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A qualitative study of child clinicians in a non-profit HMO examined implementation of evidence-based practices (EBPs) for anxiety and oppositional defiant disorders using interviews and focus groups with 33 clinicians (97% of participants), and ethnography of emails and meetings. Analysis showed statistical measures of access and service-key elements of rating organizations' "report cards"- were central in creating "pressure" making transition to EBPs difficult. EBPs were secondary to access and service targets. "Research" and "statistics" were perceived as unrealistic, "literature" as lacking authority. Rating organizations should include outcome and fidelity metrics to align market share pressures with children's health.


Journal article


Administration and Policy in Mental Health

Publication Date





203 - 210


Anxiety; attention deficit disruptive behavior disorder; child health services; evidence based medicine; health maintenance organizations; health plan implementation; health plan implementation methods; health services accessibility; marketing health services; nonprofit; organizations; pilot projects; qualitative research