scale-36 (EBPAS-36). A confirmatory factor analysis (CFA) of the EBPAS-36 measurement model, and a principal component analysis (PCA) of the factor scores were used to obtain attitudinal components for the subsequent hierarchical regression analyses. Results Three second-order attitudinal components were retained and named: professional concern, attitudes related to work conditions and requirements, and attitudes related to fit and preferences. Nurses’ global attitudinal scores were more positive than those of psychologists, while clinicians had less positive global attitudinal scores than non-clinicians. Hierarchical regression analysis showed that provider demographic, social and psychological factors in the workplace and staff role predicted attitudes towards adopting EBI, e.g. male gender, older age and working in private practice predicted more negative global attitudes, while working in academia, experiencing social support from colleagues and empowering leadership predicted more positive global attitudes to adopt EBI. The prediction outcomes for the specific attitudinal components are presented, as well. Conclusion The findings suggest that implementation efforts may benefit from being tailored to the different needs and values of the affected professionals, including the role of the context they operate within. Implications with a special emphasis on training efforts and organizational development are discussed.
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16
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Kim JJ, Brookman-Frazee L, Gellatly R, Stadnick N, Barnett ML, Lau AS. Predictors of Burnout among Community Therapists in the Sustainment Phase of a System-Driven Implementation of Multiple Evidence-Based Practices in Children's Mental Health. ACTA ACUST UNITED AC 2018; 49:131-142. [PMID: 30270968 DOI: 10.1037/pro0000182] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Burnout among community mental health (CMH) therapists has been associated with poorer therapist health, high agency turnover, poorer client outcomes, and compromised quality of care. Recent mandates to learn and implement multiple evidence-based practices (EBPs) within CMH settings are intended to improve the quality of community care, yet there is mixed evidence concerning the impacts on workforce burnout. The current study sought to identify correlates of therapist emotional exhaustion, a key aspect of burnout, during the sustainment phase of a system-driven implementation of multiple EBPs in children's mental health services. We hypothesized that high workload and unfavorable organizational climate would relate to therapist emotional exhaustion, but that positive experiences with EBPs adopted would relate to lower exhaustion. Although agency-level indices of organizational climate were unrelated to exhaustion, a multilevel model revealed that therapists' weekly work hours, caseload, and number of EBPs delivered were associated with increased emotional exhaustion. Additionally, activities associated with the EBP implementation efforts (e.g., hours spent in EBP-related activities, supervision or consultation, or outcome monitoring), were not associated with emotional exhaustion. Therapists' knowledge and confidence delivering EBPs and their positive perceptions of EBPs were protective against emotional exhaustion, but these perceptions did not buffer the risks associated with heavy workload. Findings point to implementation strategies to prevent burnout and associated turnover that compromise the returns on investments in EBP implementation.
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Affiliation(s)
- Joanna J Kim
- University of California Los Angeles, Department of Psychology
| | - Lauren Brookman-Frazee
- University of California San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Resham Gellatly
- University of California Los Angeles, Department of Psychology
| | - Nicole Stadnick
- University of California San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Miya L Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical & School Psychology
| | - Anna S Lau
- University of California Los Angeles, Department of Psychology
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17
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Rodriguez A, Lau AS, Wright B, Regan J, Brookman-Frazee L. Mixed-method analysis of program leader perspectives on the sustainment of multiple child evidence-based practices in a system-driven implementation. Implement Sci 2018. [PMID: 29534745 PMCID: PMC5850972 DOI: 10.1186/s13012-018-0737-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Understanding program leader perspectives on the sustainment of evidence-based practice (EBP) in community mental health settings is essential to improving implementation. To date, however, much of the literature has focused on direct service provider perspectives on EBP implementation. The aim of this mixed-method study was to identify factors associated with the sustainment of multiple EBPs within a system-driven implementation effort in children's mental health services. METHODS Data were gathered from 186 leaders at 59 agencies within the Los Angeles County Department of Mental Health who were contracted to deliver one of six EBPs within the Prevention and Early Intervention initiative. RESULTS Multi-level analyses of quantitative survey data (N = 186) revealed a greater probability of leader-reported EBP sustainment in large agencies and when leaders held more positive perceptions toward the EBP. Themes from semi-structured qualitative interviews conducted with a subset of survey participants (n = 47) expanded quantitative findings by providing detail on facilitating conditions in larger agencies and aspects of EBP fit that were perceived to lead to greater sustainment, including perceived fit with client needs, implementation requirements, aspects of the organizational workforce, availability of trainings, and overall therapist attitudes about EBPs. CONCLUSIONS Findings inform EBP implementation efforts regarding decisions around organizational-level supports and promotion of EBP fit.
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Affiliation(s)
- Adriana Rodriguez
- Department of Psychology, University of California, Los Angeles, California, USA.
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Blanche Wright
- Department of Psychology, University of California, Los Angeles, California, USA
| | - Jennifer Regan
- Hathaway-Sycamores Child and Family Services, Pasadena, California, USA
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, California, USA.,Child and Adolescent Services Research Center, San Diego, California, USA
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18
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Brookman-Frazee L, Zhan C, Stadnick N, Sommerfeld D, Roesch S, Aarons GA, Innes-Gomberg D, Bando L, Lau AS. Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children's Mental Health Services. Front Public Health 2018; 6:54. [PMID: 29546038 PMCID: PMC5839095 DOI: 10.3389/fpubh.2018.00054] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/12/2018] [Indexed: 11/13/2022] Open
Abstract
Evidence-based practice (EBP) implementation requires substantial resources in workforce training; yet, failure to achieve long-term sustainment can result in poor return on investment. There is limited research on EBP sustainment in mental health services long after implementation. This study examined therapists’ continued vs. discontinued practice delivery based on administrative claims for reimbursement for six EBPs [Cognitive Behavioral Interventions for Trauma in Schools (CBITS), Child–Parent Psychotherapy, Managing and Adapting Practices (MAP), Seeking Safety (SS), Trauma-Focused Cognitive Behavior Therapy (TF-CBT), and Positive Parenting Program] adopted in a system-driven implementation effort in public mental health services for children. Our goal was to identify agency and therapist factors associated with a sustained EBP delivery. Survival analysis (i.e., Kaplan–Meier survival functions, log-rank tests, and Cox regressions) was used to analyze 19 fiscal quarters (i.e., approximately 57 months) of claims data from the Prevention and Early Intervention Transformation within the Los Angeles County Department of Mental Health. These data comprised 2,322,389 claims made by 6,873 therapists across 88 agencies. Survival time was represented by the time elapsed from therapists’ first to final claims for each practice and for any of the six EBPs. Results indicate that therapists continued to deliver at least one EBP for a mean survival time of 21.73 months (median = 18.70). When compared to a survival curve of the five other EBPs, CBITS, SS, and TP demonstrated a higher risk of delivery discontinuation, whereas MAP and TF-CBT demonstrated a lower risk of delivery discontinuation. A multivariate Cox regression model revealed that agency (centralization and service setting) and therapist (demographics, discipline, and case-mix characteristics) characteristics were significantly associated with risk of delivery discontinuation for any of the six EBPs. This study illustrates a novel application of survival analysis to administrative claims data in system-driven implementation of multiple EBPs. Findings reveal variability in the long-term continuation of therapist-level delivery of EBPs and highlight the importance of both agency and workforce characteristics in the sustained delivery of EBPs. Findings direct the field to potential targets of sustainment interventions (e.g., strategic assignment of therapists to EBP training and strategic selection of EBPs by agencies).
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Affiliation(s)
- Lauren Brookman-Frazee
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, United States.,Child and Adolescent Services Research Center, San Diego, CA, United States
| | - Chanel Zhan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
| | - Nicole Stadnick
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, United States.,Child and Adolescent Services Research Center, San Diego, CA, United States
| | - David Sommerfeld
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, United States.,Child and Adolescent Services Research Center, San Diego, CA, United States
| | - Scott Roesch
- Child and Adolescent Services Research Center, San Diego, CA, United States.,Department of Psychology, San Diego State University, San Diego, CA, United States
| | - Gregory A Aarons
- Department of Psychiatry, University of California, La Jolla, San Diego, CA, United States.,Child and Adolescent Services Research Center, San Diego, CA, United States
| | | | - Lillian Bando
- Los Angeles County Department of Mental Health, Los Angeles, CA, United States
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, United States
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