The Practice of Evidence Based Practice … or Can You Finish What You Started?
Ron Van Treuren, Ph.D.
Seven Counties Services, Inc.
Louisville, KY
Where are we going …? We will examine the similarities of
experience in implementing two Evidence Based Practice Models within a CMHC Cognitive Behavioral Therapy Functional Family Therapy
We will examine common barriers Staff Turnover and Training Outcome Evaluation Financial Resources
Continued … Finally, we will look at a Competency Based
Approach that … Includes quality evaluation of the service
provider Focus on the evidence supporting Best Practices Targets training to enhance the skill base Measures Outcomes by Population And, is SUSTAINABLE over time.
Different Agendas
RESEARCHERS
PRACTITIONERS
Understanding Information
Publish Practice
Timeline: Measured in years
Timeline: Measured in months
What counts as evidence? Not just someone’s opinion or experience, such as a
theory of one study Objective data, collected using methods that
eliminate logically alternative explanations The best evidence comes from experimental studies
and studies replicated repeatedly
EBPrac EBProg n is Number EBPrac is Evidenced Based Practice EBProg is Evidenced Based Program
n
Evidenced Based Programs are not just a collection of Evidence Based Practices
However … In the real world …
Evidence Based Practices have treatment utility in their own right.
Evidence Based Practices show up regularly on Treatment Plans.
Evidence Based Practices are vital components of a Best Practice Model for treatment of various diagnoses and disorders.
Treatment Outcomes can still drive the Treatment Process.
How did we select these approaches and why …? CBT
A nationally recognized treatment for depression and anxiety
Long research history National leader in Louisville, Dr. Jesse Wright CBT fit for many of our Adult MH Clients
FFT One of the 11 Blueprint Science Based Programs FFT fit for the adolescent population we targeted We received a grant in partnership with our School
System
How did we implement these programs? CBT
Partnered with the Beck Institute for training with Judith Beck Partnered with Dr. Wright for training and supervision Monitored implementation via supervision and four certified staff
members FFT
Partnered with the FFT Organization under the terms of the grant Up front training costs for limited number of staff Ongoing phone supervision and site visits Year 2: Supervision for our site leader/supervisor Year 3: Adherence monitoring and site visits
FFT or CBT model development over time…about three years
Clinical Model
Systematic Dissemination
Adherence/Supervision
Service Delivery System
Timeline for adopting outcome oriented EBP
Early Mid-stage
Late-stage
# of Cumulative
Adopters
TIME
0
N
Staff Turnover and Training Training is Expensive.
When staff leave the organization the investment in your EBP is lost. (Either for other jobs, layoffs, etc.)
Retraining is Expensive. You’ve got to rebuild the resources within your
team. Usually the number you can train within a model
is limited by the Organization doing the training.
Outcome Evaluation Functioning vs. Symptom Reduction State Departments of Mental Health usually
have their own required data fields Federal requirements may also influence data
collected Models of Evidence Based Practice come
with standardized outcome measures which may add to the requirements for the clinician
Financial Resources Adherence Costs
Ongoing Supervision The cost of going independent
Grant Funding may be necessary to cover up front costs
Billable Funding Streams Often can’t bill third party payers for some components of
the Model Competency/Best Practice mergers target funding
toward skill building within the system.
The Competency Approach Competencies for Clinical Staff developed in
three areas: Core Child and Family Adult Mental Health
These basic competencies are not meant to be exhaustive but are meant to cover all diagnostic groups and best practice approaches to treatment.
Core Competenciesfor all Clinical Staff Cognitive behavioral therapy (and other cognitive
approaches) Group therapy Anxiety reduction strategies (relaxation, desensitization, etc.) Solution-focused therapy Pychoeducational groups (can implement relevant
curriculum, etc.) Co-occurring disorders (as applied to the spectrum of these
disorders) Skill building/coping strategies Clinical outcome evaluation (use of rating scales, etc.)
Child and Family Competenciesfor Clinical Staff Behavioral interventions Systemic family therapy Play therapy
Adult Competenciesfor Clinical Staff Dialectical Behavior Therapy Motivational interviewing Integration of recovery model
Community Mental Health Centers Strive to do what is right Strive to meet the needs of the populations
they serve Strive to stretch tight dollars to provide
effective service Strive to coordinate care and avoid
duplication of service in the community
Evidence Based Programs Provide a comprehensive model to treat
particular disorders Are focused in their application Are expensive to start up Are expensive to maintain
Evidence Based Practices Are grounded in the scientific literature Require local training and competent
supervisors to maintain fidelity Are driven by a Best Practice Model Should yield positive outcomes if measured
and the practice is applied effectively
Competency Based Skill Sets Are grounded in accepted practice literature
Evidence Based Practice orientation Are driven by a Best Practice Approach Have a wide applicability to populations served Have built in quality assurance through supervisory
review Incorporate clinical outcomes to evaluate
effectiveness Targeted training throughout the organization based
on competency data showing the skill needs.
““If you keep doing what you’ve always If you keep doing what you’ve always done, you’ll keep getting what you’ve done, you’ll keep getting what you’ve always got.”always got.”
Peter FranciscoPeter Francisco
In Conclusion …
Top Related