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

Abstract

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.

Implementation of evidence-based interventions: analyzing critical components for sustainability in community mental health services

“…Many publicly funded CMHS initiatives start as project organizations that have necessary resources guaranteed for a limited period of time. Several recently published articles have highlighted the elementary components financing and time as determinants for sustainable implementation (Aarons et al, 2016;Beidas et al, 2016;Stewart et al, 2016), something that could also be seen in the present study. Despite showing fair fidelity results after one year, the majority of the programs studied were terminated before they had the chance to develop further.…”

“…According to a study by Aarons et al (2014), the importance and complexities of collaboration when implementing EBP have been underestimated, and it shows that the issues were most apparent during the preparation phase, and peaked during the early implementation phase. Palinkas et al (2011) have highlighted the importance of social networks being developed and maintained by system leaders in order to implement EBP effectively, and according to Beidas et al (2016) coordinated collaboration is needed from the very beginning of the implementation process in order to implement EBP programs successfully if several stakeholders are involved. On this basis, some of the difficulties described in our study are readily understood in light of the organizational structures which made the implementing municipalities responsible for initiating collaboration with other agencies in order to form the IPS teams and start up the programs.…”

The Perfect Storm: Collision of the Business of Mental Health and the Implementation of Evidence-Based Practices

“…The crumbling infrastructure in outpatient settings may endanger the implementation and sustainability of EBPs (13). The financial landscape has likely become even more constrained due to reduction of funding by state agencies.…”

“…Transcripts were analyzed in an iterative process based upon a modified grounded theory approach (12). Interview guide and data analytic details are detailed elsewhere (13). …”

Clearing hurdles: the challenges of implementation of mental health evidence-based practices in under-resourced schools

“…Staff turnover is much higher among teaching and non-teaching professionals in under-resourced school districts (Mellin & Weist, 2011). Mental health agencies that provide services in schools increasingly rely on fee-for-service staff in order to control cost (Beidas et al, in review), which may increase turnover. The consequence of this is that every year it is necessary to train a new group of team members.…”