Implementing

1
Implementing Evidence-Based Practices
The Addiction Technology Transfer Center
Network Funded by Substance Abuse and Mental
Health Services Administration
2
Overview

• 1. Systems change model
• Definitions
• Principles
• Strategies
• Activities
• Steps
• 2. Case study
• 3. Discussion

3
A Comprehensive Strategy Includes

• Policies that accommodate evidence-based
  practices
• Supportive system administrators
• Willing agency directors
• Skilled clinical supervisors
• Opinion leaders who are convinced
• Skilled service providers
• Opportunities for staff/client input

4
Barriers Can Include

• Administrative philosophy
• Organizational policy
• System structure
• Unclear literature
• Agency staff
• Client population

5
So, how do you decide what to do?
????
6
The Change Book

• Principles
• Strategies
• Activities
• Steps

7
Change Initiatives Must Be

• Relevant
• Clear
• Multifaceted
• Bi-directional

• Timely
• Credible
• Continuous

The Principles
8
Dont Forget the Last Three

• Multifaceted
• Continuous
• Bi-directional

The Principles
9

• Creating Your Blueprint
• The Ten Steps

10
Ten Steps of Effective Change Initiatives

• 1. Identify the problem
• 2. Organize a team
• 3. Identify an outcome
• 4. Assess your organization
• 5. Assess your audience

The Steps
11
Ten Steps of Effective Change Initiatives

• 6. Identify the approach
• 7. Design action and maintenance plans
• 8. Implement the plans
• 9. Evaluate your plans
• 10. Revise your plans

The Steps
12
Types of Activities

• Administrative/structural
• Bi-directional dialogue
• Information dissemination
• Education
• Person to person
• Evaluation

13

• Systems Change
• A Case Study

14
Womens Residential Center Client
Characteristics

• Chronic substance abusers with extensive criminal
  histories and serious psychological and social
  deficits
• Hardcore poly-drug users who began using drugs at
  17 most still using 15 years later at treatment
  entry

15
Womens Residential Center Client
Characteristics

• Heavily involved in criminal activity 73
  arrested at least 5 times as an adult
• Victims of physical and sexual abuse in adulthood
  75 physically abused by a partner and 45
  sexually abused
• In poor health, lack education and work
  experience, and have serious mental health
  problems

16
VOA Womens Program No Arrests After One Year

• Completed treatment
• 1999 - 48
• Did not complete
• 1999 - 26

17
VOA Womens Program No Arrests After One Year

• Completed treatment
• 1999 - 48
• 2001 - 86
• Did not complete
• 1999 - 26
• 2001 - 67

18
Our Change Process - Lessons Learned
Stage of Change Action
Principle
Precontemplation Always assess and re-assess readiness to change and develop a plan based on stages of change Bi-directional

Contemplation Preparation Develop a vision that everyone understands and supports Clear Bi-directional Relevant Timely
Action Build on what you have and what is already in place Integrate what you know with the technology you want to apply Relevant Credible Clear
19
Our Change Process - Lessons Learned
Stage of Change Action
Principle

Preparation Action It is a process Its a long-term effort achieved by meeting short-term objectives Multi-faceted
Action Wrap it pretty Use incentives and reinforcements What comes off the plate when new responsibilities are added? Multi-faceted Continuous
20
(No Transcript)
21
Moving On

• 26-session program for female offenders
• Help women identify and mobilize personal and
  community resources
• Educational and cognitive skill building
• Delivered in small groups or individually

• Marilyn Van Dieten, Ph.D
• Patricia Mac Kenna, M.A.
• 416-539-9300
• vandieten_at_aol.com

22
Our Change Process - Lessons Learned
Stage of Change Action
Principle

Action Maintenance Comprehensive and long-term effort Utilize training, manuals, supervision, consultation Use a variety of methods to present information Build partnerships with customers, funders, stakeholders Capitalize on staff strengths Establish a systematic problem-solving process Multi-faceted Continuous Bi-directional Credible
23
Our Change Process - Lessons Learned

Stage of Change Action
Principle
Maintenance Relapse Anticipate barriers and relapse Respond with strength-based approaches and interventions based on the stages of change Back to precontemplation and contemplation Continuous Bi-directional
24

• In Summary

25
Knowledge Adoption Lessons Learned

• Assess and address staff and organizational
  readiness for change
• Check assumptions of all stakeholders as project
  begins
• Secure staff buy-in

26
Knowledge Adoption Lessons Learned

• Utilize researcher and provider collaboration
  throughout the project
• Implement a design tailored to the realities of
  the agency
• Develop a plan sufficient to accomplish your
  objectives
• Have an on-site champion

27
Final Tips

• No system change works without a process
• Effective strategies are multi-faceted,
  bi-directional and continuous
• Representation of all stakeholder groups in
  decision-making facilitates buy-in and adoption
• Continuous promotion, training and mentoring
  builds top-of-mind awareness and consistent use

28
Implementing Evidence-Based Practices
The Addiction Technology Transfer Center
Network Funded by Substance Abuse and Mental
Health Services Administration