Mental Health Clinicians' Experiences of Implementing Evidence-Based Treatments

Abstract

Implementation research has tremendous potential to bridge the research-practice gap; however, we know more about barriers to evidence-based care than the factors that contribute to the adoption and sustainability of evidence-based treatments (EBTs). This qualitative study explores the experiences of clinicians (N = 11) who were implementing EBTs, highlighting the factors that they perceived to be most critical to successful implementation. The clinicians’ narratives reveal many leverage points that can inform administrators, clinical supervisors, and clinicians who wish to implement EBTs, as well as other stakeholders who wish to develop and test strategies for moving EBTs into routine care.

Applying the Policy Ecology Framework to Philadelphia’s Behavioral Health Transformation Efforts

“…There are a number of barriers to implementing EBPs at the organizational-level, including (but certainly not limited to) variable organizational cultures and climates (Beidas et al, 2014; Glisson et al, 2008), implementation climates (Weiner, Belden, Bergmire, & Johnston, 2011), and leadership (Aarons, Ehrhart, & Farahnak, 2014a); lack of access to ongoing training, supervision, and consultation (Ganju, 2003; Manuel, Mullen, Fang, Bellamy, & Bledsoe, 2009; Powell, Hausmann-Stabile, & McMillen, 2013; Shapiro, Prinz, & Sanders, 2012); turnover of staff and leadership (Beidas, Marcus, Benjamin Wolk, et al, 2015), and inadequate financial supports (Hoagwood, 2003; Isett et al, 2007; Stewart et al, 2016). DBHIDS has used a number of strategies to support provider organizations and assist in covering the marginal costs of implementation (Raghavan, 2012; Raghavan et al, 2008), allowing organizations to invest more fully in the adoption, implementation, and sustainment of EBPs.…”

“…The list of EBPs and providers who deliver them is intended to serve several purposes: (1) it is a resource for individuals and families seeking services as well as clinicians, organizations, and DBHIDS staff members wishing to refer to EBP-specific services; (2) it provides a means of assessing Philadelphia’s capacity to deliver EBPs to diverse populations and geographic locations; and (3) it serves to incent the delivery of EBPs by providing public recognition to those organizations that do so. The last point is important, as stakeholders in other systems have identified the lack of role models who are also using EBPs as an implementation barrier (Powell, Hausmann-Stabile, et al, 2013); profiling providers in this way can potentially foster healthy competition and collaboration between organizations (Bunger et al, 2014). …”

Advancing Implementation Research and Practice in Behavioral Health Systems

“…Little is known about the sustainment of EBPs (Wiltsey Stirman et al, 2012), despite the fact that many implementation science models include sustainment as a key consideration in the implementation process (Tabak, Khoong, Chambers, & Brownson, 2012). Aarons and colleagues (2011) suggest several inner context factors hypothesized to be important in the sustainment phase, including leadership, organizational culture, a critical mass of therapists using the EBP (Powell, Hausmann-Stabile, & McMillen, 2013), ongoing fidelity monitoring and support, and adequate staffing. Outer context factors potentially impacting sustainment include leadership at the service system level, legislation that supports sustainment of EBPs, continued funding following the initial implementation investment, and public-academic collaborations that can support the continued process of maintaining EBPs in public settings (Aarons et al, 2011).…”

Cultural adaptation and implementation of evidence-based parent-training: A systematic review and critique of guiding evidence

“…Indeed, an evaluation of parent-training programs in one midsized Midwestern city revealed that only about 11% of agencies had adopted evidence-based programs (Kohl et al, 2009). The low rates at which evidence-based parenting interventions are delivered suggests that simply publishing reports on their availability and effectiveness, while necessary, is not sufficient given the myriad of barriers at the client, clinician, team, organizational, policy, and funding-levels (e.g., Flottorp et al, 2013; Powell, Hausmann-Stablile, & McMillen, 2013). This signals a need to study the implementation of evidence-based parenting interventions, and to evaluate strategies that can facilitate the uptake of such interventions in usual care.…”