The following is a preliminary synopsis of implementation research being conducted by the
Center on Trauma and Children.
Successful implementation of evidence-based practices (EBP) is enhanced by active support for the intervention and training process by agencies, as well as practitioner openness to EBP.
The high value and promotion of evidence-based practice (EBP) has yielded a number of training opportunities for practitioners. Unfortunately, all of this training has not always translated into availability of those evidence-based interventions to clients in need. In addition, there is evidence that a one-time training is insufficient to ensure fidelity of implementation of EBP's, and that ongoing learning, supervision and coaching is beneficial (Institute for Healthcare Improvement, 2003). Application of implementation science to the human services has been a natural consequence.
A number of factors predictive of successful implementation have been identified in the literature. It is clear that it is not only the presence of these factors, but the interactions between them that influences adoption of these practices (Fixsen, et al, 2009; Damschroder et al, 2009; Aarons et al, 2011). A recent multi-year project conducted by the Center on Trauma and Children trained more than 90 providers from 22 organizations in two evidence-based interventions for adolescents using a Learning Community training model. This model provided face-to-face training as well as ongoing coaching, supervision, assessment and support through a Learning Community which included regularly scheduled online calls and supervision sessions.
Preliminary findings point to several components which contributed to successful implementation of these interventions. Successful implementation has two facets:
- completion of the learning collaborative
- and sustained utilization of the intervention with clients.
Five factors have been identified in this sample as important to successful training and implementation:
The level of support from the agency as manifested by the support from the trainee's supervisor.Those organizations where the supervisor was aware of the training and had direct contact with training organizers had greater success in their clinician participant completing the training and utilizing the implementation with clients.
Direct supervisor involvement in the learning community was associated with greater likelihood of the clinician completing training and sustainability.
Trainees housed in organizations that supported participation in the ongoing coaching, supervision and training by providing time to attend Learning Community calls, compete paperwork and review supervisory tapes; temporary release from direct service demands to attend training; and financial reimbursement for expenses incurred to attend training activities.
Organizations that assisted trainees in identifying appropriate clients for the intervention were also correlated with higher rates of success among trainees. This involved solicitation of referrals from community partners, and in-agency identification and referral of appropriate clients to the trainees.
Trainees who reported a higher level of openness to evidence based practice achieved higher levels of completion and implementation sustainability. This was measured on the Attitudes Toward EBP subscale of the Evidence Based Practice Questionnaire (EBPQ; Upton & Upton, 2006).
These findings demonstrate the significance of both individual trainee and organizational characteristics in the successful implementation of evidence based treatments following training. Further exploration of the relationship between individual attitudes towards evidence based practice and organizational climate and culture should be pursued as there is some evidence that organizational culture influences individual attitudes (Aarons & Sawitzky, 2006).
Aarons, G.A., Hurlburt, M. & McCue Horwitz, A. (2011). Advancing a conceptual model of evidence-based practice implementation in public service sectors. Administration and Policy in Mental Health and Mental Health Services Research, 38(1), 4-23. DOI: 10.1007/s10488-010-0327-7
Aarons, G.A. & Sawitzky, A.C. (2006). Organizational culture and climate and mental health provider attitudes toward evidence-based practice. Psychological Services 3(1), 61-72. DOI: 10.1037/1541-15220.127.116.11
Damschroder, L.J., Aron, D.C., Keith, R.E., Kirsh, S.R., Alexander, J.A. & Lowery, J.C. (2009). Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science, 7(4). DOI: 10.1186/1748-5908-4-50.
Fixsen, D.L., Blase, K.A., Naoom, S.F. & Wallace, F. (2009). Core implementation components. Research on Social Work Practice, 19(5), 531-40,DOI: 10.1177/1049731509335549
Institute for Healthcare Improvement. (2003). The Breakthrough Series: IHI's Collaborative Model for Achieving Breakthrough Improvement.IHI Innovation Series white paper. Boston: Institute for Healthcare Improvement. (Available on www.IHI.org)
Upton, D. & Upton, P. (206). Deveopment of an evidence-based practice questionnaire for nurses. Journal of Advanced Nursing, 53(4), 454-8. DOI: 10.1111/j.1365-2648.2006.03739.
University of Kentucky Center on Trauma and Children
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