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. The research to practice gap 2. Our causal model 3. Study design and measurements 4. Results 5. Limitations 6. Discussion and implications WWW.UPENN.EDU 2 12/7/2017 2
The research to practice gap The most common diagnoses in Systems are mandating or community mental health are encouraging evidence-based disruptive behavior disorders practices including the City of Philadelphia (Merikangas et al., 2011; Love et al., 2014) Few youth receive the evidence-based practice for disruptive behavior disorders (i.e., parent management training) in the community (Garland et al., 2010) WWW.UPENN.EDU 3 12/7/2017 3
The implementation science gap 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 WWW.UPENN.EDU 4 12/7/2017 4
Agenda 1. The research to practice gap 2. Our causal model 3. Study design and measurements 4. Results 5. Limitations 6. Discussion & Implications WWW.UPENN.EDU 5 12/7/2017 5
Our Causal Model Policy/ Federal Federal Organizational State State Environment City Attitudes Attitudes Agency Beliefs Beliefs Norms Intentions Behavior Norms Intentions Knowledge Knowledge Self-Efficacy Skill Self-Efficacy Skill Adapted from Azjen (1986, 1991) and Williams and Glisson (2013) WWW.UPENN.EDU 12/7/2017 6
Our piece of the puzzle Policy/ Federal Organizational State Environment Organizational District Attitudes (Proficient) Culture School Beliefs Norms Intentions Behavior Intentions Use of PMT Knowledge Self-Efficacy Skill WWW.UPENN.EDU 7 12/7/2017 7
Agenda 1. The research to practice gap 2. Our causal model 3. Study design and measurements 4. Results 5. Limitations 6. Discussion & Implications WWW.UPENN.EDU 8 12/7/2017 8
The City of Philadelphia WWW.UPENN.EDU 9 12/7/2017 9
Evidence-Based Practices 2016 2013 2007 2011 2011 2012 WWW.UPENN.EDU 10 12/7/2017 10
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Timing of Data Collection Time 1 Time 2 (2013) (2015) 22 agencies 19 agencies 28 sites 23 sites 247 therapists 130 therapists WWW.UPENN.EDU 12 12/7/2017 12
For this analysis • We focused on sites that were included in the sample at both time points (k = 20) • We included clinicians that reported on treating a client with an externalizing disorder at T2 (n = 103) WWW.UPENN.EDU 13 12/7/2017 13
2-1-1 Mediation Model x Control for: client age, client gender, org size Improvement in Proficient Culture Organization (T1 to T2) Level Clinician Level Intention to use Use of PMT PMT (T2) (T2) M Y WWW.UPENN.EDU 14 12/7/2017 14
Measures: Proficient Culture (X) • Organizational Social Context (Glisson et al., 2008) Members of my unit are expected to Responsiveness improve the well being of each client Members of my unit are expected to Competence have up to date knowledge WWW.UPENN.EDU 15 12/7/2017 15
Measures: Proficient Culture (X) Change from T1 to T2 Proficient Proficient Change in Culture T1 Culture T2 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 -7.61-43.52 16
Measures: Intentions to use PMT (M) “During at least one of the sessions, I intend to talk to the parent about strategies the parent can use to help manage the child’s behavior , such as natural and logical consequences, positive and negative reinforcement, and time- out .” 1(Strongly disagree)-7(Agree) WWW.UPENN.EDU 17 12/7/2017 17
Measures: Use of PMT (Y) • TPC-FR (Weersing et al., Using a point or token system to reward the child for good behavior 2002) Making up contract for child’s behavior Using time-out from reinforcement • Mean of 6 items that Trying to extinguish undesirable behavior by discontinuing rewards for that behavior capture PMT (alpha = .84) Parent training in child management techniques Administering rewards to increase positive behavior WWW.UPENN.EDU 18 12/7/2017 18
Agenda 1. The research to practice gap 2. Our causal model 3. Study design and measurements 4. Results 5. Limitations 6. Discussion & Implications WWW.UPENN.EDU 19 12/7/2017 19
2-1-1 Mediation Model Improvement in Proficient c’ = .03 Culture Organization (T1 to T2) Level a = .06* Clinician Intention to Level Use of PMT use PMT (T2) (T2) b = .31* ✔ ✔ a*b = .019 Asymmetric 95% CI = .002 to .044 Joint Significance Test = Sig. P m = .41 WWW.UPENN.EDU 20 12/7/2017 20
Agenda 1. The research to practice gap 2. Our causal model 3. Study design and measurements 4. Results 5. Limitations 6. Discussion & Implications WWW.UPENN.EDU 21 12/7/2017 21
Limitations • Temporality: would prefer all variables to be at different time points • Measurement • Self-reported use • Did not test other antecedents of intentions (e.g., self- efficacy) WWW.UPENN.EDU 22 12/7/2017 22
Agenda 1. The research to practice gap 2. Our causal model 3. Study design and measurements 4. Results 5. Limitations 6. Discussion & Implications WWW.UPENN.EDU 23 12/7/2017 23
Discussion & Implications 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. WWW.UPENN.EDU 24 12/7/2017 24
Thank You! rbeidas@upenn.edu @Rsbeidas www.cmhpsr.org/dr-rinad-beidas K23 MH099179 (Beidas); P50 MH 113840 (Beidas, Mandell, Volpp) WWW.UPENN.EDU 25 12/7/2017 25
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