Implementation of Evidence-Based Practice in Community Behavioral Health: Agency Director Perspectives

George Warren Brown School of Social Work, Washington University in Saint Louis, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130-4899, USA.
Administration and Policy in Mental Health and Mental Health Services Research (Impact Factor: 3.44). 10/2007; 34(5):479-88. DOI: 10.1007/s10488-007-0129-8
Source: PubMed


Despite a growing supply of evidence-based mental health treatments, we have little evidence about how to implement them in real-world care. This qualitative pilot study captured the perspectives of agency directors on the challenge of implementing evidence-based practices in community mental health agencies. Directors identified challenges as limited access to research, provider resistance, and training costs. Director leadership, support to providers, and partnerships with universities were leverage points to implement evidenced-based treatments. Directors' mental models of EBP invoked such concepts as agency reputation, financial solvency, and market niche. Findings have potential to shape implementation interventions.

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Available from: Enola K Proctor, Aug 20, 2014
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    • "Positive leadership styles are associated with supportive organizational climates and receptive staff attitudes toward EBPs [15]. Thus, agency leadership is one potential route for modifying organizational climate and encouraging utilization of EBPs [16] [17]. Our study is informed by the Consolidated Framework for Implementation Research in Health Services [18], which suggests that leadership, resources, and access to knowledge and information play crucial roles in determining whether an organization is ready to adopt new practices. "
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    ABSTRACT: Objective. In recent years, New Mexico has prioritized integrated treatment for cooccurring mental health and substance use disorders within its public behavioral health system. This report describes factors likely to be important when implementing evidence-based practices (EBPs) in community agencies. Methods. Our mixed-method research design consisted of observations, semistructured interviews, and surveys undertaken with employees at 14 agencies at baseline and after 18 months. We developed four-agency typologies based on iterative coding and analysis of observations and interviews. We then examined survey data from employees at the four exemplar agencies to validate qualitative findings. Results. Financial resources and strong leadership impacted agency capacity to train providers and implement EBPs. Quantitative analysis of service provider survey responses from these agencies (N = 38) supported qualitative findings and demonstrated significant mean score differences in leadership, organizational climate, and attitudes toward EBPs in anticipated directions. Conclusion. The availability of strong leadership and financial resources were key components to initial implementation success in this study of community agencies in New Mexico. Reliance only on external funding poses risks for sustainment when demoralizing work climates precipitate employee turnover. Strong agency leadership does not always compensate for deficient financial resources in vulnerable communities.
    Full-text · Article · Mar 2014
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    • "Comprehensive leadership capacity at all levels of the implementation process helps organizations to develop appropriate strategies for maintaining an implementation-and evidenceinformed focus on the change process and its many obstacles [3]. Typical leadership activities are goal setting; developing strategies; communicating; resolving conflicts; planning; inspiring, guiding, and providing direction; providing training, time, and resources; staffing [7], affecting the organizational climate [1], and cultivating a research-attuned culture [18]. "
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    ABSTRACT: Over the last 20 years, there has been a growing emphasis on developing and identifying evidence-based programs and practices for children and families and within the last decade an increasing number of federally funded initiatives have been dedicated to replicating and scaling evidence-based programs with the hope of achieving socially meaningful impact. However, only recently have efforts to promote high-fidelity implementation been given the attention needed to ensure evidence-based practices are used as intended and generate the outcomes they were designed to produce. In this article, we propose that the wide-scale implementation of evidence-based practices requires: (1) careful assessment and selection of the “what”; (2) a stage-based approach that provides adequate time and resources for planning and installation activities; (3) the co-creation of a visible infrastructure by a triad of key stakeholders including funders and policymakers, program developers, and implementing sites; and (4) the use of data to guide decision-making and foster curiosity into continuous improvement among grantees. Each of these strategies is explored in greater detail through the lens of the Teen Pregnancy Prevention (TPP) Program, a $100 million initiative overseen by the Office of Adolescent Health (OAH) in the U.S. Department of Health and Human Services.
    Full-text · Article · Mar 2014 · Journal of Adolescent Health
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    • "There is still a huge gap in mental health between what we know and what we do (Proctor et al. 2009) even though evidencebased practice (EBP) and evidence-based methods for 884 DOI: 10.1111/jonm.12061 ª 2013 John Wiley & Sons Ltd treatment have become more readily available within mental health care in recent years (Proctor et al. 2007). However, replacing ineffective treatment with effective treatment that has been evaluated and documented in national guidelines is a formidable challenge for all health-care leaders and managers (cf. "
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    ABSTRACT: The adoption of evidence-based guidelines within the mental health field has been slow. Changing inadequate practice is therefore a formidable challenge for mental health-care managers. To explore decision-makers' attitudes and awareness regarding the national guidelines for psychosocial interventions targeting people with schizophrenia. A questionnaire distributed by e-mail to 592 Swedish decision-makers was analysed using descriptive and comparative techniques. Significantly more of the top-level mental health-care managers than politicians stated that they knew about the national guidelines (i.e. their release and content) and they considered the guidelines to be a good source of support for planning and allocating resources. If those responsible for allocating resources (i.e. politicians) are unaware of the dissemination of national guidelines or their content, and they do not perceive the national guidelines to be a good source of support for planning and allocating resources, this is likely to have a negative influence on the remit of nurse managers as well as nursing practice. Top-level mental health-care managers have a vital role to play in the implementation of national guidelines. However, our findings indicate that implementing national guidelines in practice could be virtually impossible without strategic government support.
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