Sustainment of Multiple EBP's Fiscally Mandate in Children's MH Services

描述（由申请人提供）：循证实践（EBP）越来越多地在大型社区精神卫生系统中实施。迄今为止，大部分研究都集中在预测采用和初步实施EBP的政策，组织和从业人员变量，但了解可持续性是至关重要的，以促进EBP开发的昂贵投资的回报。此外，大多数研究都集中在一个单一的EBP的实施，限制了机会，以研究理论上重要的预测实施成功的EBP和它们被利用的背景之间的配合。拟议中的研究将探讨一个重大的政策变化的影响，强制使用EBP和组织背景下，组织的住宿，和从业者的态度和适应的决定因素，EBP在美国最大的公共精神卫生系统的维持。我们感兴趣的主要成果是两个方面的可持续性：代理商级的渗透率和机构和从业者的结构和干预保真度EBP模型。具体目标如下：（1）描述可持续性成果的特征（渗透性、忠诚度）;（2）使用混合方法来描述内部环境因素和早期实施条件，这些因素和早期实施条件可能预测EBP可持续性;（3）识别内部环境（组织和 实践者）和决定维持成果的早期实施条件。该项目将产生新的理解，是否以及如何多个EBP可以在公共精神卫生系统进行政策驱动的社区实施工作的持续。我们将为表征可持续性提供可推广的模型，包括对多个EBP的保真度进行可行和灵活的测量。研究结果将为实施干预措施的制定提供信息，以促进循证医学的持续提供，以最大限度地发挥其公共卫生影响。

DESCRIPTION (provided by applicant): Evidence-based practices (EBPs) are increasingly being implemented in large community mental health systems. Much of the research to date has focused on policy, organizational and practitioner variables that predict adoption and initial implementation of EBPs, yet understanding sustainment is crucial to facilitate a return on costly investments in EBP development. Furthermore, most studies focus on the implementation of a single EBP, limiting opportunities to examine theoretically important predictors of implementation success concerning fit between EBPs and the contexts in which they are utilized. The proposed study will examine the impact of a major policy change mandating use of EBPs and organizational context, organizational accommodation, and practitioner attitudes and adaptations as determinants of EBP sustainment in the largest public mental health system in the United States. Our primary outcomes of interest are two aspects of sustainment: practitioner-level penetration and agency and practitioner structural and intervention fidelity to EBP models. Specific aims are as follows: (1) Characterize sustainment outcomes (Penetration, Fidelity); (2) Use mixed methods to characterize inner context factors and early implementation conditions that potentially predict EBP sustainment; (3) Identify inner context (organizational and practitioner) and early implementation conditions that determine sustainment outcomes. This project will yield new understanding of whether and how multiple EBPs can be sustained in public mental health systems undergoing a policy-driven community implementation effort. We will produce generalizable models for characterizing sustainment, including feasible and flexible measurement of fidelity across multiple EBPs. The findings will inform the development of implementation interventions to promote sustained delivery of EBPs to maximize their public health impact.