The Practice of Evidence Based Practice … or Can You Finish What You Started?

1. The Practice of Evidence Based Practice … or Can You Finish What You Started? Ron Van Treuren, Ph.D. Seven Counties Services, Inc. Louisville, KY

2. Where are we going …? • We will examine the similarities of experience in implementing two Evidence Based Practice Models within a CMHC • Cognitive Behavioral Therapy • Functional Family Therapy • We will examine common barriers • Staff Turnover and Training • Outcome Evaluation • Financial Resources

3. Continued … • Finally, we will look at a Competency Based Approach that … • Includes quality evaluation of the service provider • Focus on the evidence supporting Best Practices • Targets training to enhance the skill base • Measures Outcomes by Population • And, is SUSTAINABLE over time.

4. Different Agendas RESEARCHERS PRACTITIONERS Understanding Information Publish Practice Timeline: Measured in months Timeline: Measured in years

5. What counts as evidence? • Not just someone’s opinion or experience, such as a theory of one study • Objective data, collected using methods that eliminate logically alternative explanations • The best evidence comes from experimental studies and studies replicated repeatedly

6. EBPrac EBProg n • n is Number • EBPrac is Evidenced Based Practice • EBProg is Evidenced Based Program Evidenced Based Programs are not just a collection of Evidence Based Practices

7. However … • In the real world … • Evidence Based Practices have treatment utility in their own right. • Evidence Based Practices show up regularly on Treatment Plans. • Evidence Based Practices are vital components of a Best Practice Model for treatment of various diagnoses and disorders. • Treatment Outcomes can still drive the Treatment Process.

8. How did we select these approaches and why …? • CBT • A nationally recognized treatment for depression and anxiety • Long research history • National leader in Louisville, Dr. Jesse Wright • CBT fit for many of our Adult MH Clients • FFT • One of the 11 Blueprint Science Based Programs • FFT fit for the adolescent population we targeted • We received a grant in partnership with our School System

9. How did we implement these programs? • CBT • Partnered with the Beck Institute for training with Judith Beck • Partnered with Dr. Wright for training and supervision • Monitored implementation via supervision and four certified staff members • FFT • Partnered with the FFT Organization under the terms of the grant • Up front training costs for limited number of staff • Ongoing phone supervision and site visits • Year 2: Supervision for our site leader/supervisor • Year 3: Adherence monitoring and site visits

10. FFT or CBT model development over time…about three years Clinical Model Systematic Dissemination Adherence/Supervision Service Delivery System

11. Timeline for adopting outcome oriented EBP N # of Cumulative Adopters 0 Late-stage Early Mid-stage TIME

12. Staff Turnover and Training • Training is Expensive. • When staff leave the organization the investment in your EBP is lost. • (Either for other jobs, layoffs, etc.) • Retraining is Expensive. • You’ve got to rebuild the resources within your team. • Usually the number you can train within a model is limited by the Organization doing the training.

13. Outcome Evaluation • Functioning vs. Symptom Reduction • State Departments of Mental Health usually have their own required data fields • Federal requirements may also influence data collected • Models of Evidence Based Practice come with standardized outcome measures which may add to the requirements for the clinician

14. Financial Resources • Adherence Costs • Ongoing Supervision • The cost of going independent • Grant Funding may be necessary to cover up front costs • Billable Funding Streams • Often can’t bill third party payers for some components of the Model • Competency/Best Practice mergers target funding toward skill building within the system.

15. The Competency Approach • Competencies for Clinical Staff developed in three areas: • Core • Child and Family • Adult Mental Health • These basic competencies are not meant to be exhaustive but are meant to cover all diagnostic groups and best practice approaches to treatment.

16. Core Competenciesfor all Clinical Staff • Cognitive behavioral therapy (and other cognitive approaches) • Group therapy • Anxiety reduction strategies (relaxation, desensitization, etc.) • Solution-focused therapy • Pychoeducational groups (can implement relevant curriculum, etc.) • Co-occurring disorders (as applied to the spectrum of these disorders) • Skill building/coping strategies • Clinical outcome evaluation (use of rating scales, etc.)

17. Child and Family Competenciesfor Clinical Staff • Behavioral interventions • Systemic family therapy • Play therapy

18. Adult Competenciesfor Clinical Staff • Dialectical Behavior Therapy • Motivational interviewing • Integration of recovery model

19. Community Mental Health Centers • Strive to do what is right • Strive to meet the needs of the populations they serve • Strive to stretch tight dollars to provide effective service • Strive to coordinate care and avoid duplication of service in the community

20. Evidence Based Programs • Provide a comprehensive model to treat particular disorders • Are focused in their application • Are expensive to start up • Are expensive to maintain

21. Evidence Based Practices • Are grounded in the scientific literature • Require local training and competent supervisors to maintain fidelity • Are driven by a Best Practice Model • Should yield positive outcomes if measured and the practice is applied effectively

22. Competency Based Skill Sets • Are grounded in accepted practice literature • Evidence Based Practice orientation • Are driven by a Best Practice Approach • Have a wide applicability to populations served • Have built in quality assurance through supervisory review • Incorporate clinical outcomes to evaluate effectiveness • Targeted training throughout the organization based on competency data showing the skill needs.

23. In Conclusion … “If you keep doing what you’ve always done, you’ll keep getting what you’ve always got.” Peter Francisco