The assimilation of evidence-based healthcare innovations: a management-based perspective.

In order to reap the benefits of the nation's vast investments in healthcare discoveries, evidence-based healthcare innovations (EBHI) must be assimilated by the organizations that adopt them. Data from a naturalistic field study are used to test a management-based model of implementation success which hypothesizes strategic fit, climate for EBHI implementation, and fidelity will explain variability in the assimilation of EBHIs by organizations that adopted them under ordinary circumstances approximately 6 years earlier. Data gathered from top managers and external consultants directly involved with these long-term EBHI implementation efforts provide preliminary support for predicted positive linkages between strategic fit and climate; climate and fidelity; and fidelity and assimilation. Mediated regression analyses also suggest that climate and fidelity may be important mediators. Findings raise important questions about the meaning of assimilation, top managers' roles as agents of assimilation, and the extent to which results represent real-world versus implicit models of assimilation.

What gets noticed: how barrier and facilitator perceptions relate to the adoption and implementation of innovative mental health practices.

This mixed-method study examined the facilitators and barriers discussed by 166 informants interviewed from 78 innovative mental health projects. Facilitator and barrier coding reflected two dimensions: the topic of the comment (e.g., funding); and the time phase of the issue's influence (e.g., pre-decision). Proportions of facilitators to the sum of facilitator and barrier comments made by project informants were calculated. Overall, facilitator proportions were higher for projects that proceeded with implementation than those that did not adopt the practice. In addition, facilitator proportions were generally highest at pre-decision and lowest at full implementation for implementing projects.

A naturalistic study of MST dissemination in 13 Ohio communities.

The diffusion of evidence-based practices (EBPs) to child-serving human service organizations often occurs within the context of a comprehensive system-of-care in which a coordinated network of service providers collaborate to meet the needs of children and adolescents with serious behavioral and emotional disturbances. To the extent that inter-organizational networks influence the choices of organizational decision makers, it is necessary to understand interactions among participating organizations within the system when studying diffusion processes associated with EBP adoption and implementation. The present study analyzes decision making about the adoption and implementation of an EBP within the ecological context of system-of-care collaboration. Findings suggest that several factors impact the adoption decision, including system-of-care infrastructure planning and development activities before the decision process, the perception of adequate start-up and ongoing implementation resources among key players in the system-of-care, the range of motivations to participate in collaborative decision making, and the presence of entrepreneurial leadership.

What gets noticed: how barrier and facilitator perceptions relate to the adoption and implementation of innovative mental health practices.

This mixed-method study examined the facilitators and barriers discussed by 166 informants interviewed from 78 innovative mental health projects. Facilitator and barrier coding reflected two dimensions: the topic of the comment (e.g., funding); and the time phase of the issue's influence (e.g., pre-decision). Proportions of facilitators to the sum of facilitator and barrier comments made by project informants were calculated. Overall, facilitator proportions were higher for projects that proceeded with implementation than those that did not adopt the practice. In addition, facilitator proportions were generally highest at pre-decision and lowest at full implementation for implementing projects.

The de-adoption of innovative mental health practices (IMHP): why organizations choose not to sustain an IMHP.

The de-adoption or discontinuance of innovative mental health practices (IMHPs) was investigated among twelve mental health providers in Ohio. Researchers used mixed methodology to investigate factors that led the organizations to de-adopt the IMHPs. Findings suggest at least five indicators that an organization is likely to discontinue an IMHP (e.g., lack of financial resources and problems related to attracting and retaining qualified staff). Adopting agencies, state and local mental health authorities, and external technical assistance groups may be able to use this information to assist organizations in continuing with the implementation process.

The decision to adopt evidence-based and other innovative mental health practices: risky business?

OBJECTIVE: A risk-based decision-making framework was used to examine the decision to adopt innovative mental health practices, including both evidence-based and other research-guided practices. METHODS: Seventy-eight projects involving decisions to adopt one of four innovative mental health practices were the focus of this study. Key informants with direct knowledge about the adoption decision provided data for hypothesis testing. RESULTS: As predicted, the propensity to adopt an innovative practice-as measured by decision stage-was negatively related to the perceived risk of adopting the practice, positively related to expected capacity to manage risk, and positively related to an organization's past propensity to take risks. Further, perceived risk, anticipated resource availability, and exposure to field-based evidence explained a substantial part of what differentiated adopters from nonadopters. Finally, several features of innovations known to influence innovation adoption decisions were found to be related in expected ways to perceived risk, capacity to manage risk, and risk propensity. CONCLUSIONS: This research supports the view that the decision to adopt an innovative mental health practice is a decision made in consideration of risk. Contrary to popular views that early adopters of innovations are willing to take enormous risks, these data offer the novel idea that early adopters act because they see the risks associated with adopting as lower than their nonadopter counterparts, partly because the risks are seen as more manageable. Implications of results are discussed for organizations considering adoption of innovative health care practices and for state or local mental health authorities hoping for a higher level of adoption in their areas.

Identifying meaningful subgroups of adults with severe mental illness.

OBJECTIVE: The authors describe work conducted to identify, describe, and validate subgroups, or clusters, of adults with severe mental illness. METHODS: Clusters were first identified by using functional assessment ratings and statistical clustering procedures. Seven separate cluster analyses were accomplished, involving agencies in 15 counties in Ohio. Brief prose descriptions of the clusters were developed on the basis of the results of the statistical analyses. These descriptions were then used as stimuli in an extended expert-based validation and enhancement process that included work groups of consumers, family members, and providers. RESULTS: This sequential process produced generalizable, holistic descriptions of five core clusters of individuals with common strengths, problems, treatment histories, and life situations: older people in poor health who have psychiatric symptoms; individuals who have both psychiatric and substance use disorders; chronically mentally ill persons who have long treatment histories and severe disabilities; persons who appear to function well in the community but who are isolated as a result of anxiety, depression, or trauma-related social fears; and mental health consumers who function well in the community and who use personal and professional support systems to manage their mental health problems. CONCLUSIONS: The results support the hypothesis that there is meaningful, but predictable, heterogeneity among persons who have severe mental illness. The clusters identified in this study can be used to plan, manage, and evaluate services.