Provider Knowledge and Attitudes: Preliminary Findings From the 2005 Evidencebased Practice Survey

1
Provider Knowledge and Attitudes Preliminary
Findings From the 2005 Evidence-based Practice
Survey
Comprehensive Community Mental Health Services
for Children and Their Families Program
2
Evidence-based Practice SurveyBackground

• Increasing calls for using evidence-based
  practices to treat emotional and behavioral
  problems in the community-based setting.1
• Organizational challenges seen as significant
  barrier to implementing evidence-based practice
  in the service setting.2
• Little is known about how attitudes of front-line
  mental health providers impact use of
  evidence-based practice.3

1 New Freedom Commission on Mental Health, 2003
National Advisory Mental Health Council
Workgroup, 2001 DHHS, 1999. 2 Hyde, Falls,
Morris, Schoenwald, 2003 3 Aarons, G. (2004).
Mental Health Provider Attitudes Toward Adoption
of EBPs The EBPAS. Mental Health Services
Research, 6(2) 61-74.
3
Evidence-based Practice Survey Data Source

• Web-based survey of direct mental health service
  providers to children with emotional or
  behavioral problems and their families
• Conducted as part of the national evaluation of
  the Comprehensive Community Mental Health
  Services for Children and Their Families Program
• Surveyed providers affiliated with 22 communities
  funded as part of the program in 1999 and 2000
• 51-item Web-based survey (with a limited number
  of surveys conducted via telephone)

4
Evidence-based Practice Survey Purpose of the
Current Study

• To describe the characteristics of provider
  respondents,
• To describe provider knowledge, perceived
  effectiveness, and use of EBP, and
• To explore the relationships between provider
  attitudes toward EBP and workforce
  characteristics of provider respondents.

5
Evidence-based Practice Survey The Survey

• Demographic and workforce characteristics
• Based on list of 31 evidence-based or promising
  practices
• Are you familiar with the practice (familiarity)?
  
• Do you believe the practice is effective
  (effectiveness)?
• Have you used it in the past year (use)?
• Respondents were asked to complete the
  Evidence-based Practice Attitude Scale (EBPAS)
  (Aarons, 2004)
• 15-item scale pertaining to EBP attitudes and
  willingness to adopt

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Evidence-based Practice Survey The EBPAS

• Respondents were asked how much they agreed with
  each statement
• Likert Scale 1 not at all to 5 to a very
  great extent
• 15 statements grouped into 4 subscales
• Intuitive Appeal
• Likelihood to adopt if Required
• Openness to new practices
• Divergence from usual practice to
  research-based treatments
• Mean score across grouped statements represent
  subscale score, with higher mean representing
  higher agreement

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Evidence-based Practice Survey Methods

• Descriptive statistics on the characteristics of
  provider respondents,
• Descriptive statistics on provider knowledge,
  perceived effectiveness, and use of EBP, and
• Linear regression model identified to predict
  mean scores on 4 subscales of the EBPAS (DV) and
  10 IVs
• Race, gender, and age
• Education level, primary employer, position type,
  and whether licensed
• Years as a mental health provider, as a provider
  for children, and years with current employer

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Evidence-based Practice Survey Study Sample

• 287 providers responded to the EBP Survey
• 41 response rate
• 89 (n 255) were direct mental health providers
  for children with emotional or behavioral
  problems and were included in the current study
  sample
• 78 of those (n 197) provided services to
  children affiliated with the grant-funded program
• Of those, majority of providers (75) indicated
  that 40 or less of their caseload were
  grant-funded program children

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Evidence-based Practice Survey Study Sample
Note Partially completed surveys were included
in the current analyses. Race, gender and age
questions were the final survey questions,
resulting in smaller sample sizes.
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Evidence-based Practice Survey Primary Position
and Field of Discipline
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Summary of Familiarity, Perceived Effectiveness
and Use
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Evidence-based Practice Survey Familiarity,
Effectiveness, and Use

• Most Frequently Used EBPs
• Anger Management
• Cognitive Behavioral Therapy (CBT)
• Case Management
• Least Familiar EBPs
• Coping Cat for Anxious Youth
• Interpersonal Therapy for Youth
• Incredible Years
• Average of EBPs used (n 255) 7.9
• Average of EBPs used for those who use at least
  one (n 176) 11.4

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Evidence-based Practice Survey Mean Scores on
EBPAS
Aarons, 2004.
14
Evidence-based Practice Survey Linear Regression
Model to Predict EBPAS Subscale Scores

• Required subscale
• Only significant predictor was years as a mental
  health provider.1
• Appeal subscale
• Significant predictors were licensed clinician,2
  years as a mental health provider,3 as a provider
  for children,4 and years with current employer.5

Independent variables entered into the model
race, gender, age, employer type, education
level, position type, licensed, years as a mental
health provider, as a provider for children,
years with current employer.
1 b -.045, SE.020, plt.05 3 b -.032, SE.013,
plt.01 2 b -.309, SE.117, plt.01 4 b .041,
SE.015, plt.01 5 b -.027, SE.011, plt.01
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Evidence-based Practice Survey Linear Regression
Model to Predict EBPAS Subscale Scores

• Openness subscale
• Significant predictors were years as a mental
  health provider,1 as a provider for children,2
  and years with current employer.3
• Divergence subscale
• Only significant predictor was years as a mental
  health provider.4

Independent variables entered into the model
race, gender, age, employer type, education
level, position type, licensed, years as a mental
health provider, as a provider for children,
years with current employer.
1 b -.035, SE.014, plt.05 3 b -.029, SE.012,
plt.05 2 b .043, SE.017, plt.05 4 b -.035,
SE.014, plt.05
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Evidence-based Practice Survey Conclusions

• Homogenous respondent group
• Majority female, White, with advanced degrees,
  experienced based on number of years, and work
  for nonprofits.
• Suggests that respondents have similar
  backgrounds and experience.
• High rates of familiarity and lower than expected
  rates of perceived effectiveness, suggest
  respondent are familiar with EBPs but question
  the effectiveness.
• Respondents indicated using several EBPs in the
  past year, suggesting that respondents do not
  buy-in to one treatment approach.

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Evidence-based Practice Survey Conclusions

• Increase in years of experience was predictive of
  less willingness to use an EBP if it was required
  or was intuitively appealing.
• Increase in years of experience was also
  predictive of less openness to new treatments and
  less willingness to diverge from usual practice.
• Interestingly, an increase in years of experience
  working with children was predictive of higher
  openness and intuitive appeal subscale scores.
• Finally, being a licensed provider was predictive
  of a willingness to use an EBP if it was
  intuitively appealing.

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Evidence-based Practice Survey Implications

• Efforts to diversify the provider population to
  match the demographic makeup of populations being
  served is needed.
• With multiple EBPs being used by individual
  providers, more information is needed on training
  resources and implementation factors.
• More information dissemination is needed to
  increase knowledge on the effectiveness of
  evidence-based practices.
• More effort to engage experienced providers is
  needed to implement EBPs in the service setting.