Palinkas Lawrence A, Um Mee Young, Jeong Chung Hyeon, Chor Ka Ho Brian, Olin Serene, Horwitz Sarah M, Hoagwood Kimberly E
Department of Children, Youth and Families, Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, United States of America.
Chapin Hall at the University of Chicago, Chicago, IL, United States of America.
Health Res Policy Syst. 2017 Mar 29;15(1):27. doi: 10.1186/s12961-017-0190-z.
This study examined how mental health clinic administrators decided whether or not to adopt evidence-based and other innovative practices by exploring their views of implementation barriers and facilitators and operation of these views in assessment of implementation costs and benefits.
Semi-structured interviews were conducted with 75 agency chief executive officers and program directors of 34 New York State-licensed mental health clinics serving children and adolescents.
Three interconnected themes relating to barriers and facilitators were identified, namely costs and benefits associated with adoption, capacity for adoption, and acceptability of new practices. The highest percentage of participants (86.7%) mentioned costs as a barrier, followed by limited capacity (55.9%) and lack of acceptability (52.9%). The highest percentage (82.3%) of participants identified available capacity as a facilitator, followed by acceptability (41.2%) and benefits or limited costs (24.0%). Assessment of costs and benefits exhibited several principles of behavioural economics, including loss aversion, temporal discounting use of heuristics, sensitivity to monetary incentives, decision fatigue, framing, and environmental influences.
The results point to opportunities for using agency leader models to develop strategies to facilitate implementation of evidence-based and innovative practices for children and adolescents.
本研究通过探讨心理健康诊所管理人员对实施障碍和促进因素的看法以及这些看法在实施成本和效益评估中的作用，考察了他们如何决定是否采用循证及其他创新实践。
对纽约州34家为儿童和青少年提供服务的持牌心理健康诊所的75名机构首席执行官和项目主任进行了半结构化访谈。
确定了与障碍和促进因素相关的三个相互关联的主题，即采用相关的成本和效益、采用能力以及新实践的可接受性。提及成本作为障碍的参与者比例最高（86.7%），其次是能力有限（55.9%）和缺乏可接受性（52.9%）。提及可用能力作为促进因素的参与者比例最高（82.3%），其次是可接受性（41.2%）和效益或有限成本（24.0%）。成本和效益评估体现了行为经济学的若干原则，包括损失厌恶、时间贴现、启发式方法的使用、对货币激励的敏感性、决策疲劳、框架效应和环境影响。
研究结果指出了利用机构领导者模式制定策略以促进儿童和青少年循证及创新实践实施的机会。
