Motamedi Mojdeh, Lau Anna S, Lind Teresa, Lui Joyce Hl, Rodriguez Adriana, Smith Ashley, Brookman-Frazee Lauren
Department of Psychiatry, University of California San Diego, La Jolla, CA, USA.
Child and Adolescent Services Research Center, San Diego, CA, USA.
Implement Res Pract. 2021 Jan 28;2:2633489520982903. doi: 10.1177/2633489520982903. eCollection 2021 Jan-Dec.
Many strategies may be used by external consultants (such as treatment developers and trainers) and internal program leaders to support evidence-based practice (EBP) implementation. The goal of this study was to identify which educational implementation strategies are considered by therapists to be most helpful, through which mechanisms, and whether these strategies are linked to EBP use.
Semi-structured interviews were conducted with 60 therapists, and 826 therapists completed surveys regarding their perceptions of educational implementation strategies and reported delivery of EBPs within a system-driven, multiple-EBP implementation effort. Using sequential QUAL → QUAN mixed methods, we first identified qualitative themes. Next, we conducted a multilevel logistic regression to examine how quantitative survey items corresponding with qualitative themes predicted EBP use.
Initial qualitative thematic analyses revealed four implementation strategies perceived as essential for EBP delivery: connection to a community of trained therapists, ongoing consultation/supervision, availability of internal supervisors trained in the EBP, and access to EBP materials and resources. Quantitative results showed strategies related to connections with a community of trained therapists (i.e., percentage of other therapists at an agency with EBP training and delivery experience as opposed to those who are only trained in the EBP), ongoing consultation/supervision, and having an internal supervisor trained in the EBP (receiving EBP-specific in-house supervision) were significantly associated with EBP use while receiving EBP boosters was not. The closest quantitative indicator corresponding to access to EBP resources, EBP web-based training, was not associated with EBP use. Therapist reported these strategies supported EBP delivery through exposure to other therapists' cases, guidance/feedback, emotional support, and removing logistic barriers to EBP use.
These findings demonstrate how considering therapist perspectives and creating a network of EBP support via supervisors, consultants, and a community of therapists experienced in the EBP may be particularly critical to EBP delivery.
Public mental health systems are increasingly implementing multiple evidence-based practices (EBPs). There are many strategies that may be used by external consultants (such as treatment developers and trainers) and internal program leaders to support EBP implementation. The goal of this study was to identify which of these internal and external implementation strategies are considered by therapists to be most helpful and how these strategies are linked with continued use of EBPs. First, qualitative interviews with therapists revealed the following strategies are key for supporting their delivery of EBPs: (1) connections to a community of trained therapists, (2) ongoing consultation/supervision, (3) having an internal supervisor at their program who was trained in the EBP, and (4) access to EBP materials and logistic resources. Next, quantitative analyses of survey data examined whether any of the strategies therapists identified as most helpful predicted the continued delivery of EBPs by therapists after initial training. Results confirmed that strategies involving connections with a community of therapists trained in and experienced with the EBP, ongoing consultation/supervision, and having an internal supervisor trained in the EBP were each significantly associated with EBP use. Therapist reported these strategies supported EBP delivery through exposure to other therapists' cases, guidance/feedback, emotional support, and removing logistic barriers to EBP use. These findings can assist systems and programs in prioritizing implementation strategies to support the sustained delivery of EBPs.
外部顾问（如治疗方案开发者和培训师）和内部项目负责人可能会采用多种策略来支持循证实践（EBP）的实施。本研究的目的是确定治疗师认为哪些教育实施策略最有帮助，通过何种机制起作用，以及这些策略是否与循证实践的应用相关联。
对60名治疗师进行了半结构式访谈，826名治疗师完成了关于他们对教育实施策略的看法的调查，并报告了在一个系统驱动的、多种循证实践实施工作中循证实践的实施情况。采用顺序QUAL→QUAN混合方法，我们首先确定了定性主题。接下来，我们进行了多层次逻辑回归分析，以检验与定性主题相对应的定量调查项目如何预测循证实践的应用。
初步的定性主题分析揭示了四种被认为对循证实践实施至关重要的实施策略：与经过培训的治疗师群体建立联系、持续的咨询/监督、有接受过循证实践培训的内部督导，以及获取循证实践材料和资源。定量结果表明，与经过培训的治疗师群体建立联系的策略（即机构中具有循证实践培训和实施经验的其他治疗师的比例，而非仅接受过循证实践培训的治疗师）、持续的咨询/监督，以及有接受过循证实践培训的内部督导（接受特定循证实践的内部督导）与循证实践的应用显著相关，而接受循证实践强化培训则不然。与获取循证实践资源最接近的定量指标，即基于网络的循证实践培训，与循证实践的应用无关。治疗师报告称，这些策略通过让他们接触其他治疗师的案例、指导/反馈、情感支持以及消除循证实践应用中的后勤障碍来支持循证实践的实施。
这些发现表明，考虑治疗师的观点并通过督导、顾问以及有循证实践经验的治疗师群体建立循证实践支持网络，对于循证实践的实施可能尤为关键。
公共心理健康系统越来越多地实施多种循证实践（EBPs）。外部顾问（如治疗方案开发者和培训师）和内部项目负责人可能会采用多种策略来支持循证实践的实施。本研究的目的是确定治疗师认为哪些内部和外部实施策略最有帮助，以及这些策略如何与持续应用循证实践相关联。首先，对治疗师的定性访谈揭示了以下支持他们实施循证实践的关键策略：（1）与经过培训的治疗师群体建立联系，（2）持续的咨询/监督，（3）项目中有接受过循证实践培训的内部督导，（4）获取循证实践材料和后勤资源。接下来，对调查数据的定量分析考察了治疗师认为最有帮助的任何策略是否能预测他们在初始培训后持续实施循证实践的情况。结果证实，涉及与接受过循证实践培训且有经验的治疗师群体建立联系、持续的咨询/监督以及有接受过循证实践培训的内部督导的策略，均与循证实践的应用显著相关。治疗师报告称，这些策略通过让他们接触其他治疗师的案例、指导/反馈、情感支持以及消除循证实践应用中的后勤障碍来支持循证实践的实施。这些发现可以帮助系统和项目确定实施策略的优先级，以支持循证实践的持续实施。
