Implementation of Evidence-Based Practices within Treatment-As-Usual and Evidence-Based Practice Initiatives

Implementation Feasibility and Hidden Costs of Statewide Scaling of Evidence-Based Therapies for Children and Adolescents

OBJECTIVE

State mental health systems are retraining their workforces to deliver services supported by research. Knowledge about evidence-based therapies (EBTs) for child and adolescent disorders is robust, but the feasibility of their statewide scaling has not been examined. The authors reviewed implementation feasibility for 12 commonly used EBTs, defining feasibility for statewide scaling as an EBT having at least one study documenting acceptability, facilitators and barriers, or fidelity; at least one study with a racially and ethnically diverse sample; an entity for training, certification, or licensing; and fiscal data reflecting the costs of implementation.

METHODS

The authors reviewed materials for 12 EBTs being scaled in New York State and conducted a literature review with search terms relevant to their implementation. Costs and certification information were supplemented by discussions with treatment developers and implementers.

RESULTS

All 12 EBTs had been examined for implementation feasibility, but only three had been examined for statewide scaling. Eleven had been studied in populations reflecting racial-ethnic diversity, but few had sufficient power for subgroup analyses to demonstrate effectiveness with these samples. All had certifying or licensing entities. The per-clinician costs of implementation ranged from $500 to $3,500, with overall ongoing costs ranging from $100 to $6,000. A fiscal analysis of three EBTs revealed hidden costs ranging from $5,000 to $24,000 per clinician, potentially limiting sustainability.

CONCLUSIONS

The evidence necessary for embedding EBTs in state systems has notable gaps that may hinder sustainability. Research-funding agencies should prioritize studies that focus on the practical aspects of scaling to assist states as they retrain their workforces.

Characterizing supervision-as-usual: Findings from two provider surveys

Although clinical supervision is widely seen as critical for professional training and for safeguarding and promoting client well-being in mental health care, it is understudied, particularly in publicly funded services. In surveys of two large samples of youth mental health service providers (a state sample of providers billing Medicaid [N = 1,057] and a national sample of professional guild members [N = 1,720]), we examined the amount of time providers reported spending in supervision and consultation in a typical workweek and its covariation with characteristics of providers' caseloads and work settings. Across both samples, providers reported spending an average of 2-3 hr per week in supervision. Serving higher percentages of low-income clients was associated with significantly more supervision time. Working in private practice was associated with less supervision, while community mental health and residential facilities were each associated with more supervision time. The national survey also measured providers' perceptions of their current supervision. On average, providers endorsed feeling comfortable with the amount of supervision received and supported by their supervisors. However, working with more low-income clients was associated with greater need for supervisor approval and oversight and with less comfort in the amount of supervision received. Those working with more low-income clientele may benefit from additional supervision time or more focused supervision coverage of the specific needs of clients with low-income. More in-depth research on critical processes and content in supervision is a much-needed future direction for supervision research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).