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 PublishPractice 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 EarlyMid-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 Competencies for 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 Competencies for Clinical Staff  Behavioral interventions  Systemic family therapy  Play therapy

Adult Competencies for 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 done, you’ll keep getting what you’ve always got.” Peter Francisco In Conclusion …