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

描述(由申请人提供)：循证实践(EBPS)正越来越多地在大型社区精神卫生系统中实施。到目前为止，大部分研究都集中在政策、组织和实践者变量上，这些变量预测EBP的采用和初步实施，但了解维持对于促进EBP开发的昂贵投资回报至关重要。此外，大多数研究侧重于单一EBP的实施，限制了从理论上考察EBPS与其使用环境之间的匹配性的重要预测因素的机会。这项拟议的研究将考察一项重大政策变化的影响，该政策变化要求在美国最大的公共精神卫生系统中使用EBPS和组织背景、组织适应性以及从业者的态度和适应作为EBP维持的决定因素。我们感兴趣的主要结果是维持的两个方面：实践者水平的渗透以及机构和实践者对EBP模型的结构和干预忠诚度。具体目标如下：(1)确定维持成果(渗透率、忠诚度)；(2)使用混合方法描述潜在预测EBP持续的内部背景因素和早期实施条件；(3)确定内部背景(组织和 (实践者)和早日实施决定维持成果的条件。这个项目将产生新的理解，即是否以及如何在公共精神卫生系统中维持多个EBP，这些系统正在进行政策驱动的社区实施工作。我们将产生可概括的模型来表征维持，包括可行和灵活的跨多个EBP的保真度测量。研究结果将为制定实施干预措施提供信息，以促进EBPs的持续提供，以最大限度地发挥其对公共卫生的影响。

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.