Review article
Strategies for leading the implementation of evidence-based practices

https://doi.org/10.1016/S0193-953X(03)00067-4Get rights and content

Section snippets

The challenge

The good news is that research has demonstrated the effectiveness of many behavioral health practices [1]. For adults who are disabled by schizophrenia and other severe mental illnesses, for example, numerous recent reviews of the research evidence identify a core set of interventions that help persons attain outcomes they desire in terms of symptoms, functional status, and quality of life [1], [2], [3], [4], [5], [6]. Research also supports many practices for children [7], elders [8], and

Literature relevant to evidence-based practice implementation

The term “evidence-based practice” refers to services that are supported by clear, consistent research findings. The strongest scientific evidence comes when multiple well-designed controlled studies performed by different investigators conclude that a treatment is effective in promoting a desired measurable outcome. Confidence in the effectiveness of a service grows as consistent research evidence accumulates [2]. Implementing an evidence-based practice, as defined, involves transferring a

Recommendations

Leaders typically face several challenges when promoting the implementation of evidence-based practices. The next sections review some strategies that can be used to address common challenges in the motivating, enacting, and sustaining phases of evidence-based practice implementation.

Motivational phase strategies—why do it?

A leader's challenge during the motivating phase is to rally interest and support for the evidence-based practice. The work involves advocating for the practice and engaging other stakeholders in the process of implementation. The aim is to build enthusiasm and investment by answering the question: “Why implement this practice now?”

Sounding out and engaging key allies before advocating publicly is often very helpful. When brought into the planning process early, allies can provide needed

Enacting phase strategies—how to do it?

Having established interest in a practice, a leader's challenge during the enactment phase is to move from the idea of offering an evidence-based practice to actually providing a high-fidelity program to consumers who need it. The task involves planning, assigning clear responsibility, gathering the resources to make the changes, building staff competency, and shifting the flow of the daily work.

Sustaining strategies—how to maintain and extend the gains over time?

Many established practices devolve over time. Once a practice is in operation, a leader's challenge shifts to maintaining and improving the practice. Tasks at this phase include looking after the ongoing financial viability of the program, monitoring the program outcomes, celebrating success, continuing to train and support staff, and keeping focus on the practice.

Summaries

The strategies are offered as suggestions and are not all-inclusive. Additional implementation recommendations can be found in the general health and behavioral health evidence-based practice literature. The future is likely to bring further guidance, since the National Institute of Mental Health is funding [51] and research groups are developing the science of practice diffusion and implementation [16], [17], [18].

For now, research on health care improvement does not point to a single

First page preview

First page preview
Click to open first page preview

References (51)

  • S.J Bartels et al.

    Evidence-based practices in geriatric mental health

    Psychiatr Serv

    (2002)
  • W.R Miller et al.

    A methodological analysis for clinical trials of treatments for alcohol use disorders

    Addiction

    (2002)
  • R.E Drake et al.

    Regional variation in competitive employment for persons with severe mental illness

    Adm Policy Ment Health

    (1998)
  • A.F Lehman et al.

    and survey coinvestigators of the PORT Project: patterns of usual care for schizophrenia: initial results from the Schizophrenia Patient Outcomes Research Team (PORT) client survey

    Schizophr Bull

    (1998)
  • L Dixon et al.

    State policy and funding of services to families of adults with serious and persistent mental illness

    Psychiatr Serv

    (1999)
  • National Advisory Mental Health Council's Clinical Treatment and Services Research Workgroup

    Bridging science and service

    (1999)
  • National Alliance for the Mentally Ill Board of Directors

    Strategic plan for 2001–2003

    (2001)
  • H.H Goldman et al.

    Policy implications for implementing evidence-based practices

    Psychiatr Serv

    (2001)
  • S.K Schoenwald et al.

    Mental health services research and family based treatment: bridging the gap

  • P.C Panzano et al.

    The Innovation Diffusion and Adoption Research Project (IDARP): moving from the diffusion of research results to promoting the adoption of evidence-based innovations in the Ohio mental health system

  • W.C Torrey et al.

    Implementing evidence-based practices for persons with severe mental illnesses

    Psychiatr Serv

    (2001)
  • M Fishbein

    Developing effective behavioral change interventions: some lessons learned from behavioral research

  • L Green et al.

    Application of precede/proceed in community settings. Health promotion planning: an educational and environmental approach

    (1991)
  • J.M Prochaska et al.

    A transtheoretical approach to changing organizations

    Adm Policy Ment Health

    (2001)
  • K.J Klein et al.

    The challenge of innovation implementation

    Academy of Management Review

    (1996)
  • Cited by (0)

    This article was supported by a grant from the West Family Foundation.

    View full text