Weaving Strengths and Vulnerabilities: Implementing Evidence-Based Practices in Core Safety Net Settings

Thesis (Ph.D.)--University of Washington, 2014Despite a prolific amount of available evidence-based practices (EBPs), health and mental health interventions have not been implemented as anticipated. Patients relegated to the core safety net, a subset of the safety net with a mission or legal mandate to care for vulnerable populations, face even greater obstacles to receiving evidence-based care. The fundamental research that has shaped current implementation models has been primarily outside the core safety net setting. Three qualitative studies, using grounded theory methodology, were undertaken to examine the processes and contextual influences unique to implementation of EBPs in the core safety net. Semi-structured interviews and focus groups of administrators and front line clinicians were employed to ascertain their experiences implementing three EBPs in three core safety net settings. Results in all three studies revealed challenging and beneficial contextual factors woven together in ways that the fabric of their combination supported the implementations, or possessed vulnerabilities that caused them to falter. Key findings across all studies were the importance of the following for successful implementation: intervention fit with characteristics and beliefs of patients, and needs of the community; intervention compatibility with the organization mission; intervention adaptability, quality, and observability; beliefs and behaviors of clinicians; adequate, dedicated clinical staffing; ongoing training and education; structural and cultural organizational assets; and ongoing network and system building