Implementing EBPs in Mental Health Systems. David Lynde, MSW Co-Director Dartmouth EBP Center Dartmouth Psychiatric Research Center. Presentation Overview . EBP Perspective Some Lessons We Are Learning: Statewide Implementation Stages of Dissemination of EBPs in Systems.
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Implementing EBPsin Mental Health Systems David Lynde, MSW Co-Director Dartmouth EBP Center Dartmouth Psychiatric Research Center
Presentation Overview • EBP Perspective • Some Lessons We Are Learning: Statewide Implementation • Stages of Dissemination of EBPs in Systems
EBPs in Perspective • Six currently identified SAMHSA EBPs for adults with SMI that have implementation resource kits • Do not cover all service needs • Continuing process of evolution • Identify well researched practices
Core Values in EBPs • Recovery • Comprehensive Assessments • Individualized Services • Recovery-oriented practitioner skills • Informed, shared decision making
Lessons from the Field “What You Learn When You Step in It”
State/Public Mental Health AuthorityEvidence Based Practices Dissemination Stages of Change
System Stages of Change:Precontemplation Questions • What are EBPs? • What is the difference between EBPs and what we are doing right now? • Why is this a good time for us to tackle this?
System Stages of Change:Precontemplation Questions • Why should this be one of our system priorities? • What are the benefits of changing the status quo?
System Stages of Change:Precontemplation Actions • Provide information and forums for meaningful discussions for all stakeholders • Engage providers in discussions at all levels
System Stages of Change:Contemplation Questions • How committed is our leadership to disseminating EBPs in our system? • What are the unmet needs in our system for EBPs? • What EBPs are priorities for our system?
System Stages of Change:Contemplation Questions • What other EBPs already exist in our system? • What lessons can be learned from our previous experiences with systems change?
System Stages of Change:Contemplation Actions • System leadership honest discussions • Assessing priority needs areas for the system from multiple stakeholder perspectives • Assessing current outcomes for priority needs areas • Assessing current EBPs in system • Reviewing system change history
Lessons Learned: Stakeholders • Consumers, family members and providers play a crucial role • Engage in discussions and discourse with stakeholders not just information sharing • Stress philosophy, values and goals of EBPs • There is no one single consumer, family or provider perspective • Honor ambivalence
Lessons Learned: Stakeholders Involvement = Support
Lessons Learned: Stakeholders • Building “consensus” is nearly impossible • Building “Informed Support” is an alternative view • The Status Quo is powerful • Finances often “drive” resistance • Define significant and meaningful roles for stakeholder involvement
System Stages of Change:Preparation Questions • Who will lead the EBP dissemination when the resistance to this change surfaces? • Who are the stakeholders that need to be involved? • Are we willing to set up a Statewide EBP Team?
System Stages of Change:Preparation Questions • How do EBPs fit with our mission statement? • What is our system willing to change to support EBPs? • What is our system not willing to change?
System Stages of Change:Preparation Actions • Designation of EBP leadership structures • Commitment to EBP leadership • Engagement of broad spectrum of stakeholders • Statewide EBP leadership team • Understanding EBPs in relationship to system mission
Lessons Learned: Leadership “Why do we want to change the status quo? After all, that is what got us where we are today?”
Lessons Learned: Leadership • State Mental Health Authority (SMHA) Leaders have used • Public Forums • Websites • Written Statements • State System Plans and Priorities
Lessons Learned: Leadership • SMHA Leaders have used • Commitment of Resources • System Mission Statements • Internal and External Forces • Grant Funding • Commitment of Personnel
Lessons Learned: Leadership • Statewide EBP Teams • Multiple stakeholders • System feedback regarding • Implementing • Sustaining • Improving • Coordinated by State EBP Leader
System Stages of Change:Action Questions • What can we do to keep the sources of support for EBPS active and public? • How will we constantly communicate where we are and where we are going with EBPs? • How will our system support the time for staff to be trained in EBPs?
System Stages of Change:Action Questions • How will we utilize and develop training and consultation resources for EBPs? • Will we set up a technical assistance center in our system for EBPs? • How will early sites be selected and what will be the expectations? • What will our system do with fidelity and outcome assessments?
System Stages of Change:Action Actions • Plans for constant communication and feedback • Plans for training and consultation processes • Development of early site selection protocol • Description of how fidelity and outcome assessments will be used
Lessons Learned: State EBP Plan • Fit with mission statement • Methods for describing State responses to EBPs • EBP implementation process • Outreach and involvement for stakeholders
Lessons Learned: State EBP Plan • Funding delivery of EBPs • Training resources • Involvement of other State agencies
Lessons Learned: State EBP Plan “Policies and Funding are the fuel of Evidence Based Practices”
Lessons Learned: Policies & Regulations • Current State System Policies • Often cited as barrier • Rarely support EBPs as they exist • Sometimes punish providers for doing the practice
Lessons Learned: Policies & Regulations • System Policies are Crucial • Rarely designed for “structured practices” that include • Preparation Time • Supervision Time • Team Meetings • Outreach Services
Lessons Learned: Policies & Regulations “Every system is perfectly designed to achieve the results it is achieving” --Paul Batalden
Lessons Learned: Policies & Regulations • Non-SMHA are often important “Players in this Process” • Vocational Rehabilitation in SE • Substance Abuse, Law Enforcement, Judicial and Corrections in IDDT • Peer Support Agencies in IMR • Medicaid Authorities in all EBPs
Lessons Learned: Training • The goal of most mental health training as usual is not“implementation” • Implement • to give practical effect to and ensure of actual fulfillment by concrete measures • to put a plan or system into operation
Lessons Learned: Training • “We now have thousands of experiments across the country which have proven that in mental health, training by itself, is not enough to create change.” • --Bob Drake
Lessons Learned: Training • Effective implementation requires much more than just didactic “training” • Many agencies and systems benefit from university collaborations • Agencies benefit from consultation • “Skills training” is a later stage in the organizational change process, not an earlier stage
Lessons Learned: Training • Agencies benefit from high quality training & consultation • Trainers assist agency leadership in the organizational change process • Trainers engage with agencies over a sustained period of time • Trainers have access to their own peer supervision & collaboration
Lessons Learned: Fidelity & Outcomes • Clear expectations for fidelity and outcomes monitoring and use • Quality improvement/assurance process • Self-assessment is not a reliable science • Clear, consistent outcomes definitions and reporting
System Stages of Change:Maintenance Questions • What are the current fidelity assessments & outcomes? • What are the high fidelity sites are doing that they can share with other sites? • What other EBPs are we going to disseminate? • How do we extend EBPs to other populations? • What are the benefits to our system to combine EBPs?
Lessons Learned • The State Mental Health Authority plays a crucial role in the implementation of EBPs • There are many actions at the State Mental Health Authority level that may facilitate the dissemination and implementation of EBPs
State system and Mission Achievements Education re: EBPs Stakeholder Involvement Costs/Benefits of Doing or Not Doing EBPs Leadership Policies Training and Consultation Summary
Recovery & Hope “If people are treated as capable, they often surprise everyone and live up to expectations.” • Ken Steele “The Day the Voices Stopped.”