A repeated cross-sectional study of clinicians’ use of psychotherapy techniques during 5 years of a system-wide effort to implement evidence-based practices in Philadelphia

Implementation Science

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[1] 0000 0000 9689 2816, grid.450700.6, Department of Behavioral Health, Philadelphia, PA, USA;0000 0001 0244 9440, grid.410354.7, Oregon Social Learning Center, Eugene, OR, USA;0000 0001 0670 228X, grid.184764.8, School of Social Work, Boise State University, Boise, ID, USA;0000 0001 2107 4242, grid.266100.3, Department of Psychiatry, University of California San Diego, San Diego, CA, USA;0000 0001 2166 7523, grid.280937.7, American Psychological Association, Washington, DC, USA;0000 0004 1936 7822, grid.170205.1, School of Social Service Administration, University of Chicago, Chicago, IL, USA;0000 0004 1936 8606, grid.26790.3a, Department of Psychology, University of Miami, Miami, FL, USA;0000 0004 1936 8753, grid.137628.9, Department of Child and Adolescent Psychiatry, New York University Langone Health, New York, NY, USA;0000 0004 1936 8972, grid.25879.31, Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Hall- Mercer Community Mental Health Center, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Hall- Mercer Community Mental Health Center, Philadelphia, PA, USA;0000 0004 1936 8972, grid.25879.31, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA;Hall- Mercer Community Mental Health Center, Philadelphia, FL, USA;0000 0004 1936 8972, grid.25879.31, School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA;Community Behavioral Health, Impact Reach, LLC, Philadelphia, PA, USA;Community Behavioral Health, Impact Reach, LLC, Philadelphia, PA, USA;Impact Reach, LLC, Philadelphia, PA, USA;

关键词: System-level implementation;    Organizational factors;    Cognitive-behavioral therapy;    Targets;   

DOI  :  10.1186/s13012-019-0912-4

来源: publisher

【 摘 要 】

BackgroundLittle work investigates the effect of behavioral health system efforts to increase use of evidence-based practices or how organizational characteristics moderate the effect of these efforts. The objective of this study was to investigate clinician practice change in a system encouraging implementation of evidence-based practices over 5 years and how organizational characteristics moderate this effect. We hypothesized that evidence-based techniques would increase over time, whereas use of non-evidence-based techniques would remain static.MethodUsing a repeated cross-sectional design, data were collected three times from 2013 to 2017 in Philadelphia’s public behavioral health system. Clinicians from 20 behavioral health outpatient clinics serving youth were surveyed three times over 5 years (n = 340; overall response rate = 60%). All organizations and clinicians were exposed to system-level support provided by the Evidence-based Practice Innovation Center from 2013 to 2017. Additionally, approximately half of the clinicians participated in city-funded evidence-based practice training initiatives. The main outcome included clinician self-reported use of cognitive-behavioral and psychodynamic techniques measured by the Therapy Procedures Checklist-Family Revised.ResultsClinicians were 80% female and averaged 37.52 years of age (SD = 11.40); there were no significant differences in clinician characteristics across waves (all ps > .05). Controlling for organizational and clinician covariates, average use of CBT techniques increased by 6% from wave 1 (M = 3.18) to wave 3 (M = 3.37, p = .021, d = .29), compared to no change in psychodynamic techniques (p = .570). Each evidence-based practice training initiative in which clinicians participated predicted a 3% increase in CBT use (p = .019) but no change in psychodynamic technique use (p = .709). In organizations with more proficient cultures at baseline, clinicians exhibited greater increases in CBT use compared to organizations with less proficient cultures (8% increase vs. 2% decrease, p = .048).ConclusionsSystem implementation of evidence-based practices is associated with modest changes in clinician practice; these effects are moderated by organizational characteristics. Findings identify preliminary targets to improve implementation.

【 授权许可】

CC BY