1. Implementing Evidence-Based Practice in Massachusetts: The Provider Perspective Elizabeth Funk, M.B.A. President/CEO, Mental Health & Substance Abuse Corporations of Massachusetts Chairman, Board of Directors, National Council for Community Behavioral Healthcare

2. Mental Health & Substance Abuse Corporations of Massachusetts 2 It is one thing to say with the prophet Amos, “Let justice roll down like mighty waters”, and quite another to work out the irrigation system. William Sloane Coffin (social activist and clergy member)

3. Mental Health & Substance Abuse Corporations of Massachusetts 3 Why change now? Federal government driving field – President’s New Freedom Commission Demand from stakeholders and consumers for cost-effective treatments Desire to spend less money for more clients Need to defend expenditures re: outcomes

4. Mental Health & Substance Abuse Corporations of Massachusetts 4 Utilize Knowledge About Implementation Science of Implementation o Utilize body of research and literature on science of implementation o Applies across industries – manufacturing, human resources, other o Stages of change and implementation are known o Address change needed at all levels: –Clinician –Provider organization – Management, Supervision –System of Care –State/payer policies –Federal policies “Implementation: What Research and Experience Can Tell Us” Karen Blasé & Dean Fixsen, Univ. of Southern Florida, June 2005

5. Mental Health & Substance Abuse Corporations of Massachusetts 5 Example of system change: MHSACM Outcome Measurement Project Different route – originated from provider field 1995 – Spurred to initiate project under federal/other pressure Active role in development Ownership of project Adaptation of instrument, implementation to specific needs, settings, populations Used group of initial providers as “Purveyor” = “Individual or group of individuals representing a program or practice who actively work to implement that practice or program with fidelity and good effect” (Fixsen & Blasé, U. of S.F., 2005).

6. Mental Health & Substance Abuse Corporations of Massachusetts 6 Outcome Measurement Project - “Purveyors” Celebrated and recognized for their efforts Serve as role models – other seek to emulate Spread the message Teach Assume leadership Work out “bugs” Serve as advisory body – recommend changes, revise tools, processes

7. Mental Health & Substance Abuse Corporations of Massachusetts 7 Outcome Measurement Project : Learning is Multi-Faceted Providers learned about outcome measurement in multi-faceted approach Disseminating written information and doing trainings alone are ineffective Peer presentations (experiential) User groups, discussion, coaching, use of group members to review, coach, advise, including on-site, etc.

8. Mental Health & Substance Abuse Corporations of Massachusetts 8 Outcome Measurement Project: Ongoing Processes Required Sustainability requires ongoing support, involvement, oversight Ongoing processes are essential for review, monitoring, evaluating, revisions, improvements One-time effort, limited attention will result in falling-off of models/initiative

9. Mental Health & Substance Abuse Corporations of Massachusetts 9 Outcome Measurement Project: Dissemination/Incorporation Into System of Care MHSACM broadly advocated for the project with providers, state agency officials, numerous payer representatives, policymakers Efforts made to more widely disseminate the initiative and incorporate it into policies of state and other payers Sought funding to assist with loss of revenue and additional expense that accompany any change of practice

10. Mental Health & Substance Abuse Corporations of Massachusetts 10 How can we work together to deliver more EBPs? Strengthen and expand current initiatives Providers already working with state and payers to utilize Evidence-Based Practices such as: PACT (Program of Assertive Community Treatment) DBT (Dialectical Behavior Therapy) Motivational Interviewing (Substance Abuse) Other Promising Practices are in early development Collaboration in Primary Care Child wraparound services Co-Occurring Substance Abuse and Mental Health treatment State Substance Abuse Strategic Plan emphasizes greater use of Evidence-Based and Promising Practices

11. Mental Health & Substance Abuse Corporations of Massachusetts 11 EBP- Early Feedback Clinicians excited at positive results with clients for whom other treatments unsuccessful Gratified to learn new skills and have new tools to use with clients Continuously refining implementation Still learning together with purchasers to adapt models to specific settings, populations, & environments without sacrificing critical elements of the models.

12. Mental Health & Substance Abuse Corporations of Massachusetts 12 Outstanding concerns: broad- scale implementation Are Federal/State expectations unrealistic? Are providers able to deliver this change expeditiously? Providers cannot accomplish change alone Workforce cannot be transformed overnight- will take years General workforce issues add challenges – recruitment, retention, diversity, skills - President’s New Freedom Commission urges workforce strategic plan

13. Mental Health & Substance Abuse Corporations of Massachusetts 13 Implementation (continued) Current professional training does not address EBPs or prepare clinicians for new clinical framework – role of universities, medical schools, professional training programs Rates must be built around the models Hard to accomplish in under-resourced system Models must include processes for continued review of goals/objectives, outcomes, and financing