Readiness and Implementation of the GAIN and 7 Challenges

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Readiness and Implementation of the GAIN and 7
Challenges

• At NorthKey Community Care

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In the beginning . . .

• In 2005-2006 NorthKey received a grant from the
  Health Foundation of Greater Cincinnati to
  determine our readiness to implement
  evidence-based practices.

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The Players Were . . .

• Childrens Intensive Services (CIS)
• Substance Abuse Services (SA)
• Family and Children Services (FC)

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Childrens Intensive Service

• NorthKeys mental health inpatient unit knew that
  many of their adolescents had co-occurring
  disorders of mental health and substance abuse,
  yet were only assessing for and treating mental
  health.

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Substance Abuse Services

• SA had received a grant from the Center on
  Substance Abuse Treatment (CSAT) to expand our
  adolescent drug courts and to implement EBPs.

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Family and Childrens Services

• FC had received the Kentuckians Encouraging Youth
  to Succeed (KEYS) grant that required
  implementation of EBPs for co-occurring disorders.

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Additional Considerations

• More funding sources are requiring EBPs for
  programs that they will fund
• Increasing quality of care

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Requirements of the HF Grant

• All staff in the three service areas participated
  in an online survey sponsored by the Texan
  Christian Institute

• Focus groups were then held with the staff to
  clarify results from the survey and to obtain
  more information on their readiness to change

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Additionally, 2 Committees were formed . . .

• A committee composed of management level staff
  from each of the 3 service areas

• A committee composed of direct service staff from
  each of the three service areas

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Purpose of the Committees

• Research EBPs most appropriate for our clients
  and staff
• Choose most appropriate EBPs
• Discuss possible barriers to implementation and
  solutions to these barriers

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Research and other activities

• Therapy and assessment models chosen for
  consideration were those that had evidence they
  were effective with youth with co-occurring
  disorders
• Two local programs who had implemented EBPs were
  visited
• Consultation occurred with other agencies who had
  implemented EBPs

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Cont.

• Consultation occurred with creators of therapy
  and assessment models
• 4 NorthKey administrators attended a 3-day Change
  Management seminar

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Problems Encountered

• CIS direct service staff did not attend mtgs.
• Most of the SA staff who participated left the
  agency
• None of the FC staff who participated were in
  KEYS
• Some members of the management team talked the
  talk but did not walk the walk.

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Results of the Readiness Assessment

• CIS decided that staffing issues prohibited
  them from doing the staff training and
  supervision needed for implementing EBPs.
• SA (IOPs) decided to implement 7 Challenges
• CF (KEYS) decided to implement 7 Challenges and
  the GAIN

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Two Health Foundation Grants Were Awarded to
NorthKey

• One to implement 7 Challenges in KEYS and the IOPs

• One to implement the GAIN in KEYS

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The grants paid for the following costs to be
incurred within a year of implementation

• Training
• Materials (i.e. 7 Challenges journals, laptops
  for the GAIN, etc.)
• Staff time lost in additional training and
  supervision

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And then came implementation
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Challenges with 7 Challenges Within the SA IOPs

• Resistance from certain professions to implement
  to fidelity lack of executive leadership
• Dr. Schwebels fluid fidelity measures
• The time needed for training, supervision and
  reading journals
• Lack of respect to the Change Facilitator who was
  not a clinician

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Our Solutions

• Develop a Master Clinician Plan (not an original
  idea but stolen from KY River)
• Keep communication open with Dr.
  Schwebel

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Challenges with 7 Challenges in KEYS

• Most of the population presently served are too
  young for 7 Challenges
• Only 1 staff person trained
• This staff person is implementing 7Cs on an
  individual basis until he has enough clients to
  form a group

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Challenges with the GAIN in KEYS

• Personnel issues not enough staff to train in
  the appropriate settings
• Wrong people were given infrastructure
  information on operationalizing the GAIN
• Most of the population presently served are too
  young for 7 Challenges

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Our Solutions

• This is a work in progress

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Challenges for Both EBPs

• Resistant staff
• Sustainability
• Cannot bill Medicaid or private insurance for the
  time needed to provide the service
• Time needed to train and supervise
• The agency as a whole does not like change and
  has trouble with creative problem solving

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Conclusions

• You can never be too prepared to implement EBPs
• Change Management techniques are crucial in
  making the implementation and sustainability
  successful
• Never implement EBPs when most of your
  administrative staff is preparing for retirement

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Conclusions (cont.)

• Most agencies need financial resources to prepare
  their administrations and staffs for integrating
  EBPs
• Most agencies need technical assistance in order
  to implement and sustain EBPs
• Change is difficult and this process will take
  time