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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2009.161711v1 99/11/2087    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Aarons, G. A. Articles by Palinkas, L. A. PubMed PubMed Citation Articles by Aarons, G. A. Articles by Palinkas, L. A. Related Collections Community Health Health Administration Health Policy Quality of Care Mental Health Other Child and Adolescent Health

Gregory A. Aarons, PhD, Rebecca S. Wells, PhD, Karen Zagursky, MA, Danielle L. Fettes, PhD and Lawrence A. Palinkas, PhD

Gregory A. Aarons and Danielle L. Fettes are with the Department of Psychiatry at the University of California, San Diego, and the Child and Adolescent Services Research Center at Rady Children's Hospital, San Diego. Rebecca S. Wells is with the Gillings School of Global Public Health, Department of Health Policy and Management at the University of North Carolina at Chapel Hill. Karen Zagursky is with the Solana Highlands School District, Solana Beach, CA. Lawrence A. Palinkas is with the Departments of Social Work, Anthropology, and Preventive Medicine at the University of Southern California, Los Angeles, and the Child and Adolescent Services Research Center at Rady Children's Hospital.

Correspondence: Correspondence should be sent to Gregory A. Aarons, PhD, Associate Professor of Psychiatry, University of California, San Diego, Department of Psychiatry, 9500 Gilman Dr (0812), La Jolla, CA 92093-0812 (e-mail: gaarons{at}ucsd.edu). Reprints can be ordered at http://www.ajph.org by clicking the "Reprints/Eprints" link.

Objectives. We sought to identify factors believed to facilitate or hinder evidence-based practice (EBP) implementation in public mental health service systems as a step in developing theory to be tested in future studies.

Methods. Focusing across levels of an entire large public sector mental health service system for youths, we engaged participants from 6 stakeholder groups: county officials, agency directors, program managers, clinical staff, administrative staff, and consumers.

Results. Participants generated 105 unique statements identifying implementation barriers and facilitators. Participants rated each statement on importance and changeability (i.e., the degree to which each barrier or facilitator is considered changeable). Data analyses distilled statements into 14 factors or dimensions. Descriptive analyses suggest that perceptions of importance and changeability varied across stakeholder groups.

Conclusions. Implementation of EBP is a complex process. Cross-system–level approaches are needed to bring divergent and convergent perspectives to light. Examples include agency and program directors facilitating EBP implementation by supporting staff, actively sharing information with policymakers and administrators about EBP effectiveness and fit with clients' needs and preferences, and helping clinicians to present and deliver EBPs and address consumer concerns.