CMHQA

Issues Surrounding the Implementation of Evidence-Based Practices

Many issues arise during EBP implementation. Some, such as stakeholder concerns and infrastructure development are common across all practices. Others, such as cultural competence and patient-centered care are more setting-specific. You will find some discussion on these subtopics below as well as a list of linked references to articles and materials covering a wide range of issues pertaining to EBP implementation.

Factors Constraining EBP Implementation

Many factors constrain the implementation of evidence-based practices (Ganju, 2003, p. 126), such as:

Evidence-based practices may not be reimbursed by Medicaid or other health insurance
Clinicians and providers may not have been trained to deliver EBPs
Relative advantages of EBPs may not be clear to stakeholders
Innovative services may be perceived as a threat to the existing organizational structure and hierarchy
Regulations and policies may not support EBPs
Rapid turnover in staff may inhibit efforts to sustain implementation
New funding for training and transitioning service delivery procedures may not be available
Mental health systems may lack ability to provide incentives for innovative practices

Cultural Competence

A culturally competent mental health delivery system is one that is sensitive and responsive to the needs and differences among varying ethnic, cultural, and belief groups in its community of care. A recent meeting of experts (Tampa, Florida, July 2003) to discuss cultural competence and evidence-based practices resulted in a Consensus Statement on Evidence-Based Programs and Cultural Competence revealed that:

We do not know the effectiveness of many services that are delivered because they have not been researched.
Little research related to evidence-based programs has been conducted with diverse populations.
Where studies have been done that include different racial, ethnic, or cultural groups, small sample sizes have prevented any conclusions regarding the effectiveness of evidence-based programs for these populations.
In communities where evidence-based programs have been implemented, there is no discernible pattern of success or failure for those that have higher disenfranchisement or poverty levels when compared to other communities that have lower levels.
Implementation of evidence-based programs depends on the availability of an adequate infrastructure (e.g., financial and human resources), strategies to promote community organization and readiness, implementation and knowledge transfer strategies, fidelity measurement procedures, support from stakeholders is imperative so that partnerships are developed with specific racial, ethnic, and cultural communities, allowing them to participate fully in the design, implementation, and evaluation of promising and best practices models.
Further research is required to understand what adaptations and modifications need to occur to improve the implementation of best practices models in diverse communities.
There is evidence that there are services and programs that are ineffective for the problems they are intended to address and, that persons belonging to specific racial, ethnic, and cultural groups may be disproportionately affected.

EBP Stakeholders

Stakeholders have concerns about the costs, goals, and impacts of evidence-based practices (Ganju, 2003, p. 128-129).

Administrators and funders may consider that the cost of changing service delivery is too expensive an investment.
Advocates may consider that the goals of some evidence-based practices may not directly promote recovery.
Families and consumers may be concerned that evidence-based practices will be considered the only beneficial ones, and that this will limit the availability of services that families and consumers think are beneficial.

Patient-Centered Care

A renewed emphasis is increasingly being placed on patient-centered care. This will greatly influence the development and implementation of evidence-based practices. The Institute of Medicine Report (2001) predicts that patient-centered care will be a core characteristic of effective service delivery. In fact, patient preference will be an element of control exerted by people as they make health care decisions.

In health care encounters patients will grow to expect that: