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.

Consumer and case manager perspectives of service empowerment: relationship to mental health recovery.

This study examines the relationship between service empowerment and recovery. Service empowerment is defined as the extent to which consumers participate in service decisions and the level of reciprocity and respect within the relationship with their case managers. Assessments were made from two perspectives: consumers and their case managers. Structural equation models were developed to examine the direct and indirect effects of service empowerment on four recovery outcomes: Quality of Life, Level of Functioning, Consumer-Reported Symptomatology, and Case Manager-Reported Symptomatology. Consumers' perceptions of service empowerment were the most powerful predictor of recovery outcomes across the four models. Consumers' and case managers' perceptions were related but the magnitude of the relationship was small, indicating that considerable differences exist between their perceptions of service empowerment.

Impact of services, met needs, and service empowerment on consumer outcomes.

The current study examined service characteristics, needs, and outcomes of consumers with severe mental disabilities served in a public mental health setting. The study utilized a longitudinal design with three yearly waves of measurement. Data were obtained from consumer interviews and case manager questionnaires. A model specifying relationships between service characteristics, needs, and outcomes was tested using structural equation modeling. This model incorporated service-related variables pertaining to service amounts, service empowerment, and needs in order to gain a better understanding of factors that mediate service effects and account for mental health outcomes. The model focused on consumers' perspectives, in order to highlight the importance of consumers' opinions about their mental health services and needs. The results suggested that consumers' perceptions that their needs are met were related to better symptomatology and quality of life outcomes. In addition, consumers' perceptions that they had some say in service-related decisions had an indirect effect on mental health outcomes by increasing the likelihood that needs were met according to consumers' perspectives. Results were mixed with regard to the effects of these variables on level of functioning outcomes. Service amount was unrelated to mental health outcomes. Furthermore, service amount was unrelated to consumers' perceptions of needs, suggesting that consumers' views regarding met and unmet needs may not be included sufficiently in decision-making surrounding the provision of services.