Objective: This study prospectively examined the naturalistic adoption of clinical and business evidence-informed trainings by all outpatient mental health clinics licensed to treat children, adolescents, and their families in New York State. Methods: Using September 2011-August 2013 attendance data from the New York State-funded Clinic Technical Assistance Center, this study classified the adoption behavior of 346 clinics in four ways: by number, type, intensity, and an adopter group category characterizing clinics by the highest training intensity in which they participated. Descriptive statistics on these adoption classifications were examined. Results: Among the 268 adopting clinics, a median of five out of 33 trainings were adopted; business and clinical trainings were about equally accessed (82% vs. 78%). Hour-long webinars were most popular (96% participation) compared to 6-18 month-long learning collaboratives (34% participation). Among adopters of business and clinical learning collaboratives, 73-100% sampled a webinar first before they committed to the learning collaboratives, though consistent participation in learning collaborative sessions over time was a challenge. Adopter groups captured meaningful adopter profiles: 41% were low-adopters that selected fewer trainings and only participated in webinars; 34% were high-/super-adopters that accessed more trainings and participated in learning collaboratives. Conclusions: More nuanced definitions of adoption behavior can improve the understanding of clinic adoption of trainings and hence promote the development of efficient roll-out strategies by state systems.

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