NIMH program announcement PA-02-131 invites proposals that are designed to promote wider implementation of evidence-based practices than what has occurred to date. The announcement recognizes that EBPs have not been implemented to the extent anticipated, and disjunctions between research and application, science and service, and research and policy are adversely affecting the quality of public mental health programs and services. To address these problems, NIMH's National Advisory Mental Health Council has issued a call to raise the profile of dissemination research. The current proposal is a response to this call. The intimate relationship between EBPs and clinical decision-making has been noted by a number of researchers and policy makers. Understanding the factors that influence clinical decisions can facilitate the development of strategies to promote the use of EBPs. The objectives of this proposal are: 1) to identify the processes that affect decisions about adopting EBPs, then 2) pilot test a dissemination strategy that promotes the use of EBPs in evidence based medicine. The proposal targets psychiatric residents and uses treatment resistant schizophrenia as its clinical paradigm. Extant literature suggests that residents lack knowledge in how to incorporate EBPs into clinical decisions, and the proposal addresses this specific problem. The proposal indicates why a naturalistic alternative to classical theory is well suited to the task of describing clinical decision making practices, particularly concerning the complex clinical problems presented by treatment resistant schizophrenia. This naturalistic alternative, known as """"""""Image Theory,"""""""" predicates a study that has 3 components. Components 1 and 2 identify the elements of the dissemination strategy that is developed and tested in component 3. Image Theory is used to understand the processes that guide clinical decision-making and to structure the dissemination strategy. By providing a clearer understanding of the decision processes that affect how psychiatric trainees incorporate EBPs and by developing a novel strategy that targets this population, the investigation will lead to further work on disseminating EBPs via mental health training programs, and facilitate future study of how organizational process influence dissemination.
| Falzer, P R; Garman, D M (2012) Optimizing clozapine through clinical decision making. Acta Psychiatr Scand 126:47-58 |
| Falzer, Paul R; Garman, Melissa D (2009) A conditional model of evidence-based decision making. J Eval Clin Pract 15:1142-51 |
| Falzer, Paul R; Garman, D Melissa; Moore, Brent A (2009) Examining the influence of clinician decision making on adherence to a clinical guideline. Psychiatr Serv 60:698-701 |
| Falzer, Paul R; Moore, Brent A; Garman, D Melissa (2008) Incorporating clinical guidelines through clinician decision-making. Implement Sci 3:13 |
