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.     

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.     

Modernism,Postmodernism and (Evidence-Based) Practice

One dominant discourse in the mental health arena revolves around evidence-based practice (EBP). Although there is ongoing debate about the implementation of EBP in the mental health field, most of these discussions have been limited to modernist ideas. While discussions about EBP have occurred from alternate perspectives, particularly postmodernism, a lack of open dialogue has resulted in these two groups “talking past each other” (Levy in Family Process 45:55–73, 2006). In this article we discuss the positions of both modernism and postmodernism with consideration of their respective epistemologies and attitudes toward research and EBP. We argue that critical thinking about EBP needs to include mutual debate from both modern and postmodern perspectives.     

Mental health help-seeking intentions and organizational climate among military members

The psychological effects of war include anxiety, depression, alcohol misuse and Post-Traumatic Stress Disorder (PTSD). Military members that displayed symptoms of mental illness were thought to lack the strength and courage necessary to be soldiers. As a result, many military members who suffered from these symptoms would not seek help for mental health care. This paper investigates the mental health help-seeking intentions of military members using the Theory of Planned Behavior (TPB) and the role of leadership support climate and coworker support climate. This paper contributes to the literature in three ways. First, this paper applies a rigorously tested theoretical framework to the study of mental health help-seeking intentions in military members. Second, this paper incorporated the constructs of leadership support climate and coworker support climate into mental health help-seeking literature. Third, this paper introduces the concepts of leadership support climate and organizational support climate into the study of the theory of planned behavior. This study found that the personal attitudes of military members towards mental health help-seeking are positively related to their mental health help-seeking intentions. The study also found that mental health help-seeking attitudes mediated the relationship between leadership support climate and mental health help-seeking intentions. These results underscore the important role of leaders in setting a supportive organizational climate and influencing military members to seek help for mental health problems.     

The organizational context of children's mental health services

This paper reviews what is known about the organizational context of children's mental health services and describes organizational constructs, conceptual models, research methods, and intervention strategies that can be used to link organizational context to service quality and outcomes. Using evidence from studies of business and industrial organizations as well as studies of children's service organizations, the paper presents a model of organizational effectiveness that depends on several contextual characteristics that include organizational culture, structure, climate, and work attitudes. These characteristics are believed to affect the adoption of efficacious treatments (EBPs [evidence-based practices]), adherence to treatment protocols, therapeutic alliance, and the availability, responsiveness, and continuity of services. Finally, 10 components of the ARC(Availability Responsiveness and Continuity) organizational intervention are described as examples of strategies that can be used to develop organizational contexts with the prescribed characteristics. Mental health researchers are encouraged to consider including these constructs, conceptual models, research methods, and intervention strategies in dissemination, effectiveness, and implementation studies that address the gap between research-based knowledge about mental health treatment and what is actually offered in the community.     

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.     

Identifying effective mental health interventions for American Indians and Alaska Natives: a review of the literature

The pursuit of evidence-based practice (EBP) within the mental health professions has contributed to efficacious clinical intervention for individuals struggling with mental health problems. Within the context of the EBP movement, this article reviews the treatment outcome literature for mental health interventions directed specifically toward American Indians and Alaska Natives experiencing psychological distress. Fifty-six articles and chapters pertaining to the treatment of Native Americans with mental health problems were identified, though the vast majority of these did not systematically assess outcomes of specified treatments for Native American clients under scientifically controlled conditions. Of just nine studies assessing intervention outcomes, only two were controlled studies with adequate sample sizes and interpretable results relative to the identification of EBP among American Indians and Alaska Natives. The advantages and limitations of EBP for treatment of Native American mental health problems are discussed.     

Reflective Capacity: An Antidote to Structural Racism Cultivated Through Mental Health Consultation

Effecting a paradigm shift from “reproductive health” to “reproductive justice” within the perinatal field requires changes simultaneously at the levels of the individual healthcare provider and the system of care. The Infant-Parent Program at the University of California, San Francisco (UCSF) has extended its pioneering infant and early childhood mental health consultation to perinatal service systems applying an infant mental health approach to programs caring for expecting and new parents. In partnership with two nursing programs, UCSF consultants direct their efforts at supporting reflective practice capacities and use-of-self in patient–provider relationships. Both nursing programs serve vulnerable groups of expectant and new parents who grapple with challenges to health and well-being stemming from structural racism. As reflective capacities are supported within the consultation case conferences, providers spontaneously identify the need for tools to effectively address issues of race, class, and culture and to combat structural racism throughout the healthcare system. Policies and procedures that uphold structural racism cease to be tolerable to providers who bring their full selves to the work that they are trained to do. Using these nurse consultation partnerships as organizational case studies, this article describes a range of challenges that arise for providers and delineates steps to effective engagement toward reproductive justice.     

Employees' Attitudes Toward Drug Testing,Perceptions of Organizational Climate,and Withdrawal from the Employer

Theoretical models suggest that attitudes toward an employer's drug testing policy affect organizational climate and employee behavior, but empirical evidence has been scarce with limited external validity. Based on 66 manufacturing employees' questionnaire responses, attitudes toward drug testing significantly correlated with attitudes toward top management (r = +.39), support for employee safety (r = +.34), turnover intentions (r = –.31), and other variables. Although these data support a link between attitudes toward drug testing and employee withdrawal, they cannot address the issue of causality. Results suggest that perceived invasion of privacy is more strongly related to climate perceptions and turnover intentions than is perceived fairness.     

Investigating the Impact of Strength-Based Assessment on Youth with Emotional or Behavioral Disorders

The trend toward adopting a strengths approach to mental health practice with children and adolescents amounts to a paradigm shift from an emphasis on diagnosing disorders to tapping child capacities and assets toward the achievement of treatment goals. While the potential value and challenges associated with this shift has received ample attention in the literature, minimal research has been conducted to assess the benefits and barriers related to the use of strength-based strategies with youth. Utilizing an experimental design, this author examined the impact of strength-based assessment using the Behavioral and Emotional Rating Scale (BERS) with seriously emotionally or behaviorally disturbed children and adolescents. Results revealed that child functioning outcomes were significantly better for youth who received BERS-guided assessment versus the usual deficit-based assessment protocol only when the treating therapist reported an orientation toward service that reflects highly strength-based attitudes and practices. Furthermore, high adherence to the strength-based assessment protocol was associated with significantly higher parent satisfaction with services and lower rates of missed appointments. These findings highlight the importance of accounting for practitioner effects and treatment fidelity in future studies of strength-based practice effectiveness.     

中学组织气氛测量及其与教师心理健康的相关分析

在借鉴国外有关学校组织气氛理论研究成果和我国教育实践调查的基础上,对中学组织气氛的结构因素进行了理论构想。通过探索性因素分析和验证性因素分析,发现学校组织气氛主要由管理气氛、教学气氛、学习气氛、人际气氛四个维度共23个因子构成的。在此基础上,编制了中学组织气氛量表。经考察,该量表具有较好的信度与效度。应用该量表探讨学校组织气氛与教师心理健康的关系。结果发现：学校管理气氛与教师心理疾病中的敌意因子,学习气氛与强迫、人际敏感、焦虑和敌意因子具有显著的正相关;教师心理疾病各因子与学校组织人际气氛具有负相关,但不显著;学习气氛与敌意和焦虑、管理气氛与敌意因子回归显著。     

The Soft Underbelly of System Change: The Role of Leadership and Organizational Climate in Turnover during Statewide Behavioral Health Reform

This study examined leadership, organizational climate, staff turnover intentions, and voluntary turnover during a large-scale statewide behavioral health system reform. The initial data collection occurred nine months after initiation of the reform with a follow-up round of data collected 18 months later. A self-administered structured assessment was completed by 190 participants (administrators, support staff, providers) employed by 14 agencies. Key variables included leadership, organizational climate, turnover intentions, turnover, and reform-related financial stress ("low" versus "high") experienced by the agencies. Analyses revealed that positive leadership was related to a stronger empowering climate in both high and low stress agencies. However, the association between more positive leadership and lower demoralizing climate was evident only in high stress agencies. For both types of agencies empowering climate was negatively associated with turnover intentions, and demoralizing climate was associated with stronger turnover intentions. Turnover intentions were positively associated with voluntary turnover. Results suggest that strong leadership is particularly important in times of system and organizational change and may reduce poor climate associated with turnover intentions and turnover. Leadership and organizational context should be addressed to retain staff during these periods of systemic change.     

Health worker attitudes toward peer workers in hepatitis C prevention

Attitudes toward people who inject drugs (PWID) and attitudes toward peer workers among a cross-section of 101 Australian hepatitis C health workers were assessed. A survey consisting of Likert-type questions and one open-ended question regarding training was used. Bivariate and regression analyses demonstrated that health workers' attitudes toward peer workers were associated with their attitudes toward PWID, independent of type of organization or time in the hepatitis C sector. Qualitative analysis revealed four training areas suggested by health workers for peer workers. Implications of these findings for staff and peer training are discussed and future research directions suggested.     

Self‐criticism and self‐reassurance as mediators between mental health attitudes and symptoms: Attitudes toward mental health problems in Japanese workers

Japanese workers suffer high rates of mental health symptoms, recognised recently by the Japanese government, which has enacted workplace well‐being initiatives. One reason for poor mental health concerns negative attitudes about mental health problems such as shame, which may be mediated by self‐reassurance and self‐criticism. This study aimed to evaluate shame‐based attitudes toward mental health problems and explore the relationship between mental health attitudes, self‐criticism, self‐reassurance, and mental health symptoms. Japanese workers (n = 131) completed three measures: attitudes toward mental health problems, mental health symptoms, and self‐criticism/reassurance. A high proportion of workers reported negative attitudes about mental health problems. There were strong relationships between mental health attitudes, mental health symptoms, self‐criticism, and self‐reassurance. Path analyses revealed that the total and indirect effects (through self‐criticism and self‐reassurance) of mental health attitudes on mental health were larger than the direct effect alone. Hated‐self and family reflected shame were identified as predictors for mental health symptoms. The findings suggest the importance of self‐criticism and self‐reassurance in mental health and mental health attitudes. Implications for help‐seeking behaviours also are discussed. Interventions aimed at reducing self‐criticism and enhancing self‐reassurance are recommended to improve mental health attitudes and increase help‐seeking in Japanese workers.     

Testing a Theory of Implementation Leadership and Climate Across Autism Evidence-Based Interventions of Varying Complexity

Prominent theories within the field of implementation science contend that organizational leaders can improve providers’ fidelity to evidence-based practices (EBPs) by using focused implementation leadership behaviors that create an organizational climate for EBP implementation. However, this work has been criticized for overreliance on nonspecific, self-report fidelity measures and poor articulation of the boundary conditions that may attenuate leadership and climate’s influence. This study tests the predictions of EBP implementation leadership and climate theory on observed fidelity to three school-based EBPs for autism that vary in complexity: pivotal response training (PRT), discrete trial training (DTT), and visual schedules (VS). Educators in kindergarten to third-grade autism support classrooms in 65 schools assessed their principals’ EBP implementation leadership and school EBP implementation climate prior to the school year. Mid-school year, trained observers rated educator fidelity to all three interventions. Expert raters confirmed PRT was significantly more complex than DTT or VS using the Intervention Complexity Assessment Tool for Systematic Reviews. Linear regression analyses at the school level indicated principals’ increased frequency of EBP implementation leadership predicted a higher school EBP implementation climate, which in turn predicted higher educator fidelity to PRT—however, there was no evidence of a relationship between implementation climate and fidelity to DTT or VS. Comparing principals whose EBP implementation leadership was ±1 SD from the mean, there was a significant indirect association of EBP implementation leadership with PRT fidelity through EBP implementation climate (d = 0.49, 95% CI [0.04, 0.93]). Strategies that target EBP implementation leadership and climate may support fidelity to complex behavioral interventions.     

安全文化的内容、影响因素及作用机制

安全文化研究反映了现代安全管理向社会控制的发展。大多研究在态度与价值观水平上采用问卷调查的方式研究安全文化,也称安全气氛研究,不同研究中安全文化的维度结构差异很大;另一种研究取向则主张采用各种定性方法研究组织现象背后的基本意会。民族文化、生产特点与组织环境等因素都对安全文化产生影响,而安全文化则通过个体变量影响组织的安全绩效。该文进一步分析了研究分歧的原因以及组织水平研究中变量整合水平问题。文章认为,应该采用三角方法来测量安全文化,弄清它的原因及结果,以指导安全管理实践。     

The Interactive Effects of Role Conflict and Role Ambiguity on Job Satisfaction and Attitudes Toward Organizational Change: A Moderated Multiple Regression Approach

This study investigates the joint effects of both role conflict and role ambiguity on job satisfaction and three dimensions of attitudes toward organizational change, namely affective, cognitive, and behavioral tendency in a multicultural work setting. The study used a sample of 397 employees from several manufacturing and service organizations in the United Arab Emirates. Results of the moderated regression analysis revealed that role conflict and role ambiguity have no interactive effects on job satisfaction and the three dimensions of attitudes toward organizational change. Results of the moderated regression analysis revealed that role conflict and role ambiguity independently and negatively affect job satisfaction, cognitive attitudes, and behavioral tendency attitudes toward organizational change. Results further pointed out that role ambiguity affected attitude toward organizational change independently and negatively. Implications, limitations, and lines of future research were discussed.     

An empirical examination of stigma toward mental health problems and psychotherapy use in Veterans and active duty service members

Although many Veterans and active duty service members experience mental health problems, most do not seek out any sort of mental health help. Stigma (a significant predictor of treatment-seeking) has been documented among Veterans and active duty service members; however, previous research on stigma in these groups has primarily utilized correlational and qualitative designs. The purpose of this study was to gain a better understanding of stigma toward mental health problems in Veterans and active duty service members using an experimental design. One hundred sixty-five Veterans and active duty service members were randomized to read a vignette that described a Veteran who either did or did not experience a mental health problem and did or did not seek psychotherapy. Results indicated that the participants held more stigmatizing attitudes toward the Veteran who was described as having a mental health problem, but not toward the Veteran who was described as seeking psychotherapy. Additionally, participants held more positive attitudes toward the Veteran, compared to the attitudes that they believed other military members would hold. Last, with this sample of Veterans and active duty service members, self-stigma toward seeking psychotherapy was found to partially mediate the relationship between perceived public stigma and attitudes. Implications for addressing stigma in military service members and Veterans are discussed.     

Factors contributing to the utilization of mental health services in a rural setting

The purpose of this study was to examine if age, attitudes toward help-seeking, education, and sex were related to previous or intended future mental health utilization in a rural population. Data were collected via a mail survey from 438 adults. Regression analyses suggested that positive attitudes toward help-seeking, being female, and being younger were significantly related to both previous and intended future mental health service utilization. In addition, prior mental health use was significantly related to whether one would seek out mental health services in the future, Implications for mental health practitioners in rural settings are addressed, and limitations of the study discussed.