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Table 1 4KEEPS key constructs and measures as predictors of sustainment outcomes

From: The 4KEEPS study: identifying predictors of sustainment of multiple practices fiscally mandated in children’s mental health services

Measure Subscales Sample items Citations Th PM
Therapist attitudes   
Perceived Characteristics of Intervention Scale (PCIS) Relative advantage, compatibility, complexity, potential for reinvention (Practice) is more effective than other therapies I have used. Cook JM, Thompson R, Schnurr PP. Perceived characteristics of intervention scale: development and psychometric properties. Assessment. 2015;22(6):704–14. doi:10.1177/1073191114561254. x x
Evidence-Based Practice Attitude Scale (EBPAS) Divergence, openness, limitations (practice-specific) I like to use new types of therapy/interventions to help my clients. Aarons GA, Glisson C, Hoagwood K, Kelleher K, Landsverk J, Cafri G, et al. Psychometric properties and U.S. national norms of the Evidence-Based Practice Attitude Scale (EBPAS). Psychol Assess. 2010;22(2):356–65. doi:10.1037/a0019188. x  
(Practice) detracts from truly connecting with my clients.
Knowledge and confidence   I am well prepared to deliver (Practice) even with challenging clients. Project developed x  
I am confident in my ability to implement (Practice).
Implementation support   
Practice-specific implementation support Rate the frequency that the following are part of ongoing supervision for:
a.Live observation
b.Review of recorded session
c.Case discussion
d.Review of client progress monitoring (outcomes, dashboards) …
Project developed x x
Organizational context   
Organizational climate measure Autonomy, Rational Goal (Performance Feedback), HR Involvement (Therapists) Program managers and/or agency leaders let people make their own decisions much of the time. Patterson MG, West MA, Shackleton VJ, Dawson JF, Lawthom R., Maitlis S, et al. Validating the organizational climate measure: links to managerial practices, productivity and innovation. J Organ Behav. 2005;26:379–408. doi:10.1002/job.312. x x
Organizational readiness to change Staffing, Cohesion, Stress Frequent therapist turnover is a problem for your program. Lehman WEK, Greener JM, Simpson DD. Assessing organizational readiness for change. J Subst Abuse Treat. 2002;22:197–209. doi:10.1016/S0740-5472(02)00233-7   x
Maslach Burnout Inventory (adapted) Exhaustion, Personal Accomplishment I feel emotionally drained from my work. Schaufeli WB, Leiter MP. Maslach Burnout Inventory–general survey. In: The Maslach burnout inventory-test manual. 1996. p. 19–26. x  
I feel I’m positively influencing the lives of my clients through my work.
Therapist adaptations   
Adaptations of evidence-based practices I modify how I present or discuss the components of (Practice). Stirman SW, Miller CJ, Toder K, Calloway A. Development of a framework and coding system for modifications and adaptations of evidence-based interventions. Implement Sci. 2013;8(65):1–12. doi:10.1186/1748-5908-8-65. x  
I apply (Practice) to novel populations.
Barriers to implementation (client-level)   
Emergent life event (ELE) and engagement measure Did the client or client’s caregiver raise a stressful life event that was not the intended focus of session? If yes, to what extent were you able to carry out your intended activities or return to the focus of session? Project developed x