Implementing Evidence-Based Treatments in Organizations

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 44; no. 12; pp. 1313 - 1316
• Main Author: Woolston, Joseph L
• Format: Journal Article
• Language: English
• Published: United States Lippincott Williams & Wilkins 01-12-2005
• Subjects: Adolescent; Adolescent Psychiatry - organization & administration; Case Studies; Child; Child Psychiatry - organization & administration; Children; Cooperative Behavior; Diffusion of Innovation; Dissent and Disputes; Education; Evidence-Based Medicine; Health Plan Implementation - organization & administration; Humans; Medical Services; Mental Disorders; Organizational Innovation; Organizational Objectives; Outcomes of Treatment; Outpatient Clinics, Hospital - organization & administration; Program Implementation; Psychiatry; Research and Development; Theory Practice Relationship
• ISSN: 0890-8567
• DOI: 10.1097/01.chi.0000181041.21584.7a

Several case studies in implementing evidence-based treatments (EBTs) in organizations are presented. Two erroneous presuppositions about treatments with proven efficacy (henceforth called EBTs) frequently lead to major problems (Hoagwood et al., 2001). The first is that the development of an EBT has taken into account the fit between the treatment and the context of delivery. Therefore, once the efficacy of an EBT has been established, the EBT will be usable and relevant in "real world" clinical settings. The second presupposition is that the implementation of the EBT in clinical settings will be automatic once the strength of the evidence is clear to all. Hoagwood et al. (2001) argued that both presuppositions are misleading. Rosenheck (2001) proposed four strategies to promote the transition of an EBT from research to practice within an organization: (1) construction of leadership coalitions that favor implementation and provide ongoing support; (2) linking initiatives to legitimate organizational goals and values; (3) quantitative monitoring of fidelity to the model and of ongoing program performance; and (4) development of self-sustaining subcultures or communities of practice that both perpetuate and modify program procedures and values. Regarding the construction of decision-making coalitions, Rosenheck (2001) suggested an "iron rule of hierarchy": the higher in the hierarchy the decision-making coalition is, the wider the dissemination will be within the organization, but the more difficulty there will be in achieving consensus and, therefore, implementation.