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

David Mandell, ScD, Kelsie Okamura, PhD, & Jessica Fishman, PhD

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12/7/2017 1 WWW.UPENN.EDU

Implementation science is the study

• f adult behavior change.

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https://performancegrapevine.com/2014/02/09/to-get-your-team-to-embrace-change-reverse-the-alphabet/

Great frameworks of factors affecting implementation

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Damschroder et al., 2009

These factors must act on practitioner to affect implementation or directly on population to affect outcomes

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A modest proposal

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Use of EBP Intentions Organization Culture and Climate

Williams & Glisson, 2014

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Azjen, 1991)

Psychological variables

Intention I am willing to [perform this EBP]. Strongly Disagree __:__:__:__:__:__:__ Strongly Agree Attitude [Performing this EBP] would be: Good__:__:__:__:__:__ :__Bad Pleasant __:__:__:__:__:__ :__ Unpleasant Beneficial __:__:__:__:__:__ :__Harmful Enjoyable __:__:__:__:__:__ :__ Unenjoyable Wise __:__:__:__:__:__ :__Foolish Perceived Norms Most people who are important to me think I should [perform this EBP]. Strongly Disagree__:__:__:__:__:__ :__Strongly Agree Most teachers who are like me [perform this EBP]. Strongly Disagree__:__:__:__:__:__ :__Strongly Agree Self-efficacy/ Perceived Control If I really wanted to, I could [perform this EBP]. Strongly Disagree__:__:__:__:__:__ :__Strongly Agree [Performing this EBP] is completely up to me. Strongly Disagree__:__:__:__:__:__ :__Strongly Agree

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Azjen, 1991)

Our Causal Model

Adapted from Azjen (1986, 1991) and Williams and Glisson (2014)

Intentions Self-Efficacy Norms Attitudes Skill Beliefs Behavior Knowledge Org City State Federal Policy/ Organizational Environment

12/7/2017 9 WWW.UPENN.EDU

Intentions Self-Efficacy Norms Attitudes Skill Beliefs Behavior Knowledge Org City State Federal Policy/ Organizational Environment

Our Causal Model

What Behavior? See for example: Reding et al., 2014; Stirman-Wilson et al., 2016

EBP comprise complex repertoires

Cognitive Behavioral Therapy

• Cognitive restructuring
• Exposure
• Behavioral activation
• Problem-solving
• Agenda setting
• Homework
• Data collection

Beh Interventions for Autism

• Praise to behavior correction

ratio

• Token economy
• Visual schedules
• One-to-one interventions like

discrete trial training or pivotal response training

• Data collection

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Autism support teacher's intentions to use these practices

0% 10% 20% 30% 40% 50% 60% 70% positive reinforcement schedules

• ne-to-one instruction

data collection

Strongly agree Strongly agree Fishman et al, in press Strongly agree Strongly agree

Logistic regression predicting use of schedules

Adjusted Odds Ratio Each additional year of autism teaching experience 1.0 Each additional student in the classroom 1.0 Each additional support staff in the classroom 0.4 Teacher was trained in using schedules (y/n)

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Teacher strongly agrees with the statement, “I intend to use visual/verbal schedules individualized for each student every day during the next four weeks”

5.2

Autism support teacher's intentions to use these practices

Fishman et al, in press Pedagogy Resources Staffing

0% 10% 20% 30% 40% 50% 60% 70% positive reinforcement schedules

• ne-to-one instruction

data collection

Attitudes

Still many things to work out

Adapted from Azjen (1986, 1991) and Williams and Glisson (2014)

Intentions Self-Efficacy Norms Attitudes Skill Beliefs Behavior Knowledge Org City State Federal Policy/ Organizational Environment

12/7/2017 15 WWW.UPENN.EDU

Still many things to work out

Intentions Self-Efficacy Norms Attitudes Skill Beliefs Behavior Knowledge Org City State Federal Policy/ Organizational Environment

12/7/2017 16 WWW.UPENN.EDU

Two Tests

Beidas et al. Locke et al.

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12/7/2017 18 WWW.UPENN.EDU

Thank You!

mandelld@upenn.edu @dsmandell www.cmhpsr.org/dr-david-mandell

P50MH113840 · R01MH106175 · R21MH106887