Community Stakeholder Preferences for Evidence-Based Practice Implementation Strategies in Behavioral Health: A Best-Worst Scaling Choice Experiment

Abstract

Background: Community behavioral health clinicians, supervisors, and administrators play an essential role in implementing new psychosocial evidence-based practices (EBP) for patients receiving psychiatric care; however, little is known about these stakeholders’ values and preferences for implementation strategies that support EBP use, nor how best to elicit, quantify, or segment their preferences. This study sought to quantify clinician, supervisor, and administrator preferences for implementation strategies and to identify segments of these stakeholders with distinct preferences using a rigorous choice experiment method called best-worst scaling (BWS). Methods: A total of 240 clinicians, 74 clinical supervisors, and 29 administrators delivering publicly funded behavioral health services in a large metropolitan behavioral health system participated in a best-worst scaling choice experiment. Participants evaluated 14 implementation strategies developed through extensive elicitation and pilot work within the target system. Preference weights were generated for each strategy using hierarchical Bayesian estimation. Latent class analysis identified segments of stakeholders with unique preference profiles. Results: On average, clinicians, supervisors, and administrators preferred two strategies significantly more than all others—compensation for use of EBP per session and compensation for preparation time to use the EBP; two strategies were preferred significantly less than all others—performance feedback via email and performance feedback via leaderboard. However, latent class analysis identified four distinct segments of stakeholders with unique preferences: Segment 1 (n = 121, 35%) strongly preferred financial incentives over all other approaches; Segment 2 (n = 80, 23%) preferred technology-based strategies; Segment 3 (n = 52, 15%) preferred an improved waiting room to enhance client readiness and strongly disliked any type of clinical consultation; Segment 4 (n = 90, 26%) rejected financial incentives and strongly preferred strategies focused on clinical consultation. Conclusions: The presence of four heterogeneous subpopulations within this large group of behavioral health administrators, supervisors, and clinicians suggests optimal implementation may be achieved through targeted strategies derived via elicitation of stakeholder preferences. Best-worst scaling is a feasible, systematic, and rigorous method for eliciting stakeholders’ implementation preferences and identifying subpopulations with unique preferences in behavioral health settings.

Identifying Methods to Select and Tailor Implementation Strategies to Context-Specific Determinants in Child Mental Health Settings: A Scoping Review

“…Prior implementation studies have emphasized the importance of involving stakeholders who represent various roles within an organization, as well as end-users of an intervention (e.g., clients) (Beidas et al, 2019 ; Bustos et al, 2021b ). Consistent with this previous research (Bustos et al, 2021a ; Williams et al, 2020 ), four ISMMs described stakeholder engagement and collaboration as an integral component to ISMM processes. Specifically, innovation tournament and concept mapping methods described a member-checking step to systematically engage stakeholders.…”