The de-adoption of evidence-based practices (EBPs) is a largely understudied topic. The present study examined factors related to the de-adoption of an EBP for students exposed to traumatic events in a large urban school district. Qualitative interviews conducted with school clinicians and district administrators two years after the district embarked on a large-scale roll-out of the EBP distinguished between factors that impacted partial de-adoption after one year (phase 1) and complete de-adoption by the district after two years (phase 2). Phase 1 factors included organizational consistency, workforce stability, prior success, positive student outcomes, school- and district- level supports, innovation-setting fit, and innovation-related issues. Phase 2 factors included district-level leadership changes, financial and workforce instability, and shifting priorities. Study results suggest that sustainment-enhancing strategies should be included in the early stages of program implementation to most effectively adapt to school- and system- level changes.

Objective The study examined, from the perspective of therapists, the barriers to and facilitators in implementing cognitive-behavioral therapy (CBT) for anxious youths in community settings. Methods Fifty therapists (43% of the original training sample of 115 providers) participated in a follow-up interview two years after training and consultation. They reported on barriers to and facilitators in implementation of CBT for youths with anxiety. Results Qualitative analyses identified numerous barriers and facilitators, including client factors (for example, motivated clients facilitated the use of CBT, whereas clients with complex issues and numerous psychosocial stressors hindered its use), intervention factors (the structure of CBT helped facilitate its use for some providers, whereas others reported feeling constrained by such structure), and organizational factors (for example, the absence of support within one’s institution served as a barrier, whereas supervision supporting the use of CBT facilitated implementation). Conclusions Findings of this implementation trial align with conceptual implementation frameworks and may guide the tailoring of future implementation efforts in order to overcome barriers and maximize facilitators.

The training literature suggests that ongoing support following initial therapist training enhances training outcomes, yet little is known about what occurs during ongoing support and what accounts for its effectiveness. The present study examined consultation sessions provided to 99 clinicians following training in cognitive-behavioral therapy for youth anxiety. The 104 recorded consultation sessions were coded for content and consultative methods. It was hypothesized that behavioral rehearsal (an active learning technique) would predict therapist adherence, skill, self-efficacy, and satisfaction at post-consultation. Regression analyses found no significant relation, however, clinician involvement during consultation sessions positively moderated the relationship between behavioral rehearsals and skill. Implications, limitations, and future directions are discussed.

BackgroundQuestions remain regarding the sustainment of evidence-based practices following implementation. The present study examined the sustainment of community clinicians’ implementation (i.e., penetration) of cognitive-behavioral therapy, attitudes toward evidence-based practices, and knowledge of cognitive-behavioral therapy for youth anxiety two years following training and consultation in cognitive-behavioral therapy for youth anxiety.MethodsOf the original 115 participants, 50 individuals (43%) participated in the two-year follow-up. A t- test examined sustainment in penetration over time. Hierarchical linear modeling examined sustainment in knowledge and attitudes over time. Time spent in consultation sessions was examined as a potential moderator of the change in knowledge and attitudes.ResultsFindings indicated sustained self-reported penetration of cognitive-behavioral therapy for anxious youth, with low fidelity to some key CBT components (i.e., exposure tasks). Follow-up knowledge was higher than at baseline but lower than it had been immediately following the consultation phase of the study. Belief in the utility of evidence-based practices was sustained. Willingness to implement an evidence-based practice if required to do so, appeal of evidence-based practices, and openness toward evidence-based practices were not sustained. Participation in consultation positively moderated changes in knowledge and some attitudes.ConclusionsSustainment varied depending on the outcome examined. Generally, greater participation in consultation predicted greater sustainment. Implications for future training include higher dosages of consultation.