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.
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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.
Aarons, G. A. (2006). Transformational and transactional leadership: association with attitudes toward evidence-based practice. Psychiatric Services, 57(8), 1162–1169.
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.
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.
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.
Beaulieu, N. D., & Horrigan, D. R. (2005). Putting smart money to work for quality improvement. Health Services Research, 40(5), 1318–1334.
Berwick, D. M. (2003). Disseminating innovations in health care. JAMA, 289(15), 1969–1975.
Blau, P. (1964). Exchange and power in social life. New York: Wiley.
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.
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.
Davies, M., Spears, W., & Pugh, J. (2004). What VA providers really think about clinical practice guidelines. Federal Practitioner, 21(2), 15–30.
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.
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.
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.
Glisson, C. (2002). The organizational context of children’s mental health services. Clinical Child & Family Psychology Review, 5(4), 233–253.
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.
Gray, B. (1989). Collaborating: Finding common ground for multiparty problems. San Francisco: Jossey-Bass.
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.
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.
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.
Henggeler, S. W., Lee, T., & Burns, J. A. (2002). What happens after the innovation is identified? Clinical Psychology: Science & Practice, 9(2), 191–194.
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.
Huberman, H. (1994). Research utilization: The state of the art. Knowledge and Policy, 7(4), 13–33.
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.
Institute of Medicine (2006). Improving the quality of health care for mental and substance-use conditions. Washington, DC: National Academy Press.
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.
Johnson-Laird, P. (1983). Mental models: Towards a cognitive science of language, inference and consciousness. Cambridge, MA: Harvard University Press.
Klein, K. J., & Sorra, J. S. (1996). The challenge of innovation implementation. Academy of Management Review, 21(4), 1055–1081.
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.
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.
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.
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.
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.
Nathan, P., & Gorman, J. (1998). A guide to treatments that work. New York: Oxford University Press.
Proctor, E. K. (2003). Editorial: Developing knowledge for practice: Working through “trench-bench” partnerships. Social Work Research, 27(2), 67–69.
Proctor, E. K. (2004). Leverage points for the implementation of evidence-based practice. Brief Treatment and Crisis Intervention, 4(3), 227–242.
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.
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.
Rogers, E. M. (1995). Diffusion of innovations (4th ed.). New York: Free Press.
Rogers, E. M. (2003). Diffusion of innovations (5th ed.). New York: Free Press.
Roos, N. P., & Shapiro, E. (1999). From research to policy: What have we learned? Medical Care, 37(6), JS291–JS305.
Rosenheck, R. (2001). Stages in the implementation of innovative clinical programs in complex organizations. Journal of Nervous & Mental Disease, 189(12), 821.
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.
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.
Simpson, D. D. (2002) A conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment, 22(4), 171–182.
Stricker, G, & Trierweiler, S. J. (1995). The local clinical scientist: A bridge between science and practice. American Psychology, 20(12), 995–1002.
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.
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.
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.
Woolston, J. L. (2005). Implementing evidence-based treatments in organizations. Journal of the American Academy of Child & Adolescent Psychiatry, 44, 1313–1316.
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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).
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Proctor, E.K., Knudsen, K.J., Fedoravicius, N. et al. Implementation of Evidence-Based Practice in Community Behavioral Health: Agency Director Perspectives. Adm Policy Ment Health 34, 479–488 (2007). https://doi.org/10.1007/s10488-007-0129-8
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DOI: https://doi.org/10.1007/s10488-007-0129-8