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Clinician-Reported Determinants of Evidence-Based Practice Use in Private Practice Mental Health

Abstract

Efforts to examine barriers to the implementation of evidence-based practices (EBPs) have largely focused on community mental health settings, although many people receive mental health services in private practice settings. Clinicians working in private practice likely face unique barriers to EBP implementation, but identifying strategies to increase EBP use in this setting is an understudied area of implementation research. The consolidated framework for implementation research (CFIR) provides an overview of multi-level determinants that influence implementation. The Characteristics of Individuals domain of the CFIR focuses on individual-level implementation determinants, such as perceptions of an intervention and self-efficacy in delivering it. Within the private practice context, little is known about how individual clinicians perceive EBPs and how this might influence their use of them. Thus, this study examined responses from qualitative interviews with 20 private practice clinicians to assess individual-level EBP implementation determinants in this context. Clinicians identified a range of attitudes towards EBPs and described how client factors influence their EBP use. Concerns about EBPs included perceptions that EBPs are too structured, are not generalizable to clinical practice, and are not suitable for a range of client populations. Clinicians also described several barriers and facilitators related to training in EBPs. Clinicians with training in exposure therapy (a well-established, but difficult-to-implement EBP) generally reported more positive attitudes, fewer barriers, and more frequent EBP use. Potential strategies to support EBP implementation in private practice are discussed.

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Funding

This work was supported by funding from the National Institute of Mental Health (T32MH019927) and from the Warren Alpert Medical School of Brown University, Department of Psychiatry and Human Behavior.

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Authors and Affiliations

Authors

Contributions

HEF conceived of the study design, conducted interviews with research participants, coded and analyzed the data, drafted sections of the manuscript, and substantially revised the manuscript. LM assisted with data analysis and drafted and substantially revised several sections of the manuscript. KGB and JBF provided input on the study design, assisted with participant recruitment, and provided feedback on the manuscript. ARE provided input on the qualitative methods and interpretation of qualitative data. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Hannah E. Frank.

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Competing interest

The authors have no relevant financial or non-financial interests to disclose.

Ethics Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Lifespan Corporation Institutional Review Board (IRB #1516465).

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

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Milgram, L., Freeman, J.B., Benito, K.G. et al. Clinician-Reported Determinants of Evidence-Based Practice Use in Private Practice Mental Health. J Contemp Psychother (2022). https://doi.org/10.1007/s10879-022-09551-w

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  • DOI: https://doi.org/10.1007/s10879-022-09551-w

Keywords

  • Private practice
  • Evidence-based practice
  • Implementation science
  • Exposure therapy
  • Training