Will Front-Line Mental Health Workers Use a New Empirically Supported Treatment If Required?

Background:

There continues to be a movement to address the gap between effective empirically supported treatments (ESTs) and their use in social service systems. While this research-to-practice challenge is multidimensional, when a client enters the office of a clinical worker, it is that worker who has the final choice whether to use an EST or not. Clients should be confident that when they access mental health services, the professional worker remain current on new clinical research and all services are based in the most up-to-date scientific knowledge. Anything less is in violation of code of ethics and seemingly - grounds for malpractice. 

In this study we investigated whether a front-line mental health worker would be moved to use a new EST if required. We were interested how responses are distributed across worker characteristics. The primary question was: what are the characteristic(s) of workers who would refuse to use a new EST if it was required by their state, agency or supervisor, agency?

Methods:

This study was a secondary analysis of data collected for four different studies. There were seventeen (N=17) social services/mental health organizations providing a range of clinical services. The final sample consisted of (N=440) front-line workers who were responsible for a client caseload.

This study used the three items that comprise the Evidence-based practice attitude scale’s (EBPAS) Requirements subscale asking: “If you received training in a therapy or intervention that was new to you, how likely would you be to adopt it if: a) it was required by your state, b) it was required by your agency, and c) it was required by your supervisor?” Responses to the three items were combined to form the analysis variable, “Refuser.”

Results:

Percentages of respondents who would refuse using an EST if required by the state resulted in (22.6%); if required by their agency (24.6%); and if required by their supervisor (30.5%).The total percentage of respondents coded as refusing ESTs was 35.6%.

Refusers were more likely to be non-White (47% versus 31%:  χ2[1, N = 440] = 8.56, p = .003), to have more years of experience (t=-2.12, p<.04) and more years at the present job (t=-2.21, p<.03).

Conclusions:

The purpose was to examine demographic characteristics of clinical mental health workers related to their attitudes towards being required to use an EST. We found that over one-third of workers in the study would not be moved to use an EST if it was required by the state, agency, or supervisor. We found an association between race (white vs. non-white) and the likelihood of being a refuser. Refusers were also more likely to work with their agency for longer periods of time. Implementing ESTs in practice is a great challenge for mental health organizations. Closing the research-to-practice gap will require investigators to study why current front-line workers are not using new ESTs and why one-third would refuse even if mandated to do so. The most significant gap between research and practice may be that space between the worker and client.