System-level change in cultural and linguistic competence (CLC): how changes in CLC are related to service experience outcomes in systems of care.

As US demographic trends shift toward more diversity, it becomes increasingly necessary to address differential needs of diverse groups of youth in mental health service systems. Cultural and linguistic competence (CLC) is essential to providing the most appropriate mental health services to youth and their families. The successful implementation of CLC often begins at the system level. Though various factors may affect change and system-level factors set the tone for broad acceptance of CLC within systems, there is limited empirical evidence linking culturally competent practices to outcomes. The purpose of the present study was to examine system-level CLC changes over time within systems of care and their associations with service experiences among youth and their families. Participants were 4,512 youth and their families enrolled in the national evaluation of the Children's Mental Health Initiative (CMHI). Results suggest that implementation of CLC at the system level improves over time in funded systems of care. Further, variation exists in specific system-level components of CLC. In addition, the changes in CLC at the system level are related to family/caregiver participation in treatment. Implications for supporting positive changes in CLC among systems of care communities, and specific strategies for community psychologists, are discussed.

Evidence-based practice implementation: the impact of public versus private sector organization type on organizational support, provider attitudes, and adoption of evidence-based practice.

BACKGROUND: The goal of this study is to extend research on evidence-based practice (EBP) implementation by examining the impact of organizational type (public versus private) and organizational support for EBP on provider attitudes toward EBP and EBP use. Both organization theory and theory of innovation uptake and individual adoption of EBP guide the approach and analyses in this study. We anticipated that private sector organizations would provide greater levels of organizational support for EBPs leading to more positive provider attitudes towards EBPs and EBP use. We also expected attitudes toward EBPs to mediate the association of organizational support and EBP use. METHODS: Participants were mental health service providers from 17 communities in 16 states in the United States (n = 170). Path analyses were conducted to compare three theoretical models of the impact of organization type on organizational support for EBP and of organizational support on provider attitudes toward EBP and EBP use. RESULTS: Consistent with our predictions, private agencies provided greater support for EBP implementation, and staff working for private agencies reported more positive attitudes toward adopting EBPs. Organizational support for EBP partially mediated the association of organization type on provider attitudes toward EBP. Organizational support was significantly positively associated with attitudes toward EBP and EBP use in practice. CONCLUSION: This study offers further support for the importance of organizational context as an influence on organizational support for EBP and provider attitudes toward adopting EBP. The study demonstrates the role organizational support in provider use of EBP in practice. This study also suggests that organizational support for innovation is a malleable factor in supporting use of EBP. Greater attention should be paid to organizational influences that can facilitate the dissemination and implementation of EBPs in community settings.

Evidence-based practice knowledge, use, and factors that influence decisions: results from an Evidence-based Practice Survey of providers in American Indian/Alaska Native communities.

Data from the Evidence-based Treatment Survey were used to compare providers serving families in American Indian and Alaska Native communities to their counterparts in non-American Indian/Alaska Native communities on provider characteristics and factors that influence their decision to use evidence-based practices (N = 467). The findings suggest that providers affiliated with American Indian/Alaska Native communities are similar to their non-AI/AN community-affiliated counterparts in terms of familiarity, knowledge and use of evidence-based practices, and only differ slightly on the factors considered when deciding to use an evidence-based practice with a child and family.

Confirmatory factor analysis of the Evidence-Based Practice Attitude Scale in a geographically diverse sample of community mental health providers.

The Evidence-Based Practice Attitude Scale (EBPAS) assesses mental health service provider attitudes toward adopting evidence-based practices. The original scale development was done in one large California County using paper/pencil surveys. The present study examined the factor structure and internal consistency of the EBPAS in a sample of service providers from 17 states. Participants were mental health workers from agencies affiliated with communities funded under the federal Comprehensive Community Mental Health Services for Children and Their Families Program. A confirmatory factor analysis supported the originally derived a priori factor structure of the EBPAS in this new more geographically diverse sample and with a different data collection method. Analyses also demonstrated better internal consistency than in the original psychometric analyses. This study supports the factor structure and reliability of the EBPAS.