to predict implementation of evidence-based practices in community - - PowerPoint PPT Presentation
Using psychological and organizational theories to predict implementation of evidence-based practices in community settings Rinad S. Beidas, PhD, Emily Becker-Haimes, PhD, & Nathaniel Williams, PhD WWW.UPENN.EDU 1 12/7/2017 1 Agenda 1.
Rinad S. Beidas, PhD, Emily Becker-Haimes, PhD, & Nathaniel Williams, PhD
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Few youth receive the evidence-based practice for disruptive behavior disorders (i.e., parent management training) in the community (Garland et al., 2010) The most common diagnoses in community mental health are disruptive behavior disorders
(Merikangas et al., 2011; Love et al., 2014)
Systems are mandating or encouraging evidence-based practices including the City of Philadelphia
In our work and others, we have found repeatedly that therapist and organizational factors are related to implementation of evidence-based practices. Now, we must answer how they are related. This presents an opportunity to do so.
Beidas et al., 2015; Wolk et al., 2016
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Adapted from Azjen (1986, 1991) and Williams and Glisson (2013)
Intentions Self-Efficacy Norms Attitudes Skill Beliefs Behavior Knowledge Agency City State Federal Policy/ Organizational Environment Intentions Self-Efficacy Norms Attitudes Skill Beliefs Knowledge State Federal
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Intentions Self-Efficacy Norms Attitudes Skill Beliefs Behavior Knowledge School District State Federal Policy/ Organizational Environment Use of PMT Organizational (Proficient) Culture Intentions
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2007 2011 2011 2012 2016 2013
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22 agencies 28 sites 247 therapists 19 agencies 23 sites 130 therapists
sample at both time points (k = 20)
client with an externalizing disorder at T2 (n = 103)
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Improvement in Proficient Culture (T1 to T2) Intention to use PMT (T2) Use of PMT (T2) Organization Level Clinician Level
Control for: client age, client gender, org size
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Responsiveness
Members of my unit are expected to improve the well being of each client
Competence
Members of my unit are expected to have up to date knowledge
Change from T1 to T2
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Proficient Culture T1 Proficient Culture T2 Change in Proficient Culture Mean 48.6 55.3 6.7 SD 13.1 9.4 13.5 Min-Max 12.5-66.8 26.0-70.1
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2002)
capture PMT (alpha = .84)
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Using a point or token system to reward the child for good behavior Making up contract for child’s behavior Using time-out from reinforcement Trying to extinguish undesirable behavior by discontinuing rewards for that behavior Parent training in child management techniques Administering rewards to increase positive behavior
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Improvement in Proficient Culture (T1 to T2) Intention to use PMT (T2) Use of PMT (T2) Organization Level Clinician Level
a = .06* b = .31*
a*b = .019 Joint Significance Test = Sig.
c’ = .03
Asymmetric 95% CI = .002 to .044 Pm = .41
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different time points
efficacy)
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A seemingly distal non-implementation specific organizational factor, improvement in proficient culture, was related to PMT use via a clinician variable (intentions); thus elucidating potential targets for implementation strategies. Future studies should unpack the relationship between proficient culture (and other organizational variables) and antecedents of intention as well as the potential moderating role of organizational factors. Future models should include client factors as potential moderators between intentions and behavior.
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