Review
Dissemination and Implementation of Evidence-Based Practices for Child and Adolescent Mental Health: A Systematic Review

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Objective

Although there has been a dramatic increase in the number of evidence-based practices (EBPs) to improve child and adolescent mental health, the poor uptake of these EBPs has led to investigations of factors related to their successful dissemination and implementation. The purpose of this systematic review was to identify key findings from empirical studies examining the dissemination and implementation of EBPs for child and adolescent mental health.

Method

Of 14,247 citations initially identified, 73 articles drawn from 44 studies met inclusion criteria. The articles were classified by implementation phase (exploration, preparation, implementation, and sustainment) and specific implementation factors examined. These factors were divided into outer (i.e., system level) and inner (i.e., organizational level) contexts.

Results

Few studies used true experimental designs; most were observational. Of the many inner context factors that were examined in these studies (e.g., provider characteristics, organizational resources, leadership), fidelity monitoring and supervision had the strongest empirical evidence. Albeit the focus of fewer studies, implementation interventions focused on improving organizational climate and culture were associated with better intervention sustainment as well as child and adolescent outcomes. Outer contextual factors such as training and use of specific technologies to support intervention use were also important in facilitating the implementation process.

Conclusions

The further development and testing of dissemination and implementation strategies is needed to more efficiently move EBPs into usual care.

Section snippets

Databases and Search Methodology

We conducted a systematic literature search for all of the available empirical studies examining dissemination and implementation of evidence based practices in child and adolescent mental health using PubMed, Embase, PsycInfo, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINHL), and the Cochrane Library. Search terms relating to dissemination and implementation, mental health including DSM-IV diagnoses, and child and adolescent populations were used to search each

Results

A total of 14,247 citations were identified from database searches based on title alone, with an additional 336 records identified through EBP Web sites and contacting EBP model developers. These citations were further distilled down to 1,092 after reviewing the titles and eliminating duplicates. The abstract review resulted in 203 potential articles for full review; 104 were kept after full article review. Finally, these studies were assessed for methodological rigor and relevance to

Discussion

Of the many inner contextual factors that have been examined in the studies included in this review (e.g., provider characteristics, organizational resources, leadership), fidelity monitoring and supervision were most frequently examined and have the strongest empirical evidence. Ongoing fidelity assessment, supervision, and support increases the likelihood that expected intervention effects will be realized, and has important ancillary benefits including reduced staff burnout and improved

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  • Cited by (0)

    This article was reviewed under and accepted by ad hoc editor Bradley D. Stein, M.D., Ph.D.

    This study was supported in part by National Institutes of Health (NIH) grants R01DA022239, R01MH072961, P30MH074678, and R25MH080916.

    Drs. Novins and Aarons served as the statistical experts for this research.

    Disclosure: Dr. Novins is a deputy editor for the Journal of the American Academy of Child and Adolescent Psychiatry and co-editor for the special series of papers in this Journal on dissemination and implementation research. He has received funding for research, evaluation, and/or technical assistance activities from NIH, the Administration for Children and Families (ACF), the Substance Abuse and Mental Health Services Administration, and the U.S. Department of Justice. Dr. Green has received funding from for research and/or evaluation from NIH, the Centers for Disease Control and Prevention (CDC), and ACF. Dr. Aarons is co-editor for the special series of papers in this Journal focused on dissemination and implementation research. He has received funding for research and/or evaluation from NIH, CDC, and ACF. Dr. Legha reports no biomedical financial interests or potential conflicts of interest.

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