Volume 5, Issue 2, 04/2017-Enhancing Implementation of Evidence Based Interventions in Outpatient Mental Health Settings- Archive

April 2017 | Volume 5, Issue 2

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EVIDENCE IN ACTION

A quarterly research brief from the
Center on Trauma and Children

Enhancing Implementation of Evidence Based Interventions in Outpatient Mental Health Settings

The following is a preliminary synopsis of implementation research being conducted by the Center on Trauma and Children

Successful implementation of evidence based interventions may be enhanced by agency attention to identifying the providers who are likely to remain with the agency, supporting their training through productivity concessions, and promoting use of the intervention with the appropriate client population.

The Center on Trauma and Children fosters implementation of evidence based interventions as part of our translational effort to move knowledge from science into practice. This Evidence in Action seeks to further the understanding of what factors promote the successful completion of training and early implementation of evidence based practices (EBPs) among clinicians from community mental health and private behavioral health agencies.

Some key findings from an implementation study of clinicians trained to provide two EBPs for adolescents with co-occurring substance abuse and mental health problems (Functional Family Therapy and ENCOMPASS CBT) include:

Trainees who remained active in the program came from agencies that were significantly smaller, with an average of 170 employees compared to 304 among the cohort that did not successfully implement the interventions.
100% of supervisors of training completers were directly involved in the training.
Agencies that offered clinicians time to engage in the training process by allowing them to block their schedules to attend trainings and consultation calls and engage in learning without being penalized in productivity requirements, had more successful clinicians. Among those who did not successfully implement the interventions, only 74% had such concessions available compared to 94% of the training completers.
Agency ability to identify and direct appropriate clients for the interventions to trainees is important. 100% of those who completed the training and eventually received certification worked in agencies who instituted some mechanism to flag and refer appropriate clients. The processes for identifying and directing appropriate clients to trainees included telephone triage at the time of referral, assessment at the initial intake, and case assignment through a team staffing.
Employee turnover was the primary barrier to successful completion of the training with 38% of trainees leaving the organization before the end of the learning collaborative.

Translational Tips

To support the successful training in and implementation of evidence based interventions behavioral health agencies should:

Encourage supervisors of clinicians being trained to be involved in the EBP implementation process as early as possible
Support clinician trainees by allowing time for training, consultation calls and learning without negative consequences
Seek ways to enhance retention of clinicians involved in EBP training
Develop mechanisms for identifying appropriate clients for the intervention and assigning those clients to the clinician trainees
Be especially attentive to these factors if you are a large agency, which may have less flexibility or other barriers to triaging clients to specific clinicians

ADDITIONAL READING

Fixsen, D.L., Naoom, S.F., Blasé, K.A., Friedman, R.M., & Wallace, F. (2015). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).

Health Services Research Information Central (2017). Dissemination and implementation science. Available at: https://www.nlm.nih.gov/hsrinfo/implementation_science.html.

Proctor, E., Luke, D., Calhoun, A., McMillen, C., Brownson, R., McCrary, S., Padek, M. (2015). Sustainability of evidence-based healthcare: Research agenda, methodological advances and infrastructure support. Implementation Science, 10(88).

Swain, K., Whitley, R., McHugo, G.J. (2010). The sustainability of evidence-based practices in routine mental health agencies. Community Mental Health Journal, 46(2).

University of Kentucky Center on Trauma and Children
859-218-6901 | http://www.uky.edu/ctac