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Fox MT, Butler JI, Day AMB, Durocher E, Nowrouzi-Kia B, Sidani S, Maimets IK, Dahlke S, Yamada J. Healthcare providers' perceived acceptability of a warning signs intervention for rural hospital-to-home transitional care: A cross-sectional study. PLoS One 2024; 19:e0299289. [PMID: 38427646 PMCID: PMC10906905 DOI: 10.1371/journal.pone.0299289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/03/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION There is a pressing need for transitional care that prepares rural dwelling medical patients to identify and respond to the signs of worsening health conditions. An evidence-based warning signs intervention has the potential to address this need. While the intervention is predominantly delivered by nurses, other healthcare providers may be required to deliver it in rural communities where human health resources are typically limited. Understanding the perspectives of other healthcare providers likely to be involved in delivering the intervention is a necessary first step to avert consequences of low acceptability, such as poor intervention implementation, uptake, and effectiveness. This study examined and compared nurses' and other healthcare providers' perceived acceptability of an evidence-based warning signs intervention proposed for rural transitional care. METHODS A cross-sectional design was used. The convenience sample included 45 nurses and 32 other healthcare providers (e.g., physical and occupational therapists, physicians) who self-identified as delivering transitional care to patients in rural Ontario, Canada. In an online survey, participants were presented with a description of the warning signs intervention and completed established measures of intervention acceptability. The measures captured 10 intervention acceptability attributes (effectiveness, appropriateness, risk, convenience, relevance, applicability, usefulness, frequency of current use, likelihood of future use, and confidence in ability to deliver the intervention). Ratings ≥ 2 indicated acceptability. Data analysis included descriptive statistics, independent samples t-tests, as well as effect sizes to quantify the magnitude of any differences in acceptability ratings between nurses and other healthcare providers. RESULTS Nurses and other healthcare providers rated all intervention attributes > 2, except the attributes of convenience and frequency of current use. Differences between the two groups were found for only three attributes: nurses' ratings were significantly higher than other healthcare providers on perceived applicability, frequency of current use, and the likelihood of future use of the intervention (all p's < .007; effect sizes .58 - .68, respectively). DISCUSSION The results indicate that both participant groups had positive perspectives of the intervention on most of the attributes and suggest that initiatives to enhance the convenience of the intervention's implementation are warranted to support its widespread adoption in rural transitional care. However, the results also suggest that other healthcare providers may be less receptive to the intervention in practice. Future research is needed to explore and mitigate the possible reasons for low ratings on perceived convenience and frequency of current use of the intervention, as well as the between group differences on perceived applicability, frequency of current use, and the likelihood of future use of the intervention. CONCLUSIONS The intervention represents a tenable option for rural transitional care in Ontario, Canada, and possibly other jurisdictions emphasizing transitional care.
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Affiliation(s)
- Mary T. Fox
- School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Jeffrey I. Butler
- School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Adam M. B. Day
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Evelyne Durocher
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Behdin Nowrouzi-Kia
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Souraya Sidani
- School of Nursing, York University, Toronto, Ontario, Canada
| | - Ilo-Katryn Maimets
- Steacie Science and Engineering Library, York University, Toronto, Ontario, Canada
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Janet Yamada
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
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Sklar M, Ehrhart MG, Ramirez N, Carandang K, Kuhn N, Day A, Aarons GA, Williams NJ. Implementation leadership and implementation climate in context: A single organization intrinsic case study for implementation of digital measurement-based care. IMPLEMENTATION RESEARCH AND PRACTICE 2024; 5:26334895241236680. [PMID: 38550748 PMCID: PMC10976481 DOI: 10.1177/26334895241236680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Background Although studies have demonstrated that implementation leadership and climate are important constructs in predicting evidence-based practice (EBP) implementation, concrete descriptions of how they operate during organizational implementation efforts are lacking. This case study fills that gap through an in-depth description of an organization with effective implementation leadership that successfully built a strong implementation climate. This case study provides an illustration of implementation leadership and climate in tangible, replicable terms to assist managers, practitioners, and researchers in addressing the organizational context in their own implementation projects. Method A single organization, intrinsic case study was employed to paint a multifaceted picture of how one organization leveraged implementation leadership to strengthen a climate for the successful implementation of digital measurement-based care. The case was drawn from a cluster-randomized trial designed to test the effects of a leadership-focused implementation strategy on youth-level fidelity and clinical outcomes of digital measurement-based care. Following the completion of the trial, case study activities commenced. Descriptive summaries of multiple data sources (including quantitative data on implementation leadership and climate, coaching call and organizational alignment meeting recordings and notes, and development plans) were produced and revised iteratively until consensus was reached. Leadership actions were analyzed for corresponding dimensions of implementation leadership and climate. Results Specific actions organizational leaders took, as well as the timing specific strategies were enacted, to create a climate for implementation are presented, along with lessons learned from this experience. Conclusion This case study offers concrete steps organizational leaders took to create a consistent and aligned message that the implementation of a specific EBP was a top priority in the agency. The general approach taken to create an implementation climate provides several lessons for leaders, especially for EBPs that have broad implications across an organization.
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Affiliation(s)
- Marisa Sklar
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Mark G. Ehrhart
- Department of Psychology, University of Central Florida, Orlando, FL, USA
| | - Nallely Ramirez
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA
| | | | | | - Ana Day
- Oregon Community Programs, Eugene, OR, USA
| | - Gregory A. Aarons
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- UC San Diego ACTRI Dissemination and Implementation Science Center, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - Nathaniel J. Williams
- Institute for the Study of Behavioral Health and Addiction, Boise State University, Boise, ID, USA
- School of Social Work, Boise State University, Boise, ID, USA
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Zhang Y, Cook C, Fallon L, Corbin C, Ehrhart M, Brown E, Locke J, Lyon A. The Interaction Between General and Strategic Leadership and Climate on Their Multilevel Associations with Implementer Attitudes Toward Universal Prevention Programs for Youth Mental Health: A Cross-Sectional Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:427-449. [PMID: 36585557 DOI: 10.1007/s10488-022-01248-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2022] [Indexed: 12/31/2022]
Abstract
Emerging literature has highlighted the importance of discerning general and strategic organizational context (OC) factors (e.g., leadership and climate) and their interaction effect on individual implementation behaviors (e.g., attitudes toward evidence-based practices; EBPs) in youth mental healthcare. This study aimed to examine how leadership and climate (general and strategic) are associated with implementer attitudes toward EBPs across the individual and organizational levels and their interaction effect in schools. A series of multilevel models (MLMs) were fitted on a diverse sample of schools actively implementing universal prevention programs for youth mental health (441 implementers from 52 schools). The organization-level aggregates and individual educators' perceptions of general and strategic leadership and climate, and their interaction terms, were entered as level-2 and level-1 predictors of four attitudinal dimensions (Requirement, Openness, Appeal, and Divergence) based on their level of measurement. At the organizational level, higher levels of strategic leadership and climate, but not their general counterparts, were consistently associated with more favorable attitudes in all four dimensions. At the individual/within-school level, higher levels of perceived general and strategic leadership and climate were associated with more favorable attitudes of Requirement and Openness. At the organizational/between-school level, general climate moderated the positive effect of strategic climate on implementers' perception of appeal and divergence of EBPs. Our findings indicate that leaders should make data-based decisions to allocate resources on strategic and/or general leadership and climate to foster favorable staff attitudes toward EBPs based on the level of measurement, implementation-specificity, and attitudinal dimensions.
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Affiliation(s)
- Yanchen Zhang
- Department of Psychological & Quantitative Foundations, The University of Iowa, 361 Lindquist Center, Iowa City, IA, 52242, USA.
| | - Clay Cook
- Department of Educational Psychology, University of Minnesota, 341 Education Sciences Building, 56 East River Road, Minneapolis, MN, 55455, USA
| | - Lindsay Fallon
- Department of Counseling and School Psychology, University of Massachusetts-Boston, 100 William T. Morrissey Blvd., Boston, MA, 02125, USA
| | - Catherine Corbin
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
| | - Mark Ehrhart
- Department of Industrial/Organizational Psychology, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA
| | - Eric Brown
- Department of Public Health Sciences, University of Miami, Coral Gables, FL, 33124, USA
| | - Jill Locke
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
| | - Aaron Lyon
- Department of Psychiatry & Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 110, Box 354920, Seattle, WA, 98115, USA
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Lyon AR, Liu FF, Connors EH, King KM, Coifman JI, Cook H, McRee E, Ludwig K, Law A, Dorsey S, McCauley E. How low can you go? Examining the effects of brief online training and post-training consultation dose on implementation mechanisms and outcomes for measurement-based care. Implement Sci Commun 2022; 3:79. [PMID: 35869500 PMCID: PMC9306246 DOI: 10.1186/s43058-022-00325-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 07/10/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Initial training and ongoing post-training consultation (i.e., ongoing support following training, provided by an expert) are among the most common implementation strategies used to change clinician practice. However, extant research has not experimentally investigated the optimal dosages of consultation necessary to produce desired outcomes. Moreover, the degree to which training and consultation engage theoretical implementation mechanisms-such as provider knowledge, skills, and attitudes-is not well understood. This study examined the effects of a brief online training and varying dosages of post-training consultation (BOLT+PTC) on implementation mechanisms and outcomes for measurement-based care (MBC) practices delivered in the context of education sector mental health services. METHODS A national sample of 75 clinicians who provide mental health interventions to children and adolescents in schools were randomly assigned to BOLT+PTC or control (services as usual). Those in BOLT+PTC were further randomized to 2-, 4-, or 8-week consultation conditions. Self-reported MBC knowledge, skills, attitudes, and use (including standardized assessment, individualized assessment, and assessment-informed treatment modification) were collected for 32 weeks. Multilevel models were used to examine main effects of BOLT+PTC versus control on MBC use at the end of consultation and over time, as well as comparisons among PTC dosage conditions and theorized mechanisms (skills, attitudes, knowledge). RESULTS There was a significant linear effect of BOLT+PTC over time on standardized assessment use (b = .02, p < .01), and a significant quadratic effect of BOLT+PTC over time on individualized assessment use (b = .04, p < .001), but no significant effect on treatment modification. BOLT + any level of PTC resulted in higher MBC knowledge and larger growth in MBC skill over the intervention period as compared to control. PTC dosage levels were inconsistently predictive of outcomes, providing no clear evidence for added benefit of higher PTC dosage. CONCLUSIONS Online training and consultation in MBC had effects on standardized and individualized assessment use among clinicians as compared to services as usual with no consistent benefit detected for increased consultation dosage. Continued research investigating optimal dosages and mechanisms of these established implementation strategies is needed to ensure training and consultation resources are deployed efficiently to impact clinician practices. TRIAL REGISTRATION ClinicalTrials.gov NCT05041517 . Retrospectively registered on 10 September 2021.
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Affiliation(s)
- Aaron R. Lyon
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Freda F. Liu
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Elizabeth H. Connors
- grid.47100.320000000419368710Department of Psychiatry, Yale University, 389 Whitney Avenue, Office 106, New Haven, CT 06511 USA
| | - Kevin M. King
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Jessica I. Coifman
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Heather Cook
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Erin McRee
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Kristy Ludwig
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
| | - Amy Law
- grid.34477.330000000122986657Graduate Medical Education, University of Washington, Learning Gateway, Box 358220, Seattle, WA 98109 USA
| | - Shannon Dorsey
- grid.34477.330000000122986657Department of Psychology, University of Washington, Guthrie Hall, Box 351525, Seattle, WA 98195 USA
| | - Elizabeth McCauley
- grid.34477.330000000122986657Department of Psychiatry and Behavioral Sciences, University of Washington, 6200 NE 74th Street, Suite 100, Seattle, WA 98115 USA
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Barnett ML, Klein CC, Gonzalez JC, Sanchez BE, Rosas YG, Corcoran F. How do Lay Health Worker Engage Caregivers? A Qualitative Study to Enhance Equity in Evidence-Based Parenting Programs. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2021; 8:221-235. [PMID: 37323826 PMCID: PMC10266647 DOI: 10.1080/23794925.2021.1993111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Engaging caregivers in their children's mental health treatment is critical for delivering high quality, evidence-based care, particularly for young children with externalizing behaviors. Lay health workers (LHWs), including peer providers and promotoras de salud, have been identified as important workforces in addressing structural and stigma-related barriers to engagement in mental health services. Importantly, research has suggested that LHWs may be integral in efforts to address engagement disparities in evidence-based behavioral parent training programs (BPTs) for Latinx caregivers. The purpose of the study was to understand how different LHW workforces engage caregivers within their usual services, in order to inform strategies that improve access to and engagement in BPTs. Qualitative interviews were conducted with two different LHW workforces: volunteer LHWs (i.e., promotoras de salud) (n = 14), who were part of a community-embedded network, and paid LHWs (i.e., parent support partners, home visitors) (n = 9) embedded within children's mental health agencies. Participants were predominately Latinx (79%) and female (96%). Qualitative analyses revealed three primary themes related to engagement strategies used by LHWs to address barriers to care: 1.) Building Trust, 2.) Empowerment, 3.) Increasing Access. Although the majority of themes and sub-themes were consistent across the two LHW workforces, agency-embedded LHWs often discussed having the means to provide resources through their organizations, whereas community-embedded LHWs discussed acting as a bridge to services by providing information and conducting outreach. Findings have implications for partnering with different workforces of LHWs to increase equity in access to BPTs.
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Affiliation(s)
- Miya L Barnett
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Corinna C Klein
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Juan Carlos Gonzalez
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Berta Erika Sanchez
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Yessica Green Rosas
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
| | - Frederique Corcoran
- Department of Counseling, Clinical and School Psychology, University of California, Santa Barbara, CA
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Ramos G, Brookman-Frazee L, Kodish T, Rodriguez A, Lau AS. Community providers' experiences with evidence-based practices: The role of therapist race/ethnicity. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2021; 27:471-482. [PMID: 32391705 PMCID: PMC7655698 DOI: 10.1037/cdp0000357] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVES Examining therapists' experiences implementing evidence-based practices (EBPs) is fundamental to understanding how these interventions are perceived, adapted, and delivered in community settings. However, little is known about racial/ethnic variation in the experiences of therapists serving racial/ethnic minority youth and their families. Through an innovative QUAN → qual → QUAN mixed-methods approach, we examined differences in therapists' perceptions, adaptations performed, and client-engagement challenges in the largest county-operated department of mental health in the United States. METHOD Surveys were completed by 743 therapists (Latinx [44%], White [34%], other ethnic minority [22%]), most of whom were female (88%), master's level (85%), and unlicensed (58%). A subset of therapists (n = 60) completed semistructured interviews. RESULTS Latinx therapists reported more positive experiences implementing EBPs, making more adaptations to EBPs, and encountering fewer client-engagement challenges than therapists from other racial/ethnic groups. Qualitative analyses expanded on these results, revealing that Latinx therapists commonly described adapting EBPs in terms of language and culture to improve fit and promote client engagement. Informed by these qualitative themes, a refined statistical model revealed that the ability to deliver EBPs in languages other than English might have accounted for differences in therapist-reported EBP adaptations and client-engagement challenges. CONCLUSIONS The findings suggest that racial/ethnic minority therapists have positive experiences in implementing EBPs in community settings. In the case of Latinx therapists, bilingual/bicultural competence may facilitate adapting EBPs in ways that reduce perceptions of engagement challenges with racially/ethnically diverse clients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Giovanni Ramos
- Department of Psychology, University of California, Los Angeles
| | - Lauren Brookman-Frazee
- Department of Psychiatry, Child and Adolescent Services Research Center, University of California, San Diego
| | - Tamar Kodish
- Department of Psychology, University of California, Los Angeles
| | - Adriana Rodriguez
- Children and Youth Behavioral Health, Health Care Agency, Orange County
| | - Anna S Lau
- Department of Psychology, University of California, Los Angeles
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Barnett ML, Brookman-Frazee L, Yu SH, Lind T, Lui JHL, Timmer S, Boys D, Urquiza A, Innes-Gomberg D, Quick-Abdullah D, Lau AS. Train-to-Sustain: Predictors of Sustainment in a Large-Scale Implementation of Parent-Child Interaction Therapy. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2021; 6:262-276. [PMID: 34239983 PMCID: PMC8259890 DOI: 10.1080/23794925.2020.1855613] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sustainment of evidence-based practices is necessary to ensure their public health impact. The current study examined predictors of sustainment of Parent-Child Interaction Therapy (PCIT) within a large-scale system-driven implementation effort in Los Angeles County. Data were drawn from PCIT training data and county administrative claims between January 2013 and March 2018. Participants included 241 therapists from 61 programs. Two sustainment outcomes were examined at the therapist- and program-levels: 1) PCIT claim volume and 2) PCIT claim discontinuation (discontinuation of claims during study period; survival time of claiming in months). Predictors included therapist- and program-level caseload, training, and workforce characteristics. On average, therapists and programs continued claiming to PCIT for 17.7 and 32.3 months, respectively. Across the sustainment outcomes, there were both shared and unshared significant predictors. For therapists, case-mix fit (higher proportions of young child clients with externalizing disorders) and participation in additional PCIT training activities significantly predicted claims volume. Furthermore, additional training activity participation was associated with lower likelihood of therapist PCIT claim discontinuation in the follow-up period. Programs with therapists eligible to be internal trainers were significantly less likely to discontinue PCIT claiming. Findings suggest that PCIT sustainment may be facilitated by implementation strategies including targeted outreach to ensure eligible families in therapist caseloads, facilitating therapist engagement in advanced trainings, and building internal infrastructure through train-the-trainer programs.
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Affiliation(s)
- Miya L Barnett
- University of California, Santa Barbara, Department of Counseling, Clinical, & School Psychology
| | - Lauren Brookman-Frazee
- University of California, San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Stephanie H Yu
- University of California, Los Angeles, Department of Psychology
| | - Teresa Lind
- University of California, San Diego, Department of Psychiatry
- Child and Adolescent Services Research Center
| | - Joyce H L Lui
- University of California, Los Angeles, Department of Psychology
| | | | | | | | | | | | - Anna S Lau
- University of California, Los Angeles, Department of Psychology
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Changes in provider Fidelity after introducing a new model of intervention. CURRENT PSYCHOLOGY 2020; 41:3906-3915. [PMID: 32837130 PMCID: PMC7340763 DOI: 10.1007/s12144-020-00910-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Given the impact of implementation fidelity on community-based outcomes, it is important to understand how fidelity may change over time as providers learn an intervention. Attachment and Biobehavioral Catch-up is an evidence-based early intervention that assesses fidelity during weekly supervision. Providers are first trained in the infant model, with toddler model training considered to be a separate, specialized opportunity. The current study examined changes in fidelity, measured by “in-the-moment” commenting, as providers moved from infant to toddler certification. An initial drop, with a subsequent increase, in commenting fidelity over the training year was expected. Results were consistent with our hypotheses, demonstrating a main effect of time, with most indices of commenting data initially decreasing and then increasing. These findings are consistent with research suggesting that fluctuation in fidelity is typical within community dissemination and suggests that ongoing supervision after the initial training is useful in facilitating successful skill development.
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Jensen-Doss A, Smith AM, Walsh LM, Mora Ringle V, Casline E, Patel Z, Shaw AM, Maxwell C, Hanson R, Webster R. Preaching to the Choir? Predictors of Engagement in a Community-Based Learning Collaborative. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2019; 47:10.1007/s10488-019-00985-4. [PMID: 31617139 DOI: 10.1007/s10488-019-00985-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
This study examined predictors of engagement among 283 professionals from 34 agencies participating in three community-based learning collaboratives (CBLCs) on trauma-focused cognitive-behavioral therapy (TF-CBT). Only 50.2% of participants completed the CBLC, primarily due to not attending consultation calls or completing training cases. While higher engagement was associated with being trauma-informed and using more of the TF-CBT components prior to the CBLC, most predictors were not significant, perhaps due to ceiling effects. Positive attitudes and high organizational support were not sufficient to ensure engagement. Future research using longitudinal measurement of a wider range of predictors is needed.
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Affiliation(s)
- Amanda Jensen-Doss
- University of Miami, Coral Gables, USA.
- Department of Psychology, University of Miami, P.O. Box 248185, Coral Gables, FL, 33124-0751, USA.
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Gellatly R, Brookman-Frazee L, Barnett M, Gonzalez JC, Kim JJ, Lau AS. Therapist Reports of EBP Client Engagement Challenges in Sessions with Diverse Youth and Families in Community Mental Health Settings. CHILD & YOUTH CARE FORUM 2019; 48:55-75. [PMID: 32132809 PMCID: PMC7055736 DOI: 10.1007/s10566-018-9472-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND The implementation of evidence-based practices (EBPs) in community settings appears to result in reduced benefit relative to controlled trials. This difference in outcomes may be attributable in part to engagement challenges therapists encounter when delivering EBPs to low-income ethnic minority youth and families. OBJECTIVE The current study sought to identify therapist, client, and session characteristics associated with therapist-reported engagement challenges in therapy sessions, as well the associations between two types of client engagement challenges and therapists' self-reported ability to deliver the EBP in sessions within a system-driven implementation in public children's mental health services. METHOD One hundred and three therapists reported on two types of engagement challenges-Limited Client Engagement and Expressed Client Concerns-in 702 sessions with 274 clients. RESULTS Results indicated that therapists reported a higher frequency of Limited Client Engagement in sessions with male clients and in sessions where the youth was present, and by therapists with smaller caseloads. No variables significantly predicted Expressed Client Concerns. Both types of engagement challenges were negatively associated with therapists' report of their ability to carry out intended activities in the same session. CONCLUSIONS Findings suggest that therapists may benefit from learning strategies to address these two distinct types of engagement challenges encountered in implementation of EBPs with diverse families in community settings.
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Affiliation(s)
- R. Gellatly
- University of California, Los Angeles, Los Angeles, CA, USA
| | - L. Brookman-Frazee
- University of California, San Diego, La Jolla, CA, USA
- Child and Adolescent Services Research Center, San Diego, CA, USA
| | - M. Barnett
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. C. Gonzalez
- University of California, Santa Barbara, Santa Barbara, CA, USA
| | - J. J. Kim
- University of California, Los Angeles, Los Angeles, CA, USA
| | - A. S. Lau
- University of California, Los Angeles, Los Angeles, CA, USA
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11
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Barnett M, Brookman-Frazee L, Regan J, Saifan D, Stadnick N, Lau A. How Intervention and Implementation Characteristics Relate to Community Therapists' Attitudes Toward Evidence-Based Practices: A Mixed Methods Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:824-837. [PMID: 28236076 DOI: 10.1007/s10488-017-0795-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Therapists' perceptions toward evidence-based practices (EBPs) are important in implementation efforts, however little is known about characteristics of EBPs associated with more positive attitudes. This mixed-methods study examined how intervention and implementation characteristics of six EBPs related to therapist attitudes. Quantitative analysis of 793 cross-sectional surveys revealed that therapists endorsed more positive attitudes toward EBPs with (1) prescribed session content and order and (2) required consultation. Associations between these intervention and implementation characteristics and attitudes were not moderated by therapist experience or emotional exhaustion. Qualitative analyses complemented quantitative findings, indicating that "structure" was appealing for interventions and that therapists felt supported by consultation.
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Affiliation(s)
- Miya Barnett
- Department of Counseling, Clinical, & School Psychology, Gevirtz Graduate School of Education, University of California, Santa Barbara, Santa Barbara, CA, 93106-9490, USA.
| | - Lauren Brookman-Frazee
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Child and Adolescents Service Research Center, San Diego, CA, USA
| | - Jennifer Regan
- Hathaway-Sycamores, Child and Family Services, Pasadena, CA, USA
| | - Dana Saifan
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Nicole Stadnick
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.,Child and Adolescents Service Research Center, San Diego, CA, USA
| | - Anna Lau
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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Pemberton JR, Conners-Burrow NA, Sigel BA, Sievers CM, Stokes LD, Kramer TL. Factors Associated with Clinician Participation in TF-CBT Post-workshop Training Components. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 44:524-533. [PMID: 26319794 DOI: 10.1007/s10488-015-0677-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
For proficiency in an evidence-based treatment (EBT), mental health professionals (MHPs) need training activities extending beyond a one-time workshop. Using data from 178 MHPs participating in a statewide TF-CBT dissemination project, we used five variables assessed at the workshop, via multiple and logistic regression, to predict participation in three post-workshop training components. Perceived in-workshop learning and client-treatment mismatch were predictive of consultation call participation and case presentation respectively. Attitudes toward EBTs were predictive of trauma assessment utilization, although only with non-call participants removed from analysis. Productivity requirements and confidence in TF-CBT skills were not associated with participation in post-workshop activities.
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Affiliation(s)
- Joy R Pemberton
- Department of Psychiatry, UAMS Child Study Center, University of Arkansas for Medical Sciences, 11 Children's Way, Slot 654, Little Rock, AR, 72202, USA.
| | - Nicola A Conners-Burrow
- Department of Family and Preventive Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Benjamin A Sigel
- Department of Psychiatry, UAMS Child Study Center, University of Arkansas for Medical Sciences, 11 Children's Way, Slot 654, Little Rock, AR, 72202, USA
| | - Chad M Sievers
- Department of Psychiatry, UAMS Child Study Center, University of Arkansas for Medical Sciences, 11 Children's Way, Slot 654, Little Rock, AR, 72202, USA
| | | | - Teresa L Kramer
- Department of Psychiatry, UAMS Child Study Center, University of Arkansas for Medical Sciences, 11 Children's Way, Slot 654, Little Rock, AR, 72202, USA
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13
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“Now I Know the Terrain”: Phenomenological Exploration of CFTs Learning an Evidence-Based Practice. CONTEMPORARY FAMILY THERAPY 2017. [DOI: 10.1007/s10591-017-9448-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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14
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Lieneman CC, Brabson LA, Highlander A, Wallace NM, McNeil CB. Parent-Child Interaction Therapy: current perspectives. Psychol Res Behav Manag 2017; 10:239-256. [PMID: 28790873 PMCID: PMC5530857 DOI: 10.2147/prbm.s91200] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Parent-Child Interaction Therapy (PCIT) is an empirically supported intervention originally developed to treat disruptive behavior problems in children between the ages of 2 and 7 years. Since its creation over 40 years ago, PCIT has been studied internationally with various populations and has been found to be an effective intervention for numerous behavioral and emotional issues. This article summarizes progress in the PCIT literature over the past decade (2006-2017) and outlines future directions for this important work. Recent PCIT research related to treatment effectiveness, treatment components, adaptations for specific populations (age groups, cultural groups, military families, individuals diagnosed with specific disorders, trauma survivors, and the hearing-impaired), format changes (group and home-based), teacher-child interaction training (TCIT), intensive PCIT (I-PCIT), treatment as prevention (for externalizing problems, child maltreatment, and developmental delays), and implementation are discussed.
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Affiliation(s)
- Corey C Lieneman
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Laurel A Brabson
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - April Highlander
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Nancy M Wallace
- Department of Psychology, West Virginia University, Morgantown, WV, USA
| | - Cheryl B McNeil
- Department of Psychology, West Virginia University, Morgantown, WV, USA
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15
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Leathers SJ, Melka-Kaffer C, Spielfogel JE, Atkins MS. Use of evidence-based interventions in child welfare: Do attitudes matter? CHILDREN AND YOUTH SERVICES REVIEW 2016; 70:375-382. [PMID: 30416239 PMCID: PMC6221194 DOI: 10.1016/j.childyouth.2016.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Implementation of evidence-based programs in progressed slowly, with the majority of services in child welfare settings lacking empirical evidence for effectiveness. In other settings, research has identified providers' attitudes about evidence-based practices (EBPs) as a potential barrier to adoption of EBPs. As little research has focused on the role of attitudes in influencing use after training in an EBP in child welfare, the potential for attitudes to impede implementation efforts in child welfare is unclear. This study addressed this question in a sample of 55 caseworkers and therapists randomly assigned to enhanced support to use an EBP following training or a training-only condition. Information on providers' use of the intervention after training and their attitudes about EBPs were measured for up to five time points. Results indicate that attitudes did not predict providers' use of the EBP, and attitudes did not change overall or in the enhanced condition that provided greater exposure to the intervention. Providers perceived of requirements to use a practice as more influential in their use than their openness to EBPs. However, those who were more open to EBPs were more likely to participate in implementation support after the training, suggesting that openness facilitates participation in activities that support use of a new intervention.
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16
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Sidani S, Manojlovich M, Doran D, Fox M, Covell CL, Kelly H, Jeffs L, McAllister M. Nurses' Perceptions of Interventions for the Management of Patient-Oriented Outcomes: A Key Factor for Evidence-Based Practice. Worldviews Evid Based Nurs 2016; 13:66-74. [PMID: 26765667 DOI: 10.1111/wvn.12129] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Various barriers and facilitators to implementing evidence-based interventions in practice have been acknowledged. Nurses' perspectives on these interventions were overlooked as potential factors that influence their uptake in practice. The purpose of this study was to explore nurses' perception of evidence-based interventions targeting patient-oriented outcomes. METHODS A mixed method design involving concurrent application of quantitative and qualitative approaches was used. Nurses (n = 56) working in acute and rehabilitation care settings completed the Intervention Acceptability scale and responded to open-ended questions. The scale presented information on the components, activities, dose, and mode of delivering evidence-based interventions targeting each patient-oriented outcome (fatigue, nausea and vomiting, dyspnea, pain, physical function, self-care) and items to rate the interventions on five attributes (relevance, applicability, frequency of use, likelihood, and comfort in implementation). The open-ended questions inquired about the appropriateness and resources needed to use the interventions in practice. RESULTS The quantitative results indicated favorable perceptions of most interventions. Nurses rated acupressure, guided imagery, massage, and relaxation as having limited appropriateness and they reported low levels of comfort in applying them. The qualitative themes clarified the reasons underlying nurses' ratings. LINKING EVIDENCE TO ACTION This study's findings highlight the importance of examining nurses' perceptions of evidence-based interventions as an initial step toward promoting the adoption of interventions in practice. Effective interventions that are considered of limited relevance are unlikely to be implemented in practice. Nurses' perceptions can guide the design or selection of dissemination strategies to clarify any misconception about the effectiveness and risk of evidence-based interventions.
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Affiliation(s)
- Souraya Sidani
- Professor and Canada Research Chair, School of Nursing, Ryerson University, Toronto, ON, Canada
| | - Milisa Manojlovich
- Associate Professor, Nursing Business & Health Systems, University of Michigan School of Nursing, Ann Arbor, MI
| | - Diane Doran
- Professor Emerita, Lawrence S. Bloomberg Professor in Patient Safety, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mary Fox
- Associate Professor, York University, Faculty of Health, School of Nursing, Toronto, ON, Canada
| | - Christine L Covell
- CIHR Post-Doctoral Fellow, Faculty of Health Sciences and Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Helen Kelly
- Clinical Research Coordinator, Nursing Research, University Health Network, Toronto, ON, Canada
| | - Lianne Jeffs
- Director of Nursing/Clinical Research Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St. Michael's Hospital Volunteer Association Chair in Nursing Research, St. Michaels' Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Mary McAllister
- Associate Chief, Nursing Practice, Hospital for Sick Children, Toronto, ON, Canada
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Scudder A, Herschell AD. Building an evidence-base for the training of evidence-based treatments in community settings: Use of an expert-informed approach. CHILDREN AND YOUTH SERVICES REVIEW 2015; 55:84-92. [PMID: 26504259 PMCID: PMC4617599 DOI: 10.1016/j.childyouth.2015.05.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
In order to make EBTs available to a large number of children and families, developers and expert therapists have used their experience and expertise to train community-based therapists in EBTs. Understanding current training practices of treatment experts may be one method for establishing best practices for training community-based therapists prior to comprehensive empirical examinations of training practices. A qualitative study was conducted using surveys and phone interviews to identify the specific procedures used by treatment experts to train and implement an evidence-based treatment in community settings. Twenty-three doctoral-level, clinical psychologists were identified to participate because of their expertise in conducting and training Parent-Child Interaction Therapy. Semi-structured qualitative interviews were completed by phone, later transcribed verbatim, and analyzed using thematic coding. The de-identified data were coded by two independent qualitative data researchers and then compared for consistency of interpretation. The themes that emerged following the final coding were used to construct a training protocol to be empirically tested. The goal of this paper is to not only understand the current state of training practices for training therapists in a particular EBT, Parent-Child Interaction Therapy, but to illustrate the use of expert opinion as the best available evidence in preparation for empirical evaluation.
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Affiliation(s)
- Ashley Scudder
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
| | - Amy D Herschell
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine
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Lanier P, Kohl PL, Benz J, Swinger D, Drake B. Preventing Maltreatment with a Community-Based Implementation of Parent-Child Interaction Therapy. JOURNAL OF CHILD AND FAMILY STUDIES 2014; 23:449-460. [PMID: 24443637 PMCID: PMC3891779 DOI: 10.1007/s10826-012-9708-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The purpose of this study was to examine rates of child abuse and neglect reports following a community implementation of Parent-Child Interaction Therapy (PCIT), an evidence-supported intervention for the prevention of maltreatment. Among a group of families receiving PCIT, predictors of reports were examined including family demographics, course of treatment, changes in clinical measures, and caregiver report for prior maltreatment victimization and perpetration. Participants (n=120) included families at-risk for future maltreatment with and without prior maltreatment history. Agency case records were linked with state administrative records of child welfare reports. Time to follow-up ranged from 13-40 months. Bivariate and multivariate survival analyses are used to model risk for a later report. During the follow-up period, 12.5% of families had a report for physical abuse or neglect. Reports of prior victimization as a child and prior perpetration as an adult were strong predictors of a report of perpetration after PCIT. Dosage of PCIT and change in clinical measures did not increase risk for a later report. PCIT can be an effective intervention for preventing maltreatment. Family history of child welfare involvement is a prominent factor in assessing risk for future involvement.
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Affiliation(s)
- Paul Lanier
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130
| | - Patricia L. Kohl
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130
| | - Joan Benz
- Family Resource Center, St. Louis, MO
| | | | - Brett Drake
- Brown School of Social Work, Washington University in St. Louis, St. Louis, MO 63130
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Aarons GA, Glisson C, Green PD, Hoagwood K, Kelleher KJ, Landsverk JA, Weisz JR, Chorpita B, Gibbons R, Glisson C, Green EP, Hoagwood K, Jensen PS, Kelleher K, Landsverk J, Mayberg S, Miranda J, Palinkas L, Schoenwald S. The organizational social context of mental health services and clinician attitudes toward evidence-based practice: a United States national study. Implement Sci 2012; 7:56. [PMID: 22726759 PMCID: PMC3444886 DOI: 10.1186/1748-5908-7-56] [Citation(s) in RCA: 137] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2011] [Accepted: 06/07/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED ABSTBACKGROUND: Evidence-based practices have not been routinely adopted in community mental health organizations despite the support of scientific evidence and in some cases even legislative or regulatory action. We examined the association of clinician attitudes toward evidence-based practice with organizational culture, climate, and other characteristics in a nationally representative sample of mental health organizations in the United States. METHODS In-person, group-administered surveys were conducted with a sample of 1,112 mental health service providers in a nationwide sample of 100 mental health service institutions in 26 states in the United States. The study examines these associations with a two-level Hierarchical Linear Modeling (HLM) analysis of responses to the Evidence-Based Practice Attitude Scale (EBPAS) at the individual clinician level as a function of the Organizational Social Context (OSC) measure at the organizational level, controlling for other organization and clinician characteristics. RESULTS We found that more proficient organizational cultures and more engaged and less stressful organizational climates were associated with positive clinician attitudes toward adopting evidence-based practice. CONCLUSIONS The findings suggest that organizational intervention strategies for improving the organizational social context of mental health services may contribute to the success of evidence-based practice dissemination and implementation efforts by influencing clinician attitudes.
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Affiliation(s)
- Gregory A Aarons
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive (0812), La Jolla, CA 92093-0812, USA.
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Self-Brown S, Whitaker D, Berliner L, Kolko D. Disseminating child maltreatment interventions: research on implementing evidence-based programs. CHILD MALTREATMENT 2012; 17:5-10. [PMID: 22353672 PMCID: PMC3814165 DOI: 10.1177/1077559511436211] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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