Abstract
Due to the significant prevalence of mental and substance use disorders in the United States, the push for the development and implementation of evidence-based practices (EBPs) in behavioral health has risen exponentially in the last 30 years. Community-based organizations (CBOs) (i.e., self-governing and/or not-for-profit) have been recognized as important providers of behavioral health services. However, there are gaps in the literature surrounding CBO implementation capacity—ability to adopt, implement, and sustain an EBP- and capacity training initiatives (e.g., training in data-based decision-making) that specifically target CBOs and implementation practice. The purpose of this exploratory study was to assess how individuals working within Florida CBOs conceptualize implementation practice capacity and what is needed to reach adequate capacity to utilize an EBP. This qualitative study consisted of semi-structured interviews with eight administrators and nine practitioners currently employed by CBOs who deliver evidence-based behavioral health services (N = 17). Results showed certain implementation practice characteristics such as leadership, culture/climate, collaboration/communication, data-based decision-making and evaluation, and funding were all important areas of implementation practice capacity. Implications for future research focused on conceptualizing and building implementation practice capacity within the context of community behavioral health settings will be discussed.
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Data Availability
The datasets generated during and/or analyzed during the current study are not publicly available due to participant confidentiality considerations. Aggregate data are available from the corresponding author on reasonable request.
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Not applicable.
References
Aarons, G. A., Hurlburt, M., & McCue Horwitz, S. (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. https://doi.org/10.1007/s10488-010-0327-7
Aarons, G. A., Sommerfeld, D. H., & Walrath-Greene, C. M. (2009a). Evidence-based practice implementation: The impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice. Implementation Science. https://doi.org/10.1186/1748-5908-4-83
Aarons, G. A., Wells, R. S., Zagursky, K., Fettes, D. L., & Palinkas, L. A. (2009b). Implementing evidence-based practice in community mental health agencies: A multiple stakeholder analysis. American Journal of Public Health, 99(11), 2087–2095. https://doi.org/10.2105/AJPH.2009.161711
Bach-Mortensen, A. M., Lange, B. C., & Montgomery, P. (2018). Barriers and facilitators to implementing evidence-based interventions among third sector organizations: A systematic review. Implementation Science, 13(103). https://doi.org/10.1186/s13012-018-0789-7
Barwick, M., Dubrowski, R., & Damschroder, L. (2020). Factors associated with effective implementation: Research and practical implications. In B. Albers, A. Shlonsky, & R. Mildon (Eds.), Implementation Science 3.0 (pp. 81–100). Cham, Switzerland: Springer
Bauer, M. S., Damschroder, L., Hagedorn, H., Smith, J., & Kilbourne, A. M. (2015). An introduction to implementation science for the non-specialist. BMC Psychology, 3(32), 1–12. https://doi.org/10.1186/s40359-015-0089-9
Beidas, R. S., Williams, N. J., Becker-Haimes, E. M., Aarons, G. A., Barg, F. K, Evans, A. C., Jackson, K., Jones, D., Hadley, T., Hoagwood, K., Marcus, S. C., Neimark, G., Rubin, R. M., Schoenwald, S. K., Adams, D. R., Walsh, L. M., Zentgraf, K., & Mandell, D. S. (2019). A repeated cross-sectional study of clinicians’ use of psychotherapy techniques during 5 years of a system-wide effort to implement evidence-based practices in Philadelphia. Implementation Science. https://doi.org/10.1186/s13012-019-0912-4
Bernard, H. R., & Ryan, G. W. (2010). Analyzing qualitative data: Systematic approaches. Sage.
Birken, S. A., Powell, B. J., Shea, C. M., Haines, E. R., Kirk, M. A., Leeman, J., Rohweder, C., Damschroder, L., & Presseau, J. (2017). Criteria for selecting implementation science theories and frameworks: Results from an international survey. Implementation Science. https://doi.org/10.1186/s13012-017-0656-y
Brookman-Frazee, L., Chlebowski, C., Suhrheinrich, J., Finn, N., Dickson, K. S., Aarons, G. A., & Stahmer, A. (2020). Characterizing shared and unique implementation influences in two community service systems for autism: Applying the EPIS framework to two large-scale autism intervention community effectiveness trials. Administration and Policy in Mental Health and Mental Health Services Research, 47(2), 176–187. https://doi.org/10.1007/s10488-019-00931-4
Concha, M. (2014). Exploring collaboration, its antecedents, and perceived outcomes in service partnerships of community-based organizations in south Florida. International Journal of Public Administration, 37(1), 44–52. https://doi.org/10.1080/01900692.2013.809591
Dearing, J. W., Kee, K. F., & Peng, T. (2018). Historical roots of dissemination and implementation science. In R. C. Brownson, G. A. Colditz, & E. K. Proctor (Eds.), Dissemination and implementation research in health: Translating science to practice (2nd ed., pp. 47–62). Oxford University Press.
Dopp, A. R., Narcisse, M. R., Mundey, P., Silovsky, J. F., Smith, A. B., Mandell, D., Funderburk, B. W., Powell, B. J., Schmidt, S., Edwards, D., Luke, D., & Mendel, P. (2020). A scoping review of strategies for financing the implementation of evidence-based practice in behavioral health systems: State of the literature and future directions. Implementation Research and Practice, 1, 1–21. https://doi.org/10.1177/2633489520939980
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 (FMHI Publication #231). https://nirn.fpg.unc.edu/sites/nirn.fpg.unc.edu/files/resources/NIRN-MonographFull-01-2005.pdf
Fusch, P. I., & Ness, L. R., (2015). Are we there yet? Data saturation in qualitative research. The Qualitative Report, 20(9), 1408–1416
Glisson, C., Hemmelgarn, A., Green, P., Dukes, D., Atkinson, S., & Williams, N. J. (2012). Randomized trial of the availability, responsiveness, and continuity (ARC) organizational intervention with community-based mental health programs and clinicians serving youth. Journal of the American Academy of Child and Adolescent Psychiatry, 51(8), 780–787. https://doi.org/10.1016/j.jaac.2012.05.010
Green, A. E., Albanese, B. J., Shapiro, N. M., & Aarons, G. A. (2014). The roles of individual and organizational factors in burnout among community-based mental health service providers. Psychological Services, 11(1), 41–49. https://doi.org/10.1037/a0035299
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. https://doi.org/10.1177/1525822X05279903
Guest, G., MacQueen, K. M., & Namey, E. E. (2012). Applied thematic analysis. Sage.
Hogg-Graham, R., Edwards, K., Ely, T. L., Mochizuki, M., & Varda, D. (2021). Exploring the capacity of community-based organizations to absorb health system patient referrals for unmet social needs. Health and Social Care in the Community, 29(2), 487–495. https://doi.org/10.1111/hsc.13109
Kapucu, N., Healy, B. F., & Arslan, T. (2011). Survival of the fittest: Capacity building for small nonprofit organizations. Evaluation and Program Planning, 34(3), 236–245. https://doi.org/10.1016/j.evalprogplan.2011.03.005
Kelly, C. M., LaRose, J., & Scharff, D. P. (2014). A method for building evaluation competency among community-based organizations. Health Promotion Practice, 15(3), 431–437. https://doi.org/10.1177/1524839913496427
Last, B. S., Schriger, S. H., Timon, C. E., Frank, H. E., Buttenheim, A. M., Rudd, B. N., Fernandez-Marcote, S., Comeau, C., Shoyinka, S., & Beidas, R. S. (2021). Using behavioral insights to design implementation strategies in public mental health settings: A qualitative study of clinical decision-making. Implementation Science Communications. https://doi.org/10.1186/s43058-020-00105-6
Leeman, J., Calancie, L., Hartman, M. A., Escoffery, C. T., Herrmann, A. K., Tague, L. E., Moore, A. A., Wilson, K. M., Schreiner, M., & Samuel-Hodge, C. (2015). What strategies are used to build practitioners’ capacity to implement community-based interventions and are they effective?: A systematic review. Implementation Science. https://doi.org/10.1186/s13012-015-0272-7
Massey, O. T., & Vroom, E. B. (2020). The role of implementation science in behavioral health. In B. L. Levin & A. Hanson (Eds.), Foundations of Behavioral Health (pp. 101–118). Springer Nature.
Nilsen, P. (2015). Making sense of implementation theories, models and frameworks. Implementation Science. https://doi.org/10.1186/s13012-015-0242-0
Olfson, M., Druss, B. G., & Marcus, S. C. (2015). Trends in mental health care among children and adolescents. The New England Journal of Medicine, 372(21), 2029–2038. https://doi.org/10.1056/NEJMsa1413512
Proctor, E. K., Powell, B. J., & McMillen, C. (2013). Implementation strategies: Recommendations for specifying and reporting. Implementation Science. https://doi.org/10.1186/1748-5908-8-139
Ramanadhan, S., Crisostomo, J., Alexander-Molloy, J., Gandelman, E., Grullon, M., Lora, V., Reeves, C., Savage, C., PLANET MassCONECT C-PAC, & Viswanath, K. (2012). Perceptions of evidence-based programs among community-based organizations tackling health disparities: A qualitative study. Health Education Research, 27(4), 717–728. https://doi.org/10.1093/her/cyr088
Rogers, L., De Brun, A., Birken, S. A., Davies, C., & McAuliffe, E. (2020). The micropolitics of implementation; A qualitative study exploring the impact of power, authority, and influence when implementing change in healthcare teams. BMC Health Services Research. https://doi.org/10.1186/s12913-020-05905-z
Southam-Gerow, M. A., Rodriguez, A., Chorpita, B. F., & Daleiden, E. L. (2012). Dissemination and implementation of evidence based treatment for youth: Challenges and recommendations. Professional Psychology: Research and Practice, 43(5), 527–534. https://doi.org/10.1037/a0029101
Stanhope, V., Choy-Brown, M., Barrenger, S., Manuel, J., Mercado, M., McKay, M., & Marcus, S. C. (2017). A comparison of how behavioral health organizations utilize training to prepare for health care reform. Implementation Science, 12(19). https://doi.org/10.1186/s13012-017-0549-0
Stemler, S. E. (2004). A comparison of consensus, consistency, and measurement approaches to estimating interrater reliability. Practical Assessment, Research, and Evaluation, 9(4), 1–11. https://doi.org/10.7275/96jp-xz07
Vroom, E. B., & Massey, O. T. (2021). Moving from implementation science to implementation practice: The need to solve practical problems to improve behavioral health services. Journal of Behavioral Health Services and Research. https://doi.org/10.1007/s11414-021-09765-1
Willging, C. E., Aarons, G. A., Trott, E. M., Green, A. E., Finn, N., Ehrhart, M. G., & Hecht, D. B. (2016). Contracting and procurement for evidence-based interventions in public-sector human services: A case study. Administration and Policy in Mental Health and Mental Health Services Research, 43(5), 675–692. https://doi.org/10.1007/s10488-015-0681-6
Wu, A. W., Weston, C. M., Ibe, C. A., Ruberman, C. F., Bone, L., Boonyasai, R. T., Hwang, S., Gentry, J., Purnell, L., Lu, Y., Liang, S., & Rosenblum, M. (2019). The baltimore community-based organizations neighborhood network: Enhancing capacity together (CONNECT) cluster RCT. American Journal of Preventive Medicine, 57(2), e31–e41. https://doi.org/10.1016/j.amepre.2019.03.013
Acknowledgements
This research was supported by the UF Substance Abuse Training Center in Public Health from the National Institute of Drug Abuse (NIDA) of the National Institutes of Health under award number T32DA035167 (PI: Dr. Linda Cottler). This research was also supported by the National Institute on Drug Abuse under award numbers 1K01DA052679 (PI: Dr. Micah Johnson), R25DA050735 (PI: Dr. Micah Johnson), and R25DA035163 (PI: Dr. Carmen Masson). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Florida Department of Juvenile Justice.
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EBV (corresponding author) was involved in the study design and implementation, data collection and analysis, and drafting and revising the manuscript. OTM was involved in the study design and data analysis, as well as drafting and revising the manuscript. DMT was involved in the study design and data analysis, as well as drafting and revising of the manuscript. BLL was involved in the study design and drafting and revising of the manuscript. ALG was involved in the study design and drafting and revising of the manuscript.
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Vroom, E.B., Massey, O.T., Martinez Tyson, D. et al. Conceptualizing Implementation Practice Capacity in Community-Based Organizations Delivering Evidence-Based Behavioral Health Services. Glob Implement Res Appl 1, 246–257 (2021). https://doi.org/10.1007/s43477-021-00024-1
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DOI: https://doi.org/10.1007/s43477-021-00024-1