When Do Therapists Stop Using Evidence-Based Practices? Findings from a Mixed Method Study on System-Driven Implementation of Multiple EBPs for Children
When Do Therapists Stop Using Evidence-Based Practices? Findings from a Mixed Method Study on System-Driven Implementation of Multiple EBPs for Children
复制标题
DOI：
10.1007/s10488-019-00987-2
复制
发表时间：
2019-11-12
影响因子：
2.6
通讯作者：
Brookman-Frazee, Lauren
中科院分区：
文献类型：
--
作者：
Lau, Anna S.;Lind, Teresa;Brookman-Frazee, Lauren
治疗师停止提供循证实践（EBP）是社区实施EBP的关键结果。这种混合方法的研究探讨了与治疗师中止在一个大的报销驱动的实施多个EBP在公共儿童的心理健康服务的因素。该研究整合了来自65个机构的748名治疗师的定量调查数据，以及来自14个机构的79名治疗师的定性访谈。治疗师平均采用了2.41个EBP（SD=1.05，范围=1-5），近一半（n=355，47.5%）报告至少停用一个EBP。多水平模型用于预测中止的二元结果，定性分析用于扩展定量结果。定量模型显示，治疗师的因素，包括每周直接服务小时数较少，采用了更多的EBP，更高的情绪疲惫，以及对EBP的更消极的态度一般与中止。此外，EBP的具体因素，包括更多的负面看法的特定EBP和较低的自我效能感提供特定的EBP预测中断。从采访的答复主题强调了EBP与该机构的客户群，以及治疗师的看法，充分的EBP培训支持，并与治疗师的专业目标的EBP的配合的重要性。总之，研究结果表明，需要战略维持规划干预措施，目标EBP适合（即，采用EBP和机构目标人群之间的匹配，EBP和治疗师偏好和职业目标之间的匹配），并支持治疗师在提供EBP时的自我效能。
Therapist discontinuation of delivering an evidence-based practice (EBP) is a critical outcome in the community implementation of EBPs. This mixed methods study examined factors associated with therapist discontinuation within a large reimbursement-driven implementation of multiple EBPs in public children's mental health services. The study integrated quantitative survey data from 748 therapists across 65 agencies, and qualitative interviews from a subset of 79 therapists across 14 agencies. Therapists adopted, on average, 2.41 EBPs (SD=1.05, range=1-5), and nearly half (n=355, 47.5%) reported discontinuing at least one EBP. Multi-level models were used to predict the binary outcome of discontinuation, and qualitative analyses were used to expand upon quantitative findings. Quantitative models revealed that therapist factors, including fewer direct service hours per week, a greater number of EBPs adopted, higher emotional exhaustion, and more negative attitudes toward EBPs in general were associated with discontinuation. In addition, EBP-specific factors including more negative perceptions of the particular EBP and lower self-efficacy for delivering the specific EBP predicted discontinuation. Themes from interview responses highlighted the importance of fit of the EBP with the agency's client base, as well as therapist perceptions of adequate EBP training supports, and the alignment of an EBP with therapists' professional goals. Together, the findings suggest the need for strategic sustainment planning interventions that target EBP fit (i.e., fit between adopted EBPs and agency target population, fit between EBP and therapist preferences and career goals) and support therapist self-efficacy in delivering EBPs.