Developing the tools of implementation science in substance use disorders treatment: Applications of the consolidated framework for implementation research.

The implementation of evidence-based treatments (EBTs) and practices (EBPs) depends on both top-down and bottom-up responsibilities. Many articles in this special section on Implementation Science in Substance Use Disorders address the interaction between these two approaches when implementing new substance use disorder (SUD) treatments. Generally the articles place this interaction within the Consolidated Framework for Implementation Research (CFIR), a relatively new and comprehensive synthesis of theories and conceptualizations of the components needed for successful implementation strategies. The range of SUD treatments covered includes well-established behavioral interventions, such as screening and brief interventions for alcohol, as well as new pharmacotherapies, such as buprenorphine for opiates. One contribution uses the CFIR to review continuing care interventions and self-help groups that can follow-up after more intensive clinical care. External and internal pressures for change drive implementation. The successful EBT/EBP implementations reviewed in these articles recognized these potential change drivers in designing their strategy for introducing the EBT/EBP, and they modified aspects of the EBT/EBP to satisfy many of these drivers. The CFIR model has limitations, as do the contributions to this special section. The implementation science field is new and developing rapidly, and many of the EBTs and EBPs were developed and tested through controlled studies evaluating the efficacy of interventions under controlled conditions, rather than examining their performance in the broader landscape of addiction treatment programs. These limitations may also be considered as boundary conditions to be explored in further research, implementation, and development of the next edition of the CFIR. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Training psychologists for evidence-based practice.

Evidence-base practice (EBP) is now commonplace in many health care services and, in recent years, there has been a healthy debate about the role of EBP in psychology. In this article, I provide information on the nature of EBP and how it is consistent with professional training models and standards in psychology. In discussing some of the concerns that have been raised about the value of EBP in psychology, I present research findings on the relevance and potential impact of evidence-based assessment and treatment practices. Finally, after highlighting the promise of EBP, I offer some recommendations for how training efforts in professional psychology should be refocused in order to optimally prepare current and future psychologists to practice in an evidence-based manner. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

EBP ≠ EST: Reply to Crits-Christoph et al. (2005) and Weisz et al. (2005).

Replies to Crits-Christoph et al. (see record 2005-04167-007) and Weisz et al (see record 2005-04167-008). Evidence-based practice (EBP) is not a synonym of empirically supported therapies (ESTs). ESTs reflect 1 kind of evidence that should guide EBP. The authors focus in this response on 4 issues: the distinction between 2 functions of randomized clinical trials (RCTs) with very different methodological and clinical implications, problems with the experimental designs used to test ESTs that have unnecessarily limited their clinical and scientific utility, the question of how to integrate findings from RCTs with findings from other empirical methods to guide evidence-based interventions, and what one means by clinicians (i.e., whether clinicians should be paraprofessionals who implement procedures developed by researchers or full-fledged partners in the development and implementation of evidence-based psychological practice). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

What's new about evidence-based assessment?

A clear consensus has emerged around the world concerning the desirability and even the urgency of basing health care delivery systems on evidence. Among behavioral health care providers such as psychologists, evidence-based practice (EBP) has been focused largely on interventions. Psychologists have long emphasized a scientifically based psychometric approach to the development of assessment procedures. Nevertheless, the era of evidence-based assessment highlights 2 somewhat different issues. First, sophisticated assessment is closely integrated with our emerging conceptions of psychopathology, rather than standing separate from these conceptions. Second, broad-based ongoing outcomes assessment systems are increasingly required for EBP on the part of governments and health care policymakers. This article summarizes these developments and looks to the future. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementation of an evidence-based practice in a clinical setting: What happens when you get there?

Great strides have been made in creating and testing evidence-based practices (EBPs). However, without adequate dissemination and implementation in clinical settings, this progress is of limited value. This article describes the implementation of an EBP (e.g., cognitive–behavioral therapy for depression and anxiety) in a large-group practice mental health services delivery system, focusing on both the role of psychologists and on the training model developed for implementation. The experience in implementation of an EBP is reviewed, with an emphasis on the role and direction psychologists might take in engaging and developing EBP training programs for other mental health services delivery systems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using qualitative research to develop culturally competent evidence-based practice.

Kazdin (see record 2008-03389-001) pointed out that the requirement for evidence-based practice (EBP) has made the long-standing gap between research and practice in clinical psychology even more salient. He offered several strategies for bridging this gap: investigating mechanisms and moderators of therapeutic change, and qualitative research. We agree that qualitative research can be useful in bridging the gap between research and clinical practice (Silverstein & Auerbach, 2007; Silverstein, Auerbach, & Levant, 2006). In this comment we discuss using qualitative research to develop EBP that is culturally competent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Design of a C/EBP-specific, dominant-negative bZIP protein with both inhibitory and gain-of-function properties

We have developed a bZIP protein, GBF-F, with both dominant-negative (DN) and gain-of-function properties. GBF-F is a chimera consisting of two components: the DNA binding (basic) region from the plant bZIP protein GBF-1 (GBF) and a leucine zipper (F) designed to preferentially heterodimerize with the C/EBP alpha leucine zipper. Biochemical studies show that GBF-F preferentially forms heterodimers with C/EBP alpha and thus binds a chimeric DNA sequence composed of the half-sites recognized by the C/EBP and GBF basic regions. Transient transfections in HepG2 hepatoma cells show that both components of GBF-F are necessary for inhibition of C/EBP alpha transactivation. When the C/EBP alpha leucine zipper is replaced with that of either GCN4 or VBP, the resulting protein can transactivate a C/EBP cis-element but is not inhibited by GBF-F, indicating that the specificity of dominant-negative action is determined by the leucine zipper. All known members of the C/EBP family contain similar leucine zipper regions and are inhibited by GBF-F. GBF-F also exhibits gain-of-function properties, since, with the essential cooperation of a C/EBP family member, it can transactivate a promoter containing the chimeric C/EBP/GBF site. This protein therefore has potential utility both as a dominant-negative inhibitor of C/EBP function and as an activator protein with novel DNA sequence specificity.     

Induction of a subgroup of acute phase protein genes in mouse liver by hyperthermia

We have demonstrated that two members of the acute phase reactant family of positively regulated genes, alpha 1-acid glycoprotein (AGP-1 and AGP-2) and C-reactive protein (CRP) are induced by hyperthermia, while two others, the serum amyloid A (SAA) and alpha 1-antitrypsin (AT) genes, are not. Albumin (ALB), a negative acute phase reactant gene, is also induced by hyperthermia. The AGP-1, AGP-2, and CRP genes require glucocorticoids, but not IL-6, IL-1 beta or TNF alpha in response to hyperthermia. As with LPS, the C/EBP beta mRNA levels increased, while the C/EBP alpha mRNA levels decreased in response to LPS. In contrast to the LPS response, C/EBP delta was unchanged. Protein pool levels and DNA-binding activities of the 35 and 20 kDa C/EBP beta isoforms increase, whereas protein pool levels of the 42 kDa C/EBP alpha decrease and the 30kDa remained high. These studies suggest that the synthesis of specific C/EBP alpha and C/EBP beta isoforms is induced by hyperthermia, and that the regulation of the AGP-1 and AGP-2 genes during heat stress may involve one of these isoforms. The difference between the responses to hyperthermia and LPS is that the former, may not involve the participation of cytokines. Furthermore, since cis-acting heat shock elements (HSE) are located in the promoter regions of the ALB, CRP, and C/EBP beta genes, these regulatory sequences may be involved in the in vivo activation of these genes by hyperthermia.     

A Predoctoral Field Placement in Primary Care: Keeping It Simple.

The supply of psychologists with clinical experience in primary care settings has not kept pace with the growing demand. Pre- and postdoctoral training opportunities in primary care are rare, in part, because of the administrative, cultural, and educational complexities associated with interdisciplinary training endeavors. The authors describe the development of a modest, half-day primary care placement that is offered as part of a predoctoral internship in child clinical psychology. They provide a model and recommendations for exposing trainees and other interested practitioners to the themes, culture, and clinical opportunities of primary care, while avoiding many of the logistical problems that can encumber such efforts. (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)     

A meta-systems approach to evidence-based practice for children and adolescents.

Improving outcomes for children and adolescents with mental health needs demands a broad meta-systemic orientation to overcome persistent problems in current service systems. Improving outcomes necessitates inclusion of current and emerging evidence about effective practices for the diverse population of youth and their families. Key components of the meta-system for children with emotional or behavioral needs include families, cultural norms and values, and service sectors such as schools, pediatric health centers, specialty mental health systems, juvenile justice systems, child protection services, and substance use treatment systems. We describe each component of the meta-system, noting challenges to the provision of evidence-based practice (EBP) and highlighting ways to optimize outcomes. Our focus is on the inclusion of evidence-based assessment and interventions, including prevention, within a developmentally driven and culturally responsive contextual model. Recommendations for addressing disparities in research funding and essential steps to foster communication and coordination of EBP across settings are provided. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Stepped care as a heuristic approach to the treatment of alcohol problems.

A stepped care approach to treatment decisions for alcohol problems consists of the application of decision rules derived from practice in other areas of health care. The treatment used should be (a) individualized, (b) consistent with the research literature and supported by clinical judgment, and (c) least restrictive but still likely to be successful. Used in this way, stepped care emphasizes serving the needs of clients efficiently but without sacrificing quality of care. Issues concerning stepped care are discussed, and the application of a stepped care approach to alcohol treatment services is described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)