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

Ron Van Treuren, Ph.D.

Seven Counties Services, Inc.

Louisville, KY

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

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.

Different Agendas

RESEARCHERS

PRACTITIONERS

Understanding Information

Publish Practice

Timeline: Measured in years

Timeline: Measured in months

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

EBPrac EBProg n is Number EBPrac is Evidenced Based Practice EBProg is Evidenced Based Program

n

Evidenced Based Programs are not just a collection of Evidence Based Practices

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.

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

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

FFT or CBT model development over time…about three years

Clinical Model

Systematic Dissemination

Adherence/Supervision

Service Delivery System

Timeline for adopting outcome oriented EBP

Early Mid-stage

Late-stage

# of Cumulative

Adopters

TIME

0

N

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.

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

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.

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.

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.)

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

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

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

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

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

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.

““If you keep doing what you’ve always If you keep doing what you’ve always done, you’ll keep getting what you’ve done, you’ll keep getting what you’ve always got.”always got.”

Peter FranciscoPeter Francisco

In Conclusion …