Predictors of Community Therapists’ Use of Therapy Techniques in a Large Public Mental Health System

Abstract

Importance Few studies have examined the effects of both clinician and organizational characteristics on the use of evidence-based practices in mental healthcare. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices. Objective To estimate the relative contribution of clinician and organizational factors on clinician self-reported use of cognitive-behavioral, family, and psychodynamic techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families. Design Observational and cross-sectional. Data collected in 2013. Setting Twenty-three organizations. Participants We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators. Main Outcome Measures Clinician self-reported use of cognitive-behavioral, family, and psychodynamic techniques, as measured by the Therapist Procedures Checklist – Family Revised. Results Linear mixed-effects regression models were used; models included random intercepts for organization to account for nesting of clinicians within organization. Clinician factors accounted for the following percentage of the overall variation: cognitive-behavioral (16%), family (7%), psychodynamic (20%). Organizational factors accounted for the following percentage of the overall variation: cognitive-behavioral (23%), family (19%), psychodynamic (7%). Older clinicians and clinicians with more open attitudes were more likely to endorse use of cognitive behavioral techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Female clinicians were more likely to endorse use of family techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Clinicians with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic techniques. Conclusions & Relevance This study suggests that both clinician and organizational factors are important in explaining clinician behavior and the use of evidence-based practices, but that their relative importance varies by therapeutic technique.

Post-training Beliefs, Intentions, and Use of Prolonged Exposure Therapy by Clinicians in the Veterans Health Administration

“…However, a few clinicians used PE much more widely, treating 8-20 patients at a time. Other studies have also found that even if clinicians' attitudes and intentions are highly positive, organizational and contextual factors may limit how much they can use a new treatment (Aarons et al 2011;Beidas et al 2015;McHugh and Barlow 2010). Consistent with other research on clinician behavior (Couineau and Forbes 2011;Godin et al 2008), we found that intent to use and actual use of PE were partially determined by clinicians' outcome expectancies, self-efficacy, and control beliefs.…”

“…This evaluation largely limited its focus to clinician factors. We did not assess patient receptivity to PE (Kehle-Forbes et al 2014;Mott et al 2014;Watts et al 2015), nor did we assess contextual factors such as leadership support, team environment, staffing levels, or local clinic infrastructure (Aarons et al 2011;Beidas et al 2015;Cook et al 2015). Such factors are beyond the scope of this evaluation, but may be important to broader VHA efforts to expand veteran access to effective PTSD treatments.…”

“…Their ability to implement a practice may be limited by how much control they have over use of their time and treatment planning (Godin et al 2008). Larger organizational factors beyond the individual clinician, such as clinic structure, social norms, work processes, leadership support, and allocation of resources, may also dictate whether a particular practice is used (Beidas et al 2015;Cook et al 2014).…”

Factors Associated with Clinician Participation in TF-CBT Post-workshop Training Components

“…Confidence with TF-CBT components, attitudes toward EBTs, and problematic productivity requirements were not predictive of these outcomes. Finally, our predictors were not significant for our third outcome, the use Beidas et al's (2015) finding that MHPs' greater openness to trying EBPs was predictive of CBT technique use.…”

“…Potential explanatory variables not assessed in this study include factors such as agency support for TF-CBT and/or EBTs in general, therapist prior experience with EBTs, and therapist training in trauma-related interventions. In particular, more extensive examination of agency factors might have yielded stronger predictive ability, as indicated by Beidas et al's (2015) finding that organizational factors were more strongly predictive of EBP use than individual factors.…”