1 / 24

Evidence-Based Practice Selection & Implementation

Evidence-Based Practice Selection & Implementation. A Mental Health Services Act Training August 18, 2005 1:00-2:30 pm Presented by California Institute for Mental Health. Main Points. Defining evidence-based practices Levels of research and science Selecting a practice Fidelity

raoul
Download Presentation

Evidence-Based Practice Selection & Implementation

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Evidence-Based PracticeSelection & Implementation A Mental Health Services Act Training August 18, 2005 1:00-2:30 pm Presented by California Institute for Mental Health

  2. Main Points • Defining evidence-based practices • Levels of research and science • Selecting a practice • Fidelity • Integrating into the local service system • Staffing • Learning the practice • Supervision • Funding • Monitoring and evaluation • Administrative oversight • Factors that contribute to drift Evidence Based Practices

  3. Evidence-Based Practices • “…the integration of the best research evidence with clinical expertise and patient values” • Based on the definition used in “Crossing the Quality Chasm: A New Health System for the 21st Century” (2001), by the Institute of Medicine Evidence Based Practices

  4. Levels of Research • Qualitative studies • Anecdotal observations • Controlled case studies • Quasi- or partially controlled experimental studies • Within-subjects or longitudinal (pre and post comparison) studies • Between groups comparisons without assignment • Controlled experimental studies • Random clinical trials (between groups) • Random clinical trial-longitudinal studies • Higher levels of research support greater confidence in the effectiveness of the practice Evidence Based Practices

  5. Levels of Science • Effective--achieves outcomes, controlled research (random assignment), with independent replication in usual care settings. • Efficacious--achieves outcomes, controlled research (random assignment), independent replication in controlled settings. • Not effective--significant evidence of a null, negative, or harmful effect. • Promising--some positive research evidence, quasi-experimental, of success and/or expert consensus. • Emerging practice--recognizable as a distinct practice with “face” validity or common sense test. Evidence Based Practices

  6. Selecting Practices • Specific to local needs and goals • Consistent with client/family (cultural) beliefs and values • Endorsed, supported or valued by agency staff • Affordable to learn and provide • Cost effective • High level of science Evidence Based Practices

  7. Finding Practices • Office of the Surgeon General • http://www.surgeongeneral.gov/sgoffice.htm • Strengthening America’s Families • http://www.strengtheningfamilies.org • SAMHSA Model Programs • http://www.modelprograms.samhsa.gov • Promising Practices Network on Children, Families and Communities • http://www.promisingpractices.net Evidence Based Practices

  8. Finding Practices • Center for the Study and Prevention of Violence, University of Colorado at Boulder • http://www.colorado.edu/cspv/blueprints/ • Evidence-Based Practices in Mental Health Services for Foster Youth – California Institute for Mental Health • http://www.cimh.org/downloads/Fostercaremanual.pdf • SAMHSA’s National Mental Health Information Center • http://www.mentalhealth.org/cmhs/communitysupport/toolkits/ • National Institute of Mental Health • http://www.nimh.nih.gov/publicat Evidence Based Practices

  9. Finding Practices • Look past the label or the “pitch” • Be cautious of efforts to promote a practice in advance of the research. • What is the strength of the research? • Is there a comparison group? • Is there random assignment? • What was the setting? • Usual care setting? Every day clients and practitioners? • Restrictive inclusion criteria and practitioners? • Has it been independently replicated? • Has it been implemented successfully in other places? Evidence Based Practices

  10. Fidelity • Fidelity is important for achieving positive outcomes • Adopting-Implementing with fidelity to the program principles and practices • Adapting-Applying the practice with adjustments from the prescribed program • Adoption is most likely to result in similar outcomes • Adopting a practice requires attention to selection, staffing, training, consultation, supervision, evaluation, funding, competing initiatives and so forth Evidence Based Practices

  11. Integrating Into the Local Service System • Where will the practice fit into the service system? • Who will be referred? • Who will be responsible for making referrals, and under what circumstances? • Who will provide the service? • Will the service be provided independently of, in addition to, or instead of other services? Evidence Based Practices

  12. Staffing • Who will be the practitioners? • How will they be selected? • Will they have a choice? • Will they have time to learn the practice? • Will they have model adherent workloads? Evidence Based Practices

  13. Learning the Practice • Who will provide the training and consultation? The developers? • How much training and consultation is needed? • How will you know if the practice has been learned? • How will the capacity to train to the practice be maintained? Evidence Based Practices

  14. Levels of Training • The level of training varies by practice but typically involves: • Intensive training (2-3 days) • Booster trainings • Daily/every contact data & weekly supervision • Evaluation of fidelity • Evaluation of outcomes Evidence Based Practices

  15. Supervision • Who will be responsible for insuring that the referrals are made? • Who will be responsible for insuring that the practices are used? • Who will support practitioners in their early efforts to learn the practice? • How will they be selected? • Will they have a choice? • Will they be involved, given sufficient time, and be supportive of the practice? Evidence Based Practices

  16. Funding • How will the training be funded? • How will the practice be funded? • Will it be new funding, or re-tooling of existing funding? • Is the funding on-going? • Are there billing or other requirements? • Are the individuals responsible for billing involved in the planning? Evidence Based Practices

  17. Monitoring and Evaluation • How will you know if the practice is being used with fidelity? • How will you know if the practice is working (achieving child and family outcomes) • Fidelity monitoring • Achievement of practice-level child and family outcomes • Achievement of system-level child and family outcomes Evidence Based Practices

  18. Administrative Oversight • Who at the administrative level participated in implementation planning? • Who at the administrative level is committed to making sure that everything happens? • Who at the administrative level will review fidelity and outcome reports and oversee any needed corrections? • How will growing demand for the practice be managed? • How will staff attrition be managed? Evidence Based Practices

  19. Drift • Insufficient training or supervision • Practitioners have multiple or competing duties • Failure to adhere to practice specific caseload standards • Insufficient intra- and inter-agency coordination around referrals, funding, and so forth Evidence Based Practices

  20. Drift • Little or not attention to fidelity monitoring • The mid-managers/supervisors are wary, too busy, or not supportive of the practice • Staff are not interested in or oppose the practice • Increased scrutiny and accountability (“if it does not work then….”) • Demand to use the practice increases too quickly, before it is well-established • Interest in adapting the practice before it is well-established Evidence Based Practices

  21. Drift • Attrition of practice-specific practitioners • Delays between training and service provision • The service system is involved in multiple demanding reform efforts or initiatives • Competing initiatives Evidence Based Practices

  22. Considerations • Select a practice that is needed and wanted • Do not over sell the practice • Plan thoroughly in advance • Set reasonable time frames for implementation • Designate an administrative lead • Involve administrative lead and managers/supervisors in planning • Select staff with interest, based on an understanding of the practice • Focus on fidelity from the outset Evidence Based Practices

  23. Considerations • Start strategically to build skill, confidence, capacity and success • Be sensitive to the increased scrutiny on involved practitioners • Develop strong training and consultation plans • Develop sound plans for funding training and service delivery • Be sensitive to other change initiatives impacting consumers and staff Evidence Based Practices

  24. Considerations • Align agency support, at all levels, for the practice • Value involvement; involvement leads to ownership • Document results (positive results are empowering and support system capacity for change) • Evaluate new practices and existing practices, then share and discuss results Evidence Based Practices

More Related