Abstract
BackgroundUnderstanding program leader perspectives on the sustainment of evidence-based practice (EBP) in community mental health settings is essential to improving implementation. To date, however, much of the literature has focused on direct service provider perspectives on EBP implementation. The aim of this mixed-method study was to identify factors associated with the sustainment of multiple EBPs within a system-driven implementation effort in children’s mental health services.MethodsData were gathered from 186 leaders at 59 agencies within the Los Angeles County Department of Mental Health who were contracted to deliver one of six EBPs within the Prevention and Early Intervention initiative.ResultsMulti-level analyses of quantitative survey data (N = 186) revealed a greater probability of leader-reported EBP sustainment in large agencies and when leaders held more positive perceptions toward the EBP. Themes from semi-structured qualitative interviews conducted with a subset of survey participants (n = 47) expanded quantitative findings by providing detail on facilitating conditions in larger agencies and aspects of EBP fit that were perceived to lead to greater sustainment, including perceived fit with client needs, implementation requirements, aspects of the organizational workforce, availability of trainings, and overall therapist attitudes about EBPs.ConclusionsFindings inform EBP implementation efforts regarding decisions around organizational-level supports and promotion of EBP fit.
Highlights
Understanding program leader perspectives on the sustainment of evidence-based practice (EBP) in community mental health settings is essential to improving implementation
Understanding factors associated with the sustainment of evidence-based practices (EBPs) in community mental health settings is essential for leveraging resources in implementation
Examining the sustainment of single practices can generate testable hypotheses for improving implementation outcomes, the single practice focus has limited opportunities to study the fit between innovation characteristics and implementation contexts [9] and is inconsistent with the current state of many system reform efforts that involve the dissemination of multiple EBPs to address the major targeted mental health needs of client populations [10,11,12]
Summary
Qualitative analysis revealed two themes central to the sustainment of practices: (a) perceptions of fit with client needs, PEI implementation requirements, and organization program mission, and (b) perceptions of organizational context and workforce. Leaders frequently talked about the lack of fit between the practice and client symptom presentation (1a) and the mismatch between the practice and the client age range served in the agency (1b). Available trainings and ongoing supports A noted challenge for sustainment was the scarcity of practice trainings, access to ongoing supports post-certification to help therapists implement the practices effectively (6a). The absence of these formalized supports (6b) and lack of internal trainers seemed to impede active use of practices (6c). “Traumas with API [Asian/Pacific Islander] is too [much] full self-disclosure to have in a group setting...so that’s why it’s not working out.”
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