Non-participants in policy efforts to promote evidence-based practices in a large behavioral health system

Abstract

BackgroundSystem-wide training initiatives to support and implement evidence-based practices (EBPs) in behavioral health systems have become increasingly widespread. Understanding more about organizations who do not participate in EBP training initiatives is a critical piece of the dissemination and implementation puzzle if we endeavor to increase access in community settings.MethodsWe conducted 30 1-h semi-structured interviews with leaders in non-participating agencies who did not formally participate in system-wide training initiatives to implement EBPs in the City of Philadelphia, with the goal to understand why they did not participate.ResultsWe found that despite not participating in training initiatives, most agencies were adopting (and self-financing) some EBP implementation. Leadership from agencies that were implementing EBPs reported relying on previously trained staff to implement EBPs and acknowledged a lack of emphasis on fidelity. Most leaders at agencies not adopting EBPs did not have a clear understanding of what EBP is. Those familiar with EBPs in agencies not adopting EBPs reported philosophical objections to EBPs. When asked about quality assurance and treatment selection, leaders reported being guided by system audits.ConclusionsWhile it is highly encouraging that many agencies are adopting EBPs on their own, significant questions about fidelity and implementation success more broadly remain.

Understanding maternity waiting home uptake and scale-up within low-income and middle-income countries: a programme theory from a realist review and synthesis

“… 166 167 Only by seeking to understand the concerns of non-adopters can implementers design strategies for enhancing uptake. 166 167 …”

“…Diffusion of innovation theory views individuals who delay adoption as being problematic ‘laggards’ 143. This perception fails to acknowledge that individuals’ resistance can be borne out of their dehumanising experience(s) with the intervention or learning that others have been subjected to such incidents 166 167. Only by seeking to understand the concerns of non-adopters can implementers design strategies for enhancing uptake 166 167…”

Race and Equity in Statewide Implementation Programs: An Application of the Policy Ecology of Implementation Framework

“…As large-scale, system-wide implementation efforts occur within racially and ethnically diverse jurisdictions across the country, such Los Angeles County (Brookmann-Frazee et al, 2016;Southam-Gerow et al, 2014); Philadelphia, Pennsylvania (Beidas et al, 2016;Powell et al, 2017;Skriner et al, 2017;Stewart et al, 2017); Illinois (Starin et al, 2014); Maryland (Stone et al, 2019); New York state (Nadeem et al, 2016;Olin et al, 2016); and Washington state (Walker et al, 2016;Walker et al, 2019), future programs would benefit from investigations of social and political factors, such as consumer advocacy, cultural competence, racial disparities, competing legislative priorities, and workforce development initiatives (Raghavan, Bright, & Shadoin, 2008;So, McCord, & Kaminski, 2019). Omitting larger social issues ignores long-standing concerns from cultural and ethnic minority groups regarding systemic racism (Wangari Walter et al, 2017), hidden bias amongst clinicians, "clinical colonization" (Willging et al, 2012), and historical oppression and cultural trauma (Walker, Whitener, Trumpin, & Migliarni, 2015).…”