When Do Therapists Stop Using Evidence-Based Practices? Findings from a Mixed Method Study on System-Driven...

Area of Science:

• Mental Health Services Research
• Implementation Science
• Clinical Psychology

Background:

• Therapist discontinuation of evidence-based practices (EBPs) is a significant challenge in community mental health.
• Understanding factors influencing discontinuation is crucial for successful EBP implementation and sustainment.

Purpose of the Study:

• To examine therapist and EBP-specific factors associated with discontinuation of EBPs in public children's mental health services.
• To identify key drivers of EBP cessation to inform future implementation and sustainment strategies.

Main Methods:

• A mixed-methods approach integrating quantitative survey data from 748 therapists and qualitative interview data from 79 therapists.
• Multi-level modeling was used to predict discontinuation, complemented by qualitative analysis of interview themes.

Main Results:

• Nearly half of therapists (47.5%) discontinued at least one EBP.
• Factors predicting discontinuation included fewer direct service hours, more adopted EBPs, emotional exhaustion, negative EBP attitudes, lower self-efficacy, and poor EBP fit.
• Qualitative themes emphasized the importance of EBP fit with client populations and therapist goals, alongside adequate training support.

Conclusions:

• Strategic sustainment planning is needed to address EBP fit and enhance therapist self-efficacy.
• Interventions should focus on aligning EBPs with agency needs, client populations, and therapist professional development.