Adoption of Evidence-Based Practices in Community Mental
Health: A Mixed-Method Study of Practitioner Experience
Deborah Gioia Æ Æ Gregory Dziadosz
Received: 23 October 2007/Accepted: 4 March 2008/Published online: 25 March 2008
? Springer Science+Business Media, LLC 2008
ners as they adopted four evidence-based practices (EBPs)
in a community mental health center. In-depth semi-struc-
tured interviews; a measure of EBPs attitudes; and a final
focus-group were used over a 2-year study period to assess
14 mental health practitioners on one immersion team. The
framework for data collection was adapted from organiza-
tional theories that view culture and climate as mediating
factors. Analysis of practitioner themes demonstrated that
there were facilitating and impeding factors in the adoption
process. Practitioners reported positive changes in their
individual competency but two years was inadequate for
training on four EBPs. Involvement of agency administra-
practitioners as crucial to successful adoption of EBPs.
This mixed method study examined practitio-
Community mental health services ? Practitioner ?
Evidence-based practice ?
Often the delivery of services to persons with serious mental
illness (SMI) in community mental health settings does not
include evidence-based mental health treatments that might
better target clients’ symptoms and functional outcomes
(Proctor 2004; Drake et al. 2001; Corrigan et al. 2001). The
recognition of this critical gap between evidence-based
practices (EBPs) and real world delivery of mental health
services has prompted federal mental health agencies
(e.g. National Institutes of Mental Health) and national
professional organizations (e.g. American Psychiatric
Association) to identify ways of minimizing the gap
between ‘‘science and service’’, to shorten the purported
20 yearsbeforepersonswith SMIinthe communityare able
to benefit from EBPs (McHugo et al. 2007; APA/CAPP
Task Force 2007; President’s New Freedom Commission on
Mental Health 2003; Institute of Medicine 2001).
Given the persistent but unmet needs of persons with
SMI, stakeholder groups of researchers, practitioners and
family members have found themselves lobbying for more
rapid translation of science to service, albeit with limited
success. The National Implementing Evidence-Based
Practices Project took a giant leap forward in this effort and
has produced data about fidelity to EBPs models at com-
munity mental health centers across eight states (McHugo
et al. 2007). We know that mental health practitioners in
direct service play a pivotal role in the timely adoption
and implementation of EBPs; therefore, acquiring a full
understanding of their attitudes toward EBPs is crucial to
reducing the gap between science and service (Aarons
2004; Aarons and Sawitzky 2006). Yet, few studies have
explored practitioners’ personal experience with receiving
EBPs training and subsequently providing EBPs services to
the consumer. Developing a better understanding of the
challenges practitioners face in trying to adopt EBPs into
their clinical practice may yield precise knowledge of the
best methods of adapting EBPs into clinical settings as well
as to facilitate the dissemination of more effective treat-
ments into the community (Brekke et al. 2007).
D. Gioia (&)
School of Social Work, University of Maryland, Baltimore,
525 West Redwood St., Baltimore, MD 21201, USA
Touchstone innovare ´, 201 Sheldon Ave., Grand Rapids,
MI 49503, USA
Community Ment Health J (2008) 44:347–357
Understanding practitioners’ learning and use of EBPs
requires appreciation of practitioner heterogeneity. Front-
line providers usually represent a range of demographic
characteristics, and are typically faced with the struggle of
balancing multiple agency and personal demands, with the
demands of high client caseloads, but are seldom asked to
describe this dilemma. As a group, practitioners have often
been characterized as being resistant to adopting EBPs
as well as stalling the dissemination of new treatment
protocols. Although this representation might be more
speculative than accurate (Mullen et al. 2005), it is certainly
not descriptive of all practitioners.
and climate—can have a profound impact on practitioners
and their attitudes and behaviors toward others (Glisson
and Green 2006). Most frequently, fiscal constraints dictate
that practitioners shoulder enormous case-management
responsibilities, which produce increased pressures to
respond to clients in crisis, and paperwork demands that
impose further constraints on their personal time. Given the
dilemma between the greater availability than use of EBPs
(Proctor 2004; Gonzales et al. 2002) research is needed to
identify aspects of agency culture and climate that can be
used to foster critical agency and practitioner partnerships
that will promote successful EBPs adoption.
The overarching goal of this study was to discover the
complex process of EBPs adoption by examining (a) first-
hand accounts of practitioners’ experience of EBPs training
within their agency, and (b) a standardized scale of practi-
tioner attitudes regarding evidence-based practices (Aarons
of this study included the use of a mixed method approach,
and the longitudinal use of qualitative interviews that
EBPs is still in its infancy (Aarons and Sawitzky 2006) the
place at a feverish pace in many states (NY State Office of
borrowing existing models and frameworks that facilitate
the timeliness of investigation without sacrificing rigor
would appear to be good practice (Glisson and James 2002).
In this study, five dimensions of examining the individual
withinthe agency culturewere adaptedfroman
organizational rubric, known as the 5Cs, described by
Tropman (1998) in The Management of Ideas in the
Creating Organization. The 5Cs—characteristics, compe-
tencies, conditions, context, and change—pertain to
individual and agency elements and guided the develop-
ment of the interview protocol used in this study.
Characteristics refer to the practitioners’ experience,
traits and disposition toward trying something new.
Education, demands outside of work, and length of
employment were some of the target questions.
Competencies refer to skills and styles—both intellec-
tual and interpersonal—which the practitioner needs to
have for the job at hand.
Conditions point to the organizational strategies and
structures needed to carry out the tasks at hand.
Context refers to the structure and beliefs of the agency
about reaching its goals.
Change addresses the desire to improve oneself, one’s
competencies, one’s agency and the ultimately the
clients who seek services at the agency.
This model advanced the notions of the concept reflec-
tive practitioner (Schon 1983; Senge 2006) and described
individuals who lead learning organizations as idea man-
agers; that is, idea managers first translate agency mandates
into ideas and then into their own performance. Tropman
(1998) asserted that new ideas fail when organizations lack
a commitment from all levels on the 5Cs and individual
practitioners may feel blocked in their ability to carry out an
agency mandate when they have no place to talk about it.
This study explicitly sought out the first person practitioner
response about EBPs adoption in their agency.
Participants and Setting
The study group was composed of 14 practitioners from a
single large mental health agency in western Michigan who
answered an internal request email for learning new mental
health treatments. When practitioners responded with
interest to the agency director and second author (GD) who
was coordinating the project they were briefed about what
it would entail for their workload and other responsibilities.
Those who agreed formed what became known as the
‘immersion team’ for EBPs training.
The agency provides an array of clinical services to
more than 2200 persons with SMI. These services include
assertive community treatment, co-occurring substance use
treatment, medication management, dialectical behavior
therapy, case management, crisis management, clubhouse,
peer support groups, and family support (Blakely and
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