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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 ( IF 7.2 ) Pub Date : 2019-06-21 , DOI: 10.1186/s13012-019-0912-4
Rinad S Beidas 1, 2, 3 , Nathaniel J Williams 4 , Emily M Becker-Haimes 1, 5 , Gregory A Aarons 6 , Frances K Barg 7 , Arthur C Evans 8 , Kamilah Jackson 9 , David Jones 10 , Trevor Hadley 1 , Kimberly Hoagwood 11 , Steven C Marcus 12 , Geoffrey Neimark 9 , Ronnie M Rubin 9, 13 , Sonja K Schoenwald 14 , Danielle R Adams 15 , Lucia M Walsh 16 , Kelly Zentgraf 1 , David S Mandell 1, 3
Affiliation  

BACKGROUND Little 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. METHOD Using 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. RESULTS Clinicians 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). CONCLUSIONS System 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.

中文翻译:

在费城全系统实施循证实践的5年中,临床医生对心理治疗技术的使用进行了反复的横断面研究。

背景技术很少有研究调查行为健康系统努力增加基于证据的实践的使用或组织特征如何减轻这些努力的影响的效果。这项研究的目的是调查鼓励5年内实施循证实践的系统中临床医生实践的变化,以及组织特征如何缓解这种影响。我们假设基于证据的技术将随着时间的推移而增加,而基于非证据的技术的使用将保持不变。方法采用重复的横断面设计,从2013年至2017年在费城的公共行为卫生系统中收集了3次数据。在5年中对来自20个为青年服务的行为健康门诊诊所的临床医生进行了3次调查(n = 340;总缓解率= 60%)。从2013年到2017年,所有组织和临床医生都获得了循证实践创新中心提供的系统级支持。此外,约有一半的临床医生参加了市资助的循证实践培训计划。主要结果包括临床医生自我报告的使用通过治疗程序清单修订的家庭衡量的认知行为和心理动力学技术。结果临床医生是女性的80%,平均年龄37.52岁(SD = 11.40)。跨波临床医生特征无显着差异(所有ps> .05)。控制组织和临床医生的协变量,相比于心理动力技术没有变化,从第一波(M = 3.18)到第三波(M = 3.37,p = .021,d = .29),CBT技术的平均使用量增加了6%。 (p = .570)。临床医生参加的每项循证实践培训计划都预测CBT的使用将增加3%(p = .019),但心理动力学技术的使用则没有变化(p = .709)。在基础文化水平较高的组织中,与文化水平较低的组织相比,临床医生的CBT使用量增加幅度更大(增加8%,减少2%,p = .048)。结论系统实施循证实践与临床医生实践的适度变化有关。这些影响可以通过组织特征来缓和。调查结果确定了改善实施的初步目标。在基础文化水平较高的组织中,与文化水平较低的组织相比,临床医生的CBT使用量增加幅度更大(增加8%,减少2%,p = .048)。结论系统实施循证实践与临床医生实践的适度变化有关。这些影响可以通过组织特征来缓和。调查结果确定了改善实施的初步目标。在基础文化水平较高的组织中,与文化水平较低的组织相比,临床医生的CBT使用量增加幅度更大(增加8%,减少2%,p = .048)。结论系统实施循证实践与临床医生实践的适度变化有关。这些影响可以通过组织特征来缓和。调查结果确定了改善实施的初步目标。
更新日期:2019-11-28
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