How Intervention and Implementation Characteristics Relate to Community Therapists’ Attitudes Toward Evidence-Based Practices: A Mixed Methods Study

Barnett, Miya L.; Brookman‐Frazee, Lauren; Regan, Jennifer; Saifan, Dana; Stadnick, Nicole A.; Lau, Anna S.

doi:10.1007/s10488-017-0795-0

Cited by 53 publications

(60 citation statements)

References 52 publications

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“…Indeed, studies have found program leaders to have positive perceptions of MAP due to the wide range of cases or clients that MAP can be used with ( 39 , 43 ). In addition, MAP, TF-CBT, and CPP require ongoing consultation, which may have implications for their sustained delivery ( 44 ). By contrast, SS and TP do not require ongoing consultation.…”

Section: Discussionmentioning

confidence: 99%

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Brookman‐Frazee

Zhan

Stadnick

et al. 2018

Front. Public Health

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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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Section: Discussionmentioning

confidence: 99%

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Brookman‐Frazee

Zhan

Stadnick

et al. 2018

Front. Public Health

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“…However, it is also apparent that therapists have distinctive perceptions of different EBPs. In contexts where therapists are trained in multiple EBPs, therapist opinions concerning the appeal, utility and limitations of specific interventions vary (Barnett et al, in press; Reding et al, 2014). Therefore, it is plausible that the likelihood that a therapist makes a modification to an EBP that augments or reduces or reorders the content is determined by their perceptions toward that specific practice, rather than their attitudes toward EBPs in general.…”

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confidence: 99%

Therapist report of adaptations to delivery of evidence-based practices within a system-driven reform of publicly funded children’s mental health services.

Lau

Barnett

Stadnick

et al. 2017

Journal of Consulting and Clinical Psychology

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100

105

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Objective This study examined clinical adaptations reported by community therapists to multiple evidence-based practices (EBPs) currently implemented in children’s mental health services. Based on an item set informed by Stirman and colleagues’ model (2015), two factors emerged describing Augmenting adaptations and Reducing/Reordering adaptations. We employed multilevel modeling to examine therapist- and practice-level predictors of therapist reports of each type of adaptation. Method Data were drawn from an online survey, including a novel therapist report measure of EBP adaptations, completed by 572 therapists (89.2% female, Mage = 37.08 years, 33.4% Non-Hispanic White) delivering EBPs in the context of a system-driven, fiscally mandated implementation effort. Results Analyses revealed that the two types of therapist adaptations (Augmenting and Reducing/Reordering) could be readily discriminated, with therapists reporting significantly more Augmenting than Reducing/Reordering adaptations. Therapists of Hispanic/Latino ethnicity and with fewer years of experience reported more extensive Augmenting adaptations, but no therapist background characteristics were associated with Reducing/Reordering adaptations. Therapists’ general attitudes that EBPs diverged from their personal approach to therapy were associated with reporting more Augmenting and Reducing/Reordering adaptations. In contrast, negative perceptions toward the specific EBP predicted Reducing/Reordering adaptations, but not Augmenting adaptations. Conclusions Community therapist reports suggest that most adaptations undertaken involve engaging with the practice to augment the fit of the EBPs for local contexts; however, when practices were perceived negatively, therapists were more likely to make adaptations reducing or rearranging components.

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“…There are some attitudes, related to the practice and teaching of clinical psychology, that explain why some professionals prefer CAP instead of EBP (Gallo & Barlow, 2012;Stewart, Chambless, & Baron, 2012). For example, many clinicians are emotionally exhausted by high workloads and do not have the time to search for evidence-based interventions (Gallo & Barlow, 2012;Barnett, Brookman-Frazee, Regan, Saifan, Stadnick, & Lau, 2017). Some of them feel overwhelmed by the massive amount of existing information about EBP and see the search for relevant research outcomes as an endless endeavour (Gallo & Barlow, 2012), while many find the technical language used as greatly problematic -especially the statistical jargon of academic articles (Backer, 2000).…”

Section: Pragmatic Limitationsmentioning

confidence: 99%

Alternative psychotherapies: Conceptual elucidation and epidemiological framework.

Fasce¹,

Adrián‐Ventura²

2020

Professional Psychology: Research and Practice

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This article elucidates and defines alternative psychotherapies, as well as describing the variables that explain why some professional psychologists are prone to endorse these practices. First, the novel concept of "Complementary and Alternative Psychotherapies" (CAP) is defined within the framework of the established hierarchy of clinical evidence. Second, we report a literature review to aid understanding of the main variables explaining why some clinicians prefer CAP. We review rejection of scientific reasoning, misconceptions about human nature, and pragmatic limitations of evidence-based practice.

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How Intervention and Implementation Characteristics Relate to Community Therapists’ Attitudes Toward Evidence-Based Practices: A Mixed Methods Study

Cited by 53 publications

References 52 publications

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Using Survival Analysis to Understand Patterns of Sustainment within a System-Driven Implementation of Multiple Evidence-Based Practices for Children’s Mental Health Services

Therapist report of adaptations to delivery of evidence-based practices within a system-driven reform of publicly funded children’s mental health services.

Alternative psychotherapies: Conceptual elucidation and epidemiological framework.

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