Employing survival analysis of administrative claims to identify prospective predictors of evidence-based practice sustainment versus provider turnover.
Lauren Brookman-Frazee, Teresa Lind, Mojdeh Motamedi, Joyce H L Lui, Morgan Crawley, Kenny Le, Anna S Lau
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引用次数: 0
Abstract
Objective: This study described therapists' delivery of six child mental health evidence-based practices (EBPs) over 33 months during the sustainment phase of a system-driven implementation aimed at improving access to EBPs in community settings.
Method: Seven hundred seventy-seven therapists and 162 program leaders delivering at least one of six EBPs of interest completed surveys, and these data were matched to therapist administrative claims data. Survival analyses examined (a) therapists' discontinuation of delivery of all Los Angeles County Department of Mental Health direct client services (i.e., turnover) and (b) therapists' discontinuation of a specific EBP while continuing to provide psychotherapy services.
Results: A majority of therapists (58.3%) were observed to discontinue providing any direct client services over the 33-month period, and discontinuation rates for specific EBPs ranged from 100% of therapists (Cognitive Behavioral Intervention for Trauma in Schools) to 76.4% (Managing and Adapting Practice). Different factors predicted the discontinuation of all service delivery compared to the discontinuation of a specific EBP. Greater therapist emotional exhaustion predicted higher likelihood of discontinuation of all direct client services. For EBP discontinuation, EBP-level factors (e.g., EBPs that required ongoing consultation), therapist-level factors (e.g., ability to provide services in a language other than English), and agency-level factors (e.g., more positive program leader perceptions of the EBP) predicted lower likelihood of discontinuation of the specific EBP.
Conclusions: Different factors contribute to the risk of therapists leaving the service system versus discontinuing the delivery of specific EBPs. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
期刊介绍：
The Journal of Consulting and Clinical Psychology® (JCCP) publishes original contributions on the following topics: the development, validity, and use of techniques of diagnosis and treatment of disordered behaviorstudies of a variety of populations that have clinical interest, including but not limited to medical patients, ethnic minorities, persons with serious mental illness, and community samplesstudies that have a cross-cultural or demographic focus and are of interest for treating behavior disordersstudies of personality and of its assessment and development where these have a clear bearing on problems of clinical dysfunction and treatmentstudies of gender, ethnicity, or sexual orientation that have a clear bearing on diagnosis, assessment, and treatmentstudies of psychosocial aspects of health behaviors. Studies that focus on populations that fall anywhere within the lifespan are considered. JCCP welcomes submissions on treatment and prevention in all areas of clinical and clinical–health psychology and especially on topics that appeal to a broad clinical–scientist and practitioner audience. JCCP encourages the submission of theory–based interventions, studies that investigate mechanisms of change, and studies of the effectiveness of treatments in real-world settings. JCCP recommends that authors of clinical trials pre-register their studies with an appropriate clinical trial registry (e.g., ClinicalTrials.gov, ClinicalTrialsRegister.eu) though both registered and unregistered trials will continue to be considered at this time.
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