Implementation of evidence-based practices in a large urban publicly-funded mental health system
Rinad Beidas, Ph.D.
University of Pennsylvania
Importance: Few studies have examined the effects of both clinician and organizational characteristics on the use of evidence-based practices in mental healthcare. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices.
Objective: To estimate the relative contribution of clinician and organizational factors on clinician self-reported use of cognitive-behavioral, family, and psychodynamic techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families.
Design: Observational and cross-sectional. Data collected in 2013.Setting: Twenty-three organizations.Participants: We used purposive sampling to recruit the 29 largest
child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators.
Main Outcome Measures: Clinician self-reported use of cognitive-behavioral, family, and psychodynamic techniques, as measured by the Therapist Procedures Checklist – Family Revised.
Results: Linear mixed-effects regression models were used; models included random intercepts for organization to account for nesting of clinicians within organization. Clinician factors accounted for the following percentage of the overall variation: cognitive-behavioral (16%), family (7%), psychodynamic (20%). Organizational factors accounted for the following percentage of the overall variation: cognitive-behavioral (23%), family (19%), psychodynamic (7%). Older clinicians and clinicians with more open attitudes were more likely to endorse use of cognitive behavioral techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Female clinicians were more likely to endorse use of family techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Clinicians with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic techniques.
Conclusions & Relevance: This study suggests that both clinician and organizational factors are important in explaining clinician behavior and the use of evidence-based practices, but that their relative importance varies by therapeutic technique.