Advertisement

Factors Associated with Community-Partnered School Behavioral Health Clinicians’ Adoption and Implementation of Evidence-Based Practices

  • Elizabeth H. ConnorsEmail author
  • Jason Schiffman
  • Kathleen Stein
  • Sarah LeDoux
  • John Landsverk
  • Sharon Hoover
Original Article

Abstract

Community-partnered school behavioral health (CP-SBH) is a model whereby schools partner with local community agencies to deliver services. This mixed-methods study examined 80 CP-SBH clinicians’ adoption and implementation of evidence-based practice (EBP) approaches following mandated training. Forty-four clinicians were randomly assigned to one of two training conditions for a modular common elements approach to EBPs; 36 clinicians were preselected for training in a non-modular EBP. EBP knowledge improved for all training conditions at 8-month follow-up and practice element familiarity improved for modular approach training conditions, but the modular condition including ongoing consultation did not yield better results. Qualitative interviews (N = 17) highlighted multi-level influences of the CP-SBH service system and individual clinician characteristics on adoption and implementation.

Keywords

Evidence-based practices School behavioral health services Implementation context 

Notes

Funding

This study was funded by Behavioral Health System Baltimore (PI: Hoover).

Compliance with Ethical Standards

Conflict of interest

All author declares that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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.CrossRefGoogle Scholar
  2. Aarons, G. A., Glisson, C., Hoagwood, K., Kelleher, K., Landsverk, J., & Cafri, G. (2010). Psychometric properties and US national norms of the evidence-based practice attitude scale (EBPAS). Psychological Assessment, 22(2), 356.CrossRefGoogle Scholar
  3. Aarons, G. A., Green, A. E., Trott, E., Willging, C. E., Torres, E. M., Ehrhart, M. G., & Roesch, S. C. (2016). The roles of system and organizational leadership in system-wide evidence-based intervention sustainment: A mixed-method study. Administration and Policy in Mental Health and Mental Health Services Research, 43(6), 991–1008.CrossRefGoogle Scholar
  4. Aarons, G. A., Hurlburt, M., & Horwitz, S. M. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4–23.CrossRefGoogle Scholar
  5. Bains, R. M., & Diallo, A. F. (2016). Mental health services in school-based health centers: Systematic review. The Journal of School Nursing, 32(1), 8–19.CrossRefGoogle Scholar
  6. Baltimore City Public Schools. (2018). District profile—Spring 2018. Baltimore, MD: Baltimore City Public Schools. Retrieved from http://www.baltimorecityschools.org/cms/lib/MD01001351/Centricity/Domain/8048/999-DistrictProfile.pdf.
  7. Barrett, S., Eber, L., & Weist, M. (2013). Advancing education effectiveness: Interconnecting school mental health and school-wide positive behavior support. Baltimore: Center for School Mental Health.Google Scholar
  8. Beidas, R. S., Edmunds, J. M., Marcus, S. C., & Kendall, P. C. (2012). Training and consultation to promote implementation of an empirically supported treatment: A randomized trial. Psychiatric Services, 63(7), 660–665.CrossRefGoogle Scholar
  9. Beidas, R. S., & Kendall, P. C. (2010). Training therapists in evidence-based practice: A critical review of studies from a systems-contextual perspective. Clinical Psychology: Science and Practice, 17(1), 1–30.Google Scholar
  10. Beidas, R. S., Marcus, S., Aarons, G. A., Hoagwood, K. E., Schoenwald, S., Evans, A. C., et al. (2015). Predictors of community therapists’ use of therapy techniques in a large public mental health system. JAMA Pediatrics, 169(4), 374–382.CrossRefGoogle Scholar
  11. Beidas, R. S., Stewart, R. E., Adams, D. R., Fernandez, T., Lustbader, S., Powell, B. J., et al. (2016). A multi-level examination of stakeholder perspectives of implementation of evidence-based practices in a large urban publicly-funded mental health system. Administration and Policy in Mental Health and Mental Health Services Research, 43(6), 893–908.CrossRefGoogle Scholar
  12. Borntrager, C. F., Chorpita, B. F., Higa-McMillan, C., & Weisz, J. R. (2009). Provider attitudes toward evidence-based practices: Are the concerns with the evidence or with the manuals? Psychiatric Services, 60(5), 677–681.CrossRefGoogle Scholar
  13. Botvin, G. J., Griffin, K. W., Diaz, T., Scheier, L. M., Williams, C., & Epstein, J. A. (2000). Preventing illicit drug use in adolescents: Long-term follow-up data from a randomized control trial of a school population. Addictive Behaviors, 25(5), 769–774.CrossRefGoogle Scholar
  14. Botvin, G. J., Griffin, K. W., & Nichols, T. D. (2006). Preventing youth violence and delinquency through a universal school-based prevention approach. Prevention Science, 7(4), 403–408.CrossRefGoogle Scholar
  15. Brimhall, K. C., Fenwick, K., Farahnak, L. R., Hurlburt, M. S., Roesch, S. C., & Aarons, G. A. (2016). Leadership, organizational climate, and perceived burden of evidence-based practice in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 43(5), 629–639.CrossRefGoogle Scholar
  16. Bringewatt, E. H., & Gershoff, E. T. (2010). Falling through the cracks: Gaps and barriers in the mental health system for america’s disadvantaged children. Children & Youth Services Review, 32(10), 1291–1299.CrossRefGoogle Scholar
  17. Burns, B. J., & Costello, E. J. (1995). Children’s mental health service use across service sectors. Health Affairs, 14(3), 147.CrossRefGoogle Scholar
  18. Byrt, T., Bishop, J., & Carlin, J. B. (1993). Bias, prevalence and kappa. Journal of Clinical Epidemiology, 46(5), 423–429.CrossRefGoogle Scholar
  19. Charmaz, K. (2014). Constructing grounded theory. Thousand Oaks: Sage.Google Scholar
  20. Child and Adolescent Mental Health Division. (2004). Evidence-based services committee: 2004 biennial report, summary of effective interventions for youth with behavioral and emotional needs. Honolulu: Hawaii Department of Health, Child and Adolescent Mental Health Division.Google Scholar
  21. Chorpita, B. F., Daleiden, E. L., & Weisz, J. R. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5–20.CrossRefGoogle Scholar
  22. Chorpita, B. F., & Weisz, J. R. (2009). Modular approach to therapy for children with anxiety, depression, trauma, or conduct problems (MATCH-ADTC). Satellite Beach: PracticeWise, LLC.Google Scholar
  23. Connors, E. H., Stephan, S. H., Lever, N., Ereshefsky, S., Mosby, A., & Bohnenkamp, J. (2016). A national initiative to advance school mental health performance measurement in the US. Advances in. School Mental Health Promotion, 9(1), 50–69.CrossRefGoogle Scholar
  24. Daleiden, E., Lee, J., & Tolman, R. (2004). Annual evaluation report: Fiscal year 2004. Honolulu: Hawaii Department of Health, Child and Adolescent Mental Health Division.Google Scholar
  25. Damschroder, L. J., Aron, D. C., Keith, R. E., Kirsh, S. R., Alexander, J. A., & Lowery, J. C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 4(1), 50.CrossRefGoogle Scholar
  26. Flaherty, L. T., & Weist, M. D. (1999). School-based mental health services: The baltimore models. Psychology in the Schools, 36(5), 379–389.CrossRefGoogle Scholar
  27. Flaherty, L. T., Weist, M. D., & Warner, B. S. (1996). School-based mental health services in the united states: History, current models and needs. Community Mental Health Journal, 32(4), 341–352.CrossRefGoogle Scholar
  28. Forman, S. G. (2015). Implementation of mental health programs in schools: A change agent’s guide. Washington, DC: American Psychological Association.CrossRefGoogle Scholar
  29. Foster, S., Rollefson, M., Doksum, T., Noonan, D., Robinson, G., & Teich, J. (2005). School mental health services in the United States, 2002–2003. Washington, DC: Substance Abuse and Mental Health Services Administration.CrossRefGoogle Scholar
  30. Franklin, C., & Hopson, L. M. (2007). Facilitating the use of evidence-based practice in community organizations. Journal of Social Work Education, 43(3), 377–404.CrossRefGoogle Scholar
  31. Gallon, S. L., Gabriel, R. M., & Knudsen, J. R. (2003). The toughest job you’ll ever love: A pacific northwest treatment workforce survey. Journal of Substance Abuse Treatment, 24(3), 183–196.CrossRefGoogle Scholar
  32. Gioia, D. (2007). Using an organizational change model to qualitatively understand practitioner adoption of evidence-based practice in community mental health. Best Practices in Mental Health, 3(1), 1–15.Google Scholar
  33. Glisson, C., Schoenwald, S. K., Kelleher, K., Landsverk, J., Hoagwood, K. E., Mayberg, S., et al. (2008). Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 124–133.CrossRefGoogle Scholar
  34. Hallgren, K. A. (2012). Computing inter-rater reliability for observational data: An overview and tutorial. Tutorials in Quantitative Methods for Psychology, 8(1), 23–34.CrossRefGoogle Scholar
  35. Herschell, A. D., Kolko, D. J., Baumann, B. L., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30(4), 448–466.CrossRefGoogle Scholar
  36. Hoagwood, K., & Erwin, H. D. (1997). Effectiveness of school-based mental health services for children: A 10-year research review. Journal of Child & Family Studies, 6(4), 435–451.CrossRefGoogle Scholar
  37. Jensen-Doss, A., Hawley, K. M., Lopez, M., & Osterberg, L. D. (2009). Using evidence-based treatments: The experiences of youth providers working under a mandate. Professional Psychology: Research and Practice, 40(4), 417.CrossRefGoogle Scholar
  38. Kelley, S. D., de Andrade, A. R., Sheffer, E., & Bickman, L. (2010). Exploring the black box: Measuring youth treatment process and progress in usual care. Administration and Policy in Mental Health and Mental Health Services Research, 37(3), 287–300.CrossRefGoogle Scholar
  39. Landsverk, J., Brown, C. H., Chamberlain, P., Palinkas, L., Ogihara, M., Czaja, S., et al. (2018). Chapter 13: Design and analysis in dissemination and implementation research. In C. R. Brownson, G. A. Colditz, & E. K. Proctor (Eds.), Design and analysis in dissemination and implementation research (2nd ed., pp. 201–228). New York: Oxford University Press.Google Scholar
  40. Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2(3), 105–113.CrossRefGoogle Scholar
  41. Lever, N., Stephan, S., Castle, M., Bernstein, L., Connors, E., Sharma, R., et al. (2015). Community-partnered school behavioral health: State of the field in Maryland. Baltimore: Center for School Mental Health. Retrieved from http://csmh.umaryland.edu/media/SOM/Microsites/CSMH/docs/Resources/Briefs/FINALCP.SBHReport3.5.15_2.pdf.
  42. Lim, A., Nakamura, B. J., Higa-McMillan, C. K., Shimabukuro, S., & Slavin, L. (2012). Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers. Behaviour Research and Therapy, 50(6), 397–406.CrossRefGoogle Scholar
  43. Lyon, A. R., Ludwig, K., Romano, E., Koltracht, J., Vander Stoep, A., & McCauley, E. (2014). Using modular psychotherapy in school mental health: Provider perspectives on intervention-setting fit. Journal of Clinical Child & Adolescent Psychology, 43(6), 890–901.CrossRefGoogle Scholar
  44. McHatton, P. (2009). Grounded theory. In J. Paul, J. Kleinhammer-Tramill, & K. Fowler (Eds.), Qualitative research methods in special education. Denver: Love Publishing Company.Google Scholar
  45. McHugh, R. K., & Barlow, D. H. (2010). The dissemination and implementation of evidence-based psychological treatments: A review of current efforts. American Psychologist, 65(2), 73–84.CrossRefGoogle Scholar
  46. McMillen, J., Hawley, K., & Proctor, E. (2016). Mental health clinicians’ participation in web-based training for an evidence supported intervention: Signs of encouragement and trouble ahead. Administration & Policy in Mental Health & Mental Health Services Research, 43(4), 592–603.CrossRefGoogle Scholar
  47. Miller, W. R., Yahne, C. E., Moyers, T. B., Martinez, J., & Pirritano, M. (2004). A randomized trial of methods to help clinicians learn motivational interviewing. Journal of Consulting and Clinical Psychology, 72(6), 1050.CrossRefGoogle Scholar
  48. Nakamura, B. J., Higa-McMillan, C. K., Okamura, K. H., & Shimabukuro, S. (2011). Knowledge of and attitudes towards evidence-based practices in community child mental health practitioners. Administration and Policy in Mental Health and Mental Health Services Research, 38(4), 287–300.CrossRefGoogle Scholar
  49. Palinkas, L. A., Aarons, G. A., Horwitz, S., Chamberlain, P., Hurlburt, M., & Landsverk, J. (2011). Mixed method designs in implementation research. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 44–53.CrossRefGoogle Scholar
  50. Pignotti, M., & Thyer, B. A. (2009). Use of novel unsupported and empirically supported therapies by licensed clinical social workers: An exploratory study. Social Work Research, 33(1), 5–17.CrossRefGoogle Scholar
  51. Policy Leadership Cadre for Mental Health In Schools. (2001). Mental health in schools: Guidelines, models, resources, & policy considerations. Los Angeles: Center for Mental Health in Schools and Student/Learning Supports at UCLA. Retrieved from http://smhp.psych.ucla.edu.
  52. Proctor, E. K., Landsverk, J., Aarons, G., Chambers, D., Glisson, C., & Mittman, B. (2009). Implementation research in mental health services: An emerging science with conceptual, methodological, and training challenges. Administration and Policy in Mental Health and Mental Health Services Research, 36(1), 24–34.CrossRefGoogle Scholar
  53. Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: The Free Press.Google Scholar
  54. Rones, M., & Hoagwood, K. (2000). School-based mental health services: A research review. Clinical Child and Family Psychology Review, 3(4), 223–241.CrossRefGoogle Scholar
  55. Stephan, S., Westin, A., Lever, N., Medoff, D., Youngstrom, E., & Weist, M. (2012). Do school-based clinicians’ knowledge and use of common elements correlate with better treatment quality? School Mental Health, 4(3), 170–180.CrossRefGoogle Scholar
  56. Stumpf, R. E., Higa-McMillan, C. K., & Chorpita, B. F. (2009). Implementation of evidence-based services for youth: Assessing provider knowledge. Behavior Modification, 33(1), 48–65.CrossRefGoogle Scholar
  57. Substance Abuse and Mental Health Services Administration. (2014). National behavioral health quality framework. Retrieved from https://www.samhsa.gov/data/national-behavioral-health-quality-framework.
  58. Weist, M., Lever, N., Stephan, S., Youngstrom, E., Moore, E., Harrison, B., et al. (2009). Formative evaluation of a framework for high quality, evidence-based services in school mental health. School Mental Health, 1(4), 196–211.CrossRefGoogle Scholar
  59. Weist, M. D. (1997). Expanded school mental health services. In T. H. Ollendick, R. J. Prinz (eds) Advances in clinical child psychology (Vol. 19, pp. 319–352) Boston: Springer.CrossRefGoogle Scholar
  60. Weist, M. D., Ambrose, G. M, & Lewis, C. P. (2006). Expanded school mental health: A collaborative community-school example. Children & Schools, 28(1), 45–50.CrossRefGoogle Scholar
  61. Weist, M. D., & Evans, S. W. (2005). Expanded school mental health. Journal of Youth & Adolescence, 34(1), 3–6.CrossRefGoogle Scholar
  62. Weist, M. D., Evans, S. W., & Lever, N. A. (2008). Handbook of school mental health: Advancing practice and research. Berlin: Springer Science & Business Media.Google Scholar
  63. Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., et al. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial. Archives of General Psychiatry, 69(3), 274–282.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Elizabeth H. Connors
    • 1
    Email author
  • Jason Schiffman
    • 2
  • Kathleen Stein
    • 3
  • Sarah LeDoux
    • 4
  • John Landsverk
    • 5
    • 6
  • Sharon Hoover
    • 1
  1. 1.National Center for School Mental Health, Division of Child and Adolescent Psychiatry, School of MedicineUniversity of Maryland BaltimoreBaltimoreUSA
  2. 2.Department of PsychologyUniversity of Maryland Baltimore CountyBaltimoreUSA
  3. 3.Booker High SchoolSarasotaUSA
  4. 4.MPB Group, Inc.ColumbiaUSA
  5. 5.Brown School of Social WorkWashington UniversitySt LouisUSA
  6. 6.Oregon Social Learning CenterEugeneUSA

Personalised recommendations