NAMI

1
NAMIs Leadership Institute

• Promoting Evidence-Based Practices in Childrens
  Mental Health
• Presented by Darcy Gruttadaro
• Director, Child Adolescent Action Center

2
What exactly are EBPs?

• The term evidence-based practices has been
  defined as follows
• Treatment interventions, services and supports
  that have consistently shown positive outcomes
  for children and families through research
  studies.
• The integration of best research evidence with
  clinical experience and consumer values.
• The Institute of Medicine IOM

3
Why are EBPs Important?

• Promises to improve the quality of care provided
  to children and their families
• Promises to increase provider accountability and
  systems accountability and
• Promises to improve treatment outcomes (improved
  school performance, improved family and peer
  relationships, less involvement with law
  enforcement and more).

4
Why are EBPs Important?

• Reduce service and treatment costs because kids
  spend fewer days in more costly and restrictive
  settings and receive services in their homes and
  communities.
• Significant reduction in juvenile detention
  through the broader implementation of home and
  community based EBP services.
• Presentation by Barbara J. Burns, Ph.D. for CMS,
  June 2006.

5
The EBP Movement

• The EBP movement received a jolt forward with
• calls from national leaders for EBP
  dissemination
• We must close the gap between what we know from
  research works and what is practiced.
• Surgeon Generals Report, 1999
• The lag between discovering effective forms of
  mental health treatment and incorporating them
  into routine clinical practice is 15-to-20 years.
  
• Crossing the Quality Chasm, IOM, 2001.
• Call for the closing of the research to science
  15-to-20 year gap.
• Transforming Mental Health Care in America.
  Federal Action Agenda, 2005.

6
The EBP Movement

• Here is what the NFC had to say about EBPs
• Over the years, research has yielded important
  advances in our knowledge of the brain, behavior,
  and effective treatments and service delivery
  strategies for many mental illnesses.
• An array of evidence-based interventions now
  allows successful treatment of most mental
  illnesses.
• Despite these advances in science, many children
  and families are not benefiting from these
  research advances.
• New Freedom Commission Report, 2003.

7
NAMIs Focus on EBPs

• 2 recent NAMI grants secured on EBPs
• Grant funding from the MacArthur Foundation to
  build a family network to promote the broader
  dissemination of EBPs in three target states
  Illinois, Louisiana and Pennsylvania.
• CMHS grant to develop a family guide on EBPs.

8
Building a Family Network Starts with Education
and Information

• Developed family guide to provide education and
  information on EBPs.
• Worked with Barbara Burns, Ph.D., leading
  national expert on EBPs in childrens MH, on
  family guide.
• NAMI received input from stakeholders and
  families in developing the guide.

9
Overview of the Family Guide

• Defines EBPs and Why They are Important
• Cautions about EBPs
• Not widely available
• Providers not trained in EBPs and may resist
  change
• Challenge in establishing an EB for an
  intervention
• Limitations in studies in diverse communities,
  but evidence-base growing
• Limited research on co-occurring disorders and
• Research gaps for serious MI in children and
  adolescent bipolar disorder and schizophrenia.

10
Overview of the Family Guide

• Talking with Providers about Treatment Choices
  and EBPs
• Current EBPs and the EBP Chart
• Psychosocial Interventions (CBT, Exposure
  Therapy, IPT, Behavior Therapy)
• Family Interventions (BSFT, FFT, PMT, PCIT,
  Family Ed Support)
• Intensive Home and Community-Based Interventions
  (Wrap-around/ICM, MST, TFC, Mentoring, Respite)
• Medication Interventions
• Other Promising Practices in Childrens Mental
  Health
• The Role of Families in Promoting EBPs
• Resources on EBPs

11
The Role of Families in Promoting EBPs

• Families learn about EBPs and create demand
• Families contact provider organizations and
  request training and incorporation of EBPs into
  provider practice, training and postgraduate
  training programs
• Employers and insurers hear about the need for
  broader insurance coverage of EBPs (good outcomes
  lead to lower overall costs)
• Researchers involve families in design,
  implementation and dissemination of EBPs

12
Families Promoting EBPs

• Advocate with legislators, childrens MH
  directors and other community leaders for EBPs
• Learn about the available services and gaps in
  the system, opportunities to bridge gaps with
  EBPs
• Where are childrens MH funds being spent get
  the data and numbers to make the case for home
  and community-based EBPs.

13
Why EBP Advocacy is Important

• Current Over Reliance on Institutional Care
• Hospital - beyond acute care, research findings
  favor community interventions
• Residential Treatment Centers any gains from
  these facilities were equal to gains in treatment
  foster care at half the cost
• Group Homes mixed findings, youth made some
  gains and experienced deterioration in arrest
  rates
• Boot Camps negative outcomes and
• Detention Centers negative outcomes.
• Presentation by Barbara J. Burns, Ph.D. for CMS,
  June 2006.

14
EBPs Reduce Recidivism
Reduces Recidivism
Increases Recidivism
10
Boot Camps
-25
Functional Family Therapy
-31
Multi-Systemic Therapy
-37
Multidimensional Treatment Foster Care
-40 -30 -20 -10
0 10 20
30 40
Effect of Program on Recidivism Rate
SOURCE Meta-analysis conducted by the Washington
State Institute for Public Policy
15
National Use of Residential Treatment Facilities
for Youth with Mental Illnesses
25,603
Burns, 1991 Warner Pottick, 2003 Buck,
2006

• Presentation by Barbara J. Burns, Ph.D. for CMS,
  June 2006.

16
An Example of One State
Childrens Mental Health Services in North
CarolinaExpenditure by Treatment Type for FY 2005
Community-Based Services25.20
Inpatient Hospital8.18 (6 of youth served)
Outpatient Therapy 8.64
Other 5.27
Residential Treatment 43.00 (9 of youth served)
Case Management9.69
SOURCE North Carolina Division of MH/DD/SAS

• Presentation by Barbara J. Burns, Ph.D. for CMS,
  June 2006.

17
States and the EBP Movement

• State-wide initiatives for disseminating EBPs
• Michigan Cognitive behavioral therapy and
  Parent Management Training.
• Washington Functional Family Therapy in
  Juvenile Justice.
• Georgia Positive Parent Training in Juvenile
  Justice.
• Oregon EBPs required for reimbursement of MH
  services (of concern to families).
• NY, CA and OH developed training institutes on
  EBPs in childrens mental health.
• Presentation by Barbara J. Burns, Ph.D. for CMS,
  June 2006.

18
NAMIs Work in Targeted States

• On-Site Targeted Technical Assistance
• Illinois Three meetings with Childrens MH
  Partnership, DMH/Child and Adolescent Network,
  Families and Advocacy Groups
• Louisiana Meetings with Families, Childrens
  Cabinet, and Models for Change (MacArthur JJ
  Reform Initiative)
• Pennsylvania Planning underway for October
  meetings.

19
Other Targeted Activity

• Series of Fact Sheets for Families on EBPs
  information on the interventions and how to
  effectively communicate with providers,
  policymakers, and community leaders about EBPs
• Dedicated section of the website on EBPs for
  children and their families (visit our recently
  update web section at www.nami.org/CAAC)
• NAMI Beginnings focused on EBPs (Fall 2007)
• Friday Conference Calls with Dr. Duckworth
  focused on EBPs (CBT, Behavior Therapy, MST, and
  more)
• Other ideas what will make the difference?

20
What Else is Needed to Close the Science to
Service Gap?
Advocacy
Leadership
21
Wed Like to Hear from You!

• NAMI is pleased to be working on this EBP project
  to ultimately improve the services delivered to
  children and families.
• EBPs are not a panacea, much more is needed, but
  it is giant step forward.
• We look forward to working with families in
  promoting the broader dissemination of EBPs and
  would like to hear from you.

22
NAMIs EBP Project

• Darcy Gruttadaro, Director, NAMI Child
  Adolescent Action Center. Please contact Darcy
  with questions and comments about the EBP project
  
• (darcy_at_nami.org, 703-516-7965)
• Also, visit the recently updated child and
  adolescent section of NAMIs web site at
  www.nami.org/CAAC