Dissemination of Evidence-Based Depression Care for Community-Dwelling Older Adults

IntroductionIncreased attention is being focused on the strategies for adoption of evidence-based practices (EBPs) as payers including state departments of mental health are requiring their use to ensure high-quality care for patients (Goldman et al., 2001; Lopez, Osterberg, Jensen-Doss, & Rae, 2011). However, without substantial efforts in the promotion of EBPs, research has shown that effective interventions generally take anywhere from fifteen to twenty years to become incorporated into the world of routine clinical practice (Institute of Medicine, 2001 ). This lag in implementing high-quality services results in unnecessary financial costs for systems and emotional costs in terms of human suffering for patients and families.An emerging literature has begun to document the diversity of system, organizational, provider, and patient factors that are barriers to and facilitators of the implementation of EBPs (Beidas & Kendall, 2010). However, to date there is no definitive answer as to the most effective strategies for changing provider behaviors. Many of the training efforts reported in the scholarly literature are major research undertakings that are extremely costly and frequently cannot feasibly be implemented without extensive resources and expertise. There is a paucity of information on the means for training practitioners who are serving a segment of clients in community-based agency settings. This article reports on a small-scale EBP training initiative using an empirically supported depression care intervention, Problem-Solving Therapy Community-Based Settings (PST-COM), to serve depressed older patients and on the subsequent uptake of this EBP by trained practitioners.Factors Affecting EBP Implementation in Community-Based AgenciesThe service system context, in terms of the structure of organizations and funding of services, can affect the motivation and readiness of practitioners to implement EBPs (Aarons, Wells, Zagursky, Fettes, & Palinkas, 2009). Similarly, the climate and culture of organizations are extremely influential in the adoption by workers of new innovations as well as their attitudes toward EBPs (Aarons & Sawitzky, 2006; Glisson & James, 2002). For example, mental health organizations with more positive cultures/climates had workers with more positive attitudes toward implementing EBPs, whereas organizations with negative cultures were less receptive (Aarons & Sawitzky, 2006). Furthermore, the presence of organizational openness to change and support for the use of EBP is essential to adoption of EBP (Aarons, Sommerfeld, & Walrath-Greene, 2009; Ager et al., 2011). A staff person in a leadership role who champions the innovation has frequently been noted as crucial to the adoption of new interventions (Aarons, Hurlburt, & Horwitz, 2011; Rogers, 2003 ).Numerous provider-level factors have been found to be barriers to or facilitators of accepting and implementing EBPs. Provider beliefs about and misunderstandings of EBP as interventions that devalue their experience, expertise, and relationships with patients can be an overwhelming hindrance (Gibbs & Gambrill, 2002; Parrish & Rubin, 2011). Research findings by Ager and colleagues (2011) have suggested that provider social demographic characteristics, such as gender, race, and years of clinical experience, may well influence adoption. Practitioners' sense of self-efficacy at implementing the innovation, their willingness to change, their workload size, and their perceptions of the difficulty of learning the intervention contribute to whether they will adopt an EBP (Ager et al., 2011).Attributes of the EBP may well have an effect on likelihood of adoption. For example, the simplicity or degree of complexity makes a difference in the extent of implementation. Those interventions that are highly complex and require a good deal of effort and time to learn and to implement are less likely to be adopted as opposed to those that are more user friendly (Amodeo et al. …