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Intersecting Evidence-Based Practice and Cultural Competence: Methods, Models, and Tools. Oregon Juvenile Department Directors’ Association Annual Conference Jennifer L. Bellamy. Agenda. Methods, Models, and Tools EBP Process Training and Tools BEST EBBP.org Consolidation Resources

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Intersecting evidence based practice and cultural competence methods models and tools l.jpg

Intersecting Evidence-Based Practice and Cultural Competence: Methods, Models, and Tools

Oregon Juvenile Department Directors’ Association Annual Conference

Jennifer L. Bellamy


Agenda l.jpg
Agenda Competence: Methods, Models, and Tools

  • Methods, Models, and Tools

    • EBP Process Training and Tools

      • BEST

      • EBBP.org

    • Consolidation Resources

      • Campbell Collaboration

      • PWISE

    • Intervention Adaptation Models

      • PAA

      • DEBI

    • Common Elements

Questions and Conversations


Toward a comprehensive model of ebp l.jpg
Toward a Comprehensive Model of EBP Competence: Methods, Models, and Tools

General Services Research: Interventions, Cultural Competence

Local Aggregate Evidence

Case-Specific History

Clinical Theory

  • SAMHSA NREPP

  • Campbell and Cochrane Reviews

  • Californita Evidence Based Practice

  • PracticeWise EBS Database

  • Etc…

Training

Coaching and Consultation

Evaluation and Feedback

Administrative Supports

Evidence-based programs

Evidence-informed care

Evidence

Consolidation

Coordination

Implemen-tation

Practice

Adaptation

MAP Toolkit

Common Elements

Children and Families

Adapted from Chorpita July 2010


Evidence resources l.jpg
Evidence Resources Competence: Methods, Models, and Tools

  • BEST: Bringing Evidence for Social Work Training (BEST) Project

  • Edward J. Mullen, DSW

    • Willma & Albert Musher Program

    • Columbia University School of Social Work

  • To Get to the Website Search for: “EBP Musher”


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BEST Competence: Methods, Models, and Tools

  • Hands-on EBP team training

  • 3 New York City agencies

    • 4-6 Team participants per agency

    • Clinicians, supervisors, administrators and one student

  • Researchers as team members

  • Process model of EBP (Gibbs, 2003; Sackett et al. 2000)


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Project Overview Continued Competence: Methods, Models, and Tools

  • 10 Modules following EBP-related “steps”

    • Worksheets, Online resources

  • Provider-driven problem or question

  • Evidence search

  • Evidence evaluation


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Quick Link to Website Competence: Methods, Models, and Tools

  • Evidence Based Practice & Policy Website


Learning l.jpg
Learning Competence: Methods, Models, and Tools

  • EBP Process attitudes, skills, etc. can be improved

  • Evidence can be found and evaluated, but there is little to guide the implementation process- including what to do when the evidence does fit culture/context

  • Long-term partnership with technical assistance from researchers is needed


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Evidence Resources Competence: Methods, Models, and Tools

  • Evidence Based Behavioral Practice

  • Goals

    • Promote communication about EBP traditions across disciplines

    • Disseminate concepts, methods, tools

    • Provide educators with tools

    • Help interventionists acquire skills

  • Mental Health Focused


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Development Competence: Methods, Models, and Tools

  • Multidisciplinary Team

    • Social Work

    • Psychology

    • Medicine

    • Nursing

  • NIMH Funded- Behavioral Health Focused

  • Advanced Content and High Production Value


Educational modules l.jpg
Educational Modules Competence: Methods, Models, and Tools

  • EBBP Process Module

  • Search for Evidence Module

  • Systematic Review Module

  • Critical Appraisal Module

  • Randomized Controlled Trials

  • Shared Decision Making

    • Clients

    • Communities


Quick link to site l.jpg
Quick Link to Site Competence: Methods, Models, and Tools

  • Evidence Based Behavioral Practice


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Toward a Comprehensive Model of EBP Competence: Methods, Models, and Tools

General Services Research: Interventions, Cultural Competence

Local Aggregate Evidence

Case-Specific History

Clinical Theory

  • SAMHSA NREPP

  • Campbell and Cochrane Reviews

  • Californita Evidence Based Practice

  • PracticeWise EBS Database

  • Etc…

Training

Coaching and Consultation

Evaluation and Feedback

Administrative Supports

Evidence-based programs

Evidence-informed care

Evidence

Consolidation

Coordination

Implemen-tation

Practice

Adaptation

MAP Toolkit

Common Elements

Children and Families

Adapted from Chorpita July 2010


Consolidation resources l.jpg
Consolidation Resources Competence: Methods, Models, and Tools

  • Campbell Collaboration

  • Mission

    • Help people make well-informed decisions by preparing, maintaining, and disseminating systematic reviews in education, crime, and social welfare

    • http://www.campbellcollaboration.org/library.php


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Systematic Review Competence: Methods, Models, and Tools

  • Sums up the best available evidence on a specific question

  • Why Campbell does it better

    • Clear protocol

    • Search of published and grey literature

    • Includes other languages

    • Teams of peer and editorial reviews

    • Updates reviews


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Reviews of Interest Competence: Methods, Models, and Tools

  • Opportunities for preventing youth gang involvement for children and young people

  • Serious juvenile offenders: A systematic review of treatment effectiveness in secure corrections

  • Effects of early family/parent training programs on antisocial behavior and delinquency


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Reviews of Interest Competence: Methods, Models, and Tools

  • Cognitive behavioral treatment for antisocial behavior in youth in residential treatment

  • Multisystemic therapy for social, emotional and behavioral problems in youth 10-17

  • Scared straight and other juvenile awareness programs for preventing juvenile delinquency


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Consumer Synopsis Competence: Methods, Models, and Tools

  • Programs like 'Scared Straight' involve organized visits to prison facilities by juvenile delinquents or children at risk for becoming delinquent. The programs are designed to deter participants from future offending by providing first-hand observations of prison life and interaction with adult inmates. Results of this review indicate that not only does it fail to deter crime but it actually leads to more offending behavior. Government officials permitting this program need to adopt rigorous evaluation to ensure that they are not causing more harm to the very citizens they pledge to protect.


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Campbell Reviews Competence: Methods, Models, and Tools

  • Limited info on racial and ethnic diversity and whether or not this impacts outcomes

    • Reflection of the literature

  • Slow going in developing reviews

    • Expense (few funding sources)

    • Time


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Quick Link to Website Competence: Methods, Models, and Tools

  • The Campbell Collaboration


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Consolidation Resources Competence: Methods, Models, and Tools

  • California Evidence Based Clearninghouse

    • Provides child welfare professionals with easy access to vital information about selected child welfare related programs based on research evidence

    • http://www.cebc4cw.org/


Reviews l.jpg
Reviews Competence: Methods, Models, and Tools

Level 1: Well supported

No risk or harm

Manualized

2 RCTs

Sustained effect (at least one year) in 1 RCT

Reliable and valid measures

Overall “weight” of evidence shows benefit


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Reviews Competence: Methods, Models, and Tools

Level 2: Supported

No risk or harm

Manualized

At least one RCT

Sustained effect (at least one year) Reliable and valid measures

Overall “weight” of evidence shows benefit


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Reviews Competence: Methods, Models, and Tools

Level 3: Promising

No risk or harm

Manualized

Some study using a control group

Overall “weight” of evidence shows benefit

Level 4: Failed to demonstrate effect

Level 5: Concerning

NR: Not Rated


Topic areas of interest l.jpg
Topic Areas of Interest Competence: Methods, Models, and Tools

  • Child and adolescent anxiety treatment

  • Child and adolescent disruptive behavior treatment

  • Adolescent substance abuse treatment

  • Trauma treatment for children

  • Youth transitioning into adulthood


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Quick Link to Website Competence: Methods, Models, and Tools

  • The California Evidence-Based Clearinghouse


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California Evidence Based Clearinghouse Competence: Methods, Models, and Tools

  • Provides information as to which racial and ethnic groups have been included in research

  • Includes languages available

  • Information about training and other resources, including references on culture and evidence-supported interventions


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Toward a Comprehensive Model of EBP Competence: Methods, Models, and Tools

General Services Research: Interventions, Cultural Competence

Local Aggregate Evidence

Case-Specific History

Clinical Theory

  • SAMHSA NREPP

  • Campbell and Cochrane Reviews

  • Californita Evidence Based Practice

  • PracticeWise EBS Database

  • Etc…

Training

Coaching and Consultation

Evaluation and Feedback

Administrative Supports

Evidence-based programs

Evidence-informed care

Evidence

Consolidation

Coordination

Implemen-tation

Practice

Adaptation

MAP Toolkit

Common Elements

Children and Families

Adapted from Chorpita July 2010


Planned adaptation lee et al 2008 l.jpg
Planned Adaptation (Lee et al. 2008) Competence: Methods, Models, and Tools

  • Emphasizes researchers’ role in identifying the core intervention components- and partnership with practitioners

  • Technical assistance from developers, disseminators, and other middle persons

    • Very often this is not based on empirical evidence

    • May be based on a logic model


4 steps of planned adaptation l.jpg
4 Steps of Planned Adaptation Competence: Methods, Models, and Tools

  • Examine the Theory of Change

    • What are the core components responsible for change

    • What are the moderators that enhance or diminsh outcomes

  • Identify Population Differences

    • Can the key program processes be generalized across populations?

  • Adapt Program Content

    • Maintain the core elements, but modify other intervention pieces

  • Adapt Evaluation Strategy

    • Are you getting the outcomes you would expect?


Diffusion of effective behavioral interventions debi l.jpg
Diffusion of Effective Behavioral Interventions (DEBI) Competence: Methods, Models, and Tools

  • Began in 2002 in response to an Institute of Medicine report urging CDC transfer of HIV prevention to practice

  • Goals: Training, Technical Assistance, and Capacity building to service providers to support implementation and adaptation of evidence-based interventions

  • Brought together: providers, intervention developers, trainers, and various other technical assistance and support for evaluation, capacity building etc.


Slide37 l.jpg
DEBI Competence: Methods, Models, and Tools

  • Implemented multiple interventions

  • Lessons from traditional implementation

    • Providers are suspicious of “efficacious” interventions

    • DEBI interventions as competition for local interventions

    • Intervention developers vary in terms of their preference to maintain control over their interventions

      • Fear of letting go and facing claims that the intervention didn’t work, when in fact implementation was poor

    • Very little research on how to implement interventions


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DEBI Competence: Methods, Models, and Tools

  • Marketing

    • Conferences, presentations

  • Training

    • Organizational capacity to deliver a given intervention,

    • Population needs, and

    • Relative advantages compared to current programming.


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Quick Link to Website Competence: Methods, Models, and Tools

  • Diffusion of Effective Behavioral Interventions


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A Compliment to Top Down and Bottom Up EBP Competence: Methods, Models, and Tools

  • Common Elements Approach

    • PWISE


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Toward a Comprehensive Model of EBP Competence: Methods, Models, and Tools

General Services Research: Interventions, Cultural Competence

Local Aggregate Evidence

Case-Specific History

Clinical Theory

  • SAMHSA NREPP

  • Campbell and Cochrane Reviews

  • Californita Evidence Based Practice

  • PracticeWise EBS Database

  • Etc…

Training

Coaching and Consultation

Evaluation and Feedback

Administrative Supports

Evidence-based programs

Evidence-informed care

Evidence

Consolidation

Coordination

Implemen-tation

Practice

Adaptation

MAP Toolkit

Common Elements

Children and Families

Adapted from Chorpita July 2010


Search for research by population and setting l.jpg
Search for Research by Population and Setting Competence: Methods, Models, and Tools

  • Problem

  • Age

  • Gender

  • Ethnicity

  • Setting

  • Strength of Evidence


What the evidence supported interventions l.jpg
What the Evidence Supported Interventions Competence: Methods, Models, and Tools

Parent

Training

Incredible

Years

PCIT

Defiant

Children

Commands

Attending

Commands

Time Out

Commands

Time Out

Rewards

These are the practice elements.


Building a treatment from high quality parts l.jpg

Building a Treatment Competence: Methods, Models, and Tools

from High Quality Parts

Common Elements Approach


A complimentary approach l.jpg
A Complimentary Approach Competence: Methods, Models, and Tools

  • Common Elements Approach

    • Identified components of evidence-based treatments

    • Complements traditional integrated program approach


A different level of analysis l.jpg
A Different Level of Analysis Competence: Methods, Models, and Tools

Family

Protocol

Protocol

Protocol


A different level of analysis48 l.jpg
A Different Level of Analysis Competence: Methods, Models, and Tools

Parent

Training

Incredible

Years

PCIT

Defiant

Children


A different level of analysis49 l.jpg
A Different Level of Analysis Competence: Methods, Models, and Tools

Family

Protocol

Protocol

Protocol

Practice

Element

Practice

Element

Practice

Element

Practice

Element

Practice

Element

Practice

Element


A different level of analysis50 l.jpg
A Different Level of Analysis Competence: Methods, Models, and Tools

Parent

Training

Incredible

Years

PCIT

Defiant

Children

Commands

Attending

Commands

Time Out

Time Out

Rewards

These are the practice elements.


Which practice elements should we learn l.jpg

AMONG ALL THE EVIDENCE-BASED TREATMENTS FOR A GIVEN PROBLEM, WHICH ARE THE MOST COMMON?

Which Practice Elements Should We Learn?


Anxiety l.jpg
Anxiety WHICH ARE THE MOST COMMON?


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ADHD WHICH ARE THE MOST COMMON?


Depression l.jpg
Depression WHICH ARE THE MOST COMMON?


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Disruptive WHICH ARE THE MOST COMMON?Behavior


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Disruptive WHICH ARE THE MOST COMMON?Behavior


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Traumatic WHICH ARE THE MOST COMMON?Stress


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Among all the evidence-based treatments for a given problem, which elements are the most common?

Which Practice Elements Should We Learn?


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Rather than Learning X Number of Packages which elements are the most common?

  • Most Interventions for Youth are Covered by Approximately 30 Different Practice Elements


We also need recipes l.jpg
We Also Need Recipes which elements are the most common?

Not just ingredients…




Match protocol l.jpg
MATCH Protocol treatment types.

  • Coordinated library of evidence based procedures

  • Available online and trained online to therapists


Putting practices together l.jpg
Putting Practices Together treatment types.

Focus

Connect

Cultivate

Consolidate

Interference


Depression example l.jpg
Depression Example treatment types.

Focus

Connect

Engagement

Psychoeducation

Cultivate

Activity Selection

Cognitive

Problem Solving…

Consolidate

Maintenance

Booster

Interference

Low Motivation: Rewards

Complaining and Irritability: Active Ignoring

Tantrums: Time Out…


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Practitioner Guides treatment types.

One 2-sided page per practice


Other questions l.jpg
Other Questions treatment types.

  • How do I know if it is working?

  • What do I do if it is not?


Case specific history l.jpg
Case Specific History treatment types.

  • Clinical Dashboard

    • Progress

    • Practices



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Child STEPs Treatment Project treatment types.

  • Youth Network on Child Mental Health

  • 5-Year, multisite randomized trial

    • Boston, Honolulu

  • Anxiety, Depression, Conduct Problems

  • Community therapists

  • Standard Manuals, MATCH, Usual Care

  • N = 174 children ages 7-13

  • Funded by John D. and Catherine T. MacArthur Foundation


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Effectiveness: Attitudes treatment types.

If therapists like it better, they will be more engaged

Attitudes Towards Evidence-Based Practices

p < .05


Effectiveness satisfaction l.jpg
Effectiveness: Satisfaction treatment types.

p < .05

p < .05

If therapists like it better, they will use it when the study is over

Therapist Satisfaction with Treatment (rated after each case)


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Thank you! treatment types.

[email protected]


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