Psychiatry and Behavioral Sciences
Transportability & Dissemination
45. Schoenwald, S.K., & Henggeler, S.W. (2002). Services research and family based treatment. In H. Liddle, G. Diamond, R. Levant, J. Bray, & D. Santisteban (Eds.), Family psychology intervention science. Washington, DC: American Psychological Association.
211. Schoenwald, S.K., Hoagwood, K., (2001). Effectiveness, transportability, and dissemination of interventions: What matters when? Journal of Psychiatric Services, 52 (9), 1190-1197.
215. Henggeler, S.W. , Schoenwald, S.K., Liao, J.G., Letourneau, E.J., Edwards, D.L. (2002). Transporting efficacious treatments to field settings: The link between supervisory practices and therapist fidelity in MST programs. Journal of Child and Adolescent Psychology, 31 (2), 155-167.
216. Hoagwood, K., Burns, B.J., Kiser, L., Ringeisen, H., Schoenwald, S.K. (2001). Evidence-based practice in child and adolescent mental health services. Journal of Psychiatric Services, 52 (9), 1179-1189.
222. Henggeler, S.W., Lee, T., & Burns, J.A. (2002). What happens after the innovation is identified? Clinical Psychology: Science and Practice, 9, 191-194.
235. Schoenwald, S.K., Sheidow, A.J., Letourneau, E.J., & Liao, J.G. (2003). Transportability of multisystemic therapy: evidence for multi-level influences. (2003) Mental Health Service Research, 5 (4), 223-239.
242. Schoenwald, S.K., Sheidow, A.J., & Letourneau, E.J., (2004). Toward effective quality assurance in evidence-based practice: Links between expert consultation, therapist fidelity and child outcomes. Journal of Clinical Child and Adolescent Psychology, 33 (1), 94-104.
244. Schoenwald, S.K., Halliday-Boykins , C.A. , & Henggeler, S.W., (2003). Client-level predictors of adherence to MST in community service settings. Family Process, 42 (3), 345-359.
245. Schoenwald, S.K., & Henggeler, S.W. (2003). Current strategies for moving evidence-based interventions into clinical practice: Introductory comments. Cognitive and Behavioral Practice, 10, 275-277.
248. Ogden, T., & Halliday-Boykins, C, A. (2004). Multisystemic treatment of antisocial adolescents in Norway : Replication of clinical outcomes outside of the US . Child and Adolescent Mental Health, 9(2), 77-83.
257. Schoenwald, S.K., Henggeler, S.W. (2004). A public health perspective on the transport of evidence-based practices. Clinical Psychology: Science and Practice, V11 N4, 360-363.
264. Ogden, T., & Hagen , K.A. (2006). Multisystemic therapy of serious behavior problems in youth: Sustainability of therapy effectiveness two years after intake. Child and Adolescent Mental Health, 11 (3), 142-149.
276. Schoenwald, S.K., Letourneau, E.J., Halliday-Boykins, C.A. (2005). Predicting therapist adherence to a transported family-based treatment for youth. Journal of Clinical Child and Adolescent Psychology, 34 (4), 658-670.
284. Glisson, C., & Schoenwald, S.K. (2005). The ARC organizational and community intervention strategy for implementing evidence-based children’s mental health treatments. Mental Health Services Research, 7(4), 243-259.
291. Timmons-Mitchell, J., Bender, M.B., Kishna, M.A., & Mitchell, C.C. (2006). An independent effectiveness trial of multisystemic therapy with juvenile justice youth. Journal of Clinical Child and Adolescent Psychology, 35(2), 227-236.
293. Sheidow, A.J., Schoenwald, S.K., Wagner, H.R., Allred, C. A., & Burns, B.J. (2006). Predictors of workforce turnover in a transported treatment program. Administration and Policy in Mental Health and Mental Health Services Research, 1, 1-12.
298. Henggeler, S.W., Chapman, J.E., Rowland, M.D., Halliday-Boykins, C.A., Randall, J., Shackelford, J., Schoenwald, S.K. (2007). If you build it, they will come: Statewide practitioner interest in contingency management for youths. Journal of Substance Abuse Treatment, 32(2), 121-131.
301. Saldana, L., Chapman, J.E., Henggeler, S.W., Rowland, M.D. (2007). The organizational readiness for change scale in adolescent programs: Criterion validity. Journal of Substance Abuse Treatment, 33, 159-169.
307. Schoenwald, S.K., Kelleher, K., Weisz, J., & The Research Network on Youth Mental Health (2008). Building bridges to evidence-based practice: The macArthur foundation child system and treatment enhancement projects (child steps). Administration and Policy in Mental Health and Mental Health Services Research, 35(1), 66-72.
308. Schoenwald, S.K., Chapman, J.E., Kelleher, K., Hoagwood, K.E., Landsverk, J., Stevens, J., Glisson, C., Rolls-Reutz, J., & The Research Network on Youth Mental Health (2008). A survey of the infrastructure for children's mental health services: Implications for the implementation of empirically supported treatments (ESTs). Administration and Policy in Mental Health and Mental Health Services Research, 35(1), 84-97.
309. Glisson, C., Schoenwald, S.K., Kelleher, K., Landsverk, J., Hoagwood, K.E.,Mayberg, S., Green, P., and The Research Network on Youth Mental Health (2008). Assessing the organizational social context (osc) of mental health services: Implication for research and practice. Administration and Policy in Mental Health and Mental Health Services Research, 35(2), 124-133.
310. Glisson, C., Landsverk, J., Schoenwald, S.K., Kelleher, K., Hoagwood, K.E.,Mayberg, S., Green, P., and The Research Network on Youth Mental Health (2008). Therapist turnover and new program sustainability in mental health clinics as a function of organizational culture, climate, and service structure. Administration and Policy in Mental Health and Mental Health Services Research, 35 (1-2), 98-113.
311. Hoagwood, K.E., Green, E., Kelleher, K., Schoenwald, S. K., Rolls-Reutz, J., Landsverk, C., Glisson, S., Mayberg, S., and The Research Network on Youth Mental Health (2008). Family advocacy, support and education in children’s mental health: Results of a national survey. Administration and Policy in Mental Health and Mental Health Services Research, 35(1), 73-83.
323. Schoenwald, S.K. (2008). Toward evidence-based transport of evidence-based treatments: MST as an example. Journal of Child and Adolescent Substance Abuse, 17(3), 69-91.
326. Schoenwald, S.K., Carter, R.E., Chapman, J.E., and Sheidow, A.J. (2008). Therapist adherence and organizational effects on change in youth behavior problems one year after multisystemic therapy. Administration and Policy in Mental Health and Mental Health Services Research, 35, 379-394.
327. Palinkas, L.A., Schoenwald, S.K., Hoagwood, K., Landsverk, J., Chorpita, B.F., Weisz, J.R., and the Research Network on Youth Mental Health (2008). An ethnographic study of implementation of evidence-based practice in child mental health: First steps. Psychiatric Services, 59, 738-746.
329. Henggeler, S. W., Chapman, J. E., Rowland, M. D., Halliday-Boykins, C. A., Randall, J., Shackelford, J., Schoenwald, S.K. (2008). Statewide adoption and initial implementation of contingency management for substance-abusing adolescents. Journal of Consulting and Clinical Psychology, 76(4), 556-567.
332. Henggeler, S.W., Sheidow, A.J., Cunningham, P.B., Donohue, B.C., & Ford, J.D. (2008). Promoting the implementation of an evidence-based intervention for adolescent marijuana abuse in community settings: Testing the use of intensive quality assurance. Journal of Clinical Child & Adolescent Psychology, 37(3), 682-689.
337. Schoenwald, S.K., Chapman, J.E., Sheidow, A.J., & Carter, R.E. (2009). Long-term youth criminal outcomes in MST transport: The impact of therapist adherence and organizational climate and structure. Journal of Clinical Child & Adolescent Psychology, 38(1), 91–105.
344. Schoenwald, S.K., Sheidow, A.J., & Chapman, J.E. (2009). Clinical supervision in treatment transport: Effects on adherence and outcomes. Journal of Consulting and Clinical Psychology, 77, 410-421.
348. Ogden, T., & Hagen, K.A. (2009). What works for whom? Gender differences in intake characteristics and treatment outcomes following multisystemic therapy. Journal of Adolescence, 1-11.
356. Schoenwald, S.K. (2010). From policy pinball to purposeful partnership. In J.R. Weisz & A.E. Kazdin (Eds.), Evidence-based psychotherapies for children and adolescents, 2nd edition (pp.538-553). New York: Guilford Press.
381. Glisson, C., Schoenwald, S. K., Hemmelgarn, A., Green, P., Dukes, D., Armstrong, K. S., Chapman, J. E. (2010). Randomized trial of MST and ARC in a two-level Evidence-Based treatment implementation strategy. Journal of Consulting and Clinical Psychology, 78(4), 537-550.
392. Schoenwald, S. K., Garland, A. F., Chapman, J. E., Frazier, S. L., Sheidow, A. J., Southam-Gerow, M. A. (2011). Toward the effective and efficient measurement of implementation fidelity. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 32-43.
393. Schoenwald, S. K. (2011). It’s a bird, it’s a plane, it’s . . . fidelity measurement in the real world. Clinical Psychology: Science and Practice, 18, 142-147.
397. Holth, P., Torsheim, T., Sheidow, A. J., Ogden, T., Henggeler, S. W. (2011). Intensive quality assurance of therapist adherence to behavioral interventions for adolescent substance use problems. Journal of Child and Adolescent Substance Abuse, 20, 289-313.
400. Schoenwald, S. K., Garland, A. F., Southam-Gerow, M. A., Chorpita, B. F., & Chapman, J. E. (2011). Adherence Measurement in treatments for disruptive behavior disorders: Pursuing clear vision through varied lenses. Clinical Psychology Science and Practice, 18(4), 331-341.
401. Schoenwald, S. K., Chapman, J. E., Henry, D. B., & Sheidow, A. J. (2012). Taking effective treatments to scale: Organizational effects on outcomes of multisystemic therapy for youths with co-occurring substance use. Journal of Child and Adolescent substance Abuse, 21(1), 1-31.
409. Schoenwald, S.K., McHugh, R. K., & Barlow, D. H. (2012) The science of dissemination and implementation. In McHugh, R. K. & Barlow, D. H (Eds.), Dissemination and implementation of evidence-based psychological interventions (pp. 16-42). New York, Oxford University Press.
410. Schoenwald, S.K. (2012) The transport and diffusion of multisystemic therapy. In McHugh, R. K. & Barlow, D. H (Eds.), Dissemination and implementation of evidence-based psychological interventions (pp. 227-246). New York, Oxford University Press.
416. Ogden, T., Bjornebekk, G., Kjobli, J., Patras, J., Christiansen, T., Taraldsen, K., & Tollefsen, N. (2012). Measurement of implementation components ten years after a nationwide introduction of empirically supported programs – a pilot study. Implementation Science, 7:49.
422. McCart, M. R., Henggeler, S. W., Chapman, J. E., & Cunningham, P. B. (2012). System-level effects of integrating a promising treatment into juvenile drug courts. Journal of Substance Abuse Treatment, 43, 231-243.
The authors identify and define key aspects of the progression from research on the efficacy of a new intervention to its dissemination. They highlight the role of transportability questions that arise in that progression and illustrate key conceptual and design features that differentiate efficacy, effectiveness, and dissemination research. An ongoing study of the transportability of multisystemic therapy is used to illustrate independent and interdependent aspects of effectiveness, transportability, and dissemination studies. Variables relevant to the progression from treatment efficacy to dissemination include features of the intervention itself as well as variables pertaining to the practitioner, client, model of service delivery, organization, and service system. The authors provide examples of how some of these variables are relevant to the transportability of different tytpes of interventions. They also discuss sample research questions, study design, and challenges to be anticipated in the arena of transportability research.
Validated a measure of clinical supervision practices, further validated a measure of therapist adherence, and examined the association between supervisory practices and therapist adherence to an evidence-based treatment model (i.e., multisystemic therapy [MST]) in real-world clinical settings. Evidence of linkages between supervisor adherence to the MST supervisory protocol, as assessed through therapist reports, and therapist adherence to MST principles, as assessed through caregiver reports, was obtained from 285 families of youths presenting serious clinical problems, and 74 therapists and 12 supervisors of 16 teams in 9 organizations providing MST across 3 states. The findings provide a valuable step in examining the determination of therapist fidelity to complex treatments in real-world clinical settings.
The authors review the status, strength, and quality of evidence-based practice in child and adolescents mental health services. The definitional criteria that have been applied to the evidence base differ considerably across treatments, and these definitions circumscribe the range, depth, and extensionality of the evidence. The authors describe major dimensions that differentiate evidence-based practices for children from those for adults and summarize then status of the scientific literature on a range of service practices. The readiness of the child and adolescent evidence base for large-scale dissemination should be viewed with healthy skepticism until studies of the fit between empirically based treatments and the context of service delivery have been undertaken. Acceleration of the pace at which evidence-based practices can be more readily disseminated will require new models of development of clinical services that consider the practice setting in which the service is ultimately to be delivered. (Psychiatric Services 52:1179-1189, 2001)
Although the identification of efficacious and effective mental health treatments represents a potentially important synthesis of research literatures, such identification is but a first step in the transport of evidence-based treatments to field settings. Based on multidisciplinary research on the diffusion of innovation articulated by Rogers, this commentary briefly describes characteristics of the innovation and of the social system that may influence the adoption of mental health innovations.
Key words: evidence-based practices, dissemination of innovation, evidence-based treatments, program improvement, mental health innovations. [Clin Psuchol Sci Prac 9:191-194, 2002]
This study examined the association of youth and family characteristics with therapist fidelity to an evidence-based treatment provided in real world practice settings. Participants were 233 families that reported on the 66 therapists organized into 16 teams in nine organizations providing Multisystemic therapy (MST). Therapist adherence ratings were lower for youths referred for both criminal offenses and substance abuse than for youths referred either for substance abuse or status offenses, and was negatively associated with pretreatment arrests and school suspensions. Adherence ratings were positively associated with educational disadvantage and caregiver-therapist ethnic match and marginally positively associated with economic disadvantage. The findings suggest directions for future research on the implementation of evidence-based treatments in community settings.
This special section presents four evidence-based practices that are currently being transported to community-based settings: Nurse-Family Partnership for infant health and development, Assertive Community Treatment for adults with serious and persistent mental illness. Oregon Therapeutic Foster Care for chronic juvenile offenders, and Parenting Wisely for caregivers of children with disruptive behavior: Although each model addresses a very different clinical population, their similarities in development, emphasis on fidelity and quality assurance, and use of dedicated organizations to support effective transport are noteworthy. Admirably, the intervention developers are taking the same care in crafting strategies to transport their models as they took in validating these clinical innovations. Such care is critical to increasing the probability that the intervention models will be transported to community settings with the fidelity needed to achieve intended outcomes.
Background: MST is an intensive home- and community-based intervention for youths with serious antisocial behavior and other serious clinical problems that has been effective at reducing out-of-home placements and producing favorable long-term clinical outcomes in the U.S. The aims of the study were to determine the degree to which these outcomes would be replicated in Norway for youths with serious behavior problems and to conduct a randomized trial of MST by an independent team of investigators.
Method: Participants were 100 seriously antisocial youths in Norway who were randomly assigned to Multisystemic Therapy (MST) or usual Child Welfare Services (CS) treatment conditions. Data were gathered from youths, parents, and teachers pre- and post-treatment.
Results: MST was more effective than CS at reducing youth internalizing and externalizing behaviors and out-of-home placements, as well as increasing youth social competence and family satisfaction with treatment.
Discussion: This is the first study of MST outside of the US and one of the first not conducted by the developers of MST. The findings replicate those obtained by MST's developers and demonstrate the generalisability of short-term MST effects beyond the US.
264. Multisystemic therapy of serious behavior problems in youth: Sustainability of therapy effectiveness two years after intake
Method: Participants were 75 adolescents who were randomly assigned to MST or Regular Child Welfare Services (RS) at 4 sites across Norway. Data were gathered from youths, caregivers and teachers.
Results: MST was more effective than RS in reducing out of home placement and behavioral problems including internalizing and externalizing behaviour.
Discussion: The sustainability of MST effects was evident, supporting the MST approach to therapy of serious behavioral problems in youth. Site differences and the moderating effects of age and gender are discussed.
Key words: Serious behavior problems, Multisystemic Therapy, Follow up study
This study examined relations between therapist, caregiver, and youth characteristics and therapist adherence to multisystemic therapy (MST). Participants were 405 therapists in 45 organizations and the 1,711 families they treated with MST. Therapist perceptions that the flexible hours required to implement MST are problematic predicted lower adherence. Therapist demographic variables, professional training and experience, endorsement of the MST model, perceived difficulty and rewards of doing MST, and perceived similarity of treatments previously used did not predict adherence. Therapist-caregiver similarity on ethnicity and gender predicted higher adherence. Low caregiver education and African American ethnicity predicted higher adherence. With the exception of youth psychosocial functioning, indicators of severity of youth problems did not predict adherence.
This paper reviews the implications of organizational and community intervention research for the implementation of effective mental health treatments in usual community practice settings. The paper describes an organizational and community intervention model named ARC for Availability, Responsiveness and Continuity, that was designed to support the improvement of social and mental health services for children. The ARC model incorporates intervention components from organizational development, interorganizational domain development, the diffusion of innovation, and technology transfer that target social, strategic, and technological factors in effective children's services. This paper also describes a current NIMH-funded study that is using the ARC intervention model to support the implementation of an evidence-based treatment, Multisystemic Therapy (MST), for delinquent youth in extremely rural, impoverished communities in the Appalachian Mountains of East Tennessee.
Keywords: evidence-based practices - organizational change - community development -delinquency - rural mental health.
This study examined relations between workforce turnover and select clinician (demographic and professional characteristics and perceptions of treatment model features and job requirements) organizational (perceptions of organizational climate and structure) and program level (salary, case mix) variables in a sample of 453 clinicians across 45 organizations participating in a transportability study of an empirically supported adolescent treatment (i.e., MST). At 20% annually, turnover was lower than in the national mental health workforce (i.e., 50-60%). Clinician demographic, professional background, and perceptions of the treatment model and demands did not predict turnover. Perceptions of an emotionally demanding organizational climate, program salary level, and program case mix of youth did predict turnover.
Key words: transported treatment, dissemination, evidence-based treatment, empirically supported treatment, workforce turnover
Addressing the science–service gap, we examined in this study the amenability of a large heterogeneous sample of community-based therapists in the state mental health and substance abuse treatment sectors to learn about an evidence-based practice (EBP) for adolescent substance abuse (i.e., contingency management [CM]) when such learning was supported administratively and logistically. Leadership in most (44 of 50) public sector agencies supported practitioner recruitment, and 432 of 543 eligible practitioners subsequently attended a 1-day workshop in CM. Workshop attendance was predicted by organizational factors but not by practitioner demographic characteristics, professional background, attitudes toward EBPs, or service sector. Moreover, the primary reason for workshop attendance was to improve services for adolescent clients; the primary barriers to attendance, for those who did not attend, were practical in nature and not due to theoretical incompatibility. The findings demonstrate a considerable amount of interest practitioners showed in both the substance abuse and mental health sectors in learning about an EBP.
This study examined the convergent validity and concurrent validity of the Organizational Readiness for Change (ORC; Lehman WEK, Greener JM, Simpson DD, 2002. Assessing organizational readiness for change. Journal of Substance Abuse Treatment. 22 197-210) scale among practitioners who treat adolescents. Within the context of a larger study, we administered the ORC scale and measures of practitioner attitudes toward evidence-based practices as well as treatment manuals to a heterogeneous sample of 543 community-based therapists in the state mental health and substance abuse treatment sectors. Using a contextual random-effects regression model, the association between ORC scale domains and measures of practitioner characteristics and attitudes were examined at both therapist and agency levels. The results support the convergent validity and concurrent validity of several domains. Namely, the domains focusing on motivational readiness and training needs were associated with higher appeal and openness to innovations. Those on program resources and climate were less related, however. Our discussion focuses on the utility of the ORC scale in helping evaluate the needs of programs considering the adoption of evidence-based practices.
The papers in this special issue describe research undertaken by the MacArthur Foundation-funded Research Network on Youth Mental Health. The project is designed to understand the challenges of implementing evidence-based treatments in community-based mental health practices. This Introduction and the following articles describe the impetus and conceptual framework underlying one cluster of the Network's activity-i.e., the Clinic Systems Project (CSP). The CSP studies examined the organizational and service system environments in a large national sample of community mental health and affiliated organizations that provide services to children. The main goal is to identify leverage points for, and barriers to, the adoption and implementations of evidence-based practices for children.
A structured interview survey of directors of a large national sample (n=200) of mental health service organizations treating children examined the governance, financing, staffing, services, and implementation practices of these organizations; and, director ratings of factors important to implementation of new treatments and services. Descriptive analyses showed private organizations financing services with public (particularly Medicaid) funds are prevalent and that employment of professional staff, clinical supervision and training, productivity requirements, and outcomes monitoring are common. Results of random effects regression models (RRMs) evaluating associations between governance, financing, and organizational characteristics and the use of new treatments and services showed for-profit organizations more likely to implement such treatments, and organizations with more licensed clinical staff and weekly clinical supervision in place less likely to do so. Results of RRMs evaluating relations between director ratings of the importance to new treatment and service implementation of three factors-fit with existing implementation practices, infrastructure support, and organizational mission and support-suggest greater importance to public than private organizations of these factors. Implications for EST implementation and future research are described.
The organizational social context in which mental health services are proviced is believed to affect the adoption and implementation of evidence-based practices (EBPs) as well as the quality and outcomes of the services. A fully developed science of implementation effectiveness requires conceptual models that include organizational social context and tools for assessing social context that have been tested in a broad cross-section of mental health system. This paper describes the role of organizational social context in services and implementation research and evaluates a comprehensive contextual measure, labeled Organizational Social Context (OSC), designed to assess the key latent constructs of culture, climate and work attitudes. The psychometric properties of the OSC measure were assessed in a nationwide study of 1,154 clinicians in 100 mental health clinics with a second-order confirmatory factor analysis of clinician responses, estimates of scale reliabilities, and indices of within-clinic agreement and between-clinic differences among clinicians. Finally, the paper illustrates the use of nationwide norms in describing the OSC profiles of individual mental health clinics and examines the cross-level association of organizational-level culture and climate with clinician-level work attitudes.
The present study incorporates organizational theory and organizational characteristics in examining issues related to the successful implementation of mental health services. Following the theoretical foundations of socio-technical and cultural models of organizational effectiveness, organizational climate, culture, legal and service structures, and workforce characteristics are examined as correlates of therapists turnover and new program sustainability in a nationwide sample of mental health clinics. Results of General Linear Modeling (GLM) with the organization as the unit of analysis revealed that organizations with the best climates as measured by the Organizational Social Context (OSC) profiling system, had annual turnover rates (10%) that were less than half the rates found in organizations with the worst climates (22%). In addition, organizations with the best culture profiles sustained new treatment or service programs over twice as long (50 vs. 24 months) as organizations with the worst cultures. Finally, clinics with separate children's services units had higher turnover rates than clinics that served adults and children within the same unit. The findings suggest that strategies to support the implementation of new mental health treatments and services should attend to organizational culture and climate, and to the compatibility of organizational service structures with the demand characteristics of treatments.
In conjunction with the national survey of mental health service organizations (Schoenwald et al. this issue), a separate but complementary national survey was conducted of family advocacy, support and education organizations (FASEOs). Directors of FASEOs within the same localities as the mental health agencies responded to a survey and provided information in four areas: (1) structure and funding; (2) factors influencing advocacy decisions about children's mental health; (3) types of services provided by FASEOs and factors perceived as related to improved outcomes; and (4) the types of working relationships between FASEOs and local mental health clinics. Findings from a total of 226 (82% response rate) portray a network of family advocacy, support and eduction organizations that are strategically poised to effect substantive change and characterized by significant fiscal instability. Results from this survey and implications for delivery of family-based services are provided.
This article describes the journey toward evidence-based transport and implementation in usual care settings of Multisystemic Therapy (MST) for youth with drug abuse and behavioral problems (Henggeler, Schoenwald, Bordium, Rowland, & Cunningham, 1998). Research and experience informing the design of the design of the MST transport strategy, progress in evaluating its viability and validity, and implications for future research are described. Findings from transportability research indicated that the MST transport strategy supports the cultivation of therapist, supervisor, and consultant adherence in usual care settings; that such adherence is a consistent predictor of short-and long-term outcomes in such settings; and that clinician and organizational factors also affect adherence and outcomes. These findings have important implications for the transport of other evidence-based practices to usual care settings.
The current study investigated the relations among therapist adherence to an evidence-based treatment for youth with serious antisocial behavior (i.e., Multisystemic Therapy), organizational climate and structure, and improvement in youth behavior problems one-year post treatment. Participants were 1979 youth and families treated by 429 therapists across 45 provider organizations in North America. Hierarchical Linear Modeling (HLM) results showed therapist adherence predicted improvement in youth behavior. Two structure variables and one climate variable also predicted therapist adherence. No statistical support for formal mediation of organizational effects through adherence was found, though examination of changes in parameter estimates suggest a possible interplay of organizational climate with adherence and youth behavior change.
The experiences of clinicians in regard to initial and long-term intention to use evidence-based treatments were examined in order to better understand factors involved in implementation of innovative treatments. Ethnographic methods of participant observation and extended semistructured interviews with four trainers, six clinical supervisors, and 52 clinicians at five agencies in Honolulu and six in Boston were used to understand treatment implementation in the Clinic Treatment Project, a randomized effectiveness trial of evidence-based treatments for depression, anxiety, and conduct problems of children. Grounded-theory analytic methods were used to analyze field notes, interview transcripts, and meeting minutes. Three patterns were perceived to be associated with three preimplementation factors: lag time between initial training in the treatment protocol and treatment use in practice, clinician engagement with the project, and clinician-treatment fit. Four additional factors were proximal outcomes of the three determinants as well as first steps of implementation: clinicians' first impressions of the evidence-based treatments after initial use, competence in treatment use, clinician and researcher adaptability, and clinician-researcher interactions. Interactions between preimplementation factors and initial implementation experiences and between researchers and clinicians during the early implementation steps were related to intentions to sustain treatment.
Four hundred thirty-two public sector therapists attended a workshop in contingency management (CM) and were interviewed monthly for the following 6 months to assesss their adoption and initial implementation of CM to treat substance-abusing adolescent clients. Results showed that 58 % (n= 225) adopted CM. Rates of adoption varied with therapist service sector (mental health vs. substance abuse), educational background, professional experience, and attitudes toward treatment manuals and evidence-based practices. Competing clinical priorities and client resistance were often reported as barriers to adopting CM, whereas unfavorable attitudes toward and difficulty in implementing CM were rarely cited as barriers. The fidelity of initial CM implementation among adopters was predicted by organizational characteristics. Overall, the findings support the amenability of public sector practitioners to adopt evidence-based practices and suggest that the predictors of adoption and initial implementation are complex and multifaceted.
The development and evaluation of effective strategies for transporting evidence-based practices to community-based clinicians has become a research and policy priority. Using multisystemic therapy programs as a platform, an experimental design examined the capacity of an Intensive Quality Assurance (IQA) system to promote therapist implementation of contingency management (CM) for adolescent marijuana abuse. Participants included 30 therapists assigned to Workshop Only (WSO) versus IQA training conditions, and 70 marijuana-abusing youths and their caregivers who were treated by these clinicians. Analyses showed that IQA was more effective than WSO at increasing practitioner implementation of CM cognitive-behavioral techniques in the short-term based on youth and caregiver reports, and these increases were sustained based on youth reports. On the other hand, IQA did not increase therapist use of CM monitoring techniques relative to WSO, likely because of an unanticipated ceiling effect. Both sets of findings contribute to the emerging literature on the transport of evidence-based practice to real-world clinical settings.
This study investigated relations among therapist adherence to an evidence-based treatment for youth with serious antisocial behavior (i.e., Multisystemic Therapy), organizational climate and structure, and youth criminal charges on average 4 years posttreatment. Participants were 1,979 youth and families treated by 429 therapists across 45 provider organizations. Results showed therapist adherence predicted significantly lower rates of youth criminal charges independently and in the presence of organizational variables. Therapist perceptions of job satisfaction and opportunities for growth and advancement relative to the organizational average predicted youth criminal charges, as did organizational average levels of participation in decision making. These associations washed out in the presence of adherence, despite the fact that job satisfaction and growth and advancement were associated with adherence.
This nonexperimental study used mixed-effects regression models to examine relations among supervisor adherence to a clinical supervision protocol, therapist adherence, and changes in the behavior and functioning of youths with serious antisocial behavior treated with an empirically supported treatment (i.e., multisystemic therapy [MST]) 1 year posttreatment. Participants were 1,989 youths and families treated by 429 clinicians across 45 provider organizations in North America. Four dimensions of clinical supervision were examined. Mixed-effects regression model results showed that one dimension, supervisor focus on adherence to treatment principles, predicted greater therapist adherence. Two supervision dimensions, Adherence to the Structure and Process of Supervision and focus on Clinician Development, predicted changes in youth behavior. Conditions required to test hypothesized mediation by therapist adherence of supervisor adherence effects on youth outcomes were not met. However, direct effects of supervisor and therapist adherence were observed in models including both of these variables.