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The Adoption and Implementation of an Evidence Based Practice in Child and Family Mental Health Services Organizations: A Pilot Study of Functional Family Therapy in New York State

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Abstract

Numerous challenges persist in providing evidence-based treatments to children and families in community-based settings. Functional Family Therapy (FFT), one such evidence-based treatment, is a family prevention and intervention program for adolescents with conduct disorder or oppositional defiant disorder. This paper presents pilot data in support of a conceptual framework explaining the adoption and implementation of FFT in a small sample of family and child mental health services organizations in New York State. The conceptual framework is grounded in the diffusion of innovations and the organizational behavior literatures, as well as previously published accounts of the adoption and implementation of evidence-based treatments in mental health. Pilot study data demonstrated that factors associated with the adoption of FFT included: The program fitting with the mission of the organization, as well as the organization having a strong interest in evidence-based treatments. Once a decision to adopt FFT was made, the degree to which it fit with organizational characteristics (e.g., available resource sets, organizational structure, and culture) influenced the ease with which it was implemented. Implications for the adoption and implementation of other evidence-based treatments are discussed.

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Notes

  1. For two of the organizations included in the sample, an additional administrator was interviewed because the original key respondent said the additional administrator was likely to have important information about the adoption and implementation of the FFT program.

  2. Due to resource constraints and the limited number of interviews, only one RAND researcher coded the interviews. It is recommended that future tests of the framework include reliability tests using two or more coders.

References

  • Alexander, J. F., & Sexton, T. L. (2002). Functional family therapy: A model for treating high-risk, acting-out youth. In: F. W. Kaslow (Ed.), Comprehensive handbook of psychotherapy (Vol. 4, pp. 111–132). New York, NY, USA: Integrative/eclectic, 22, 602.

  • Alexander, J. F., & Parsons, B. V. (1973). Short-term behavioral intervention with delinquent families: Impact on family process and recidivism. Journal of Abnormal Psychology, 81(3), 219–225.

    Article  PubMed  CAS  Google Scholar 

  • Barnoski, R. (2003). Outcome evaluation of Washington State’s research-based programs for juvenile offenders. Washington State Institute for Public Policy. Available at: www.wsipp.wa.gov.

  • Crawford, P., Brown, B., Anthony, P., & Hicks, C. (2002). Reluctant empiricists: Community mental health nurses and the art of evidence-based praxis. Health and Social Care in the Community, 10(4), 287–298.

    Article  PubMed  Google Scholar 

  • Daft, R. L. (2000). Organization theory and design (7th ed). South Western College Publishing.

  • D’Aunno, T., Vaughn, T., & McElroy, P. (1999). An institutional analysis of HIV prevention efforts by the nation’s outpatient drug abuse treatment units. Journal of Health and Social Behavior, 40, 175–192.

    Article  PubMed  CAS  Google Scholar 

  • DiMaggio, P. J., & Powell, W. W. (1991). Chapter 3: The Iron cage revisited: Institutional isomorphism and collective rationality. In W. W. Powell, & P. J. DiMaggio (Eds.), The new institutionalism in organizational analysis (pp. 63–82). Chicago: University of Chicago Press.

    Google Scholar 

  • Drake, R. E., Goldman, H. E., Leff, H. S., et al. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52(2), 179–182.

    Article  PubMed  CAS  Google Scholar 

  • Elliott, D. S. (Ed.). (1998). Blueprints for violence prevention. University of Colorado, Center for the Study and Prevention of Violence. Boulder, CO: Blueprints Publications.

  • Fixsen, D. L., Naoom, S. F., Blase, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network.

    Google Scholar 

  • Glisson, C. (2000). Organizational climate and culture. In R. J. Patti (Ed.), The handbook of social welfare management. Thousand Oaks, CA: Sage Publications.

    Google Scholar 

  • Glisson, C. (2002). The organizational context of children’s mental health services. Clinical Child and Family Psychology Review, 5(4), 233–253.

    Article  PubMed  Google Scholar 

  • Goldman, H. H., Ganju, V., Drake, R. E., Gorman, P., Hogan, M., Hyde, P. S., et al. (2001). Policy implications for implementing evidence-based practices. Psychiatric Services, 52(12), 1591–1597.

    Article  PubMed  CAS  Google Scholar 

  • Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., & Kyriakidou, O. (2004). Diffusion of innovations in service organizations: Systematic review and recommendations. Milbank Quarterly, 82(4).

  • Greenhalgh, T., Robert, G., Macfarlane, F., Bate, P., Kyriakidou, O., & Peacock, R. (2005). Storylines of research in diffusion of innovation: A meta-narrative approach to systematic revie. Social Science and Medicine, 61(2), 417–430.

    Article  PubMed  Google Scholar 

  • Hage, J., & Aiken, M. (1969). Routine technology, social structure, and organization goals. ASQ, 10, 366–376.

    Article  Google Scholar 

  • Hannan, M., & Freeman, J. (1984). Structural inertia and organizational change. American Sociological Review, 49, 149–164.

    Article  Google Scholar 

  • Henggeler, S. W., Schoenwald, S. K., Borduin, C. M., Rowland, M. D., & Cunningham, P. B. (1998). Multisystemic treatment of antisocial behavior in children and adolescents. New York and London: Guilford Press.

    Google Scholar 

  • Hoagwood, K., Burns, B. J., Kiser, L., Ringelsel, H., & Schoenwald, S. K. (2001). Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52(9), 1179–1189.

    Article  PubMed  CAS  Google Scholar 

  • Jerrell, J. M., & Ridgely, M. S. (1999). Impact of robustness of program implementation on outcomes of clients in dual diagnosis programs. Psychiatric Services, 50(1), 109–112.

    PubMed  CAS  Google Scholar 

  • Kanter, R. M. (1988). When a thousand flowers bloom: Structural, collective and social conditions for innovation in organizations. Research in Organizational Behavior, 10, 169–211.

    Google Scholar 

  • Levine, S., & White, P. (1961). Exchange as a conceptual framework for the study of interorganizational relationships. Administrative Science Quarterly, 5, 583–601.

    Article  Google Scholar 

  • McHugo, G. J., Drake, R. E., Teague, G. B., & Xie, H. (1999). Fidelity to assertive community treatment and client outcomes in the New Hampshire dual disorders study. Psychiatric Services, 50(6), 818–824.

    PubMed  CAS  Google Scholar 

  • Meyer, J. W., & Rowan, B. (1991). Chapter 2: Institutionalized organizations: Formal structure as myth and ceremony. In W. W. Powell, & P. J. DiMaggio (Eds.), The new institutionalism in organizational analysis (pp. 41–62). Chicago: University of Chicago Press.

    Google Scholar 

  • Nohria, N., & Gulati, R. (1996). Is slack good or bad for innovation? Academy of Management Journal, 39, 1245–1264.

    Article  Google Scholar 

  • Pfeffer, J., & Salancik, G. R. (1978). The external control of organizations: A resource dependence perspective. New York: Harper and Row.

    Google Scholar 

  • Provan, K., Sebastian, J., & Milward, H. (1996). Interorganizational cooperation in community mental health: A resource-based explanation of referral and case coordination. Medical Care Research and Review, 53(1), 94–119.

    PubMed  CAS  Google Scholar 

  • Rogers, E. M. (1995). Diffusion of innovations (4th ed.). New York: Free Press.

    Google Scholar 

  • Roggenkamp, S. D., & White, K. R. (2001). Is hospital case management a rationalized myth? Social Science and Medicine, 53, 1057–1066.

    Article  PubMed  CAS  Google Scholar 

  • Rosenheck, R. (2001a). Stages in the implementation of innovative clinical programs in complex organizations. The Journal of Nervous and Mental Disease, 189(12), 812–821.

    Article  PubMed  CAS  Google Scholar 

  • Rosenheck, R. A. (2001b). Organizational process: A missing link between research and practice. Psychiatric Services, 52(12), 1607–1612.

    Article  PubMed  CAS  Google Scholar 

  • Schoenwald, S. K., Sheidow, A. J., Letourneau, E. J., et al. (2003). Transportability of multisystemic therapy: Evidence for multilevel influences. Mental Health Services Research, 5(4), 223–239.

    Article  PubMed  Google Scholar 

  • Schoenwald, S. K., & Hoagwood, K. (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Psychiatric Services, 52(9), 1190–1197.

    Article  PubMed  CAS  Google Scholar 

  • Scott, W. R. (2003). Organizations: Rational, natural, and open systems (5th ed.). Upper Saddle River, NJ: Prentice-Hall.

    Google Scholar 

  • Sexton, T. L., & Alexander, J. F. (2002). Family-based empirically supported interventions. Counseling Psychologist, 30(2), 238–261.

    Article  Google Scholar 

  • Sexton, T. L., & Alexander, J. F. (2003). Functional family therapy: A mature clinical model. In T. Sexton, G. Weeks, & M. Robbins (Eds.), Handbook of family therapy. New York, NY: Brunner/Routledge.

    Google Scholar 

  • Sexton, T. L., & Alexander, J. F. (2005). Functional family therapy for externalizing disorders in adolescents. In J. Lebow (Ed.). Handbook of clinical family therapy (pp. 164–194). NJ: Wiley.

    Google Scholar 

  • Shortell, S. M., Zazzali, J. L., Burns, L. R., Alexander, J. A., Gillies, R. R., Budetti, P. P., et al. (2001). Implementing evidence-based medicine: The role of market pressures, compensation incentives and culture in physician organizations. Medical Care, 39(7), I-62–I-78.

    CAS  Google Scholar 

  • Simpson, D. D. (2002). A conceptual framework for transferring research to practice. Journal of Substance Abuse Treatment, 22(4), 171–182.

    Article  PubMed  Google Scholar 

  • Stirman, S., Crits-Christoph, P., & DeRubeis, R. (2004). Achieving successful dissemination of empirically supported adult psychotherapies: A synthesis of dissemination theory. Clinical Psychology: Science and Practice, 11, 343–359.

    Article  Google Scholar 

  • Thompson, J. (1967). Chapter 5: Technology and structure. Organizations in Action, 51–65.

  • Valente, T. W., & Davis, R. L. (1999). Accelerating the diffusion of innovations through the use of opinion leaders. The Annals of the American Academy, 566, 55–67.

    Article  Google Scholar 

  • Westphal, J. D., Gulati, R., & Shortell, S. M. (1997). Customization or conformity? An institutional and network perspective on the content and consequences of TQM adoption. Administrative Science Quarterly, (42), 366–394.

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Acknowledgments

We are grateful to Bradley D. Stein M.D., Ph.D. and Bonnie Zima M.D., M.P.H. for their thoughtful comments on the conceptual framework and its application to mental health settings, and to Kenneth B. Wells M.D., M.P.H. and David Chambers, Ph.D. for their helpful feedback on how to improve our manuscript. This pilot study was supported by the UCLA/RAND Health Services Research Center on Quality in Managed Care via a grant from the National Institute of Mental Health (P30 MH068639).

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Correspondence to James L. Zazzali.

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Zazzali, J.L., Sherbourne, C., Hoagwood, K.E. et al. The Adoption and Implementation of an Evidence Based Practice in Child and Family Mental Health Services Organizations: A Pilot Study of Functional Family Therapy in New York State. Adm Policy Ment Health 35, 38–49 (2008). https://doi.org/10.1007/s10488-007-0145-8

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  • DOI: https://doi.org/10.1007/s10488-007-0145-8

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