A comparison of policy and direct practice stakeholder perceptions of factors affecting evidence-based practice implementation using concept mapping

Background: The goal of this study was to assess potential differences between administrators/policymakers and those involved in direct practice regarding factors believed to be barriers or facilitating factors to evidence-based practice (EBP) implementation in a large public mental health service system in the United States. Methods: Participants included mental health system county officials, agency directors, program managers, clinical staff, administrative staff, and consumers. As part of concept mapping procedures, brainstorming groups were conducted with each target group to identify specific factors believed to be barriers or facilitating factors to EBP implementation in a large public mental health system. Statements were sorted by similarity and rated by each participant in regard to their perceived importance and changeability. Multidimensional scaling, cluster analysis, descriptive statistics and t-tests were used to analyze the data. Results: A total of 105 statements were distilled into 14 clusters using concept-mapping procedures. Perceptions of importance of factors affecting EBP implementation varied between the two groups, with those involved in direct practice assigning significantly higher ratings to the importance of Clinical Perceptions and the impact of EBP implementation on clinical practice. Consistent with previous studies, financial concerns (costs, funding) were rated among the most important and least likely to change by both groups. Conclusions: EBP implementation is a complex process, and different stakeholders may hold different opinions regarding the relative importance of the impact of EBP implementation. Implementation efforts must include input from stakeholders at multiple levels to bring divergent and convergent perspectives to light. Background The implementation of evidence-based practices (EBPs) into real-world children’s mental health service settings is an important step in improving the quality of services and outcomes for youth and families [1,2]. This holds especially true for clients in the public sector who often have difficulty accessing services and have few alternatives if treatments are not effective. Public mental health services are embedded in local health and human service systems; therefore, input from multiple levels of stakeholders must be considered for effective major change efforts such as implementation of EBP [3,4]. In public mental healthcare, stakeholders include not only the individuals most directly involved–the consumers, clinicians, and administrative staff–but also program managers, agency directors, and local, state, and federal policymakers who may structure organizations and financing in ways more or less conducive to EBPs. Considerable resources are being used to increase the implementation of EBPs into community care; however, actual implementation requires consideration of multiple stakeholder groups and the different ways they may be impacted. Our conceptual model of EBP implementation in public sector services identifies four phases of