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.

Public Health Relevance

Although there are increasing numbers of large-scale efforts to implement evidence-based practices in community service settings, many of these efforts fail or practices are not sustained after initial implementation. We will take advantage of the large-scale, fiscally mandated implementation of multiple EBPs in Los Angeles County to study determinants of key sustainment outcomes. The proposed study will inform the development of implementation interventions to promote the sustained delivery of EBPs to maximize the public health impact of community mental health services.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Pintello, Denise
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University of California Los Angeles
Schools of Arts and Sciences
Los Angeles
United States
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Barnett, Miya L; Brookman-Frazee, Lauren; Gonzalez, Juan Carlos et al. (2018) Qualitative Reports of How and When Therapists Adapt Children's Evidence-Based Practices during Community Implementation. J Clin Child Adolesc Psychol :1-12
Kim, Joanna J; Brookman-Frazee, Lauren; Gellatly, Resham et al. (2018) Predictors of Burnout among Community Therapists in the Sustainment Phase of a System-Driven Implementation of Multiple Evidence-Based Practices in Children's Mental Health. Prof Psychol Res Pr 49:131-142
Saifan, Dana; Brookman-Frazee, Lauren; Barnett, Miya et al. (2018) Ethnic minority community therapists' acculturation and reported adaptations to children's evidence-based practices. Cultur Divers Ethnic Minor Psychol 24:530-540
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Barnett, Miya; Brookman-Frazee, Lauren; Regan, Jennifer et al. (2017) How Intervention and Implementation Characteristics Relate to Community Therapists' Attitudes Toward Evidence-Based Practices: A Mixed Methods Study. Adm Policy Ment Health 44:824-837
Regan, Jennifer; Lau, Anna S; Barnett, Miya et al. (2017) Agency responses to a system-driven implementation of multiple evidence-based practices in children's mental health services. BMC Health Serv Res 17:671
Brookman-Frazee, Lauren; Stadnick, Nicole; Roesch, Scott et al. (2016) Measuring Sustainment of Multiple Practices Fiscally Mandated in Children's Mental Health Services. Adm Policy Ment Health 43:1009-1022

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