Infusing Evidence-Informed Treatment Into Current Practice J.R. Griffin, LCSW

Typical Clinical Supervision and Staff Meetings Structure/Format Frequency Focus Supervision Model Group vs. Individual; How often of each; Clinical vs. Administrative vs. Venting/Support

Typical Clinical Training In-services One-day trainings Licensing required courses Few times a year How often use what learned in these trainings?

Typical Clinical Practice Common philosophies of graduate schools Entry-level therapists “Eclectic Approach” Ecosystems, strengths, empowerment practice, “stay informed of EBP” (school teaches strengths-based/solution focused); some hint of CBT, focused on theory more than practice. 1-2 field placements

Impact of “Treatment as Usual” Outcomes and Productivity Billing Morale Family’s lives Line staff are most valuable asset Everything we measure comes from the client interactions – why so nonchalant about it?

EBT Shared Traits Structured and Purposeful Adherent to Model Therapeutic Relationship Differs from traditional “family engaging” Regular training via consultation and/or supervision

EBT v. Supervision As Usual Family-focused Supervisor as teacher Direct and supportive feedback Consistent clinical training Model adherence Purposeful Individual and group Demographics, time of drop, e.g. Planning Direct observations Model adherence extremely important, these are structured models. Repetitive at times; Generalize clinical feedback to all case; session planning/structured

FFT Supervision Group 1x/week Individual 1x/week + Phone Calls 2-4 cases/week Individual 1x/week + Phone Calls Entire caseload, if possible Regular Phone Calls with Consultant

Implementing EBT - Where to Start? Size and makeup of agency workforce Who to train? Primary populations served, in what setting Data driven Dig deep and be creative Budgetary Considerations Ability to implement more than one, education level; primary clientele drives what we want (CBT most broad)

FFT Training Project High Time in Program (TIP) Low Completion Rates 132 Days in 2013 Low Completion Rates Never higher than 67% from 2008-2013

FFT Training Project, cont’d Outcomes on Closed Families 85% of families maintaining progress 3 months post-treatment (no further legal involvement and remaining in the home) 90%+ on all other contracted outcomes Post Externship Data Site lead = 81% completion, 104 days TIP Therapist R = 67% completion, 118 days TIP Rest of team = 62% completion, 140 days TIP Project Description Replicate externship Emphasis on observation, feedback, and coaching All other attempts had failed, e.g., staffing cases at certain points, treatment pacing

Project Outcomes (August 2016) Level of Service Completion Rate Time in Program Outcomes Pre - 83% in 2013 - 91% in 2014 Never higher than 67% 140 days from 2011-2013 85% positive 3 months post 92% no legal involvement Post 96% in 2015 100% last 6 months 2015 78% 2nd half of 2014 81.4% in 2015 84.5% 2nd half of 2015 115 days in 2014 113 days in 2015 94% positive 3 months post 97% no legal involvement 2016 YTD n/a – therapist on leave (prorated = 95-100%) 88.1% From Feb-June, completed 28 In a row, 40/42 (95%) 116 days 97% positive 3 months post - 100% no legal involvement

Project Take-Homes Train the trainer model - One time training = One time cost = Sustainable Incorporated into program practice Regular videotaping and observations New hire midway through project Data to justify grant was not an outcome or measurable

Important Considerations Agency Culture Current Workforce Readiness for change Who to train? Hiring Budget Future of the field Train the trainer = supervisors, agency leaders in order to be able to train new staff; hiring staff open to critical feedback/not eclectic, but will make change. Future is EBT

Local EBT available CBT DBT www.beckinstitute.org Training available for organizations Frequent one day trainings DBT www.dbtcenterofnj.com Training available in multiple EBT One day trainings available Contact trainer

Local EBT Available TF-CBT PCIT www.tfcbt.musc.edu www.pcit.org 10 CEUs possible PCIT www.pcit.org http://pcit.ucdavis.edu/pcit-web-course Free 10 hour web-course on providing PCIT

Local EBT Available California Clearinghouse on Evidence-Based Treatments www.cebc4cw.org Includes guides on selecting and implementing EBT Your Agency Supervisions and staff meetings Continuing Education

Summary Agency’s Most Valuable Asset Questions and Comments J.R. Griffin, LCSW jgriffin@robinsnestinc.org 856-881-8689 x. 750 Families are the main reason