Implementation of evidence-based practices for children in four countries: a project of the World Psychiatric Association

Abstract

A b s t r a c t Objective: The present study examined implementation issues in adopting cognitive-behavioral therapies in routine clinical settings in four countries reflecting diverse cultures, languages, settings, and traditions. Method: A Director's Systems Survey was administered prior to program implementation and one year later. Therapist ratings on attitudes about evidence-based practices and satisfaction were also gathered. Results: All sites reported successful adoption of the program, although significant variations existed in fiscal support, family involvement, prior experience with cognitive-behavioral therapies, and plans for sustainability. Therapists' ratings indicated overall satisfaction with the implementation of the project. Findings from the Director's Systems Survey pointed to five factors facilitating implementation: 1) early adoption and guidance by innovative leaders (i.e., the Directors); 2) attention to the "fit" between the intervention model and local practices; 3) attention to front-end implementation processes (e.g., cultural adaptation, translation, training, fiscal issues); 4) attention to back-end processes early in the project (e.g., sustainability); and 5) establishing strong relationships with multiple stakeholders within the program setting. Conclusions: The implementation issues here mirror those identified in other studies of evidence-based practices uptake. Some of the obstacles to implementation of evidence-based practices may be generic, whereas issues such as the impact of political/economic instability, availability of translated materials, constitute unique stressors that differentially affect implementation efforts within specific countries.Keywords: Evidence-based medicine; Cognitive therapy; Behavior; Feasibility studies; Child Resumo Objetivo: Este estudo visa a examinar problemas na implementação de técnicas psicoterápicas cognitivo-comportamentais em ambientes clínicos de atendimento primário em quatro países que refletem diversas culturas, línguas, ambientes e tradições. Método: Uma pesquisa foi aplicada aos diretores de Sistemas Clínicos antes da implementação do programa e um ano após. Também foram coletados dados sobre como os terapeutas avaliavam as ações relativas à prática baseada em evidências e qual seu grau de satisfação com essa prática. Resultados: Todos os locais de implementação relataram a adoção bem sucedida do programa, ainda que com significativas variações no apoio fiscal, envolvimento familiar, experiência prévia com terapias cognitivocomportamentais e planos de sustentação em longo prazo. As avaliações dos terapeutas indicaram uma satisfação generalizada com a implementação do projeto. Achados da pesquisa com os diretores dos Sistemas Clínicos apontaram cinco fatores que facilitaram a implementação: 1) rápida adoção e orientação por líderes inovadores (i.e., os diretores); 2) atenção à adequação entre o modelo de intervenção e as práticas locais; 3) atenção desde o início à relação entre os processos de implementação e os usuários finais (e....

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