Bringing in EvidenceBased Practice: How Do We Make EBP TAU

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Bringing in Evidence-Based Practice How Do We
Make EBP TAU?
National Crime Victims Research and Treatment
Center

• Ben Saunders, Ph.D., LISW-CP
• Professor and Director, Family and Child Program
• National Crime Victims Research and Treatment
  Center
• Department of Psychiatry
• Medical University of South Carolina
• Charleston, South Carolina

Keynote address at The Leadership Symposia on
Evidence-Based Practice in the Human Services
sponsored by The California Social Work Education
Center, The Child Family Policy Institute of
California, and the California Department of
Social Services, January 30, 2009, San Diego, CA.
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Bringing Evidence Supported Treatments to South
Carolina Children and Families

• Coordinating Centers
• The Dee Norton Lowcountry Childrens Center
• Charleston, SC
• National Crime Victims Research and Treatment
  Center
• Medical University of South Carolina

Project BEST is funded by Grant Appropriation No.
1582-SP from The Duke Endowment
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Project BEST Planning Team

• Elizabeth Ralston, Ph.D.
• Ben Saunders, Ph.D.
• Rochelle Hanson, Ph.D.
• Monica Fitzgerald, Ph.D.
• Michael de Arellano, Ph.D.
• Elizabeth Ciesar, Ph.D.
• Jan Koenig, M.Ed.

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Mission of Project BEST
The long-term goal of this project is to ensure
that all South Carolina children and their
families, who are identified as having
experienced abuse and resulting trauma, receive
appropriate, empirically supported mental health
assessment and psychosocial treatment services.
To achieve this goal, Project BEST will
substantially increase the capacity of every
community in South Carolina to deliver them.
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Why Use Evidence Supported Treatments?
when he looked around and realized he was all
clear with 30 metres to go, he coasted and still
set a world record of 9.69 seconds.
The
New Zealand Herald 8/17/08
Usain Bolt
Bolt grabbed another gold, running the 200 in
19.30, two-hundredths of a second faster than
Michael Johnson's previous record, set at the
Atlanta Olympics in 1996.

The
Seattle Times 8/21/08
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Why Use Evidence Supported Treatments?
The race is not always won by the swift, nor the
contest by the strong, but the smart man bets
that way.
Damon Runyon
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Large Gap Between Scientific Knowledge and
Front-line Practice
Practice
17 years
Knowledge
Goal reduce this gap.
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Great Thoughts About EBP
What do I think of Western civilisation? I think
it would be a very good idea. Mahatma Gandhi
New ideas pass through three periods 1) It
can't be done. 2) It probably can be done, but
it's not worth doing. 3) I knew it was a good
idea all along! Arthur C. Clarke
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Common Continuing Education Dissemination Model
One day workshop
Use Tx with appropriate clients
Therapist
Book
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Supportive Implementation Model
Administrative Leadership and Support for EBT
Obtain client feedback
Supervision
Technical Assistance
Expert Consultation
Use EST with appropriate clients
Therapist
Training
Materials
Community/Consumer Support for EBT
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Learning Collaborative Emphasis Over Time
Implementation
Learning Session-3
Learning Session-2
Learning Session-1
Action Period-1
Action Period-2
ActionPeriod-3
Pre-Work
Training
12-14 Months
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Brokers of Mental Health Services

• Make a determination (on some basis) that their
  clients need to be referred for mental health
  services.
• Select mental health treatment providers to refer
  their clients to.
• Refer their clients for mental health services
  (or even mandate they go to mental health
  services.)
• Monitor the progress of their referred clients in
  treatment.
• Monitor the outcomes of treatment for their
  referred clients.
• Take action concerning their referred clients
  based on the outcomes of treatment.

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Critical Role of Brokers of Mental Health Services
Medical Services
Nonprofit MH Services
Rape Crisis Center
Dept. of Mental Health
Referral
Dept. of Social Services
MH Providers
Brokers
Private Practitioners
Victim Advocates
University MH Services
Guardian Ad Litem
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Community Supply and Demand for TF-CBT
Brokers
Therapists
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Building Community Capacity
Needed Community Capacity for TF-CBT
Therapists knowledgeable and skilled and using
TF-CBT
Brokers knowledgeable about and referring for
TF-CBT
Current Community Situation
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Responsibilities of Brokers of Mental Health
Services
Because they take actions based upon treatment
progress and outcome

• Brokers have a responsibility to be reasonably
  familiar with the evidence-based mental health
  interventions that are appropriate for the
  problems their clients often have.
• Brokers have a duty to obtain appropriate,
  evidence-based treatments for their clients from
  providers who are trained, knowledgeable, and
  skilled in their use.
• Brokers have a responsibility to know what types
  of treatment their clients are getting and to
  monitor client progress on treatment goals.

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Key Elements of a Community-Based Learning
Collaborative

• Development of a Community Change Team
• Therapists, clinical supervisors, senior leaders
• Brokers, supervisors, senior leaders
• Multiple training events over time
• Adult learning principles and active learning
  techniques
• Web-based learning
• Promotion of team-building, collective
  responsibility, and effective interaction as well
  as learning the new practices.
• Action periods to implement the new practices
• Practice the new practice with expert
  consultation
• Expose barriers to implementation and
  sustainability, find solutions
• Promote Collaborative learning
• Discussion board, Resource Library
• Expert consultation, Peer consultation statewide
• Involvement of prior participants in subsequent
  learning collaboratives
• Monitor community, agency, and individual outcomes

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Community Change Team

• 15-20 mental health professionals and brokers
• Complete all training and implementation
  activities together.
• Champion the implementation and sustained use of
  TF-CBT in their communities.
• CCT members include
• Mental health professionals from multiple
  agencies.
• public mental health agencies, private nonprofit
  organizations, private practice.
• Brokers from multiple agencies.
• child protective service and child welfare
  workers, victim advocates, guardians ad litem,
  juvenile justice workers, nonclinical CAC
  workers.
• Senior leaders, supervisors, and frontline
  professionals from all these agencies.
• Consumers of mental health and broker services.
• Other community stakeholders (?)

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CBLC Curriculum Areas
Common Material and Activities Clinicians and
Brokers
Clinical Track TF-CBT
Broker Track EBTP EBCM
Learning It
Doing It
Joint Community Responsibility
Team Building
Supervisor
Senior Leader
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Principles Guiding a Community-Based Learning
Collaborative

• Promote collective community responsibility for
  abused and traumatized children and their
  families.
• Build the capacity of communities to deliver
  ESTs, not just one agency or set of providers.
• Build the supply of therapists who use ESTs
  properly.
• Build demand for ESTs from brokers through use
  of EBTP and EBCM.
• Build cooperative, sustainable linkages between
  brokers and therapists and agencies.
• Promote organizational and community change as
  well as individual learning and practice change.
• Cultivate local expertise in ESTs.

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Lessons Learned
Brokers are critical to sustained use of ESTs by
a community!
Learning EBTP
Knowledge about ESTs
Tx Criteria
Questions to ask Therapists
Implementing EBTP
Empowerment
View of job
Tx Components
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Lessons Learned

• Marketing (internal/external), Branding, and
  Style are important.
• Bottom up, organic spread over time,
  strategically build demand.
• How to make it theirs, ownership.
• Gain state leadership permission and soft, behind
  the scenes encouragement. Avoid directives.

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Lessons Learned

• You get what you monitor.
• Well-communicated, simple, directly useful
  metrics on multiple levels of implementation are
  critical.
• Tie metrics directly to outcomes.
• Publicize positive anecdotes.
• Use technology to make it easier Google Groups,
  Google Apps, Survey Monkey (FREE)
• Have surprises.
• Primary attention to cultivating relationships,
  interaction, team building.

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Process Role of Senior Leadership

• Committed senior leadership is necessary but not
  sufficient.
• Goal is to change the fundamental way we do
  business as an organization even as personnel
  comes and goes.
• Senior leadership roles
• Interest, commitment, leadership
• Participate
• Encouragement and tangible rewards
• Offer time
• Offer resources
• Find solutions to barriers
• Avoid directives

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Time to Dive In!