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      Advancing a Conceptual Model of Evidence-Based Practice Implementation in Public Service Sectors

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          Abstract

          Implementation science is a quickly growing discipline. Lessons learned from business and medical settings are being applied but it is unclear how well they translate to settings with different historical origins and customs (e.g., public mental health, social service, alcohol/drug sectors). The purpose of this paper is to propose a multi-level, four phase model of the implementation process (i.e., Exploration, Adoption/Preparation, Implementation, Sustainment), derived from extant literature, and apply it to public sector services. We highlight features of the model likely to be particularly important in each phase, while considering the outer and inner contexts (i.e., levels) of public sector service systems.

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          Most cited references47

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          Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity.

          Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research. We identify the barriers and challenges within the intervention and implementation sciences, discuss how CBPR can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR.
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            Changing provider behavior: an overview of systematic reviews of interventions.

            Increasing recognition of the failure to translate research findings into practice has led to greater awareness of the importance of using active dissemination and implementation strategies. Although there is a growing body of research evidence about the effectiveness of different strategies, this is not easily accessible to policy makers and professionals. To identify, appraise, and synthesize systematic reviews of professional educational or quality assurance interventions to improve quality of care. An overview was made of systematic reviews of professional behavior change interventions published between 1966 and 1998. Forty-one reviews were identified covering a wide range of interventions and behaviors. In general, passive approaches are generally ineffective and unlikely to result in behavior change. Most other interventions are effective under some circumstances; none are effective under all circumstances. Promising approaches include educational outreach (for prescribing) and reminders. Multifaceted interventions targeting different barriers to change are more likely to be effective than single interventions. Although the current evidence base is incomplete, it provides valuable insights into the likely effectiveness of different interventions. Future quality improvement or educational activities should be informed by the findings of systematic reviews of professional behavior change interventions.
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              Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS).

              Mental health provider attitudes toward organizational change have not been well studied. Dissemination and implementation of evidence-based practices (EBPs) into real-world settings represent organizational change that may be limited or facilitated by provider attitudes toward adoption of new treatments, interventions, and practices. A brief measure of mental health provider attitudes toward adoption of EBPs was developed and attitudes were examined in relation to a set of provider individual difference and organizational characteristics. Participants were 322 public sector clinical service workers from 51 programs providing mental health services to children and adolescents and their families. Four dimensions of attitudes toward adoption of EBPs were identified: (1) intuitive Appeal of EBP, (2) likelihood of adopting EBP given Requirements to do so, (3) Openness to new practices, and (4) perceived Divergence of usual practice with research-based/academically developed interventions. Provider attitudes varied by education level, level of experience, and organizational context. Attitudes toward adoption of EBPs can be reliably measured and vary in relation to individual differences and service context. EBP implementation plans should include consideration of mental health service provider attitudes as a potential aid to improve the process and effectiveness of dissemination efforts.
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                Author and article information

                Contributors
                gaarons@ucsd.edu
                hurlburt@usc.edu
                Sarah.Horwitz@stanford.edu
                Journal
                Adm Policy Ment Health
                Administration and Policy in Mental Health
                Springer US (Boston )
                0894-587X
                1573-3289
                14 December 2010
                14 December 2010
                January 2011
                : 38
                : 1
                : 4-23
                Affiliations
                [1 ]University of California, 9500 Gilman Dr. (0812), La Jolla, CA 92093-0812 USA
                [2 ]Department of Pediatrics and the Centers for Health Policy and Primary Care and Outcomes Research, Stanford University, Stanford, CA USA
                [3 ]University of Southern California, Los Angeles, CA USA
                [4 ]Child and Adolescent Services Research Center at Rady Children’s Hospital, San Diego, CA USA
                Article
                327
                10.1007/s10488-010-0327-7
                3025110
                21197565
                5935a32a-5f07-4b38-849b-cc474822b906
                © The Author(s) 2010
                History
                Categories
                Original Paper
                Custom metadata
                © Springer Science+Business Media, LLC 2011

                Social policy & Welfare
                mental health,alcohol/drug,sustainability,implementation,organization,adoption,child welfare,public sector,sustainment,social service,dissemination

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