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

描述（由申请人提供）：基于证据的实践（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EBP的采用和初始实施的政策、组织和从业者变量上，然而，理解可持续性对于促进EBP开发中昂贵投资的回报至关重要。此外，大多数研究都集中在单个EBP的实施上，限制了研究理论上重要的实施成功预测因素的机会，这些预测因素涉及EBP与使用它们的环境之间的契合度。本研究将考察美国最大的公共精神卫生系统中，强制使用EBP的主要政策变化、组织背景、组织适应、从业者态度和适应作为EBP维持的决定因素的影响。我们感兴趣的主要结果是维持的两个方面：从业者水平的渗透和代理以及从业者结构和干预对EBP模型的保真度。具体目标如下：(1)描述可持续成果（渗透、保真度）；(2)采用混合方法表征可能预测EBP持续的内部背景因素和早期实施条件；(3)识别内部环境(组织和

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.