Implementation of evidence-based practices for children in four countries: a project of the World Psychiatric Association.
OBJECTIVE
The present study examined implementation issues in adopting cognitive-behavioral therapies in routine clinical settings in four countries reflecting diverse cultures, languages, settings, and traditions.


METHODS
A Director's Systems Survey was administered prior to program implementation and one year later. Therapist ratings on attitudes about evidence-based practices and satisfaction were also gathered.


RESULTS
All sites reported successful adoption of the program, although significant variations existed in fiscal support, family involvement, prior experience with cognitive-behavioral therapies, and plans for sustainability. Therapists' ratings indicated overall satisfaction with the implementation of the project. Findings from the Director's Systems Survey pointed to five factors facilitating implementation: 1) early adoption and guidance by innovative leaders (i.e., the Directors); 2) attention to the "fit" between the intervention model and local practices; 3) attention to front-end implementation processes (e.g., cultural adaptation, translation, training, fiscal issues); 4) attention to back-end processes early in the project (e.g., sustainability); and 5) establishing strong relationships with multiple stakeholders within the program setting.


CONCLUSIONS
The implementation issues here mirror those identified in other studies of evidence-based practices uptake. Some of the obstacles to implementation of evidence-based practices may be generic, whereas issues such as the impact of political/economic instability, availability of translated materials, constitute unique stressors that differentially affect implementation efforts within specific countries.
Hoagwood
Kimberly E
KE
Columbia University, New York, NY 10031, USA. Hoagwood@childpsych.columbia.edu
Kelleher
Kelly
K
Murray
Laura K
LK
Jensen
Peter S
PS
D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods / Q000458:organization & administration*; D019317:Evidence-Based Medicine / Q000458:organization & administration*; D006306:Health Surveys; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008604:Mental Health Associations; D008605:Mental Health Services / Q000458:organization & administration*; D012559:Schizophrenia / Q000628:therapy*