title: Predictors of community therapists' use of therapy techniques in a large public mental health system.
abstract: OBJECTIVE
  Few studies have examined the effects of individual and organizational characteristics on the use of evidence-based practices in mental health care. Improved understanding of these factors could guide future implementation efforts to ensure effective adoption, implementation, and sustainment of evidence-based practices.
  
  
  OBJECTIVE
  To estimate the relative contribution of individual and organizational factors on therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques within the context of a large-scale effort to increase use of evidence-based practices in an urban public mental health system serving youth and families.
  
  
  METHODS
  In this observational, cross-sectional study of 23 organizations, data were collected from March 1 through July 25, 2013. We used purposive sampling to recruit the 29 largest child-serving agencies, which together serve approximately 80% of youth receiving publically funded mental health care. The final sample included 19 agencies with 23 sites, 130 therapists, 36 supervisors, and 22 executive administrators.
  
  
  METHODS
  Therapist self-reported use of cognitive-behavioral, family, and psychodynamic therapy techniques, as measured by the Therapist Procedures Checklist-Family Revised.
  
  
  RESULTS
  Individual factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 16%; family therapy techniques, 7%; and psychodynamic therapy techniques, 20%. Organizational factors accounted for the following percentages of the overall variation: cognitive-behavioral therapy techniques, 23%; family therapy techniques, 19%; and psychodynamic therapy techniques, 7%. Older therapists and therapists with more open attitudes were more likely to endorse use of cognitive-behavioral therapy techniques, as were those in organizations that had spent fewer years participating in evidence-based practice initiatives, had more resistant cultures, and had more functional climates. Women were more likely to endorse use of family therapy techniques, as were those in organizations employing more fee-for-service staff and with more stressful climates. Therapists with more divergent attitudes and less knowledge about evidence-based practices were more likely to use psychodynamic therapy techniques.
  
  
  CONCLUSIONS
  This study suggests that individual and organizational factors are important in explaining therapist behavior and use of evidence-based practices, but the relative importance varies by therapeutic technique.
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors: Rinad S
authors: RS
authors: Beidas
authors: School of Social Policy and Practice, University of Pennsylvania, Philadelphia3Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
authors: Steven
authors: S
authors: Marcus
authors: Department of Psychiatry, University of California, San Diego.
authors: Gregory A
authors: GA
authors: Aarons
authors: Department of Psychiatry, New York University, New York, New York.
authors: Kimberly E
authors: KE
authors: Hoagwood
authors: Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston.
authors: Sonja
authors: S
authors: Schoenwald
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia7Department of Behavioral Health and Intellectual Disability Services, Philadelphia, Pennsylvania.
authors: Arthur C
authors: AC
authors: Evans
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia7Department of Behavioral Health and Intellectual Disability Services, Philadelphia, Pennsylvania8Community Behavioral Health, Philadelphia, Pennsylvania.
authors: Matthew O
authors: MO
authors: Hurford
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors: Trevor
authors: T
authors: Hadley
authors: Department of Family Medicine and Community Health, University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors: Frances K
authors: FK
authors: Barg
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors: Lucia M
authors: LM
authors: Walsh
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors: Danielle R
authors: DR
authors: Adams
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia.
authors: David S
authors: DS
authors: Mandell
mesh_terms: D002755:Choice Behavior; D015928:Cognitive Behavioral Therapy / Q000706:statistics & numerical data*; D003156:Community Mental Health Services; D003430:Cross-Sectional Studies; D055317:Evidence-Based Practice; D005196:Family Therapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D015279:Organizational Culture; D010414:Pennsylvania; D011613:Psychotherapy; D064889:Psychotherapy, Psychodynamic / Q000706:statistics & numerical data*; D012737:Sex Factors