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