Providers’ perspectives of factors influencing implementation of evidence-based treatments in a community mental health setting: A qualitative investigation of the training–practice gap.

Abstract

The present study aimed to elucidate relations between provider perceptions of aspects of the Consolidated Framework for Implementation Research (CFIR; Damshroder et al., 2009) and provider attitudes towards the implementation of evidence-based treatments (EBTs) in an ethnically diverse community health setting. Guided by directed content analysis, we analyzed 28 semi-structured interviews that were conducted with providers during the pre-implementation phase of a larger implementation study for Cognitive Processing Therapy for Posttraumatic Stress Disorder (CPT-C for PTSD, Resick et al., 2008). Our findings extend the existing literature by also presenting provider-identified client-level factors that contribute to providers' positive and negative attitudes towards EBTs. Provider-identified client-level factors include: client motivation to engage in treatment, client openness to EBTs, support networks of family and friends, client use of community and government resources, the connection and relationship with their therapist, client treatment adherence, client immediate needs or crises, low literacy or illiteracy, low levels of education, client cognitive limitations, and misconceptions about therapy. These results highlight the relations between provider perceptions of their clients, provider engagement in EBT training, and subsequent adoption of EBTs. We present suggestions for future implementation research in this area.

The relevance of transformational leadership for promoting professional social work competence with EBPA

“…In addition to the organisational context construction and personal capacity building that were discussed in previous sections, it is crucial to promote EBP acceptance in the social work profession, which includes positive attitudes, wide adoption and scientific implementation. There are several approaches to achieve this: enhancing the curriculum in academic training, providing ongoing continuous professional training and capitalising on local opinion leaders (Marques et al., 2016). In this study, we found that personal characteristics were not significantly related to EBPA in China.…”

“…Although many demographic factors, such as age, gender and ethnicity, may influence practitioners' EBPA, education, training and professional experience have received more attention as factors associated with EBPA and EBP implementation (Aarons, 2005; Chonody & Teater, 2018; Marques et al., 2016; Wike et al., 2014). For social workers, EBP has been viewed as a kind of PC through which developmental and dynamic abilities are derived from continuous learning, thus allowing for the integration and application of knowledge and skills in practice in real situations (CSWE, 2015).…”

Outcomes Associated With Adapting a Research-Supported Treatment for Children With Behavior Disorders

“…Over the past 30 years, research has advanced the treatment of serious mental health disorders during childhood and adolescence such as depression, anxiety, and disruptive behavior disorders (Hoagwood et al, 2014; Mufson & Moreau, 1999). However, few research-supported treatments (RSTs) reach children in need (Marques et al, 2016; Park, Moskowitz, & Chorpita, 2018; Ringle et al, 2015). Beyond access issues-an oft cited statistic suggests that up to 65% of children and adolescents with serious mental health problems never access the mental health service system (Agency for Healthcare Research and Quality, 2010), and 60% of youth who initially engage in treatment drop out prematurely (Gopalan et al, 2010), RSTs are not commonly available in real-world community mental health settings (Marques et al, 2016).…”

“…Frameworks such as Damschroder et al’s (2009) consolidated framework for implementation research (Keith, Crosson, O’Malley, Taylor, & Cromp, 2017) and Aaron and colleagues’ exploration preparation implementation sustainment model (Aarons et al, 2011) differentiate between barriers and facilitators that are external to or in the outer context of the organization and factors that are internal (or the inner context) to the setting. External factors include mental health legislature and policies, state mandates, and funding, including funding sources, costs associated with the RST, and the availability of funds (Beidas & Kendall, 2010; Marques et al, 2016; Ringle et al, 2015; Stirman, Gutner, Langdon, & Graham, 2016). An analysis of the costs associated with seven RSTs by Okamura et al (2018) ranged from over US$2,000 to as high as US$19,000 due to training, supervision, and certification: Unsurprisingly, this expense, which also includes the loss of billable hours when providers are engaged in training and supervisory activities, has been identified as a deterrent to adoption (Okamura et al, 2018; Palinkas, Saldana, Chou, & Chamberlain, 2017).…”

“…The inner context, on the other hand, includes the organization’s social context, which encompasses the setting’s culture and climate (e.g., expectations that staff have about their work environment, including the rigidity and proficiency of the organization; Glisson, Williams, Hemmelgarn, Proctor, & Green, 2016), and factors pertaining to leadership, including support for the RST and the perceived alignment of the intervention with the agency’s mission (Beidas & Kendall, 2010; Marques et al, 2016; Palinkas et al, 2017; Ringle et al, 2015). Inner contextual factors also include provider factors, and of them, clinician attitudes and perceptions about RSTs have received considerable attention in the literature (Aarons, 2005; Aarons et al, 2011).…”