Where the Rubber Meets the Road: Getting Best Practices Into Your Practice

1
Where the Rubber Meets the RoadGetting Best
Practices Into Your Practice

• Patrick Cullinane, MS, Director
• Special Projects
• American Society on Aging
• San Francisco, CA
• 415-974-9642
• pcullinane_at_asaging.org

2
TRIPping in Older Adults Substance Abuse
Services

• Translating Research Into Practice

3
Session Objectives

• Identify key knowledge and attitudes to enable
  translating research or best practices into your
  practice
• Learn strategies for expanding awareness and
  activity on best practices

4
The Good News

• Conference Sessions Highlight
• Evidenced-based approaches to screening,
  identifying, intervening and treating older
  adults with substance abuse problems
• Treatment Works Recovery Happens

5
But Now What?

• How do we give meaning and value to this
  information?
• What can we do to use and translate this evidence
  into effective service for our clients?

6
First Thoughts

• Remember why we are here and do this work
• We make a positive difference
• The quality of our clients lives, their
  caregivers and their communities all benefit from
  the work we do
• We want to strengthen community capacity for
  high quality programs
• Treatment Works Recovery Happens

7
But We Know

• Most people do not get the help they need
• Many social and medical institutions that could
  help identify and treat fail to do so
• No one person or institution is responsible for
  increasing demand or service
• Wide disparity between evidenced-based treatment
  and its delivery at the local level

8
And We Know

• Community support for quality treatment (Tx) can
  be win-win
• ? personal health and social function
• ? drug use
• ? threats to public health and safety
• ? health care costs

9
The Challenges

• Wide gap between practice and the best possible
  results
• Made worse by persistent discrimination against
  people with drug and alcohol problems

10
Other Challenges

• Access to Tx severely restrained
• Many payers refuse to adequately fund or to meet
  standards of care
• Where help available, addiction is frequently
  treated as acute condition vs. chronic relapsing

11
Outcomes

• Self-perpetuating cycle of poor outcomes and
  misperception about the disease
• Dangerous lack of opportunity for effective Tx

12
How Can We Make It Better?

• Three areas to think about
• Knowledge
• Attitudes
• Strategies

13
Knowledge

• What do we need to know about a practice that is
  presented as evidenced based?
• Proven quality through evaluation studies
• Demonstrated positive outcomes
• Documented and replicated
• Clearly identified fidelity measures, key
  components

14
What About Expert Consensus?

• Need to check
• Nature of the consensus and the process to reach
  consensus
• Documentation for the consensus
• Current empirical evidence
• Why further evidence not available now

15
An Example

• SAMHSA/CSAT Treatment Improvement Protocol 26
  Substance Abuse Among Older Adults
• Comprehensive overview
• Based upon research and knowledge and experience
  of the expert consensus panel

16
TIP 26 Consensus Panel

• Experts in the field nominated by their peers
• Representing diverse settings
• Process of expert review of draft document
• Panel Chair to ensure document reflects panel
  collaboration

17
Importance of Attitudes

• Openness to new ways
• Appreciation of different approaches for
  different people
• Willingness to explore current beliefs and
  cultural values
• Acceptance of others values as valid

18
Goal of TRIPping

• to reduce systematic, programmatic and fiscal
  barriers to the prevention and treatment of
  problems, and
• to enhance the knowledge, resources, and skills
  of agencies that serve the aging population in
  the areas of alcohol and other drug use and
  misuse.

19
Key Approach Consideration

• Focus on what will make things better
• Not on how bad things are
• Pay attention to the following key steps

20
Community Goals

• Screening for early identification
• Care responsive to individuals
• Monitoring and aftercare that assures sustained
  disease management
• Continuous feedback for system improvement

21
Build a Coalition

• Identify key players needed to
• Develop
• Evaluate
• Advocate
• Implement

22
Some Key Players

• Think broadly
• Health care professionals
• Payers
• Purchasers
• Criminal justice professionals
• Clergy
• Educators
• People in recovery and their families

23
Gather Local Data

• Best describes the problem
• Most persuasive to your audiences
• Highlights level of service currently available
  vs. desired service level

24
Set Strategy

• To promote your agenda
• To influence outcome
• To broaden base of support

25
Strategy Examples

• Use local data to drive policies to raise
  standards of care
• E.g. compare data on need vs. current service
  capacity

26
Share Research Findings

• On effective treatment protocols
• On effective performance measures
• With public and private payers
• E.g. care standards in EAP

27
Build Partnerships

• With medical organizations
• To advocate routine screenings as part of overall
  health assessment
• E.g. SBIR in San Diego

28
Work with Providers

• To increase knowledge and practice of
  evidenced-based findings
• E.g. Senior Center nutrition intake

29
What does that mean?
30
Educate Consumers

• On NIDA Principles for Quality Treatment
• On how to demand quality for themselves and
  family members
• E.g. advertising campaign, toll free IR number

31
Remember

• TRIPping is an ongoing process
• All the pieces generally do not come together at
  the same time
• Its okay to act and develop simultaneously

32
Also Remember

• To define realistic and achievable goals and
  objectives
• To develop and disseminate continuous feedback to
  your partners and the community
• To remind everyone that treatment works, recovery
  happens
• Everyone wins with quality service

33
Four Strategic Elements in TRIP

• Leadership To accept responsibility for the
  process
• Information To help providers and consumers find
  and make intelligent choices
• Quality Improvement To establish and ensure
  quality standards
• End of Discrimination To achieve insurance
  coverage for Tx at parity with other diseases

34
CSATs National Tx Plan Initiative Key Elements

• Invest for Results
• Close serious gaps in Tx capacity to reduce
  health, economic and social costs
• Establish standard insurance benefits for
  coverage
• Set reimbursement rates and funding levels to
  cover reasonable cost of care

35
No Wrong Door to Tx

• Require appropriate assessment, referral and Tx
  in all systems
• Ensure participants in all systems become engaged
  in most appropriate type and level of Tx and
  receive continuing services at level needed

36
Commit to Quality

• Establish system that connects services and
  research to continually promote best
  evidence-based services
• Use system to develop standards of care, training
  and credentialing
• Attract and maintain a workforce responsive to a
  diverse client population

37
Change Attitudes

• Engage recovery community in all levels of
  discussion
• Conduct research to better understand stigma and
  discrimination
• Conduct educational initiatives to reduce stigma
  and discrimination

38
Build Partnerships

• Form groups to unite people and systems
  responsible for various aspects of problem
• Create forums where public and private can
  collaborate
• Provide support to collaborative projects

39
What About Evaluation and Successful Translation?
40
Successful Proposals

• New ideas or approaches (if appropriate)
• Targeted
• Seek funding for new programs or components
• Sustainability Involve collaborations/partnership
  s to leverage resources
• Appear well-planned with realistic activities to
  accomplish specific measurable goals and
  objectives

41
What makes programs attractive?

• Clear definition of problem you plan to address
• Description of the reasons behind the approach
• Outline of how you anticipate measuring your
  achievements

42
Planning a Program Where to Begin?

• At The End!
• Find your focus What results do you want?
• What kinds of activities (new or ongoing) will
  make this happen?
• What are your resources?

43
Helpful Tools Clear Goals and Objectives

• Format for objectives
• By date(A), percent or change (B) of who (C)
  will what result or benefit (D).
• Example 1 By 6/30/05 (A), there will be a 25
  reduction (B) in harmful drinking (D) in all
  older adults who have received the brief
  intervention protocol (C).

44
Helpful Tools for Program Planning Logic Model

• Begin with what you want Results
• End with what you have Resources

Resources/Inputs
Program Activities
Outputs
Results !
45
List your Outputs

• Your outputs are the number of
• Participants
• Staff/volunteers trained
• Flyers distributed
• Classes offered per year
• Requests per month seeking info about the program
• We expect that once completed or underway these
  activities will produce the following evidence
  that services were delivered

46
Activities Review and Add

• What activities does your organization already
  engage in that could help to address the problem?
• What new activities would you like to offer that
  require additional funding or resources?

47
Do Your Homework

• Clarify program purpose and objectives
• Prioritize your needs
• Conduct key informant interviews, focus groups,
  surveys to find out what community wants
• Research literature and Internet to find examples
  of programs that have been successful in
  communities similar to yours
• Helpful websites ASAs Live Well, Live Long
  www.asaging.org/cdc and NCOAs Best Practices
  webpage http//www.ncoa.org/content.cfm?sectionID
  63

48
Strategies for Making Your Logic Model
Evidence-based

• Use
• Best practices take goals, objectives and
  activities of successful programs and adapt to
  your community
• Established, proven theories of behavior change
  to explain why your program will work
• Current statistics on the health status of older
  adults in your community
• An evaluation plan to measure more than just
  participant s and satisfaction. (e.g., ask
  participants to report changes in health status,
  what steps they have taken as a result of your
  program)

49
Theory-of-Change Model - Components

• Problem/Issue
• What problem(s) are you attempting to solve or
  what issue(s) are you striving to address?
• Community needs/assets
• What needs or assets will help you address the
  issue?
• Desired results
• What do you expect your program to achieve in the
  near and longer term?

50
Theory-of-Change Model Components (contd)

• Influential factors
• Are there any special circumstances in your
  community that make your program more likely to
  work? Are there any barriers? How do you plan
  to address these?
• Strategies
• Why do you believe your program will work? Has
  this type of program worked in other communities
  like yours?
• Assumptions
• Why will your approach be effective? (Behavior
  change theory)

51
Developing an Evaluation Plan

• Base on your logic model
• Means of comparing what you planned with what
  actually happened

52
Evaluation Plan Components (contd)

• Results/Outcomes Effectiveness, Magnitude
  Satisfaction
• Review your programs short-term outcomes and
  intermediate outcomes
• What is our assessment of what resulted from our
  work in the community?

53
Evaluation Plan Components (contd)

• Overall Lessons Learned
• What have we learned about doing this kind of
  work in a community like ours?
• Review what changes need to be made in your
  activities to improve your results/outcomes

54
Evaluation Summary

• Clear logic model -gt Clear program description -gt
  Better chance of successful proposals
• Note Logic model may be implied by clearly
  stated goals, obj.s, activities, and timeline
• Step back periodically to evaluate the classes,
  workshops, and other services you offer
• Do they work together to create a measurable
  difference in older adults health and
  well-being?
• Examine opportunities for partnership with other
  aging and health organizations

55
How to Get Started

• Step 1 Assess Your Organizational Strengths and
  Challenges
• Interests/Willingness
• Knowledge/Education
• Training/Experience
• Organizational Resources
• Challenges/ Constraints

56
Interest/Willingness

• Do you have support for a program?
• If no, how can I get buy-in, e.g., short agency
  program, view video, staff meeting discussion

57
Knowledge/Education

• Learn what was done in the past, by whom and what
  happened as a result
• If nothing, review available materials, seek
  input from local experts or resources

58
Training/Experience

• Any staff already trained?
• If no, seek in-service by appropriate party

59
Organizational Resources

• Are staff available to lead?
• Are resources in place?
• Are there external, supplemental resources that
  could help?

60
Challenges/ Constraints

• Are there program champions internally and
  externally?
• Internal or external factors working against the
  effort?
• Proceed accordingly

61
Step 2 Identify Resources

• Know what you are looking for, resources needed
  to support the program
• Opportunity for making connections to the broader
  community
• Develop standardized form to promote consistent
  data across resources
• See sample resource matrix

62
Step 3 Educate Staff

• Enhance knowledge, capacity and comfort in
  program area
• Cross-train with other agencies to strengthen
  program ties
• Consider developing staff in-house expert
• Address staff attitudes and beliefs abut older
  adults and substance abuse

63
Step 4 Educate Older Adults

• Inform and get input about program
• If operational program, be sure protocols are in
  place and functioning well to respond to
  customers

64
Step 5 Plan Future Developments

• Monitor evaluation feedback
• Adjust as needed to maintain momentum and
  direction

65

• Knowledge
• Attitudes
• Strategies

66
Conclusion

• I am only one
• But still I am one.
• I cannot do everything,
• But still I can do something.
• And Because I cannot do everything
• I will not refuse to do the
• something I can do.
• Edward Everrett Hale

67
We Can Do It

• Treatment Works
• Recovery Happens

68
For more information

• Contact Patrick Cullinane, MS, Director
• Special Projects, American Society on Aging, 833
  Market Street, Suite 511,
• San Francisco, CA 94103, 415-974-9642
  pcullinane_at_asaging.org