ABSTRACT
Publicly funded initiatives are underway to improve implementation of evidence-based practices (EBP) in youth mental health services. However, we know little about the success of these initiatives or about EBP implementation independent of such initiatives. We examined EBP implementation in a treatment as usual (TAU) state and in six states with publicly funded EBP initiatives (EBPIs). In Study 1, we examined providers' use of practices derived from the evidence base (PDEB) and their predictors among 780 providers in a TAU state. In Study 2, we conducted a systematic review of implementation strategies, outcomes, and predictors of EBP use in six state funded EBPIs. Study 1 suggests TAU providers use PDEB alongside practices without consistent research support; provider racial/ethnic minority status, learning theory orientation, and manual use predict greater PDEB use. Study 2 indicates EBPIs employ multiple recommended implementation strategies with variable outcomes across studies and measurement approaches. Predictors of EBP use in EBPIs also varied, though training, setting, and youth age were consistent predictors across studies. While sample differences and inconsistent measurement across studies made direct comparisons somewhat tenuous, rates of PDEB use in the TAU sample appeared similar to those in publicly funded EBPIs. However, two states reported comparisons with TAU samples and found higher EBP implementation under EBPI. Different predictors impacted EBP use in TAU versus EBPIs. Our findings highlight the need for improved evaluation of EBPIs including clear reporting standards for outcomes and more consistent, standardized measurement of EBP use in order to better understand and improve EBPIs.
Subject(s)
Ethnicity , Mental Health Services , Adolescent , Evidence-Based Practice , Humans , Minority GroupsABSTRACT
Structured child and adolescent treatments, tested through controlled clinical trials, have produced beneficial effects in hundreds of studies. By contrast, the limited pool or research on traditional clinical treatments raises doubts about their effectiveness. Thus, identification of empirically supported treatments may contribute something of real value to clinical practice and training. The Child Task Force report represents an important initial step in this direction. Here we offer both praise and critique, suggesting a number of ways the task force process and product may be improved. In addition, we suggest several ways to strengthen and enrich the clinical trials research available to the Task Force, emphasizing the need to test empirically supported treatments with referred youth in practice settings.
Subject(s)
Mental Disorders/therapy , Psychology, Adolescent/standards , Psychology, Child/standards , Psychology, Clinical/standards , Psychotherapy/methods , Psychotherapy/standards , Adolescent , Child , Child, Preschool , Female , Guidelines as Topic , Humans , Male , Meta-Analysis as Topic , Models, Psychological , Motivation , Psychiatric Status Rating Scales , Reproducibility of Results , Social Adjustment , Treatment OutcomeABSTRACT
A genomic sequence close to the cystic fibrosis locus with the characteristics of an HTF island has been selectively cloned and characterized. Two markers flanking this sequence, which is conserved throughout mammalian evolution, show a very much greater disequilibrium than that found with any existing marker. A single mutational event accounts for most cases of cystic fibrosis. The sequence is expressed, and is a candidate for the cystic fibrosis gene.
