1. Implementing Evidence-Based Practice (EBPs) in Mental Health Richard H. Beinecke Suffolk University Department of Public Management 8 Ashburton Place, Boston, MA 02108 617-573-8062, [email protected] American Public Health Association
December 12, 2005
3. Evidence-Based Practices “ A quality improvement process that provides accountability through the monitoring of the practices to models that have been demonstrated by research to be effective.” (Goldman et al, 2001)
“The purchase of treatments and services that have been scientifically confirmed to improve outcomes.” (Lehman et al, 2004)
4. Status of EBPs
Mental health (and health) systems are in shambles. Much improvement in care is needed (e.g., effective care for depression only 57% of the time; for alcohol dependence only 10% of the time). Need to change yourself, your program, and your environment.
Many EBPs are now known but are not being implemented, e.g.
Supportive Employment Programs
Assertive Community Treatment
Integrated treatment for mental health and substance use disorders
5. Calls for Implementing EBPs Crossing the Quality Chasm (IOM 2001)
Four areas for redesigning health systems: “Applying evidence to the delivery of health services.”
President’s New Freedom Commission (2003)
“Goal: Advancing evidence-based practices.”
Committee on Crossing the Quality Chasm Adaptation to Mental Health and Addictive Services (IOM, 2005)
Call for “Better dissemination and adoption of evidence through the use of evidence-based approaches to knowledge dissemination and uptake.”
6. Factors for Successful Implementation Implementation: “A specified set of activities designed to put into practice an activity or program of known dimensions. (Fixsen et al, 2005)
Success depends upon
Scientific study of what works or is not effective. Effectiveness of the intervention practices or policies.
Compilation, distribution, and use in practice of this information. Effectiveness of the implementation practices.
7. Elements Important to Organizational Change (Redesign Process) (Fixsen et al, 2005) Commitment of leadership to the implementation process.
Involvement of stakeholders.
Creation of an implementation task force with stakeholders.
Suggestions for “unfreezing” current organizational practices.
Resources for extra costs, effort, materials, recruiting, access to expertise, retraining.
Alignment of organizational structures to integrate staff selection, training, performance evaluation.
8. Core Implementation Components (Fixsen et al, 2005) Communication and feedback from the source of the innovation to those who will implement it.
Staff and program evaluation.
Consultation and coaching.
Also organizational components, e.g.:
Organizational Culture and climate
External Influences: Social, economic, and political.
Strong leadership and powerful champions.
9. Seven Task Clusters to Promote State EBPs ((Rapp et al, 2005) Strategic planning.
Focus on outcomes that clients value.
Have design and task specifications in the regulatory standards.
Create incentives and disincentives.
Provide workforce development
10. Stages of the Implementation Process (Catalytic Leadership) (Luke, 1998) Focus attention by elevating the issue.
Engage people in the effort.
Stimulate multiple strategies and options for action.
Sustain action and maintain momentum.
11. Stages of Change (Lynde, 2005) Pre-contemplation (information sharing)
Contemplation (needs assessment)
Preparation (leadership and stakeholder engagement)
Action (planning, training, consultation, communication and feedback, policies and regulations, funding)
Must fully involve consumers, family members, providers).
12. Degrees of Implementation (Fixsen, 2005) Paper Implementation: Put into place new policies and procedures.
Process Implementation: Putting new procedures into place to conduct training, supervision, change reporting forms, etc.
Performance Implementation: Procedures and processes of change are used to good effect for consumers (outcomes, real performance measurement).
13. State Initiatives to Promote EBPs (Ganju, 2005) All states offering at least one EBP and 23 offering at least six. But few states are implementing EBPs in a comprehensive way.
Awareness/training/support for clinicians; Centers of Excellence.
Incorporating EBPs into contracts.
Modifications to information systems.
EBP budget requests and financial incentives.
14. Future of Behavioral Health EBPs (Leff, 2005) EBPs identified by national registries (e.g. NREPP) and venues for meta-analyses (e.g. Cochrane Collaboration).
Explicit criteria for recognizing practices.
Convergence of Federal, state, and private payer listings.
Listings as “Arbiters of Value.”
This will alter the nature of mental health services, favor some practices and not others, and make favored practices more consistent and expensive.
15. Status in Massachusetts Some EBPs being supported by the state.
“Expanding and sharing evidence-based and best practices and convening evidence-based practice training for providers is one of the goals in the state Department of Mental Health plan.
Introductory forum September 2005.
Committee of stakeholders being formed.
Delays now due to possible restructuring of the Medicaid Behavioral Health Plan.
16. Discussion Lessons and application to other public sector change initiatives and business innovation