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1. Steven S. Sharfstein, M.D.AHRQ ConferenceSeptember 27, 2010 revised Patient-Centered Care: Improving Outcomesthat Matter to Patientsin the Real World
2. Sheppard Pratt Served more than 57,000 individuals in 2009, including children, adolescents, and adults
37 locations in 12 Maryland counties, Baltimore City, and Northern Virginia
Comprehensive continuum, including hospitals, residential treatment centers, psychiatric rehabilitation programs, outpatient mental health and substance abuse treatment clinics, and special education schools. Mission Statement:Sheppard Pratt, a not-for-profit behavioral health system, is dedicated to the improvement of quality of life in communities by serving the behavioral health and special education needs of individuals, families, and organizations.
3. Evidence-Based PracticesPsychiatric Rehabilitation Programs
High Fidelity:
Supported employment
Assertive community treatment
Integrated dual disorders treatment
Family psycho-education
Multisystemic therapy
Seeking Fidelity: Illness Management and Recovery
Planning This Year: Permanent Supportive Housing
Evidence-supported Practice: Transition to Independence Process
4. Supported Employment Pilot –Components Five-Year Pilot at 8 Sites in 7 Jurisdictions
Serving More than 600 Low-Income SMI/Year
Integrating Three Interventions:
EBP supported employment
Customized employment
Benefits counseling
Technical Assistance for Replication
Public-Private Partnership
5. Supported Employment Pilot - Research Dartmouth College
Measuring
Impact of benefits counseling
Cost-benefit analysis of state funding
Eight non-Sheppard Pratt organizations in two comparison groups
Boston University
Measuring impact of adding a vocationally-focused illness management and recovery curriculum to EBP SE
6. Implementing EBP in Real World -Challenges and Recommendations Challenge #1: EBPs More Expensive to Implement
Recommendations:
More research studies should include cost-benefit analyses relative to state funding
More states should employ Maryland strategy of implementation, focusing on incentives vs. mandates
7. Implementing EBP in Real World -Challenges and Recommendations Challenge #2: Difficult for Front-Line Stakeholders to Let Go of Traditional Approaches and Beliefs
Zero exclusion and rapid job search for EBP SE
Discovery process for customized employment
8. Implementing EBP in Real World -Challenges and Recommendations Recommendations
Use independent fidelity assessment process to reinforce and inspire provider staff
States develop fidelity assessment expertise
Providers do better job of articulating interventions for families and funders
9. Implementing EBP in Real World -Challenges and Recommendations Challenge #3: Tension Between EBP Integration vs. Recovery Model Consumer Choice
EBPs require integration of services, which is most effectively implemented by one provider agency
Recovery model values consumer choice of providers, which can result in multiple agencies providing one EBP
10. Implementing EBP in Real World -Challenges and Recommendations Recommendations
Reframe choice as:
between EBP providers
between EBP and non-EBP services
Compromise where possible for certain EPBs
Coordination vs. integration
States need flexible definition of coordination
11. Final Comment There is no EBP for acute inpatient care
Need for comparative effectiveness studies
Ultra-acute care versus acute care
Hospital care versus residential diversion
A major public health issue