Advertisement

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

  • Enola K. Proctor
  • Kraig J. Knudsen
  • Nicole Fedoravicius
  • Peter Hovmand
  • Aaron Rosen
  • Brian Perron
Original Paper

Abstract

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.

Keywords

Implementation Evidence-based practice Science and service 

Notes

Acknowledgements

The preparation of this article was supported by the Center for Mental Health Services Research, at the George Warren Brown School of Social Work, Washington University in St. Louis; through an award from the National Institute of Mental Health (5P30 MH068579).

References

  1. Aarons, G. A. (2004). Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research, 6(2), 61–74.PubMedCrossRefGoogle Scholar
  2. Aarons, G. A. (2006). Transformational and transactional leadership: association with attitudes toward evidence-based practice. Psychiatric Services, 57(8), 1162–1169.PubMedCrossRefGoogle Scholar
  3. Aarons, G. A., & Sawitzky, A. C. (2006). Organizational climate partially mediates the effect of culture on work attitudes and staff turnover in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 33(3), 289–301.Google Scholar
  4. Aarons, G. A. & Palinkas, L. A. (2007). Implementation of evidence-based practice in child welfare: Service provider perspectives. Administration and Policy in Mental Health & Mental Health Services Research, 34, 411–419.Google Scholar
  5. Baydar, N., Reid, M. J., & Webster-Stratton, C. (2003). The role of mental health factors and program engagement in the effectiveness of a preventive parenting program for head start mothers. Child Development, 74(5), 1433–1453.PubMedCrossRefGoogle Scholar
  6. Beaulieu, N. D., & Horrigan, D. R. (2005). Putting smart money to work for quality improvement. Health Services Research, 40(5), 1318–1334.PubMedCrossRefGoogle Scholar
  7. Berwick, D. M. (2003). Disseminating innovations in health care. JAMA, 289(15), 1969–1975.PubMedCrossRefGoogle Scholar
  8. Blau, P. (1964). Exchange and power in social life. New York: Wiley.Google Scholar
  9. Corrigan, P. W., Steiner, L., McCracken, S. G., Blaser, B., & Barr, M. (2001). Strategies for disseminating evidence-based practices to staff who treat people with serious mental illness. Psychiatric Services, 52(12), 1598–1606.PubMedCrossRefGoogle Scholar
  10. Coyle, D., Panchanadeswaran, S., & Daining, C. (2004). Predictors of job satisfaction of licensed social workers: Perceived efficacy as a mediator of the relationship between workload and job satisfaction. Journal of Social Service Research, 31(1), 12.Google Scholar
  11. Davies, M., Spears, W., & Pugh, J. (2004). What VA providers really think about clinical practice guidelines. Federal Practitioner, 21(2), 15–30.Google Scholar
  12. Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., et al. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469–476.PubMedCrossRefGoogle Scholar
  13. Essock, S. M., Goldman, H. H., Van Tosh, L., Anthony, W. A., Appell, C. R., Bond, G. R., et al. (2003). Evidence-based practices: Setting the context and responding to concerns. Psychiatric Clinics of North America, 26, 919–938.PubMedCrossRefGoogle Scholar
  14. Fernandopulle, R., Ferris, T., Epstein, A. M., McNeil, B., Newhouse, J., Pisano, G., & Blumenthal, D. (2003). A research agenda for bridging the “quality chasm”. Health Affairs, 22(2):178–190.PubMedCrossRefGoogle Scholar
  15. Glisson, C. (2002). The organizational context of children’s mental health services. Clinical Child & Family Psychology Review, 5(4), 233–253.CrossRefGoogle Scholar
  16. Glisson, C., & Schoenwald, S. K. (2005). The ARC organization and community intervention strategy for implementing evidence-based children’s mental health treatments. Mental Health Services Research, 7(4), 243–259.PubMedCrossRefGoogle Scholar
  17. Gray, B. (1989). Collaborating: Finding common ground for multiparty problems. San Francisco: Jossey-Bass.Google Scholar
  18. Greenhalgh, T., Robert, G., MacFarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. The Milbank Quarterly, 82(4), 581–629.PubMedCrossRefGoogle Scholar
  19. Guest, G., Bunce, A., & Johnson, L. (2006). How many interviews are enough? An experiment with data saturation and variability. Field Methods, 18(1), 59–82.CrossRefGoogle Scholar
  20. Hemmelgarn, A. L., Glisson, C., & James, L. R. (2006). Organizational culture and climate: Implications for services and interventions research. Clinical Psychology-Science and Practice, 13(1), 73–89.CrossRefGoogle Scholar
  21. Henggeler, S. W., Lee, T., & Burns, J. A. (2002). What happens after the innovation is identified? Clinical Psychology: Science & Practice, 9(2), 191–194.CrossRefGoogle Scholar
  22. Herschell, A. D., McNeil, C. B., & NcNeil, D. W. (2004). Clinical child psychology’s progress in disseminating empirically supported treatments. Clinical Psychology: Science & Practice, 11, 267–288.CrossRefGoogle Scholar
  23. Huberman, H. (1994). Research utilization: The state of the art. Knowledge and Policy, 7(4), 13–33.Google Scholar
  24. Hysong, S. J., Best, R. G., Pugh, J. A., & Moore, F. I. (2005). Not of one mind: Mental models of clinical practice guidelines in the Veteran’s Health Administration. Health Services Research, 40(3), 829–847.PubMedCrossRefGoogle Scholar
  25. Institute of Medicine (2006). Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academy Press.Google Scholar
  26. Johnson, M., & Austin, M. (2005). Evidence-based practice in the social services: Implications for organizational change. Journal of Administration in Social Work, 30(3), 75–104.CrossRefGoogle Scholar
  27. Johnson-Laird, P. (1983). Mental models: Towards a cognitive science of language, inference and consciousness. Cambridge, MA: Harvard University Press.Google Scholar
  28. Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055–1081.CrossRefGoogle Scholar
  29. Kleinpeter, C., Pasztor, E., & Telles-Rogers, T. (2003). The impact of training on worker performance and retention: Perceptions of child welfare supervisors. The International Journal of Continuing Social Work Education, 6(3), 39–49.Google Scholar
  30. Lavis, J. N., Robertson, D., Woodside, J. M., McLeod, C. B., Abelson, J., & The Knowledge Transfer Group. (2003). How can research organizations more effectively transfer research knowledge to decision makers? The Milbank Quarterly, 81(2), 221–249.PubMedCrossRefGoogle Scholar
  31. Leatherman, S., Berwick, D., Iles, D., Lewin, L. S., Davidoff, F., Nolan, T., et al. (2003). The business case for quality: Case studies and an analysis. Health Affairs, 22(2), 17–30.PubMedCrossRefGoogle Scholar
  32. Lee, B., McMillen, C., Knudsen, K., & Woods, C. (2007). Quality directed activities and barriers to quality in social service organizations. Administration in Social Work, 31(2), 67–85.CrossRefGoogle Scholar
  33. Megivern, D. A., McMillen, J. C., Proctor, E. K., Striley, C. W., Cabassa, L. J., & Munson, M. R. (2007). Quality of care: Expanding the social work dialogue. Social Work, 52(2), 115–124.PubMedGoogle Scholar
  34. Nathan, P., & Gorman, J. (1998). A guide to treatments that work. New York: Oxford University Press.Google Scholar
  35. Proctor, E. K. (2003). Editorial: Developing knowledge for practice: Working through “trench-bench” partnerships. Social Work Research, 27(2), 67–69.Google Scholar
  36. Proctor, E. K. (2004). Leverage points for the implementation of evidence-based practice. Brief Treatment and Crisis Intervention, 4(3), 227–242.CrossRefGoogle Scholar
  37. Proctor, E. K., & Rosen, A. (2004). Concise standards for developing evidence-based practice guidelines. In A. R. Roberts & K. Yeager (Eds.), Evidence-based practice manual (pp. 193–199). New York: Oxford University Press.Google Scholar
  38. Proctor, E. K., & Rosen A. (2005, November). From knowledge production to implementation: Research challenges and imperative. Presented at What Works – Modernizing the Knowledge Base of Social Work. Bielfeld, Germany.Google Scholar
  39. Rogers, E. M. (1995). Diffusion of innovations (4th ed.). New York: Free Press.Google Scholar
  40. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.Google Scholar
  41. Roos, N. P., & Shapiro, E. (1999). From research to policy: What have we learned? Medical Care, 37(6), JS291–JS305.PubMedCrossRefGoogle Scholar
  42. Rosenheck, R. (2001). Stages in the implementation of innovative clinical programs in complex organizations. Journal of Nervous & Mental Disease, 189(12), 821.CrossRefGoogle Scholar
  43. Rubenstein, L. V., Mittman, B. S., Yano, E. M., & Mulrow, C. D. (2000). From understanding health care provider behavior to improving health care: The QUERI framework for quality improvement. Medical Care, 38(6, Supplement I), I129–I141.PubMedCrossRefGoogle Scholar
  44. Sackett, D. L., Strauss, S. E., Richarson, W. S., Rosenberg, W. M. C., & Haynes, R. B. (1997). Evidence-based medicine (2nd ed.). Edinburgh: Churchill-Livingstone.Google Scholar
  45. Simpson, D. D. (2002) A conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment, 22(4), 171–182.PubMedCrossRefGoogle Scholar
  46. Stricker, G, & Trierweiler, S. J. (1995). The local clinical scientist: A bridge between science and practice. American Psychology, 20(12), 995–1002.CrossRefGoogle Scholar
  47. Walrath, C. M., Nickerson, K. J., Crowel, R., & Leaf, P. J. (1998). Serving children with serious emotional disturbance in a system of care: Do mental health and non-mental health agency referrals look the same? Journal of Emotional & Behavioral Disorders, 6(4), 205–213.Google Scholar
  48. Walrath, C. M., Sheehan, A. K., Holden, E. W., Hernandez, M., Blau, G. M. (2006). Evidence-based treatments in the field: A brief report on provider knowledge, implementation, and practice. The Journal of Behavioral Heath Services and Research, 33(2), 244–253.CrossRefGoogle Scholar
  49. Walter, I., Nutley, S., & Davies, H. (2005). What works to promote evidence-based practice? A cross-sector review. The Policy Press, 1(3), 335–363.Google Scholar
  50. Woolston, J. L. (2005). Implementing evidence-based treatments in organizations. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 1313–1316.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Enola K. Proctor
    • 1
  • Kraig J. Knudsen
    • 1
    • 2
  • Nicole Fedoravicius
    • 1
    • 3
  • Peter Hovmand
    • 1
  • Aaron Rosen
    • 1
  • Brian Perron
    • 1
  1. 1.George Warren Brown School of Social WorkWashington University in Saint LouisSt. LouisUSA
  2. 2.Ohio Department of Mental HealthOffice of Program Evaluation and ResearchColumbusUSA
  3. 3.Center for Mental Health Services Research, George Warren Brown School of Social WorkWashington University in Saint LouisSt. LouisUSA

Personalised recommendations