Attitudes toward adoption of evidence-based practices: A comparison of autism early intervention providers and children’s mental health providers.

Across the country, states are reporting increases in the number of children with autistic spectrum disorders (ASDs) served each year in the early intervention system. Research examining factors impacting the successful dissemination and implementation of evidence-based practices (EBPs) into service systems for these children is limited. Preliminary information indicates that adoption of EBPs is variable. Provider attitudes toward the adoption of EBPs may be one factor that limits or facilitates implementation of efficacious treatments and these attitudes vary by organizational context and provider individual differences. The current study examines cross-context differences in provider attitudes toward EBPs by comparing the attitudes of 71 education-based early intervention providers working with children with ASD to the attitudes of 238 mental health providers in the public mental health system. This provides the first examination of ASD early intervention provider attitudes toward EBP. Results indicated that early intervention providers reported significantly more favorable attitudes toward adopting EBPs than did mental health providers. Early intervention providers with extended experience in the field perceived less divergence between their current practice and EBPs. Implications are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Organizational culture and climate and mental health provider attitudes toward evidence-based practice.

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using evidence-based treatments: The experiences of youth providers working under a mandate.

Whether as clinicians, administrators, or evaluators, psychologists are increasingly involved in efforts to implement evidence-based treatments (EBTs) within clinical practice settings. The state of Texas has undertaken what may be the largest EBT implementation effort to-date. A survey was conducted to understand the experiences of 197 children’s service providers working within this effort. Providers’ own attitudes toward the EBTs and their perceptions of their colleagues’ support for the EBTs were somewhat negative, although they gave positive ratings of the quality of their EBT training and of their agencies’ support for the EBTs. Significant, independent predictors of providers’ attitudes toward the EBTs included provider views of their colleagues’ and their agencies’ support for the EBTs, their opinions of the quality of their training in the EBTs, and their perceptions of institutional barriers to EBT use (all ps     

Development of an audiotape review system for supporting adherence to an evidence-based treatment.

In bridging the science-to-service gap, effective yet practical strategies are needed for supporting practitioner implementation of evidence-based treatments. The development and preliminary evaluation of an adherence monitoring system to support clinician fidelity to an evidence-based treatment for substance-abusing adolescents was tested for community-based practitioners. Session tapes were monitored for adherence to a family-based approach to contingency management for 27 practitioners during baseline, postworkshop, and follow-up periods. Approximately half of the practitioners were randomized to receive intensive quality assurance following a family-based contingency management workshop as part of a larger study. Findings supported the clinical feasibility of the developed system as well as the face and content validity, reliability, and concurrent validity. Future directions are discussed in light of these results, including instructions for the use of the developed system to efficiently train clinicians to adequate fidelity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Responses of practicing psychologists to a web site developed to promote empirically supported treatments.

Increased adoption of empirically supported treatments (ESTs) has been hindered in part by inadequate and inconvenient access to EST information and training. To improve diffusion of ESTs, the authors developed a Web application to provide practitioners with concise information by disorder on ESTs. The resulting site, therapyadvisor.com, was evaluated by 239 practicing psychologists to assess the usefulness of the site and explore possible interactions of EST attitudes on ratings of usefulness and impact. Two thirds of participants indicated using ESTs in practice, and limited time and resources were cited as primary barriers to EST adoption. The Web application was rated positively by most participants and was reported to increase awareness of and commitment to try ESTs among approximately 60% of participants. The results of this project support the feasibility of a Web application to increase diffusion and promote further adoption of ESTs. Technological and e-learning advances are promising directions for encouraging the adoption of ESTs specifically and evidence-based practice generally, particularly among busy practitioners who have inadequate time and resources for more traditional forms of dissemination and training. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of computers on professional practice: A survey of current practices and attitudes.

Surveyed 227 practicing psychologists to explore the impact of computers on the everyday practice of psychology and practitioners' attitudes toward specific uses of computers. Whereas more than half of the respondents reported using computers in their practices, most restricted their use to clerical applications. Few practitioners used their computer for more clinical applications. Reasons most frequently reported for not using computers related to lacking the necessary skills and experience and to financial considerations. Overall, practitioners had positive attitudes toward a variety of specific applications of computers. Implications of these findings for facilitating the appropriate use of computers by practitioners are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing Web-Based Project Management Systems in the United States and Japan

This paper reports on results of research conducted at the University of Washington to investigate the means and methods for overcoming barriers to the implementation of Web-based project management systems (WPMS), and to develop a set of best practices in both the United States and Japanese construction industries. The United States and Japanese economies are high-tech intensive and both cultures have embraced technology. However, a relatively small sector of the construction industry in each country has implemented WPMS. The question posed here is why have these drivers not resulted in the industry’s adoption of this new technology, and further, perhaps there are lessons learned from those who have successfully implemented WPMS. This research seeks to broaden our understanding of implementation barriers that are limiting the use of WPMS tools as well as means and methods of overcoming those barriers based on successful implementation in both countries.     

Paving the Way for Public–Private Partnerships in Infrastructure Development

Infrastructure privatization has multidimensional impacts with long-term uncertainties and wide risk portfolios. A wide range of barriers to public–private partnerships (PPPs) in infrastructure development have been identified through a questionnaire survey, which are broadly classified into six aspects: (1) social, political, and legal risk; (2) unfavorable economic and commercial conditions; (3) inefficient public procurement framework; (4) lack of mature financial engineering techniques; (5) problems related to the public sector; and (6) problems related to the private sector. To explore measures for removing these barriers, a systematic research approach (literature review, case studies and interviews/correspondences with experts and experienced practitioners) has been taken to draw experience, learn lessons, and benchmark the best practices in international PPPs. An improved PPP protocol for infrastructure projects in general has been developed, addressing key issues in nine areas: (1) appropriate roles of governmental authorities; (2) best value for money approach; (3) effective management of adviser services; (4) formulation of appropriate PPP schemes; (5) use of relational contracts; (6) improvement of the procurement framework; (7) payment structure; (8) contract monitoring, termination, and step-in rights; and (9) transfer management. Effective measures for successful PPPs are identified in each of the nine areas.     

Therapist strategies for building involvement in cognitive–behavioral therapy for adolescent depression.

This study examined predictive relations between 9 therapist behaviors and client involvement in manual-guided, cognitive–behavioral therapy for adolescent depression. Analyses included 42 adolescents who met criteria for a depressive disorder (major depressive disorder, dysthymic disorder, or adjustment disorder with depressed mood) and who were treated in school-based clinics. Therapist behaviors hypothesized to promote client involvement were coded from Session 1 audiotapes; client involvement was coded from Session 2. Unlike prior research, the current study examined associations between behaviors and involvement while controlling for initial client resistance to isolate the therapist contribution to involvement. Results show that 3 therapist behaviors from Session 1 (attending to teen’s experience, exploring teen’s motivation, and less structure) predicted greater client involvement in Session 2, controlling for initial resistance. Only exploring motivation and less structure uniquely predicted Session 2 involvement when the 3 behaviors were examined simultaneously. Session 1 therapist behaviors predicted significant variance in involvement at Sessions 2, 4, and 8. Client initial presentation as resistant was associated with more exploring motivation and praising, but initial resistance did not explain associations between therapist behaviors and involvement. Implications for implementing evidence-based treatments are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Price Competitive Alliance Projects: Identification of Success Factors for Public Clients

The need to identify the critical factors in the successful development and management of the price competitive alliance model has become a priority for public sector clients, as there is an increasing need to obtain better value for money (VfM) for its infrastructure projects. Yet, there has been limited research undertaken about the nature and use of price competitive alliances. This research determines the success factors (SFs) for price competitive alliances during their relationship development phases as this form of alliance contract is being used extensively by public sector clients to procure critical infrastructure projects in Western Australia (WA). A review of the literature of partnering and alliance contracting is used to develop a conceptual model of potential SFs. Interviews with 21 practitioners who participated in alliances on behalf of a WA public sector client were conducted to determine their perceived SF for price competitive alliances throughout the relationship development process. Contrary to the literature, each of the SFs identified was required in each stage of the relationship development process. In particular, the development of a leadership enriched culture (where people view the project as an extension of themselves and feel good about what they personally achieve through cooperation) was deemed necessary for the successful implementation of a price competitive alliance. Moreover it was revealed that the establishment of trust for the client began to arise at the point when a realistic target outturn cost that was able to deliver VfM, as well as an innovative sustainable outcome could be attained. Price competitive alliance models are considered to be an appropriate procurement method, albeit during the current economic climate an alternative to public private partnerships, for delivering large complex infrastructure projects.     

Mental health service utilization among African American and Caucasian mothers and fathers.

Mental health services have been routinely underutilized. This study investigated the influence of parents' gender, race, and psychopathology on perceived barriers and attitudes toward mental health utilization for themselves and for their children. A unique contribution of this study is the examination of father, mother, and child factors influencing service utilization from the parents' perspective. A total of 194 African American and Caucasian parents were recruited from the community to participate. Parents completed measures on barriers and attitudes toward treatment for themselves and for their children, history of mental health service utilization for themselves and for their children, and their own current psychological symptoms. Results indicated that 36.3% and 19.4% of parents and children, respectively, had used mental health services during their lifetime. Parents perceived fewer barriers and had more positive attitudes toward seeking services for their children than for themselves. Race and gender differences were found in parents' perceptions of barriers and attitudes toward treatment. Furthermore, barriers, attitudes, and psychopathology predicted parents' plans for future utilization of mental health services. The clinical implications of this study and directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychometric properties and U.S. National norms of the Evidence-Based Practice Attitude Scale (EBPAS).

[Correction Notice: An erratum for this article was reported in Vol 22(3) of Psychological Assessment (see record 2010-18043-022). There were three errors in Table 1 on p. 360. In the last row, the row label should be “Overall EBPAS mean,” M = 2.73, and SD = 0.49. The revised Table 1 appears in the erratum.] The Evidence-Based Practice Attitude Scale (EBPAS) assesses mental health and social service provider attitudes toward adopting evidence-based practices. Scores on the EBPAS derive from 4 subscales (i.e., Appeal, Requirements, Openness, and Divergence) as well as the total scale, and preliminary studies have linked EBPAS scores to clinic structure and policies, organizational culture and climate, and first-level leadership. EBPAS scores are also related to service provider characteristics, including age, education level, and level of professional development. The present study examined the factor structure, reliability, and norms of EBPAS scores in a sample of 1,089 mental health service providers from a nationwide sample drawn from 100 service institutions in 26 states in the United States. The study also examined associations of provider demographic characteristics with EBPAS subscale and total scores. Confirmatory factor analysis supported a second-order factor model, and reliability coefficients for the subscales ranged from .91 to .67 (total scale = .74). The study establishes national norms for the EBPAS so that comparisons can be drawn for U.S. local as well as international studies of attitudes toward evidence-based practices. The results suggest that the factor structure and reliability are likely generalizable to a variety of service provider contexts and different service settings and that the EBPAS subscales are associated with provider characteristics. Directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An algorithm for determining use of trauma-focused cognitive–behavioral therapy.

The shift toward dissemination of evidence-based practices has led to many questions about who is appropriate for a particular treatment model, particularly with complex clients, in diverse community settings, and when multiple evidence-based models have overlapping target populations. Few research-based tools exist to facilitate these clinical decisions. The research on trauma-focused cognitive–behavioral therapy (TF-CBT), an evidence-based treatment for children suffering from posttraumatic stress reactions, is reviewed to inform development of an algorithm to assist clinicians in determining whether a particular client is appropriate for TF-CBT. Recommendations are made for future research that will facilitate matching TF-CBT and other evidence-based practices to particular child clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Aarons et al. (2010).

Reports an error in "Psychometric properties and U.S. National norms of the Evidence-Based Practice Attitude Scale (EBPAS)" by Gregory A. Aarons, Charles Glisson, Kimberly Hoagwood, Kelly Kelleher, John Landsverk and Guy Cafri (Psychological Assessment, 2010[Jun], Vol 22[2], 356-365). There were three errors in Table 1 on p. 360. In the last row, the row label should be “Overall EBPAS mean,” M = 2.73, and SD = 0.49. The revised Table 1 appears in the erratum. (The following abstract of the original article appeared in record 2010-10892-016.) The Evidence-Based Practice Attitude Scale (EBPAS) assesses mental health and social service provider attitudes toward adopting evidence-based practices. Scores on the EBPAS derive from 4 subscales (i.e., Appeal, Requirements, Openness, and Divergence) as well as the total scale, and preliminary studies have linked EBPAS scores to clinic structure and policies, organizational culture and climate, and first-level leadership. EBPAS scores are also related to service provider characteristics, including age, education level, and level of professional development. The present study examined the factor structure, reliability, and norms of EBPAS scores in a sample of 1,089 mental health service providers from a nationwide sample drawn from 100 service institutions in 26 states in the United States. The study also examined associations of provider demographic characteristics with EBPAS subscale and total scores. Confirmatory factor analysis supported a second-order factor model, and reliability coefficients for the subscales ranged from .91 to .67 (total scale = .74). The study establishes national norms for the EBPAS so that comparisons can be drawn for U.S. local as well as international studies of attitudes toward evidence-based practices. The results suggest that the factor structure and reliability are likely generalizable to a variety of service provider contexts and different service settings and that the EBPAS subscales are associated with provider characteristics. Directions for future research are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating practice changes in mental health clinics: A guide for implementation development in health care systems.

For more than a decade, health care systems have attempted to implement evidence-based practices and guidelines. These efforts have demonstrated the difficulty in making practice changes in complex systems of care. Many health care systems, including the Department of Veterans Affairs (VA) and state community mental health systems, have made adoption of evidence-based treatments, especially psychotherapies, a priority. Psychologists, as behavioral change experts and clinical leaders, are positioned to aid local implementation efforts but may have limited knowledge of the “implementation science” literature. This article provides a brief introduction to the implementation literature and offers a guide for developing an implementation plan to adopt evidence-based psychotherapies in local health care settings illustrated by a hypothetical example. Challenges to implementation are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The impact of evidence-based practice implementation and fidelity monitoring on staff turnover: Evidence for a protective effect.

Staff retention is an ongoing challenge in mental health and community-based service organizations. Little is known about the impact of evidence-based practice implementation on the mental health and social service workforce. The present study examined the effect of evidence-based practice implementation and ongoing fidelity monitoring on staff retention in a children's services system. The study took place in the context of a statewide, regionally randomized effectiveness trial of an evidence-based intervention designed to reduce child neglect. In the study 21 teams consisting of 153 home-based service providers were followed over a 29-month period. Survival analyses revealed greater staff retention in the condition where the evidence-based practice was implemented along with ongoing fidelity monitoring presented to staff as supportive consultation. These results should help to allay concerns about staff retention when implementing evidence-based practices where there is good values–innovation fit and when fidelity monitoring is designed as an aid and support to service providers in providing a high standard of care for children and families. (PsycINFO Database Record (c) 2010 APA, all rights reserved)