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Evidence-Based Practice Implementation in Community Mental Health Settings: The Relative Importance of Key Domains of Implementation Activity

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Abstract

Implementation research has examined practice prioritization, implementation leadership, workforce development, workflow re-engineering, and practice reinforcement, but not addressed their relative importance as implementation drivers. This study investigated domains of implementation activities and correlated them to implementation success during a large national evidence-based practice implementation project. Implementation success was correlated with active leadership strategically devoted to redesigning the flow of work and reinforcing implementation through measurement and feedback. Relative attention to workforce development was negatively correlated with implementation. Active leaders should focus on redesigning the flow of work to support the implementation and on reinforcing program improvements.

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References

  • 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, 61–74.

    Article  PubMed  Google Scholar 

  • Aarons, G. A. (2006). Transformational and transactional leadership: Association with attitudes toward evidence-based practice. Psychiatric Services, 57, 1162–1169.

    Article  PubMed  Google Scholar 

  • Atlas.ti 2.0 (2002) Atlas.ti 2.0 [Computer software]. Berlin, Germany: GmbH.

  • Batalden, P. B., & Stoltz, P. K. (1993). A framework for the continual improvement of health care: Building and applying professional and improvement knowledge to test changes in daily work. Joint Commission Journal on Quality Improvement, 19, 424–445.

    PubMed  CAS  Google Scholar 

  • Berwick, D. M. (2003). Disseminating innovations in health care. Journal of the American Medical Association, 289, 1969–1975.

    Article  PubMed  Google Scholar 

  • Bodenheimer, T. (1999). The American health care system—the movement for improved quality in health care. New England Journal of Medicine, 340, 488–492.

    Article  PubMed  CAS  Google Scholar 

  • Bond, G. R., Becker, D. R., & Drake, R. E. (2011). Measurement of fidelity of implementation of evidence-based practices: Case example of the IPS Fidelity Scale. Clinical Psychology: Science and Practice, 18, 125–140.

    Article  Google Scholar 

  • Bond, G. R., Drake, R. E., McHugo, G. J., Rapp, C. A., & Whitley, R. (2009). Strategies for improving fidelity in the National Evidence-Based Practices Project. Research on Social Work Practice, 19, 569–581.

    Article  Google Scholar 

  • Bond, G. R., Evans, L., Salyers, M. P., Williams, J., & Kim, H. K. (2000). Measurement of fidelity in psychiatric rehabilitation. Mental Health Services Research, 2, 75–87.

    Article  PubMed  CAS  Google Scholar 

  • Brunette, M. F., Asher, D., Whitley, R., Lutz, W. J., Wieder, B. L., Jones, A. M., et al. (2008). Implementation of integrated dual disorders treatment: A qualitative analysis of facilitators and barriers. Psychiatric Services, 59, 989–995.

    Article  PubMed  Google Scholar 

  • Chambers, D. A. (2008). Advancing the science of implementation: A workshop summary. Administration and Policy in Mental Health and Mental Health Services Research, 35, 3–10.

    Article  PubMed  Google Scholar 

  • Corrigan, P. W., Lickey, S. E., Campion, J., & Rashid, F. (2000). Mental health team leadership and consumers satisfaction and quality of life. Psychiatric Services, 51, 781–785.

    Article  PubMed  CAS  Google Scholar 

  • Davis, D. A., Thomson, M. A., Oxman, A. D., & Haynes, R. B. (1995). Changing physician performance. A systematic review of the effect of continuing medical education strategies. Journal of the American Medical Association, 274, 700–705.

    Article  PubMed  CAS  Google Scholar 

  • Drake, R. E., & Essock, S. M. (2009). The science-to-service gap in real-world schizophrenia treatment: The 95% problem. Schizophrenia Bulletin, 35, 677–678.

    Article  PubMed  Google Scholar 

  • Drake, R. E., Goldman, H. H., Leff, H. S., Lehman, A. F., Dixon, L., Mueser, K. T., et al. (2001). Implementing evidence-based practices in routine mental health service settings. Psychiatric Services, 52, 179–182.

    Article  PubMed  CAS  Google Scholar 

  • Durlak, J. A., & DuPre, E. P. (2011). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350.

    Article  Google Scholar 

  • Finnerty, M. T., Rapp, C. A., Bond, G. R., Lynde, D. W., Ganju, V. J., & Goldman, H. H. (2009). The State Health Authority Yardstick (SHAY). Community Mental Health Journal, 45, 228–236.

    Article  PubMed  Google Scholar 

  • 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.

    Google Scholar 

  • Forsetlund, L., Bjorndal, A., Rashidian, A., Jamtvedt, G., O’Brien, M. A., Wolf, F., et al. (2009). Continuing education meetings and workshops: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (Online), 2(2), CD003030. doi:10.1002/14651858.CD14003030.pub14651852.

  • Godfrey, J. L. (2010). Re-implementing assertive community treatment: One agency’s challenge of meeting state standards. Unpublished dissertation. Indianapolis: Indiana University-Purdue University Indianapolis.

  • Grimshaw, J. M., & Eccles, M. P. (2004). Is evidence-based implementation of evidence-based care possible? Medical Journal of Australia, 180(6 Suppl), S50–S51.

    PubMed  Google Scholar 

  • Grol, R. (1997). Personal paper: Beliefs and evidence in changing clinical practice. BMJ, 315, 418–421.

    Article  PubMed  CAS  Google Scholar 

  • Grol, R., & Grimshaw, J. M. (2003). From best evidence to best practice: Effective implementation of change in patients’ care. Lancet, 362, 1225–1230.

    Article  PubMed  Google Scholar 

  • Hermann, R. C., Chan, J. A., Zazzali, J. L., & Lerner, D. (2006). Aligning measurement-based quality improvement with implementation of evidence-based practices. Administration and Policy in Mental Health and Mental Health Services Research, 34, 636–645.

    Article  Google Scholar 

  • Hoffman, L. R. (1979). The group problem solving process: Studies of a valence model. New York: Praeger.

    Google Scholar 

  • Hoge, M. A., Tondora, J., & Stuart, G. W. (2003). Training in evidence-based practice. Psychiatric Clinics of North America, 26, 851–865.

    Article  PubMed  Google Scholar 

  • Insel, T. R. (2007). Devising prevention and treatment strategies for the nation’s diverse populations with mental illness. Psychiatric Services, 58, 395.

    Article  PubMed  Google Scholar 

  • Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

    Google Scholar 

  • Jamtvedt, G., Young, J. M., Kristoffersen, D. T., O’Brien, M. A., & Oxman, A. D. (2006). Audit and feedback: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (Online), 2(2). doi:10.1002/14651858.CD14000259.pub14651852.

  • Joyce, B., & Showers, B. (2002). Student achievement through staff development (3rd ed.). Alexandria, VA: Association for Supervision and Curriculum Development.

    Google Scholar 

  • Kimberly, J., & Cook, J. M. (2008). Organizational measurement and the implementation of innovations in mental health services. Administration and Policy in Mental Health and Mental Health Services Research, 35, 11–20.

    Article  PubMed  Google Scholar 

  • McFarlane, W. R., McNary, S., Dixon, L., Hornby, H., & Cimett, E. (2001). Predictors of dissemination of family psychoeducation in community mental health centers in Maine and Illinois. Psychiatric Services, 50, 818–824.

    Google Scholar 

  • McGrew, J. H., Bond, G. R., Dietzen, L. L., & Salyers, M. P. (1994). Measuring fidelity of implementation of a mental health program model. Journal of Consulting and Clinical Psychology, 62, 670–678.

    Article  PubMed  CAS  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, 818–824.

    PubMed  CAS  Google Scholar 

  • McHugo, G. J., Drake, R. E., Whitley, R., Bond, G. R., Campbell, K., Rapp, C. A., et al. (2007). Fidelity outcomes in the National Implementing Evidence-Based Practices Project. Psychiatric Services, 58, 1279–1284.

    Article  PubMed  Google Scholar 

  • Mendel, P., Meredith, L. S., Schoenbaum, M., Sherbourne, C. D., & Wells, K. B. (2008). Interventions in organizational and community context: A framework for building evidence on dissemination and implementation in health services research. Administration and Policy in Mental Health and Mental Health Services Research, 35, 21–37.

    Article  PubMed  Google Scholar 

  • New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Final Report. DHHS Pub. No. SMA-03-3832. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  • O’Brien, M. A., Rogers, S., Jamtvedt, G., Oxman, A. D., Odgaard-Jensen, J., Kristoffersen, D. T., et al. (2007). Educational outreach visits: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (Online), 4(4):CD000409. doi:10.1002/14651858.CD14000409.pub14651852.

  • 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, 24–34.

    Article  PubMed  Google Scholar 

  • Rapp, C. A., & Goscha, R. J. (2006). The strengths model: Case management with people with psychiatric diabilities (2nd ed.). New York: Oxford University Press.

    Google Scholar 

  • Rapp, C. A., Goscha, R. J., & Carlson, L. S. (2010). Evidence-based practice implementation in Kansas. Community Mental Health Journal, 46, 461–465.

    Article  PubMed  Google Scholar 

  • Rollins, A. L., Salyers, M. P., Tsai, J., & Lydick, J. M. (2010). Staff turnover in statewide implementation of ACT: Relationship with ACT fidelity and other team characteristics. Administration and Policy in Mental Health and Mental Health Services Research, 37, 417–426.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  • Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., & Southam-Gerow, M. A. (2010a). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 37, doi:10.1007/s10488-10010-10321-10480.

  • Schoenwald, S. K., Hoagwood, K. E., Atkins, M. S., Evans, M. E., & Ringeisen, H. (2010b). Workforce development and the organization of work: The science we need. Administration and Policy in Mental Health and Mental Health Services Research, 37, 71–80.

    Article  PubMed  Google Scholar 

  • Seffrin, B., Panzano, P. C., & Roth, D. (2008). What gets noticed: How barrier and facilitator perceptions relate to the adoption and implementation of innovative mental health practices. Community Mental Health Journal, 44, 475–484.

    Article  PubMed  Google Scholar 

  • Shojania, K. G., & Grimshaw, J. M. (2005). Evidence-based quality improvement: The state of the science. Health Affairs, 24, 138–150.

    Article  PubMed  Google Scholar 

  • Shortell, S. M., Bennett, C. L., & Byck, G. R. (1998). Assessing the impact of continuous quality improvement on clinical practice: What it will take to accelerate progress. Milbank Quarterly, 76, 593–624.

    Article  PubMed  CAS  Google Scholar 

  • Siskind, D., & Wiley-Exley, E. (2009). Comparison of assertive community treatment programs in urban Massachusetts and rural North Carolina. Administration and Policy in Mental Health and Mental Health Services Research, 36, 236–246.

    Article  PubMed  Google Scholar 

  • Sluyter, G. V. (1995). Mental health leadership training: A survey of state directors. Journal of Mental Health Administration, 22, 201–204.

    Article  PubMed  CAS  Google Scholar 

  • Surgeon General. (2000). Surgeon General’s report on mental health. Washington, DC: US Government Printing Office.

    Google Scholar 

  • Teague, G. B., Bond, G. R., & Drake, R. E. (1998). Program fidelity in assertive community treatment: Development and use of a measure. American Journal of Orthopsychiatry, 68, 216–232.

    Article  PubMed  CAS  Google Scholar 

  • Thomson O’Brien, M. A., Oxman, A. D., Haynes, R. B., Davis, D. A., Freemantle, N., & Harvey, E. L. (2000). Local opinion leaders: Effects on professional practice and health care outcomes. Cochrane Database of Systematic Reviews (Online), 2(2), CD000125. doi:10.1002/14651858.CD000125.

  • Torrey, W. C., Drake, R. E., Dixon, L., Burns, B. J., Rush, A. J., Clark, R. E., et al. (2001). Implementing evidence-based practices for persons with severe mental illness. Psychiatric Services, 52, 45–50.

    Article  PubMed  CAS  Google Scholar 

  • Torrey, W. C., Lynde, D. W., & Gorman, P. (2005). Promoting the implementation of practices that are supported by research: The National Implementing Evidence-Based Practice Project. Child and Adolescent Psychiatric Clinics of North America, 14, 297–306.

    Article  PubMed  Google Scholar 

  • Wang, M. C., Hyun, J. K., Harrison, M. I., Shortell, S. M., & Fraser, I. (2006). Redesigning health systems for quality: Lessons from emerging practices. Joint Commission Journal on Quality and Patient Safety, 11, 599–611.

    Google Scholar 

  • West, J. C., Wilk, J. E., Olfson, M., Rae, D. S., Marcus, S., Narrow, W. E., et al. (2005). Patterns and quality of treatment for patients with schizophrenia in routine psychiatric practice. Psychiatric Services, 56, 283–291.

    Article  PubMed  Google Scholar 

  • Whitley, R., Gingerich, S., & Lutz, W. (2009). Facilitators and barriers to the implementation of the illness management and recovery program in community mental health settings. Psychiatric Services, 60, 202–209.

    Article  PubMed  Google Scholar 

  • Woltmann, E. M., Whitley, R., McHugo, G. J., Brunette, M., Torrey, W. C., Coots, L., et al. (2008). The role of staff turnover in the implementation of evidence-based practices in mental health care. Psychiatric Services, 59, 732–737.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported by grant 036805 from the Robert Wood Johnson Foundation; contract 280-02-8070 from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration; a gift from the West Family Foundation; and the Johnson & Johnson–Dartmouth Community Mental Health Program. The authors thank the members of the National Implementing Evidence-Based Practices Project team and the participants at the sites in the eight states.

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Authors and Affiliations

  1. Department of Psychiatry, Dartmouth Medical School, Dartmouth Psychiatric Research Center, Rivermill Comercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA

    William C. Torrey, Gary R. Bond & Gregory J. McHugo

  2. Department of Community & Family Medicine, Dartmouth Medical School, Dartmouth Psychiatric Research Center, Rivermill Comercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA

    Gregory J. McHugo

  3. Department of Psychiatry, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA

    William C. Torrey

  4. Dartmouth Psychiatric Research Center, Rivermill Comercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA

    Karin Swain

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  1. William C. Torrey
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  4. Karin Swain
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Correspondence to William C. Torrey.

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Torrey, W.C., Bond, G.R., McHugo, G.J. et al. Evidence-Based Practice Implementation in Community Mental Health Settings: The Relative Importance of Key Domains of Implementation Activity. Adm Policy Ment Health 39, 353–364 (2012). https://doi.org/10.1007/s10488-011-0357-9

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