There continues to be a movement to address the gap between empirically supported treatment research and social services practice. While the general social services field values services based in science, many therapists’ practices are not grounded in and directed by empirical evidence. This study was a secondary analysis of data collected from 17 (N = 17) social service organizations. The final sample consisted of 440 frontline therapists.
Findings
We find that about one-third (32.7%) of therapists are reluctant to use a new intervention if required by their state, agency, or supervisor. These reluctant empirically supported treatment users had higher levels of field experience (aOR = 1.02, 95% CI = 1.00, 1.05, p = .002) and more years at their present job (aOR = 1.05, 95% CI = 1.01, 1.09, p = .001). We also find an association between race (white versus nonwhite) and the likelihood of being reluctant to using empirically supported treatments, with nonwhites being more likely to be reluctant to use empirically supported treatments (aOR = 1.72, 95% CI = 1.00, 2.95, p = .001).
Applications
Outcomes indicate that there is a cohort of frontline clinical therapists who are reluctant to use new, empirically supported interventions even if mandated to do so. Organizational leaders may need to consider barriers such as therapist demographics (e.g. years in the field or at the agency), client demographics (e.g. race/ethnicity concordance), and the perceived level of cultural appropriateness of empirically supported treatments by therapists when determining strategies to achieve increased use of empirically supported treatments.
AaronsG. A. (2004) Mental health provider attitudes toward adoption of evidence-based practice: The Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research6(2): 61–74. doi: 10.1023/b:mhsr.0000024351.12294.65.
2.
AaronsG. A. (2005) Measuring provider attitudes toward evidence-based practice: Organizational context and individual differences. Child and Adolescent Psychiatric Clinic of North America14: 255–271. doi: 10.1016/j.chc.2004.04.008.
3.
AaronsG. A.SawitzkyA. C. (2006) Organizational culture and climate and mental health provider attitude toward evidence-based practices. Psychological Services3: 61–72. doi: 10.1037/1541-1559.3.1.61.
4.
Aarons, G. A., Zagursky, K., & Palinkas, L. (2007). Multiple stakeholder perspectives on evidence-based practice implementation. In Proceedings of the 19th annual research conference: A system of care for children’s mental health: Expanding the research base, Tampa, FL. Retrieved from http://rtckids.fmhi.usf.edu/rtcconference/handouts/pdf/19/Session%2049/Aarons.pdf.
5.
Ajzen, I. (1996). The directive influence of attitudes on behavior. In P. M. Gollwitzer & J. A. Bargh (Eds), The psychology of action: Linking cognition and motivation to behavior (pp. 385–403). New York, NY: Guilford Press.
6.
AmodeoM.StortiS. A.LarsonM. J. (2010) Moving empirically-supported treatment to the workplace: Recruiting addiction program supervisors to help in technology transfer. Substance Use & Abuse45(6): 968–982. doi: 10.3109/10826080903534467.
7.
BernalG.Scharrón-Del-RíoM. R. (2001) Are empirically supported treatments valid for ethnic minorities? Toward an alternative approach for treatment research. Cultural Diversity and Ethnic Minority Psychology7(4): 328–342. doi: 10.1037/1099-9809.7.4.328.
8.
BurnsB. J.HoagwoodK. E. (2005) Evidence-based practice, part II: Effecting change. Child and Adolescent Psychiatric Clinic of North America14: 255–271. doi: 10.1016/j.chc.2005.01.001.
9.
DamschroderL.AronD.KeithR.KirshS.AlexanderJ.LoweryJ. (2009) Fostering implementation of health services research findings into practice: A consolidated framework for advancing implementation science. Implementation Science4: 50. doi: 10.1186/1748-5908-4-50.
10.
DavisS.GervinD.WhiteG.WilliamsA.TaylorA.McGriffE. (2013) Bridging the gap between research, evaluation, and evidence-based practice. Journal of Social Work Education49: 16–29. doi: 10.1080/10437797.2013.755099.
11.
Epstein, I. (2015). Building a bridge or digging a pipeline? Clinical data mining in evidence-informed knowledge building. Research on Social Work Practice. 25, 499–506. doi: 10.1177/1049731514536475.
12.
Fazio, R. H., & Roskos-Ewoldsen, D. R. (1994). Acting as we feel: When and how attitudes guide behavior. In S Shavitt & Timothy C. Brock (Eds), Persuasion: Psychological insights and perspectives (pp. 71–93). Boston, MA: Allyn & Bacon.
13.
Floyd-TaylorM.BentleyK. J. (2005) Professional dissonance: Colliding values and job tasks in mental health practice. Community Mental Health Journal41: 469–480. doi: 10.1007/s10597-005-5084-9.
14.
GittermanA.KnightC. (2013) Evidence-guided practice: Integrating the science and art of social work. Families in Society94: 70–78. doi: 10.1606/1044-3894.4282.
15.
GlissonC.GreenP.WilliamsN. (2012) Assessing the Organizational Social Context (OSC) of child welfare systems: Implications for research and practice. Child Abuse & Neglect36: 621–632. doi: 10.1016/j.chiabu.2012.06.002.
16.
Institute of Medicine (2000) To err is human: Building a safer health system, Washington, DC: National Academy Press.
17.
Institute of Medicine (2001) Crossing the quality chasm: A new health system for the 21st century, Washington, DC: National Academy Press.
18.
Institute of Medicine (2006) Improving the quality of health care for mental and substance-use conditions: Quality chasm series, Washington, DC: National Academy Press.
19.
JaureguiE.PachecoA. M.SolteroE. G.O’ConnorT. M.CastroC. M.EstabrooksP. A.LeeR. E. (2015) Using the RE-AIM framework to evaluate physical activity public health programs in México. BMC Public Health15: 162. doi: 10.1186/s12889-015-1474-2.
20.
KnudsenH. K.JohnsonJ. A.RomanP. M. (2003) Retaining counseling staff at substance abuse treatment centers: Effects of management practices. Journal of substance abuse treatment24(2): 129–135. doi: 10.1016/S0740-5472(02)00357-4.
21.
Patterson, D. A. (2014). What are the ideal characteristics of empirically supported treatment adopters? Journal of Human Behavior in the Social Environment, 24, 408–414. http://dx.doi.org/10.1080/10911359.2014.875343.
22.
Patterson, D. A., & Dulmus, C. N. (2012). Organizational barriers to adopting an alcohol screening and brief intervention in community-based mental health organizations. Best Practices in Mental Health: An International Journal, 8, 16–28. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3953346/pdf/nihms425377.pdf.
23.
Patterson, D., Dulmus, C., Maguin, E., Keesler, J., & Powell, B. (2014). Organizational Leaders' and Staff Members' Appraisals of Their Work Environment Within a Children's Social Service System. Human service organizations, management, leadership & governance, 38, 215–227.
24.
Patterson, D. A., Maguin, E., Dulmus, C. N., & Nisbet, B. (2013). Individual worker-level attitudes toward empirically supported treatments. Research on Social Work Practice, 23, 95–99. http://dx.doi.org/10.1177/1049731512463442.
25.
Patterson, D. A., Maguin, E., Ramsey, A. L., & Stringfellow, E. (2014). Measuring attitudes towards empirically supported treatment in real world addiction services. Journal of Social Work Practice in the Addictions, 14, 141–154. http://dx.doi.org/10.1080/1533256x.2014.902717.
26.
Patterson, D. A., & Ramsey, A. T. (2016). Do organizational expectations influence workers' implementation perceptions? Psychological Services, 13(4), 428--435.
27.
PriorM.GuerinM.Grimmer-SomersK. (2008) The effectiveness of clinical guideline implementation strategies – A synthesis of systematic review findings. Journal of Evaluation in Clinical Practice14: 888–897. doi: 10.1111/j.1365-2753.2008.01014.x.
28.
RosenA. (2003) Evidence-based social work practice: Challenges and promise. Social Work Research27: 197–208. doi: 10.1093/swr/27.4.197.
Sales, A. E., Fraser, K., Baylon, M., O’Rourke, H. M., Gao, G., Bucknall, T., & Maisey, S. (2015). Understanding feedback report uptake: Process evaluation findings from a 13-month feedback intervention in long-term care settings. Implementation Science, 10, 20. doi: 10.1186/s13012-015-0208-2.
31.
SheldonK. M.KasserT. (1998) Pursuing personal goals: Skills enable progress, but not all progress is beneficial. Personality and Social Psychology Bulletin24: 1319–1331. doi: 10.1177/01461672982412006.
32.
ShlonskyA.GibbsL. (2004) Will the real evidence-based practice please stand up? Teaching the process of evidence-based practice to the helping profession. Brief Treatment and Crisis Intervention4: 137–153.
33.
StahmerA. C.AaronsG. A. (2009) Attitudes toward adoption of evidence-based practices: A comparison of Autism early intervention teachers and children’s mental health providers. Psychological Services6: 223–234. doi: 10.1037/a0010738.
34.
ThyerB. A. (2013) Evidence-based practice or evidence-guided practice: A rose by any other name would smell as sweet [Invited response to Gitterman & Knight’s “Evidence-guided practice”]. Families in Society94: 79–84. doi: 10.1606/1044-3894.4283.
35.
ThyerB. A. (2014) Preparing current and future practitioners to integrate research in real practice settings. Research on Social Work Practice25(4): 463–472. doi: 10.1177/1049731514538105.
36.
U.S. Department of Health and Human Services (2006) The road ahead: Research partnerships to transform services, Rockville, MD: Author.
37.
Watkins-Hayes, C. (2009). The new welfare bureaucrats: Entanglements of race, class, and policy reform. Chicago, Il: University of Chicago Press.
38.
Watkins-HayesC. (2011) Race, respect, and red tape: Inside the black box of racially representative bureaucracies. Journal of Public Administration Research and Theory21(suppl 2): i233–i251. doi: 10.1093/jopart/muq096.
39.
Watkins-HayesC.Pittman-GayL.BeamanJ. (2012) ‘Dying from’ to ‘living with’: Framing institutions and the coping processes of African American women living with HIV/AIDS. Social Science & Medicine74(12): 2028–2036. doi: 10.1016/j.socscimed.2012.02.001.
