When Evidence Meets a Higher Power: Implementing Evidence-Based Practices in Traditional Treatment Settings

Background: Efforts to promote the implementation of evidence-based practices (EBPs) in challenging human services settings are advancing, but we still have much to learn. Most community-based agencies still struggle to use EBPs. This is especially true in routine substance abuse treatment (SAT) settings where traditional organizational norms and practices can affect practitioners’ inclinations and capacities to implement evidence-based treatment approaches (Miller et al., 2006). To assist administrators and practitioners, research must continue to identify and clarify mechanisms that promote the use of EBPs in particular organizational contexts. Theory suggests that organizational norms and culture will affect how practitioners perceive and implement training in EBPs (Schein, 2010). In SAT, organizational cultures vary substantially in their reflection of traditional versus research-oriented treatment norms. Factors that promote training implementation in research-oriented treatment organizations may differ from the factors that promote training implementation in traditional treatment organizations. This study aims to identify how factors associated with practitioners’ implementation of training in EBPs differ in research-oriented and traditional organizational cultures.

Methods: The study data come from a cross-sectional survey of counselors who provide outpatient SAT. Counselors were selected via a nested probability sample. Fifty-seven (81%) organizations and 293 (68%) counselors participated. Training implementation and organizational contexts were measured with scales designed to assess specific dimensions of practitioners' beliefs (Humphreys et al., 1996), treatment practices (Ball et al. 2002), and organizational culture (using sub-domains from the TCU-ORC scale,  Lehman, Greener & Simpson, 2002). Multilevel (HLM) models were employed to test hypotheses addressing nested individual and organizational influences on training implementation.

Results: Training implementation varied substantially within treatment organizations, but about 12% of the variance in training implementation was between organizations (ICC = .12). At the individual level, training implementation was positively associated with practitioners’ openness to and knowledge of EBPs. In addition, practitioners who perceived stronger organizational accountability mechanisms favoring EBPs were more likely to implement training. At the organization level, training implementation was more likely in organizations with a stronger focus on outcomes. Further, cross-level interactions indicated that the association between training implementation and knowledge about EBPs was stronger in less traditional, research-oriented treatment organizations, whereas the association between training implementation and accountability mechanisms was stronger in more traditional treatment organizations.

Implications: Efforts to promote training implementation and the use of EBPs will be more effective if the efforts are more specifically targeted to organizational type. This study offers organizational administrators the kind of targeted information they need to more effectively promote the use of EBPs in community settings. The findings suggest that administrators of traditional treatment organizations might promote training implementation through the use of clear accountability mechanisms. The findings are consistent with theory and a building body of research suggesting that practices within treatment organizations are influenced by prevailing norms (e.g., Rieckmann et al., 2007). The findings also highlight the need for further investigation of the notion that norms within treatment organizations constitute a key influence on whether and how practitioners use evidence in routine practice (Nelson et al., 2006).