Multilevel Predictors of Clinic Adoption of State-Supported Trainings in Children’s Services

Abstract

Objective Characteristics associated with participation in training in evidence-informed business and clinical practices by 346 outpatient mental health clinics licensed to treat youths in New York State were examined. Methods Clinic characteristics extracted from state administrative data were used as proxies for variables that have been linked with adoption of innovation (extraorganizational factors, agency factors, clinic provider-level profiles, and clinic client-level profiles). Multiple logistic regression models were used to assess the independent effects of theoretical variables on the clinics’ participation in state-supported business and clinical trainings between September 2011 and August 2013 and on the intensity of participation (low or high). Interaction effects between clinic characteristics and outcomes were explored. Results Clinic characteristics were predictive of any participation in trainings but were less useful in predicting intensity of participation. Clinics affiliated with larger (adjusted odds ratio [AOR]=.65, p<.01), more efficient agencies (AOR=.62, p<.05) and clinics that outsourced more clinical services (AOR=.60, p<.001) had lower odds of participating in any business-practice trainings. Participation in business trainings was associated with interaction effects between agency affiliation (hospital or community) and clinical staff capacity. Clinics with more full-time-equivalent clinical staff (AOR=1.52, p<.01) and a higher proportion of clients under age 18 (AOR=1.90, p<.001) had higher odds of participating in any clinical trainings. Participating clinics with larger proportions of youth clients had greater odds of being high adopters of clinical trainings (odds ratio=1.54, p<.01). Conclusions Clinic characteristics associated with uptake of business and clinical training could be used to target state technical assistance efforts.

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

“…In an earlier study with the entire cohort of mental health clinics in New York State from which this sample was drawn, Olin et al [29] found clinic size, efficiency and outsourcing were significantly associated with participation in business trainings and proportion of youth clients and full-time clinical staff were associated with participation in clinical trainings. The present study enriches those findings by highlighting the potential importance of local/contextual factors not available in state administrative data sets.…”

Access to Care for Youth in a State Mental Health System: A Simulated Patient Approach

“…In our prior work, we found that larger clinical staff capacity and having a higher proportion of youth clients predicted participation in state-supported evidence-based practice training. 23 Having a larger clinical staff capacity may explain the shorter psychiatry appointment wait times in these clinics. However, in our model, clinical staff capacity (i.e., clinical fulltime equivalent) was not significantly associated with psychiatry wait times.…”

“…22-23 Briefly, clinics were characterized by OMH-defined administrative regions (Central, Hudson, Long Island, NYC, Western) and clinic types (hospital, state-operated facilities vs. community clinics). Data from the US Department of Health and Human Services Area Health Resources Files (AHRF) provided county rural–urban continuum codes that were used to categorize clinics by urbanicity (metropolitan versus non-metropolitan).…”

Developing a sustainable child and family service system after a community tragedy: Lessons from Sandy Hook

“…Questions were adapted from ongoing research with New York State behavioral health agencies (Chor et al, 2014; Chor, Wisdom, Olin, Hoagwood, & Horwitz, 2015; Olin et al, 2015a, 2015b). The in-person interviews asked about barriers and facilitators to implementing and sustaining services, current and future needs of the community, local professional networks, and characteristics of an ideal services system.…”