The Effect of a Change Agent on Use of Evidence-Based Mental Health Practices

Abstract

Children’s service systems are faced with a critical need to disseminate evidence-based mental health interventions. Despite the proliferation of comprehensive implementation models, little is known about the key active processes in effective implementation strategies. This proof of concept study focused on the effect of change agent interactions as conceptualized by Rogers’ diffusion of innovation theory on providers’ (N = 57) use of a behavioral intervention in a child welfare agency. An experimental design compared use for providers randomized to training as usual or training as usual supplemented by change agent interactions after the training. Results indicate that the enhanced condition increased use of the intervention, supporting the positive effect of change agent interactions on use of new practices. Change agent types of interaction may be a key active process in implementation strategies following training.

Use of evidence-based interventions in child welfare: Do attitudes matter?

“…The ZIP analysis provides estimates of both amount of use, from the Poisson portion of the model, and zero inflation to model an excess of zeros in the data (i.e., no use of the intervention reported for the past 30 days). In these analyses, placement in the enhanced change agent interaction group significantly predicted greater use, as reported in a previous publication (Leathers et al, 2016). However, coefficients for overall attitudes were not significantly associated with intervention use in either part of the ZIP model (Table 2).…”

“…A full description of the study’s methods is found in a previous publication (Leathers, Spielfogel, Blakey, Christian, & Atkins, 2016). Briefly, 57 caseworkers and therapists (“providers”) from a single large urban child welfare agency in the United States were randomly assigned to one of two training conditions, a “training as usual” control group ( n = 26) that received only training and experimental group ( n = 31) that received training enhanced by support after the training.…”

“…To address problems with skewed data due to a few providers reporting a high level of contact, a dichotomous variable was created. Because previous results indicated that having at least 30 min of contact supported significantly more use of the intervention while less contact did not (Leathers et al, 2016), a dichotomous variable indicating 30 min or more contact was created.…”

A Cross-Site Partnership to Examine Implementation and Sustainability of a School-Based Trauma Program

“…15 Without widespread belief (norms and attitudes) that a particular mental health condition warrants attention and that an identified intervention can successfully improve the condition, uptake is unlikely. 16,22 Resources including dedicated staff time and access to ongoing consultation and/or coaching are critical to implementation and sustainment of evidence-based practices 20,23,24 and persuasive change agents have been shown to be central to the adoption of new innovations in community-settings 23,25 Finally, an organization's structure and processes can significantly influence implementation in community mental health settings. 21 To address the need for schoolfocused implementation research and further our understanding of the factors that drive and impede the use of evidence-based practices in schoolsettings, this study expands the use of Mendel's model to examine the implementation of a group-based trauma intervention, the Cognitive Behavioral Intervention for Trauma in Schools (CBITS) in the unique service setting of schools.…”

“…Onsite leadership from either the clinician and/or school administrator can strongly influence the use of CBITS on campus. Active onsite leadership has been critical to the implementation of evidence-based practices (EBPs) in other child-service settings 23,25 Additionally, the Reflective Learning Group supervision approach provided by the centralized mental health unit in the Western region was a significant source of support for clinicians. This mirrors earlier studies demonstrating that ongoing implementation support and consultation are crucial to establishing new EBPs within community settings.…”