ORIGINAL ARTICLE Predictors of Use of Evidence-Based Practices for Children and Adolescents in Usual Care Charmaine K. Higa-McMillan • Brad J. Nakamura • Ashley Morris • David S. Jackson • Lesley Slavin Ó Springer Science+Business Media New York 2014 Abstract Practice data from 74 therapists providing public mental health services to 519 youth ages 5–19 were exam- ined. Multilevel modeling suggested child and therapist characteristics predicted use of practices derived from the evidence-base (PDEB) and use of practices with minimal evidence support (PMES). Longer episode length predicted greater receipt of PDEB; older youth, males, and youth in out-of-home levels of care were more likely to receive PMES; and youth receiving an evidence-based treatment program were less likely to receive PMES. Professional specialty and theoretical orientation significantly predicted PDEB whereas therapist characteristics did not predict PMES. Implementation implications are discussed. Keywords Usual care Á Evidence-based practices Á Therapists Á Implementation Á Dissemination Á Youth Introduction A growing body of research is dedicated to examining effective ways to disseminate and implement programs with empirical support (e.g., Aarons et al. 2011; Damsch- roder et al. 2009; Proctor et al. 2009). This body of research holds promise to improve mental health services for children and adolescents. A complimentary approach to understanding how to effectively implement new programs is the study of practices already in place in usual care settings (Garland et al. 2010a, b). The examination of usual care practices can provide information about the overlap and discrepancies between programs with demonstrated effectiveness and what is already occurring in usual care. It may also be helpful to identify the predictors of evidence- based practice (EBP) usage in usual care settings so that we can draw on these predictors when developing implemen- tation programs. In one of the first studies to date to compare the prac- tices of usual care clinicians to the evidence-based litera- ture, Garland and colleagues (2010a) found that for youth referred for disruptive behavior problems, clinicians pro- vided an array of treatment strategies, however, all strate- gies were delivered at low intensity. Further, while some strategies that were consistent with the evidence base for disruptive behavior problems (e.g., psychoeducation, problem-solving, positive reinforcement) were delivered frequently, there were also a number of approaches derived from the evidence-base that were rarely observed (e.g., role-play, homework). Consistent with these findings, two recent studies on children receiving public mental health services for traumatic stress and anxiety reported similar findings (Borntrager et al. 2013a; Higa-McMillan et al. 2011, respectively).Both studies found that exposure, the most commonly occurring practice among evidence-based treatment protocols for youth with anxiety and traumatic stress, was reported as being used infrequently. Borntrager et al. (2013a) reported that youth receiving out-of-home services with a diagnosis of post-traumatic stress disorder Parts of this research study were presented in May 2013 at the Seattle Implementation Research Conference in Seattle, WA. C. K. Higa-McMillan (&) Á A. Morris Department of Psychology, University of Hawaii at Hilo, 200 W. Kawili St., Hilo, HI 96720, USA e-mail: higac@hawaii.edu B. J. Nakamura University of Hawaii at Manoa, Honolulu, HI, USA D. S. Jackson Á L. Slavin Child and Adolescent Mental Health Division, Hawaii Department of Health, Honolulu, HI, USA 123 Adm Policy Ment Health DOI 10.1007/s10488-014-0578-9