Methods: Semi-structured interviews were conducted with masters-level clinicians (N = 12) working in community mental health agencies. Interviews were digitally recorded, transcribed, and analyzed using a grounded theory approach.
Results: While clinicians acknowledged that implementing EBTs was initially difficult, time consuming, and expensive, they emphasized that EBTs enhanced their overall effectiveness and highlighted ways in which their clients, teams, and agencies benefited from the process of implementation. Clinicians discussed incentives at multiple levels, including profession-level (e.g., commitment to a recovery or empowerment model of clinical practice), clinician-level (e.g., first-hand experiences of effectiveness – as opposed to reliance on empirical evidence of effectiveness, an increased sense of competency, a competitive advantage on the job market, the appeal of the structure of manualized treatments, and reduced burnout), organizational-level (financial, increased staff retention, increased staff capacity, and increased accountability to funding agencies), and client-level (clients' appreciation of structure, efficiency of treatment, and hope for recovery). Frequently cited barriers included lack of adequate funding, inadequate support and oversight, and difficulty in determining when specific EBTs were appropriate for their clients. Despite the barriers, clinicians cited many elements that facilitated the successful implementation of ESTs, such as: organizational commitment and support, adequate funding, intensive training, ongoing support (supervision, consultation, and booster training), and routine fidelity monitoring. All of the clinicians interviewed mentioned their desire to sustain the EBTs in some form. Many indicated that they could “never go back” to practice as usual, as they had internalized the components of the EBTs (i.e., integrated them into their therapeutic repertoire). However, clinicians acknowledged that sustaining the EBTs outside of the context of the organization would be difficult, even if they fully intended to do so.
Conclusions and Implications: This study suggests that robust supports that foster early successes with EBTs can go a long way in fostering clinicians' perceived self-efficacy and long-term commitment to EBT implementation. Clinicians demonstrated a clear desire for intensive implementation strategies that include ongoing training, supervision, peer-support, and expert consultation. For the promise of EBTs to be fully realized, cost-effective strategies that ensure adequate levels of ongoing training, supervision, and expert consultation must be developed and tested. Strategies that utilize existing human capital, facilitate collaboration within and between organizations, and employ web-based implementation tools may be well-suited to strike the proper balance between intensity, comprehensiveness, feasibility, and cost.
