Introduction to this Emerging Minds funded project by the Lead Researcher, Dr Holly Bear, University of Oxford:
Despite efforts to increase access to services and a proliferation in the number of interventions available, outcomes for young people remain suboptimal. This can be attributed, in part, to the complex process of implementing evidence-based approaches into practice. Providers are faced with a complex array of barriers which impede the implementation and adoption of established evidence-based practice (EBP). Similarly, researchers can face challenges in progressing their findings into ‘real-world’ settings and there remains a lack of consensus on implementation measurement.
To address this complex challenge, we will use implementation frameworks to investigate factors which optimise and hinder the implementation of research into practice in order to make recommendations across clinical, commissioning, and academic settings. In collaboration with the McPin Foundation and young co-researchers, we will use a theoretically informed survey to gather case study data on the implementation of EBP in children and young people’s mental health settings. Next, we will carry out qualitative work to gain a greater depth of understanding of stakeholders’ experiences and perspectives to better understand why implementation succeeds and fails.
We hope that this project will generate core knowledge about what facilitates and inhibits the uptake of mental health interventions in practice. From this knowledge, we will co-develop several outputs including a validated tool to measure barriers in practice which can be used in different contexts and settings and recommendations on how to develop a successful implementation strategy.
Following the end of the project, Dr Holly Bear shared some of the key messages from the research findings and identified possible future action.
What did we do?
We designed a survey in which respondents were asked to identify an evidence-based practice that they have been involved in developing and/or evaluating to help us better understand the barriers and facilitators to implementing it in routine ‘real world’ practice. We asked them questions about their professional experience and involvement in the development, evaluation, and implementation of evidence-based practice in their workplace. We have produced a tool to evaluate implementation and assess barriers in practice. During this project, there were 13 respondents.
Through focus groups and interviews, we also spoke to 17 people working in the field of children and young people’s mental health (CYP MH) to understand their views and perspectives of the implementation of evidence-based practice. We were particularly interested in understanding the challenges faced by clinicians, researchers, and those commissioning CYP’s mental health services in implementing evidence-based practice and knowing more about the features of good practice and things that worked well. In the interviews we asked them questions about their involvement in implementation, what works well and works not so well.
What did we find out?
Clinicians, commissioners, and researchers discussed that there is a lack of robust evidence base, and that the evidence used to inform practice is flawed and limited in many ways which impedes implementation efforts. The constraints around evidence include, but are not limited to, the reality that service-level data does not exist and there is no incentive to record things, as well as no agreed data source. Researchers specifically reported that often the interventions they are evaluating have not been tested rigorously enough to merit full-scale implementation efforts. The lack of robust evidence means that some interventions are being delivered in mental health services and in schools that do not yet have evidence to support their effectiveness. Those with a clinical role also highlighted that evidence can be inaccessible to them and spoke about how it is hard to stay up to date with new, emerging evidence and that academic papers were often behind a paywall. Clinicians described trying to keep their head above the water and not having time to seek out things like data and research.
We also identified many areas of good practice, including a participatory commissioning approach, asset mapping, multidisciplinary decision-making, commissioners being brave and using prototype testing, and commissioning as a disruptive role. Engaging in practice-based evidence and the inclusion of patient and public involvement activities were also discussed.
Improving efficient and effective implementation of evidence-based interventions is attainable but requires practical and collective efforts from those working in this field including academics, clinicians, government policy makers, decision-makers, leaders, and consumers. Clinical, commissioning, policy, research, research funding representatives must actively come together with CYP and their families to prioritise the use of evidence to improve services. This process has to be active, regular, and prioritised with clear roles for all. Stakeholders responsible for the commissioning and delivery of CYP MH services need support to do this. The qualitative work highlighted the potential value of the survey as part of a toolkit during the process of implementing an EBP.
In terms of ways forward, recommendations include developing professional competencies and roles for knowledge practitioners responsible for bridging and shortening the implementation gap, for example knowledge mobilisers, knowledge brokers, boundary spanners, intermediaries, and implementation specialists, as evidenced in many countries. Furthermore, researchers should actively engage with local commissioners, clinicians, and consumers to maximise research impact by considering how interventions will be used and in what contexts, early in their research endeavour.
Animation Co-produced with Young People
Contemplations from Copenhagen: “Just ask young people” and other key thoughts from a youth mental health conference.
Video: Researcher reflections: Implementing evidence-based practice in youth mental health.
For more information about this project please contact the project lead Holly Bear by emailing email@example.com.