Leverage Points for the Implementation of Evidence-Based Practice

Adoption of evidence-based practice (EBP) is an increasingly advocated yet formidable challenge. Much work on EBP has implied simplistic solutions: if researchers would produce practice-relevant evidence-based approaches, practitioners would find, adopt, and use them. Blaming researchers for problems in supply, and practitioners for resistance in adoption, will only thwart progress at improving the quality of service. The dissemination and implementation of evidence-based practice requires a more discerning analysis of issues in agency, research, and professional cultures. Drawing on literatures on knowledge diffusion, innovation, and quality improvement, this paper proposes a conceptual framework for the multiple tasks, participants, and leverage points required for the adoption of EBP. Evidence-based practice requires attainment of four intermediate outcomes—access, adoption, implementation, and assessment—each with distinct interventions required for attainment. The framework reveals action points and leverage points for researchers, agency administrators, educators, and individual practitioners. Implementation of EBP requires supportive research, training, and organizational infrastructures. [Brief Treatment and Crisis Intervention 4:227–242 (2004)]