1. Implementation Strategy for Evidence- Based Practices CIMH Community Development Team Model Pam Hawkins, Senior Associate Association for Criminal Justice Research (California) October 24-25, 2013

2. Systems Change New practices do not fare well in old organizational structures and systems System change is disruptive System change requires new resources System change requires courage System change requires dogged persistence Dean Fixsen & Karen Blasé, National Implementation Research Network (NIRN) 2

3. Program Effectiveness What we do How well we do it When outcomes are less than optimal –How much is attributable to not selecting/using the most effective intervention –How much is attributable to the complexity of mental health disorders –How much is attributable to factors that impinge on clients –How much is attributable to an effective intervention not being used well 3

4. Program Effectiveness Effectiveness research has drawn attention to what we do Dissemination research is drawing attention to the importance of how well we do it As our clinical work becomes increasingly research informed, we want to be sure that our service systems are increasingly adherence (integrity)-focused What have we learned from work in California –13 EBPs, 200+ sites, 41 counties, 150 agencies 4

5. Community Development Teams Organizational development (dissemination) model Close the science-to-practice gap Currently the focus of an NIMH funded research trial 5

6. Community Development Teams A training and technical assistance, dissemination and implementation process, to promote selection, installation and model-adherent sustainability of evidence-based intervention models Informed by implementation science Development of internal (organizational) structures, controls and processes Designed for public mental health system, bringing EBPs to scale, with focus on late-ish adopters, The goal is model adherent and sustainable programs 6

7. Why CDT? Implementing and sustaining innovative programs is challenging Deliberate (focused) ongoing organizational support is needed to establish/sustain programs and achieve the full benefit of research informed practice Development Teams are particularly useful when first establishing a new program –If an agency has relatively little experience sustaining EBPs –Would like some help in planning, starting, supporting, sustaining 7

8. CDT Phases Pre-Implementation –Engagement –Planning –Training protocol Implementation –Training –Practitioner competence –Achieving model adherence –Program performance evaluation Sustainability –Internal controls for insuring model adherence –Quality improvement activities linked to program evaluation 8

9. Development Team Features Clinical training –Provided by model developers or their designees Organizational supports –Provided by CIMH or County CDT staff –Implementation planning –Administrators calls –Program performance evaluation supports –Individualized technical assistance Peer-to-peer assistance 9

10. CDT Processes Need-benefit analysis Planning Monitoring and support Technical investigation and problem solving Procedural skills Peer-to-peer support 10

11. CDT Activities CDT planning meetings Administrators conference calls Website supports Site-specific (technical assistance) calls and correspondence Fidelity monitoring and program performance evaluation protocols Developer’s calls 11

12. Organizational Support Implementation planning –Thorough understanding of the model, training protocols, and key implementation supports Individualized technical assistance –Address system and program level issues Program performance/outcome evaluation –Tracking service delivery –Preparation of database (Excel) –Analysis, interpretation and reporting of outcomes Monthly peer-to-peer administrators “champions” conference calls –Share successes, raise concerns, and offer solutions 12

13. Sustainability Administrative champion Thorough pre-implementation planning Participation in full training protocols Routine use of program performance protocols Commitment to replacement training Commitment to refresher training 13

14. CDT Projects Aggression Replacement Training ® CBT for Depression Depression Treatment Quality Improvement Early Detection and Intervention for the Prevention of Psychosis (in development) Functional Family Therapy Incredible Years Trauma Focused Cognitive Behavior Therapy Managing and Adapting Practice Multidimensional Family Therapy Multidimensional Treatment Foster Care Multisystemic Therapy Triple P Parenting (High Fidelity) Wraparound 14

15. Cal-40 Study Focus of NIMH trial –Testing an implementation model (CDT) for promoting the scale-up of an EBP –RTC 60 sites (California and Ohio) randomized to CDT and implementation as usual –Currently the only empirical test of an implementation model OutcomesOutcomes –System leaders engaged CDT: 125 IND: 96 –Clients enrolled CDT: 133 IND: 51 15

16. FFT in California Currently 41 FFT Teams in 15 California CountiesCurrently 41 FFT Teams in 15 California Counties Largest implementation of FFT internationallyLargest implementation of FFT internationally 90.5% retention rate of California FFT sites (loss of 5 teams since 2004)90.5% retention rate of California FFT sites (loss of 5 teams since 2004) 16

17. Questions Pam Hawkins, Senior Associate California Institute for Mental Health (916) 317-6318 phawkins@cimh.org 17