Evidence-based practices for substance abuse prevention: Reports from the front line.

摘要

Federal funding agencies have been requiring community substance abuse coalitions to use evidence-based practices (EBPs) available as packaged prevention programs. Historically, such rigorous program and evaluation methods were not required; coalitions constructed prevention strategies based on local interpretations of risk and protective factors. A literature review revealed that researchers were not communicating with the street-level implementors charged with facilitating and implementing this shift to EBPs. This study of implementors from 20 community prevention coalitions in a small East Coast state examined implementors' (a) experiences doing prevention while being pressured to use EBPs, (b) perceptions of barriers and facilitating factors to using EBPs, and (c) rationales for using non-EBP methods. Sociological theories informed the study: the sociology of knowledge, social constructionism and social policy implementation. Constructivist grounded theory methods using semi-structured interviews elucidated the views of the coalition implementors. Data coding and re-coding allowed themes to emerge across multiple participant interviews. This constant comparative method of analysis led to the development of key theoretical concepts. Findings indicate that many coalitions are not using EBPs. Instead, they use "home grown" or locally constructed strategies based on common sense knowledge. Among perceived barriers to EBP implementation: (a) the state provided very little support or guidance, (b) implementors lacked prior training to deliver EBPs, and (c) funding was insufficient. Among perceived facilitating factors: (a) networking with other implementors helped with the shift to EBPs, and (b) obtaining additional funding made complex, time consuming, and costly EBPs affordable. A significant contributor to resistance to EBPs was the implementors' perceptions that their locally constructed methods were successful. Overall, implementors experienced the EBP mandate as coercive and they felt alienated from their work product when using methods they did not construct. Giving voice to street-level implementors is fundamental to understanding community resistance to EBPs and facilitating future EBP utilization. Technical consultants deployed at the local level to guide implementation and conduct continuous evaluation using triangulated methods would help improve the science to praxis learning curve.; Keywords. sociology of knowledge; research to praxis; implementation theory; grounded theory; ethnomethodology