Evidence-based practice implementation and staff emotional exhaustion in children's services

Understanding the implementation of evidence-based practice (EBP) in community service settings is critical for the successful translation of research to practice. However, we have limited research evidence about the impact of EBP implementation on the mental health and social service workforce. In a previous study we demonstrated reduced staff turnover where an EBP was implemented with fidelity monitoring in the form of supportive ongoing supervision and consultation. Other research has shown that staff burnout and emotional exhaustion in particular is associated with poor quality of care and increased staff turnover intentions and turnover. Current research, however, has focused less on the effects that EBP implementation may have on staff emotional exhaustion. The present study investigates the association of EBP implementation and fidelity monitoring with staff emotional exhaustion in a statewide EBP implementation study. The 21 case-management teams in this study were randomized in a 2 (EBP vs. services as usual [SAU]) by 2 (monitoring vs. no monitoring) design. The EBP in this study was SafeCare^®, a home-based intervention that aims to reduce child neglect in at-risk families. SafeCare was developed from a behavior analysis approach and is based in cognitive behavioral principles. In keeping with our previous research, we hypothesized that providers implementing SafeCare with monitoring would have the lowest levels of emotional exhaustion and those receiving additional monitoring not in the context of EBP implementation would have higher emotional exhaustion relative to the other groups. Results supported our hypotheses in that we found lower emotional exhaustion for staff implementing the EBP but higher emotional exhaustion for staff receiving only fidelity monitoring and providing SAU. Together, these results suggest a potential staff and organizational benefit to EBP implementation and we discuss implications of the findings relative to EBPs and to fidelity monitoring.     

LEADERSHIP AND EMPLOYEES’ REACTIONS TO CHANGE: THE ROLE OF LEADERS’ PERSONAL ATTRIBUTES AND TRANSFORMATIONAL LEADERSHIP STYLE

We examined the role of leaders’ personal attributes and transformational leadership behaviors in explaining employees’ intentions to resist a large‐scale organizational change. Through a multilevel analysis of data from 75 school principals and 586 teachers, we found that teachers’ intentions to resist the organizational change were negatively related to their principals’ openness to change values and transformational leadership behaviors, and positively related to their principals’ dispositional resistance to change. Furthermore, principals’ transformational leadership behaviors moderated the relationship between teachers’ dispositional resistance and intentions to resist the change.     

Barriers and Facilitators to the Implementation of Intensive Treatments for PTSD: Early Lessons Learned From the Field

This article addresses the barriers and facilitators associated with the implementation of PTSD Intensive Outpatient Programs (IOP) across three VHA Medical Centers. Each site developed programs that delivered EBPs in a massed or condensed format and relied on implementation science and the i-PARIHS model to help direct the innovation. Face-to-face, virtual, and combined platforms were used, demonstrating flexibility in design. While each site experienced unique challenges associated with local contextual factors, multiple themes emerged across sites that may help guide future IOP and massed EBP implementations. Common facilitators of the implementation process included: the availability or presence of a credible lead (i.e., champion) to guide the innovation, opportunities to consult with national or outside experts, strong team engagement, processes in place that allowed for ongoing review, clinic operations that are aligned with principles of PTSD specialty care (e.g., time-limited, evidence-based, utilization of measurement based care, willingness to treat complex cases), and leadership support. Alternately, shared barriers included limitations on available resources, options for provider coverage, early staff buy-in, and organizational factors. Solutions to address these barriers and recommendations for future direction are shared.     

Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics

Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD offers initial support for such efforts to improve care. Specifically, quantitative data from a recent pilot study indicate that CMH therapists with limited ASD experience can deliver an EBP intervention with fidelity and perceive it as useful to their practice. Further, client attendance is high and children demonstrate improvement on standardized measures. To further understand the feasibility and impact of training CMH therapists to deliver EBPs, this mixed-methods study examined parent perspectives of the process and impact of outpatient psychotherapy for 13 parents of children ages 5–13 with ASD whose therapists were trained to deliver the EBP intervention. Results complement and expand previously reported quantitative data on psychotherapy process indicating that parents are highly involved in treatment for their children, perceive a strong therapeutic alliance with their children’s therapist, and highlight that treatment was different once therapists began delivering the intervention. Results also indicate themes related to parents’ perceptions of positive child and parent outcomes that provide important details on the specific gains that were observed during treatment. Study findings underscore the importance of parent perspectives in understanding the process and impact of implementing EBPs in CMH settings for families of children with ASD.     

School Climate and Implementation of a Preventive Intervention

Although there has been wide dissemination of research-based psychosocial prevention programs, a similarly strong research base to guide program implementation has been lacking. Program implementation has been particularly difficult for schools, due partly to insufficient understanding of how school ecologies interact with these programs. This study examined the effects of multiple dimensions of school climate on level and rate of change in implementation of a violence prevention intervention across three school years. Using multi-level modeling, the study found that teacher-reported support between staff and among teachers and students predicted higher average levels of implementation. Teacher-reported administrative leadership predicted greater growth in implementation across 3 years. Findings offer implications for an ecological model of program implementation that considers school-level contextual effects on adoption and sustainability of new programs in schools. The Metropolitan Area Child Study Research Group is a collaboration of (in alphabetical order) Leonard Eron, University of Michigan; Nancy Guerra, University of California, Riverside; David Henry, University of Illinois at Chicago; L. Rowell Huesmann, University of Michigan; Patrick Tolan, University of Illinois at Chicago; and Richard VanAcker, University of Illinois at Chicago.     

Teacher Job Stress and Satisfaction in Urban Schools: Disentangling Individual-, Classroom-, and Organizational-Level Influences

Schools remain among the most frequent providers of children’s mental health services, particularly in low-income urban settings. Several decades of research have focused on training teachers to implement evidence-based interventions for minimizing disruptive behavior. Studies consistently demonstrate robust improvements in student behavior and learning; however, the impact on teachers’ work-related stress or satisfaction is not well understood. Six urban, high-poverty elementary schools were randomly assigned to a school mental health services model (Links to Learning; L2L) for referred, disruptive students or to services and professional development as usual (SAU). Teachers (n = 71, K-4 general education teachers) in L2L schools participated in professional development and consultation in two universal and two targeted interventions to reduce disruptive behaviors and promote learning. Teachers (n = 65) in SAU schools participated in professional development as usual. Multiple regression models examined teacher reports of individual-level self-efficacy, classroom-level student functioning, and school-level organizational health as predictors of stress and satisfaction. Findings revealed no significant difference between conditions on teacher work-related stress or satisfaction. Organizational health was the strongest predictor of stress and satisfaction. Training on and implementation of evidence-based classroom interventions did not appear to significantly impact teachers’ work-related stress or satisfaction. Instead, findings point to organizational climate and teacher connectedness as potential levers for change, supporting prior work on teacher stress and satisfaction in schools. The significance of targeting organizational factors may be particularly significant in urban school districts.     

Effects of Principal-Teacher Gender Similarity on Teacher’s Trust and Organizational Commitment

In many Western public primary school systems, the gender composition of the principals is more heterogenic than that of the teachers, but research on the effect of gender on social psychological processes related to school leadership is scarce. The present work aims to address this lacuna by exploring the effects of principal-teacher gender similarity in the Israeli public primary school system, where most teachers are women, on teachers’ trust in their principals and on organizational commitment. Data from 594 female public primary teachers working with male and female principals were analyzed. The results show that when the principal and teacher are of the same gender, both affective and cognitive trust in the principal are higher. Moderation analysis indicated that female teachers’ affective trust in male principals increases with relational duration. A second moderation effect that was found indicated that gender similarity and cognitive trust in principal have a negative interactive effect on teachers’ continued commitment to school, countering the positive effect of gender similarity on commitment. The results and their implications are discussed, and future research is recommended.     

Diversity in practitioners' perspectives on the implementation of the evidence‐based Triple P—Positive Parenting Program

Evidence‐based programs (EBPs) have the potential to improve the well‐being of families and children, but do not necessarily produce the expected outcomes when implemented in real‐world settings. It thus appears essential to consider the factors that can impact the implementation process, especially those related to the practitioners who deliver these programs. This study aimed to identify and describe common patterns in practitioners' experience of the implementation of an EBP. To this end, six focus groups were conducted with 38 practitioners from the health, social and education sectors, 1 year after they had received training in the evidence‐based Triple P—Positive Parenting Program. An in‐depth analysis of the content of these interviews revealed a diversity in the practitioners' experience of the implementation of Triple P. Three distinct types of discourse regarding the implementation process, labelled ‘conviction’, ‘mastering’ and ‘estrangement’ discourse, were identified. Motivational theories were used to understand the interaction between the factors that appeared to be key elements differentiating the discourses in this typology (i.e., practitioners' attitudes, perceived organisational support, self‐efficacy and level of program use). This study highlights the dynamic nature of the implementation process, and shows that a negative initial position towards a new EBP can change over time, given the appropriate organisational conditions.     

Effects of workshop trainings on evidence-based practice knowledge and attitudes among youth community mental health providers

Enhancing the public health impact of evidence-based practices (EBPs) in usual care settings is a key priority of the National Institute of Mental Health. Longitudinal data from community mental health providers (N = 268) participating in a series of state-sponsored workshops in modular approaches to EBPs for youth are presented. EBP workshop attendance for youth anxiety resulted in increased knowledge for EBPs for anxiety (and not other conditions) and EBP workshop attendance for youth disruptive behaviors resulted in increased knowledge for EBPs for disruptive behaviors (and not other conditions). Providers' tendencies toward incorrectly classifying non-EBP therapies as evidence-based increased over time, suggesting that providers over-generalize the EBP label as a result of attending these types of workshops. Regarding EBP attitudes, most measures of attitudes improved when providers attended a workshop. Additionally, an overly inclusive view of what constitutes an EBP at intake was related to significant decreases in openness to trying EBPs over time, whereas more positive attitudes at intake was related to achieving a more refined view of what constitutes an EBP over the course of attending trainings. Study limitations and implications for implementation of EBPs in usual care settings are discussed.     

Attitudes Toward Adoption of Evidence-Based Practices: A comparison of Autism Early Intervention Providers and Children's Mental Health Providers

Across the country, states are reporting increases in the number of children with autistic spectrum disorders (ASD) served each year in the early intervention system. Research examining factors impacting the successful dissemination and implementation of evidence-based practice (EBPs) into service systems for these children is limited. Preliminary information indicates that adoption of EBPs is variable. Provider attitudes toward the adoption of EBPs may be one factor that limits or facilitates implementation of efficacious treatments and these attitudes vary by organizational context and provider individual differences. The current study examines cross-context differences in provider attitudes toward EBPs by comparing the attitudes of 71 education-based early intervention providers working with children with ASD to the attitudes of 238 mental health providers in the public mental health system. This provides the first examination of ASD early intervention provider attitudes toward EBP. Results indicated that early intervention providers reported significantly more favorable attitudes toward adopting EBPs than did mental health providers. Early intervention providers with extended experience in the field perceived less divergence between their current practice and EBPs. Implications are discussed.     

校长领导行为与校长类型

对3800名中小学教师和200名校长进行问卷施测,考察校长工作角色五个方面的相互关系,并在此基础上对校长领导行为进行聚类分析,得到四个类型。四种类型校长所在学校的组织气氛和学校效能感均有显著差异。     

Development and evaluation of the evidence‐based practice classroom observation measure (EBP‐COM)

Due to the increased emphasis on evidence‐based practices (EBPs) in recent education initiatives, classroom observers need an objective way to measure teacher use of EBPs. Although some measures for this purpose exist, these measures are limited by their reliance on self‐report. Therefore, we created a direct observation tool titled the Evidence‐Based Practice Classroom Observation Measure (EBP‐COM) for observers to assess the use of EBPs by teachers of students with autism spectrum disorder (ASD). We evaluated reliability and validity of the EBP‐COM, as well as whether the assessment tool could detect change in teacher behavior. A measurement refinement process involving six raters collecting 65 data points revealed the EPB‐COM to have sound psychometric properties. With this tool, researchers can conduct comprehensive and objective assessments of teacher EBP use.     

胜任力对农村小学校长工作满意度的影响:领导效能与职业认同的中介作用

本研究基于综合激励理论考察了领导效能和职业认同在胜任力与农村小学校长工作满意度关系中的链式中介效应,使用胜任力量表、领导效能量表、职业认同量表和工作满意度量表对随机抽取的269名农村小学校长进行调查。研究显示：（1）胜任力、领导效能、职业认同与工作满意度这四个变量均两两显著正相关;（2）胜任力、领导效能、职业认同均显著正向预测农村小学校长工作满意度,胜任力、领导效能会正向预测职业认同,胜任力会正向预测领导效能;（3）领导效能中介了胜任力与农村小学校长工作满意度之间的关系;（4）职业认同中介了领导效能与农村小学校长工作满意度之间的关系。因此,领导效能和职业认同在胜任力与农村小学校长工作满意度之间起链式中介作用。     

How Do Leaders and their Teams Bring about Organizational Learning and Outcomes?

How do leaders generate a learning climate that yields favorable organizational outcomes? To address this question, we offer and test a model linking charismatic leadership with the team‐emergent states of shared vision and trust within the team, as predicting organizational learning climate, and long‐term assessments of organizational outcomes by key stakeholders. We examined this model in a sample of 69 Arab elementary schools in Israel using multiple sources of raters, predicting long‐term assessments by key stakeholders of respective schools (parents and superintendents) at 2 points in time: 1 year and 3 years following the survey of the teachers. In line with our expectations, we obtained an overall, indirect effect between charismatic leadership and organizational learning climate. We also found support for both the direct and indirect effects of leader charisma through trust within the team on organizational learning climate and school outcomes. Although charismatic leadership predicted shared vision among team members, shared vision did not predict organizational learning climate, and hence, our proposed mediating effects of shared vision on organizational learning climate and outcomes were not supported. We discuss both theoretical and practical implications for the effects of leaders on learning processes and outcomes.     

Impact Challenges in Community Science-with-Practice: Lessons from PROSPER on Transformative Practitioner-Scientist Partnerships and Prevention Infrastructure Development

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships-networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy.     

Exploring the link between principal leadership and family engagement across elementary and middle school

As leaders in the school, principals play an important role in fostering family engagement. Unfortunately, little is known about specific aspects of leadership that promote family engagement. Collegial leadership, an aspect of principal leadership that promotes organizational health via trusting relationships and a sense of community, may be particularly useful to understanding how principals influence family engagement. Drawing on data from two randomized controlled trials evaluating the effects of teacher training in universal classroom management practices, the current study explores the relationship between teacher reports of family engagement and principal collegial leadership. Participants included 3208 students and 207 teachers across 18 elementary and middle schools in the Midwest United States. Utilizing hierarchical linear modeling, results revealed a significant positive relationship between family engagement and overall collegial leadership in addition to specific collegial leadership practices/characteristics. Further, baseline collegial leadership predicted increased end-of-year family engagement when controlling for baseline family engagement, developmental context, intervention status, and student-level characteristics. Overall, results provide empirical evidence for an important link between principal leadership practices and family engagement. Albeit promising, more research is needed to identify and explain the particular mechanisms by which principal collegial leadership may promote family engagement.     

Updating the Textbook: A Novel Approach to Training Graduate Students in Evidence-Based Youth Practices

Despite the ever-improving base of evidence-based practices (EBPs) for the treatment of childhood disorders, a gap between EBP research and their use in community settings continues to exist. An exciting opportunity to close this gap exists in the form of graduate student training; however, at present, several roadblocks exist. In this paper, we review the current state of graduate training in delivering EBPs and obstacles involved in training future community clinicians (i.e., graduate students) in EBPs. Next, we describe in detail our initiative to develop a curriculum that addresses these challenges. This innovative course empowered graduate students to receive training in the delivery of youth EBPs in community settings through reviews of the research literature, active learning techniques (e.g., discussions of case conceptualizations, role-playing case studies), and a written, publication-quality review of EBPs. Finally, we offer recommendations for other educators of mental health professionals (e.g., psychologists, social workers, counselors) to improve upon this curriculum in their training of graduate students in the theory and application of EBPs for treating childhood disorders.     

The role of different levels of leadership in predicting self- and collective efficacy: evidence for discontinuity

This study identified potential discontinuities in the antecedents of efficacy beliefs across levels of analysis, with a particular focus on the role of leadership climate at different organizational levels. Random coefficient modeling analyses conducted on data collected from 2,585 soldiers in 86 combat units confirmed that soldiers' experience, role clarity, and psychological strain predicted self-efficacy to a greater extent than did leadership climate. Also, leadership climate at a higher organizational level related to self-efficacy through role clarity, whereas leadership climate at a lower organizational level related to self-efficacy through psychological strain. Group-level analyses identified leadership climate at a higher organizational level as the strongest predictor of collective efficacy. Theoretical and practical implications and directions for future research are discussed.     

Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes

Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.