Abstract
This study examined patterns of evidence-based treatment (EBT) delivery following a county-wide EBT reform initiative. Data were gathered from 60 youth and their 21 providers, who were instructed to deliver therapy as they normally would under the EBT initiative. Results showed limited applicability of county-supported EBTs to this service sample, and that most youth did not receive traditional delivery of EBTs. Findings suggest that it may be unrealistic to expect providers to deliver EBTs with fidelity with all clients, and that EBT implementation may be best thought of as a strategy for improving mental health services rather than a goal.
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Notes
The LACDMH PEI Plan is intended to promote effective mental health services for underserved cultural populations, individuals experiencing onset of serious psychiatric illness, children and youth in stressed families, trauma-exposed individuals, children and youth at risk of school failure, and children and youth at risk of or experiencing juvenile justice involvement. Given the aims of this study, we have focused on aspects of the PEI Plan related to early intervention for children and youth.
The EBTs supported by the LACDMH PEI Plan were selected through a feedback loop between community stakeholders (e.g., caregivers, community forum participants) and decision-making bodies (e.g., LACDMH staff, advisory groups). Although MAP—an evidence-informed services support system that offers a collection of “how to” guides for delivering common EBT practices to address a variety of mental health concerns and a searchable database that can identify the EBT practices that may be appropriate for specific clients—has been supported by the LACDMH PEI Plan since July 2010, MAP was not included in analyses because: (a) the randomized effectiveness trial from which data were gathered was designed to exclude providers who were trained in MAP; and (b) this decision enhances the generalizability of our findings to mental health service systems promoting the use of EBTs—as MAP is not an EBT per se.
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This work was supported by the John D. and Catherine T. MacArthur Foundation, who did not shape the design or conduct of the study; collection, management, analysis, or interpretation of the data, or preparation, review, or approval of the manuscript.
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Approval by the institutional review board of the University of California, Los Angeles, as well as those institutional review boards of participating service agencies that requested independent reviews, was obtained for this research. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
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Park, A.L., Tsai, K.H., Guan, K. et al. Unintended Consequences of Evidence-Based Treatment Policy Reform: Is Implementation the Goal or the Strategy for Higher Quality Care?. Adm Policy Ment Health 45, 649–660 (2018). https://doi.org/10.1007/s10488-018-0853-2
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DOI: https://doi.org/10.1007/s10488-018-0853-2