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Adoption of strategies to improve decision support in community mental health centers


Assessment of specific skills acquired during training of a new practice is important in understanding adoption, but often difficult to do. This project summarizes information from a clinical skills assessment over one year post training of a program to increase treatment decision support by staff for individuals receiving mental health services.


Training and implementation on a Decision Support Toolkit (Pat Deegan & Associates) was provided and supported by a managed behavioral health care organization to interested providers. Individuals in service and staff at four community mental health centers completed a skills and practices survey where they rated how often 18 activities occurred during their clinical sessions on a Likert scale. To examine subscales, an exploratory factor analysis was conducted using the Principal Axis Factoring method for non-normally distributed data with Promax rotation to account for correlations among subscales.


Surveys were completed by 41 staff at baseline, 43 at 6 months, 40 at 12 months and 300 individuals in service at baseline, 352 at 6 months, and 347 at 12 months. Three subscales were derived: Clinical (e.g., establish goals, discuss medication instructions), Empathy (e.g., offer empathy, support individual-clinician communication), and Information (e.g., provide information, educate families on mental health). Confirmatory factor analysis yielded chi-square p-value = 0.09 indicating a good fit. Staff ratings for Empathy were significantly higher at 12 months v. baseline (p = 0.008) and on average were higher than individual report (p = 0.004). The same pattern was seen for Information (p = 0.007), but on average staff ratings were lower than reported by individuals (p < 0.0001). Clinical skills were not expected to change and did not. Discrepancies between staff and individual reports will be further investigated.


Assessment of specific skills acquired during training can be monitored and compared to report from those receiving services to confirm adoption of a new practice and discover needed improvements.


Community Care Behavioral Health Organization.

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Correspondence to Shari L Hutchison.

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This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

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Hutchison, S.L., Karpov, I., Deegan, P.E. et al. Adoption of strategies to improve decision support in community mental health centers. Implementation Sci 10 (Suppl 1), A27 (2015).

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