Chapter 25 Flashcards
What did Everett Rogers describe in his work ‘Diffusion of Innovation’?
He described how a British sea captain discovered in 1601 that citrus fruit could prevent scurvy, but it took 184 years for the British Navy to implement this practice.
What discovery did Ignaz Semmelweis make in 1846?
He demonstrated that childbed fever deaths could be nearly eliminated if physicians washed their hands with disinfectant before delivering a baby.
Why does the discovery of an effective treatment not always lead to its immediate use?
There is inertia in practice behavior, and providers tend to continue familiar practices unless they have a strong incentive to change.
What impact does publishing a superior test or treatment have on medical practice?
It can influence practice within a few years and failure to provide effective treatment may constitute malpractice.
Why has behavioral health lagged in implementing evidence-based treatments?
Providers often practice freely without objective verification, and they may genuinely believe they are providing evidence-based treatment when they are not.
What is the challenge in defining evidence-based practice?
There is confusion about how much and what quality of scientific evidence is needed to designate a treatment as effective.
What equation describes the failure of implementation of effective treatment?
Effective treatment + Ineffective implementation = No benefit.
What are the two dimensions of getting behavioral treatments into practice?
Dissemination (getting new information to practitioners) and implementation (ensuring it is used in practice).
What are the five characteristics that favor the dissemination of innovations?
Relative advantage, compatibility, simplicity, trialability, and observability.
Why do some behavioral interventions fail to be implemented despite evidence?
They may be perceived as irrelevant, incompatible with current practices, or difficult to implement in real-world settings.
What are some major U.S. providers of information on addiction treatment?
NIDA, NIAAA, CSAT, and CSAP.
What does the Consolidated Framework for Implementation Research (CFIR) identify?
It identifies five broad domains that can facilitate or hinder effective implementation of new treatments.
What are some common barriers to implementing evidence-based treatments?
Lack of training, high workload, organizational resistance, and lack of technical capacity.
What role do organizational factors play in implementation?
They include institutional priorities, staff morale, funding, and available technical support for new interventions.
What does research suggest about training workshops for behavioral interventions?
Workshops alone often have little impact on practice behavior unless followed by coaching and feedback.
What strategies help overcome barriers to implementation?
Involving staff in decision-making, offering incentives, pilot testing, and providing ongoing training and support.
Why is direct observation important in implementing new treatments?
It ensures fidelity and helps practitioners learn and apply the method correctly.
What is the impact of manual-guided treatments on real-world practice?
Strict adherence to manuals may not improve outcomes and flexibility is often necessary.
What is SBIRT and what challenges has it faced?
SBIRT (Screening, Brief Intervention, and Referral to Treatment) has struggled with implementation issues, such as inadequate training and limited impact on illicit drug use.
What has been the shift in addiction treatment philosophy?
It has moved from a ‘one-size-fits-all’ approach to a flexible, client-centered model emphasizing empathy and motivation.
