Examining Provider Factors Supporting the Adoption and Use of Evidence-Based Practices for Outpatient Mental Health Clinics Serving Youth

Background: A significant barrier to effective mental health care for children, adolescents, and families is the low rate of the adoption and implementation of evidence-based practices in outpatient mental health settings. The benefits of incorporating evidence-based practice in mental health settings is well documented. However, many mental health settings continue to not adopt or implement evidence-based practices.  As a result of mental health reform, through policies and other initiatives, this gap has been growing smaller. However, the poor uptake of evidence-based practices in mental health care settings continues to be one of the major barriers to providing safe, effective and efficient care. The gap between knowledge and practice results in decreased quality care for the youth and families who utilize the public mental health system. Purpose: This study aimed to explore the relationship between provider beliefs of evidence-based practice and adoption of evidence-based practice among outpatient mental health providers. Methods: This exploratory cross-sectional study involves secondary analysis of data in a NIMH-funded study of behavioral parent training group intervention, entitled the 4Rs and 2Ss for Strengthening Families.  All participants (n=52) were providers of outpatient child mental health clinics in the New York Metropolitan Area.  Attitudes towards evidence-based practice were measured by the Evidence-Based Practice Attitude Scale (EBPAS) and adoption of evidence-based practices by the Training Exposure and Utilization Scale (TCU).  Data were examined using Structural Equation Modeling (SEM) in Mplus. Results: Of the 52 participants in the sample, the mean age was 41.74 (± 15.18); the majority of the sample identified as White/Caucasian (54%) and non-Hispanic/Latino (56%) and eighty-eight percent held a graduate degree, 83% had a social work license (LSCW or LMSW). No significant differences were found in EBP use by provider education, race, ethnicity, license type, employment, payment type, caseload and role. There were, however, significant differences found in EBP use by provider age and number of years in practice. These findings emphasize the impact of the role of provider beliefs on the adoption and implementation of EBPs. The SEM-based model that was tested supported the primary hypothesis, that more positive provider attitudes and beliefs about evidence-based practices will be associated with the adoption of evidence-based practice in outpatient mental health clinics. Providers who reported more positive attitudes and beliefs of EBP adoption and implementation also reported increased use of evidence-based practices, emphasizing the importance of provider beliefs on the adoption and implementation of EBPs. This study also looked at specific factors of provider beliefs and found a significant relationship between providers who reported that they liked to use new types of therapy and interventions and other providers, who noted that they were required to use EBPs by their supervisors, reported increased programmatic use of evidence-based practices. Conclusion: This study examined the way in which provider factors (attitudes and beliefs) affect the adoption and implementation of evidence-based family strengthening approaches in mental health settings serving youth and found a significant relationship that has implications for practice, policy and research.