The Legacy of Evidence-Based Mental Health Interventions: What Gets Sustained and How

Concerns over the quality of mental health services for children in the United States have led to the creation, dissemination and implementation of evidence-based mental health interventions. However, the impacts of these interventions on the systems in which they are implemented (i.e., practice settings) are unclear. Conceptualizing interventions ecologically as system events (Hawe, Shiell, & Riley, 2009) may provide a more complete understanding of intended and unintended intervention effects. The purpose of this qualitative pilot study, therefore, was to explore the impacts of evidence-based mental health interventions from the perspectives of community-based practitioners. A number of (unintended) effects on clients, staff members and the broader organization emerged. Further, the process by which they were achieved was one of mutual adaptation, in which interventions were modified to improve fit with the implementation system, and the organization changed by interacting with interventions over time. Findings suggest that conceptualizing intervention impacts more broadly will result in improved understanding of intervention-system interactions over time. Implications for re-conceptualizing intervention sustainability and conducting contextualized intervention research are discussed.