Readiness and Implementation of the GAIN and 7 Challenges

1. Readiness and Implementation of the GAIN and 7 Challenges At NorthKey Community Care

2. In the beginning . . . • In 2005-2006 NorthKey received a grant from the Health Foundation of Greater Cincinnati to determine our readiness to implement evidence-based practices.

3. The ‘Players’ Were . . . • Children’s Intensive Services (CIS) • Substance Abuse Services (SA) • Family and Children Services (FC)

4. Children’s Intensive Service • NorthKey’s mental health inpatient unit knew that many of their adolescents had co-occurring disorders of mental health and substance abuse, yet were only assessing for and treating mental health.

5. Substance Abuse Services • SA had received a grant from the Center on Substance Abuse Treatment (CSAT) to expand our adolescent drug courts and to implement EBPs.

6. Family and Children’s Services • FC had received the Kentuckians Encouraging Youth to Succeed (KEYS) grant that required implementation of EBPs for co-occurring disorders.

7. Additional Considerations • More funding sources are requiring EBPs for programs that they will fund • Increasing quality of care

8. All staff in the three service areas participated in an online survey sponsored by the Texan Christian Institute Focus groups were then held with the staff to clarify results from the survey and to obtain more information on their readiness to change Requirements of the HF Grant

9. A committee composed of management level staff from each of the 3 service areas A committee composed of direct service staff from each of the three service areas Additionally, 2 Committees were formed . . .

10. Purpose of the Committees • Research EBPs most appropriate for our clients and staff • Choose most appropriate EBPs • Discuss possible barriers to implementation and solutions to these barriers

11. Research and other activities • Therapy and assessment models chosen for consideration were those that had evidence they were effective with youth with co-occurring disorders • Two local programs who had implemented EBPs were visited • Consultation occurred with other agencies who had implemented EBPs

12. Cont. • Consultation occurred with creators of therapy and assessment models • 4 NorthKey administrators attended a 3-day Change Management seminar

13. Problems Encountered • CIS direct service staff did not attend mtgs. • Most of the SA staff who participated left the agency • None of the FC staff who participated were in KEYS • Some members of the management team “talked the talk” but did not “walk the walk”.

14. Results of the Readiness Assessment • CIS – decided that staffing issues prohibited them from doing the staff training and supervision needed for implementing EBPs. • SA – (IOPs) decided to implement 7 Challenges • CF (KEYS) – decided to implement 7 Challenges and the GAIN

15. One to implement 7 Challenges in KEYS and the IOPs One to implement the GAIN in KEYS Two Health Foundation Grants Were Awarded to NorthKey

16. The grants paid for the following costs to be incurred within a year of implementation • Training • Materials (i.e. 7 Challenges journals, laptops for the GAIN, etc.) • Staff time lost in additional training and supervision

17. And then came implementation

18. Challenges with 7 Challenges Within the SA IOPs • Resistance from certain professions to implement to fidelity – lack of executive leadership • Dr. Schwebel’s ‘fluid’ fidelity measures • The time needed for training, supervision and reading journals • Lack of respect to the Change Facilitator who was not a clinician

19. Our Solutions • Develop a Master Clinician Plan (not an original idea but stolen from KY River) • Keep communication open with Dr. Schwebel

20. Challenges with 7 Challenges in KEYS • Most of the population presently served are too young for 7 Challenges • Only 1 staff person trained • This staff person is implementing 7Cs on an individual basis until he has enough clients to form a group

21. Challenges with the GAIN in KEYS • Personnel issues – not enough staff to train in the appropriate settings • Wrong people were given infrastructure information on operationalizing the GAIN • Most of the population presently served are too young for 7 Challenges

22. Our Solutions • This is a work in progress

23. Challenges for Both EBPs • Resistant staff • Sustainability • Cannot bill Medicaid or private insurance for the time needed to provide the service • Time needed to train and supervise • The agency as a whole does not like change and has trouble with creative problem solving

24. Conclusions • You can never be too prepared to implement EBPs • Change Management techniques are crucial in making the implementation and sustainability successful • Never implement EBPs when most of your administrative staff is preparing for retirement

25. Conclusions (cont.) • Most agencies need financial resources to prepare their administrations and staffs for integrating EBPs • Most agencies need technical assistance in order to implement and sustain EBPs • Change is difficult and this process will take time