A mixed-method analysis on the impacts of a system-driven implementation of multiple child evidence-based practices on community mental health providers.

Abstract

This document is copyrighted by the American Psychological Association or one of its allied publishers.This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.Initiatives to scale up evidence-based practices (EBPs) in routine care are likely to have myriad impacts on community providers, but these impacts have not yet been examined in depth. This is especially true within the context of simultaneous implementation of multiple evidence-based practices. The aim of this study was to characterize the multifaceted impacts on community mental health therapists within a system-driven implementation of multiple EBPs for youth and families. Semistructured interview and survey data were gathered from 60 therapists at 11 agencies contracted with the Los Angeles County Department of Mental Health to deliver EBPs within the Prevention and Early Intervention initiative. Therapists' accounts of impacts varied, and were either predominately negative, predominantly positive, or mixed-valence. Mixed-methods analyses using Kruskal-Wallis tests showed therapist valence groups varied on mean levels of self-reported burnout on surveys. Themes from qualitative data revealed several favorable (e.g., increased EBP knowledge, structure) and unfavorable (e.g., distress, feeling constrained by EBPs) impacts of county-contracted EBP implementation. These findings inform the development and implementation of future system-driven EBP initiatives that consider therapist perspective to optimize positive impacts and minimize negative impacts on therapists. Public Significance StatementThe present study found that community mental health therapists were impacted by the implementation of evidence-based practices in multiple ways, and that in particular, levels of therapist burnout related to how clinicians perceived the impacts. Therapists reported positive impacts of improved knowledge and skill and feeling more structured, as well as less favorable impacts such as feeling more distressed and constrained due to demands of multiple interventions.

Leveling the practice field for youth mental health: Institution-supported training in evidence-based practice for clinicians.

“…Overall, self-efficacy for using standardized measures improved. This is consistent with other research that has found improved therapist confidence and knowledge following EBP training (Rodriguez et al, 2021). Supervisor-reported, but not clinician-reported, attitudes toward using standardized assessment during diagnostic evaluation improved post seminar.…”

Applying best practices for health disparities work to create a treatment adaptation framework for culturally diverse communities: A mixed-methods approach.

“…For instance, Chu and Leino (2017) conducted a systematic review to develop a new, data-driven CA framework that distinguishes between core (facets that cause symptom change) and peripheral (facets that increase feasibility and acceptability of the intervention) aspects that therapists can adapt in psychotherapy. Although this demarcation is helpful for understanding mechanisms of change in therapy, these characteristics may not be particularly useful to community therapists who carry large caseloads and provide treatment to clients with complex presentations, including poverty, clinical severity, and comorbidity (Rodriguez et al, 2021). Hence, community-based participatory research (CBPR) has emerged in the last decade as a transformative research paradigm to bridge the gap between science and practice through community engagement and social justice to address health disparities (Wallerstein & Duran, 2017).…”