From a “Perfect Storm” to “Smooth Sailing”

Self Cite

105

116

Our goal was to identify barriers and facilitators to the implementation of evidence-based practices from the perspectives of multiple stakeholders in a large publicly funded mental health system. We completed 56 interviews with three stakeholder groups: treatment developers (n = 7), agency administrators (n = 33), and system leadership (n = 16). The three stakeholder groups converged on the importance of inner (e.g., agency competing resources and demands, therapist educational background) and outer context (e.g., funding) factors as barriers to implementation. Potential threats to implementation and sustainability included the fiscal landscape of community mental health clinics and an evolving workforce. Intervention characteristics were rarely endorsed as barriers. Inner context, outer context, and intervention characteristics were all seen as important facilitators. All stakeholders endorsed the importance of coordinated collaboration across stakeholder groups within the system to successfully implement evidence-based practices.

Section: Discussionmentioning

confidence: 99%

A Multi-Level Examination of Stakeholder Perspectives of Implementation of Evidence-Based Practices in a Large Urban Publicly-Funded Mental Health System

Beidas

Stewart

Adams

et al. 2015

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105

116

“…Qualitative and quantitative data were drawn from a larger mixed-method investigation of EBI sustainment (Aarons, Green, et al, 2014). Previous work from this project has examined the role of collaboration in implementing and sustaining EBIs (Green et al, 2016), policymaker’s perspectives on EBI sustainment (Willging, Green, Gunderson, Chaffin, & Aarons, 2015), and the role of performance-based contracting in EBI sustainment (Willging et al, In press). The current study examines the roles of leadership in the outer system and inner organizational context (i.e., first-level leadership) in sustaining EBI service delivery.…”

Section: The Present Studymentioning

confidence: 99%

The Roles of System and Organizational Leadership in System-Wide Evidence-Based Intervention Sustainment: A Mixed-Method Study

Aarons

Green

Trott

et al. 2016

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179

166

If evidence-based interventions (EBIs) are not sustained, investments are wasted and public health impact is limited. Leadership has been suggested as a key determinant of implementation and sustainment; however, little empirical work has examined this factor. This mixed-methods study framed using the Exploration, Preparation, Implementation, Sustainment (EPIS) conceptual framework examines leadership in both the outer service system context and inner organizational context in eleven system-wide implementations of the same EBI across two U.S. states and 87 counties. Quantitative data at the outer context (i.e., system) and inner context (i.e., team) levels demonstrated that leadership predicted future sustainment and differentiated between sites with full, partial, or no sustainment. In the outer context positive sustainment leadership was characterized as establishing a project’s mission and vision, early and continued planning for sustainment, realistic project plans, and having alternative strategies for project survival. Inner context frontline transformational leadership predicted sustainment while passive-avoidant leadership predicted non-sustainment. Qualitative results found that sustainment was associated with outer context leadership characterized by engagement in ongoing supportive EBI championing, marketing to stakeholders; persevering in these activities; taking action to institutionalize the EBI with funding, contracting, and system improvement plans; and fostering ongoing collaboration between stakeholders at state and county, and community stakeholder levels. For frontline leadership the most important activities included championing the EBI and providing practical support for service providers. There was both convergence and expansion that identified unique contributions of the quantitative and qualitative methods. Greater attention to leadership in both the outer system and inner organizational contexts is warranted to enhance EBI implementation and sustainment.

“…Results indicate that 47% of sites sustained delivery of an EBP after six years; the adequacy of funding was the most significant predictor of whether an agency sustained delivery of the EBP. While the Bond and colleagues (2014) study provides an important step towards understanding patterns of sustainment by MH systems, additional research is imperative, because costly, time-intensive implementation initiatives will have a limited public health impact if these practices are not maintained over time (Rhoades, Bumbarger, & Moore, 2012; Willging, Green, Gunderson, Chaffin, & Aarons, 2015). …”

mentioning

confidence: 99%

Measuring Sustainment of Multiple Practices Fiscally Mandated in Children’s Mental Health Services

Brookman‐Frazee

Stadnick

Roesch

et al. 2016

Examining sustainment of multiple evidence-based practices is crucial to understanding the processes and outcomes of system-driven implementation efforts that are increasingly common. This study used administrative claims data to characterize volume and penetration of six practices over 19 fiscal quarters following initial implementation within the context of a system-driven, fiscally mandated implementation effort in Los Angeles County Department of Mental Health’s Prevention and Early Intervention services. Patterns of volume changes over time revealed an overall ramp up of practice claims over time, but variability in patterns of volume and penetration for each practice. Findings varied by the methods used to index and analyze volume and penetration. Furthermore, a number of client case-mix and therapist characteristics were associated with the volume of therapists’ claims for each practice relative to their claims for the other practices.