Challenges for Community Mental Health Agencies in Implementing Evidence-Based Trauma Treatments

Background and Purpose:  Research over the last two decades reveals a major public health problem concerning the high prevalence of trauma exposure in children and families coming to the attention of child serving agencies.  Findings point to the need for increased agency capacity for trauma informed treatment, yet addressing this need presents a major workforce development challenge for mental health agencies.  Barriers to implementation of evidence-based trauma treatments include clinician, agency and system impediments.

 This project examines the effectiveness of using an implementation science framework (NIRN) with six field agencies and their respective social work schools. Each field agency implemented an evidence-based trauma treatment: a unique aspect of the initiative was the selection of different evidence-based trauma treatments.  This presentation highlights the experience of one agency to illustrate the manner in which findings at each six month were used to guide adjustments to the implementation process.

 Methods:  This project used a time series design. Staff at each agency participated in an organizational readiness survey every six months.  Data from the results of the administration of the survey at the baseline (N=152-161), 6 months (N=126-139) and 12 months (N=116-119) for 3 agencies will be presented.   A factor analysis yielded 8 factors which loaded well on the drivers (Leadership, Competency and Organization) from the NIRN model.  After each administration, the agency received a Gap Analysis Report to plan for future interventions.  An in-depth analysis of one agency with results from four time points (baseline, 6, 12 and 18 months) will track the data against the backdrop of the four stages of the implementation process (exploration, installation, initial implementation and full implementation). 

Results:  Findings indicate that the Organizational Driver increased significantly, contributing to a facilitative administration environment; training and coaching in evidence-based trauma treatment increased staff competency, and all 3 agencies started to construct their data decision systems.  Based on findings at 18 months, one agency entered the full implementation stage, with all data points above the two-thirds cut-off point used as a threshold for strong organizational readiness, and with significant progress in effectively using data systems to monitor client outcomes.

Conclusions and Implications:  The study indicates that clinician training in an evidence based trauma treatment is but one of the factors to be addressed to effectively implement an evidence-based trauma treatment.  More significant is the Organization Driver with all its elements: the external system function, the presence, or lack thereof, of a facilitative administration, the existence of usable data decision support systems and staff attitudes toward change.  The biggest challenge to a strong Competency Driver continues to be the ability of an agency to measure fidelity to the implementation of a particular practice. 

Implications of this study suggest that while, with consultation and support from a school of social work an agency can implement an evidence-based trauma treatment, it is a long process (2-4 years) and the challenges to building an infrastructure to collect staff fidelity measures and client trauma assessment and client outcome data remain significant.