title: 'Better than nothing' is not good enough: challenges to introducing evidence-based approaches for traumatized populations.
abstract: BACKGROUND
  Focus group data were generated by a larger, mixed-methods investigation on treatment practices among therapists working with significantly traumatized populations in a primarily rural, underdeveloped region of the USA. This paper explores reasons behind low utilization of evidence-based practices (EBPs) that putatively would benefit poor communities where these behavioural health care providers serve.
  
  
  METHODS
  Eight focus groups of 45 licensed and certified behavioural health professionals were conducted over a 6-month period of time in 2006. Sites were selected based on Beale code designations with representation from urban, rural, and rural with urban influence providers. Potential respondents were selected from licensing board membership rosters and invited to participate in the study. Focus groups were facilitated by trained interviewers using a semi-structured interview schedule that focused on how participants defined, assessed, and understood trauma, as well as the information therapists utilized to determine interventions for clients with trauma histories.
  
  
  RESULTS
  Focus group transcripts were analysed using qualitative data reduction methods and six major themes emerged regarding the limited use of EBPs: complexity of trauma identification, issues with manualized assessment, role of treatment settings, conditions for innovation success and failure, untangling cultural effects, and defining successful treatment outcomes.
  
  
  CONCLUSIONS
  These findings shed light on the endurance of insufficient behavioural health infrastructures despite therapists' access to scientifically validated treatments for trauma spectrum and co-morbid mental disorders suffered by children and adults. Such insights have implications for the success of global dissemination of validated behavioural health interventions.
authors.affiliation: University of Kentucky Center for Study of Violence Against Children, Lexington, KY 40509, USA. jjclar00@uky.edu
authors.forename: James J
authors.initials: JJ
authors.lastname: Clark
authors.forename: Ginny
authors.initials: G
authors.lastname: Sprang
authors.forename: Benjamin
authors.initials: B
authors.lastname: Freer
authors.forename: Adrienne
authors.initials: A
authors.lastname: Whitt-Woosley
mesh_terms: D001524:Behavioral Medicine / Q000379:methods*; D003466:Cultural Characteristics; D055317:Evidence-Based Practice; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000628:therapy*; D036301:Qualitative Research; D012424:Rural Population; D017741:Survivors / Q000523:psychology*; D014481:United States; D014754:Violence