1. Integrated Recovery Implementing IDDT: Lessons Learned Integrated Recovery Implementing IDDT: Lessons Learned Three Year Training & Evaluation Grant Implementation Vicki Smith, MSW, CPRP California Institute for Mental Health January 19, 2007, Sacramento, CA

2. California IDDT Training & Evaluation Grant California Department of Mental Health was awarded a SAMHSA grant in 2003 to provide training for and evaluation of the implementation integrated dual diagnosis treatment in eight sites in four counties throughout the state The project was contracted to CiMH for Implementation

3. Background RWJ sponsored a convening of mental health professionals and researchers that identified six mental health evidence based practices for adults SAMHSA commissioned the development of fidelity scales and implementation strategies or these six practices. Subsequently SAMHSA demonstration funds for implementation of these practices In 2003, SAMHSA gave funding specifically to provide training and evaluation of the implementation of these practices

4. Implementation Counties Eight sites, 7 multicultural; one Latino Alameda – two community providers (one Latino serving site) Los Angeles - two county sites Ventura - two county sites Stanislaus – two county sites

5. Why Test Training & Implementation? Components of the IDDT model have been effective in some studies, but… in other studies effectiveness was not established when not effective, implementation has frequently been poor or unsuccessful is the model or implementation the problem? “Resource Manual” proposes highly structured approach to implementation

6. Evaluation Issues: California Grant 3 general questions California project hopes to answer can the IDDT model be implemented with high fidelity in a variety of California sites typical of public mental health programs serving persons with severe mental illness? is the Toolkit helpful? What else is important in making implementation work? will client outcomes in our programs correlate with the fidelity of implementation of the IDDT model?

7. Evaluation Issues: California Grant 2 other more specific research questions will the IDDT model and the toolkit approach work for clients not from the mainstream culture? will our design of starting with a program that has already partially implemented the model and then using it to leverage implementation in a less developed program in the same county be successful?

8. Recommended Dissemination SAMHSA IDDT Resource Manual recommended several strategies to use in implementation: User friendly manuals, toolkits, references Education and training For all levels of stakeholders pre-service and in-service training for staff

9. Recommended Dissemination Improve organizational dynamics quality improvement model team leadership interactive staff training Dissemination research

10. California Implementation Based on CiMH experience with counties of the effectiveness of peer learning, the project employed the Community Development Team as a major strategy for implementation Key representatives of each county and site participated in a CDT to help develop the progress of the project and sharing of successes and problem solving

11. County & Site Level Process Develop County-wide Steering Committee Introduce and review IDDT intervention model to broad base of stakeholders Establish baseline understand training and technical assistance needs of each county Provide monthly (and the offer of phone consultation) staff training in the practice using a trainer who has provided integrated services Help manage system change Development team training in organizational change

12. Site Visit Teams The teams that conducted the quarterly site reviews, included: PI lead trainer project manager cultural competence advisor evaluator As we gained more experience the number of reviewers decreased

13. Modifications Training and Implementation modifications The development team reviewed the training and implementation experience and the project made changes as necessary, e.g., Training was expanded to include project management expertise

14. Implementation Resource National Implementation Research Network: http://nirn.fmhi.usf.edu/resources/publications/ Monograph/