Adoption of innovative and evidence-based practices for children and adolescents in state-supported mental health clinics: a qualitative study

Abstract

BackgroundThis study examined how mental health clinic administrators decided whether or not to adopt evidence-based and other innovative practices by exploring their views of implementation barriers and facilitators and operation of these views in assessment of implementation costs and benefits.MethodsSemi-structured interviews were conducted with 75 agency chief executive officers and program directors of 34 New York State-licensed mental health clinics serving children and adolescents.ResultsThree interconnected themes relating to barriers and facilitators were identified, namely costs and benefits associated with adoption, capacity for adoption, and acceptability of new practices. The highest percentage of participants (86.7%) mentioned costs as a barrier, followed by limited capacity (55.9%) and lack of acceptability (52.9%). The highest percentage (82.3%) of participants identified available capacity as a facilitator, followed by acceptability (41.2%) and benefits or limited costs (24.0%). Assessment of costs and benefits exhibited several principles of behavioural economics, including loss aversion, temporal discounting use of heuristics, sensitivity to monetary incentives, decision fatigue, framing, and environmental influences.ConclusionsThe results point to opportunities for using agency leader models to develop strategies to facilitate implementation of evidence-based and innovative practices for children and adolescents.

Viewpoints from families for improving transition from NICU-to-home for infants with medical complexity at a safety net hospital: a qualitative study

“…Transcripts were imported into ATLAS.ti (v 1.5.4, Scientific Software, Berlin, Germany). We used an inductive-deductive thematic analysis approach; an iterative process of coding to identify the patterns between concepts [29,30]. A team of three people, with experience in neonatology (A.L.)…”

Annual Research Review: The state of implementation science in child psychology and psychiatry: a review and suggestions to advance the field

“…Given the disappointing findings emerging from training studies and the recognition that context was important (McHugh & Barlow, ), implementation research entered a third wave, focused primarily on identifying determinants at multiple levels (e.g., clinician, organization, system) that might be related to implementation success or failure spurred on by the publication of several heuristic implementation frameworks (Aarons, Hurlburt, & Horwitz, ; Damschroder et al., ; Greenhalgh, Robert, Macfarlane, Bate, & Kyriakidou, ). Third wave studies often used mixed‐methods to describe the determinants or test the relationships between these determinants and a variety of implementation outcomes such as EBP adoption, fidelity, and sustainment (Beidas et al., , ; Locke et al., ; Palinkas et al., ; Stein, Celedonia, Kogan, Swartz, & Frank, ). We refer to this approach as the ‘ disaggregation paradigm’ because it involves dismantling established social science theories such as the Theory of Planned Behavior (Ajzen, ), Social Cognitive Theory (Bandura, ), Learning Theory (Blackman, ), and Organizational Climate Theory (Ehrhart, Schneider, & Macey, ) into their constituent variables (e.g., attitudes, organizational culture), measuring a large number of these variables in a single study, and examining which are most strongly associated with implementation in a single multivariate model that includes all measured variables.…”

Agency Leaders' Assessments of Feasibility and Desirability of Implementation of Evidence-Based Practices in Youth-Serving Organizations Using the Stages of Implementation Completion

“…Finally, the assessments of EBP implementation feasibility and desirability are based on different forms of engagement, including engagement with other EBPs at the Pre-Implementation phase and engagement with information or evidence, and with other stakeholders at the Pre-Implementation and Implementation phases. An earlier study by Palinkas et al ( 19 ) reported that personal experience was an important source of “evidence” used by systems leaders in deciding whether or not to implement EBPs. Clinical experience is one of the types of evidence used in the practice of evidence-based medicine ( 29 ).…”

“…As Proctor et al ( 17 ), p. 72) have observed, “the success of efforts to implement evidence-based treatment may rest on their congruence with the preferences and priorities of those who shape, deliver, and participate in care.” Similar pragmatic arguments have been made by Bhattacharyya et al ( 18 ) who pose that theory is not necessarily better than “common sense” for guiding implementation. For example, highlighting the importance of fiscal viability and feasibility, a study by Palinkas et al ( 19 ) found that directors of youth-serving mental health clinics made decisions to adopt or not adopt innovative EBPs based on an assessment of costs and benefits associated with adoption, capacity for adoption, and acceptability of new practices. Moreover, assessment of costs and benefits exhibited several principles of behavioral economics including loss aversion, temporal discounting, use of heuristics, sensitivity to monetary incentives, decision fatigue, framing, and environmental influences.…”

“…Moreover, assessment of costs and benefits exhibited several principles of behavioral economics including loss aversion, temporal discounting, use of heuristics, sensitivity to monetary incentives, decision fatigue, framing, and environmental influences. However, the extent to which these preferences and priorities change from one stage of implementation to the next ( 19 ) and how decision-makers self-assess the weight of these considerations remains unknown.…”