Teacher attitudes toward evidence-based practices: Exploratory and confirmatory analyses of the school-adapted evidence-based practice attitude scale.

Background: The Evidence-Based Practice Attitudes Scale (EBPAS) is widely used in implementation research, but it has not been adapted and validated for use among general education teachers, who are most likely to deliver evidence-based prevention programs in schools, the most common setting where youth access social, emotional, and behavioral health services. Method: School-based stakeholders and a research team comprised of experts in the implementation of evidence-based practices in schools adapted the EBPAS for teachers (the S-EBPAS). The adapted instrument was administered to a representative sample (n = 441) of general education teachers (grades K-5) to assess the reliability and internal consistency via factor analyses. The S-EBPAS included two forms (i.e., EBP-agnostic and EBP-specific item referents), therefore, a multiple-group confirmatory factor analysis (CFA) was also performed to establish measurement invariance between the two forms. Results: After adaptation and refinement, a 9-item, 3-factor structure was confirmed, with the final model supporting three first-order factors that load onto a second-order factor capturing attitudes toward adopting evidence-based practices. Multiple-group CFA analyses of measurement invariance indicated there were no significant differences between the two forms. Conclusions: Overall, this study provides a brief, flexible instrument capturing attitudes toward adopting EBPs that has high reliability and internal consistency, which support its use among general education teachers in school settings implementing evidence-based practices. Plain Language Summary: The Evidence-Based Practice Attitudes Scale (EBPAS) is a popular instrument for measuring attitudes toward evidence-based practices (EBPs). This instrument provides valuable information during implementation initiatives, such as whether providers or front-line implementers have favorable attitudes toward a given practice. The EBPAS has been used in many different settings, such as in community-based mental health clinics, medical hospitals, and in child welfare. However, it's use in schools has been limited, and it has not yet been tested with general education teachers, who are key implementers of evidence-based practices in schools. In order to trust that the scores from an instrument are accurate, it needs to be evaluated when scaling it out to new populations and settings. One popular method to determine this is to use factor analysis, which was employed in this study. This study fills the identified gap by assessing the reliability (i.e., accuracy) and internal consistency of the EBPAS among a representative sample of general education teachers. Findings from this study indicate that the school-adapted EBPAS (S-EBPAS) is a brief, nine-item instrument that provides a reliable estimate of teachers' attitudes toward evidence-based practices. Our results also provide evidence that the S-EBPAS can be used to capture attitudes toward specific EBPs as well as attitudes toward EBP-agnostic. This study provides a flexible instrument that can be used by school-based implementation researchers, practitioners, and intermediaries at multiple phases of implementation projects, such as when exploring a new EBP to adopt.

Expect the Unexpected: A Qualitative Study of the Ripple Effects of Children's Mental Health Services Implementation Efforts.

Background: Strategies to implement evidence-based interventions (EBIs) in children's mental health services have complex direct and indirect causal impacts on multiple outcomes. Ripple effects are outcomes caused by EBI implementation efforts that are unplanned, unanticipated, and/or more salient to stakeholders other than researchers and implementers. The purpose of the current paper is to provide a compilation of possible ripple effects associated with EBI implementation strategies in children's mental health services, to be used for implementation planning, research, and quality improvement. Methods: Participants were identified via expert nomination and snowball sampling. Online surveys were completed by 81 participants, each representing one of five roles: providers of mental health services to children or youth, researchers, policy makers, caregivers, and youth. A partially directed conventional content analysis with consensus decision making was used to code ripple effects. Results: Four hundred and four unique responses were coded into 66 ripple effects and 14 categories. Categories include general knowledge, skills, attitudes, and confidence about using EBIs; general job-related ripple effects; EBI treatment adherence, fidelity, and alignment; gaming the system; equity and stigma; shifting roles, role clarity, and task shifting; economic costs and benefits; EBI treatment availability, access, participation, attendance, barriers, and facilitators; clinical process and treatment quality; client engagement, therapeutic alliance, and client satisfaction; clinical organization structure, relationships in the organization, process, and functioning; youth client and caregiver outcomes; and use of EBI strategies and insights in one's own life. Conclusions: This research advances the field by providing children's mental health implementers, researchers, funders, policy makers, and consumers with a menu of potential ripple effects. It can be a practical tool to ensure compliance with guidance from Quality Improvement/Quality Assurance, Complexity Science, and Diffusion of Innovation Theory. Future phases will match potential ripple effects with salient children's mental health implementation strategies for each participant role.

User testing to drive the iterative development of a strategy to improve implementation of evidence-based practices in school mental health.

Research has produced a steady stream of evidence-based practices (EBP) that can promote youth behavioral health, but widespread implementation is often poor. To narrow the "science to practice gap," an implementation strategy was developed to enhance school-based mental health providers' intentions to implement EBP. The current study adopted a user-testing approach to inform the iterative development of this implementation strategy, which consisted of strategic education, social influence techniques, and motivational interviewing. Segments of the implementation strategy were demonstrated live for a representative sample of the intended audience. Participants rated each segment on acceptability, appropriateness, and likely impact on intentions to use EBP. Ratings were tallied in real time and presented to participants to spur discussion. Qualitative input was coded via conventional content analyses. Results indicated that that implementation strategies may need to be tailored to the specific EBP. In addition, implementation goal setting was well-received by some participants but not others, suggesting a difficulty of conducting motivational interviewing in group settings. Participants also perceived themselves as familiar with EBP and strong advocates of school mental health services. The paper concludes with a discussion of how this research has influenced the ongoing development of the strategy and implications for EBP implementation efforts.

Sex differences in heritability of BMI: a comparative study of results from twin studies in eight countries.

Body mass index (BMI), a simple anthropometric measure, is the most frequently used measure of adiposity and has been instrumental in documenting the worldwide increase in the prevalence of obesity witnessed during the last decades. Although this increase in overweight and obesity is thought to be mainly due to environmental changes, i.e., sedentary lifestyles and high caloric diets, consistent evidence from twin studies demonstrates high heritability and the importance of genetic differences for normal variation in BMI. We analysed self-reported data on BMI from approximately 37,000 complete twin pairs (including opposite sex pairs) aged 20-29 and 30-39 from eight different twin registries participating in the GenomEUtwin project. Quantitative genetic analyses were conducted and sex differences were explored. Variation in BMI was greater for women than for men, and in both sexes was primarily explained by additive genetic variance in all countries. Sex differences in the variance components were consistently significant. Results from analyses of opposite sex pairs also showed evidence of sex-specific genetic effects suggesting there may be some differences between men and women in the genetic factors that influence variation in BMI. These results encourage the continued search for genes of importance to the body composition and the development of obesity. Furthermore, they suggest that strategies to identify predisposing genes may benefit from taking into account potential sex specific effects.