CSOC EvidenceBased Practices

1
CSOC Evidence-Based Practices

• Georgetown Technical Assistance Center
• May 18, 2006

2
Overview

• More than training
• Transformational principles
• Sustainable model adherent practices
• Preventing drift
• Technical assistance possibilities

3
More Than Training

• Training and supervision is an ongoing process,
  not a moment in time
  
• Learning a practice for the first time typically
  takes about a year and includes
  
• Intensive initial training and booster trainings
• Periodic (weekly) supervision
• Fidelity monitoring (checklists, child/family
  report, videotape reviews)
  
• Continuing training and supervision needs to be
  routine
  
• Clinical training and supervision is necessary
  but not sufficient

4
Transformational Principles

• Evidence-Based
• Practice-specific training
• Model adherence
• Specialist
• Service effectiveness

• Traditional
• Postgraduate training
• Medi-Cal compliance
• Generalist
• Quantity of service

5
Sustainable Model Adherence

• Planning
• Staffing
• Supervision
• Administrative oversight
• Monitoring fidelity
• Evaluating outcomes
• Intra- and interagency coordination

6
Planning

• Develop comprehensive and thorough plans
• Plan for the long term
• Know the practice, how it works and what it takes
  to make it work
  
• Use inclusive (team-based) planning with
  oversight from a single responsible
  administrator
  
• Clearly articulate who will be served, and which
  goals will be pursued
  
• Integrate the practice into a larger system that
  provides individualized (need and goal specific)
  care

7
Staffing

• Staffing is critical to success
• Not all practitioners can succeed with all
  clients or all practices
  
• Select practitioners specific to each practice
  based on education, experience, skills, interest,
  and disposition
  
• Mutually informed decisions

8
Supervision

• Supervisors insure practice integrity
• Select supervisors specific to each practice
  based on prior experience with the practice,
  interest and disposition
  
• Supervisors need to take responsibility for
  practice fidelity
  
• Supervisors need to monitor and support fidelity
• Supervisors need to effectively support
  practitioners in the use of the practice

9
Administrative Oversight

• Designate a single responsible administrator with
  the authority to execute all aspects of the
  implementation plan
  
• Needs to understand the practice
• Needs to be personally involved in planning and
  implementation
  

10
Monitoring Fidelity

• Adherence to treatment models is the cornerstone
  of quality care
  
• Adherence to the model is critical to replicating
  published outcomes
  
• Adherence is to the model is needed in order to
  make inferences about program effectiveness

11
Monitoring Fidelity

• Develop the capacity to routinely monitor
  fidelity (all practices and practitioners,
  always)
  
• Practitioner completed checklists
• Child and family ratings
• Independent observations (audiotapes, videotapes,
  in-person)
  
• Be prepared to offer training and/or supervision
  to promote fidelity (prevent drift)
  
• Monitoring fidelity in itself promotes fidelity

12
Evaluating Outcomes

• Outcome evaluation is a cornerstone of quality
  care
  
• EBP are part of larger service systems
• The relative value of a practice can only be
  understood in the context of alternatives
  
• Need to evaluate new and existing practices
• Is the practice model adherent?
• Do children/families achieve a positive outcome
  during or immediately after a course of
  treatment?
  
• Do children/families achieve increasing success
  overtime?
  

13
Intra- and interagency coordination

• Practices need to fit into the existing
  service-compliance and collaboration system
  
• Or, the system needs to conform to support the
  use of evidence-based practices
  
• Referrals--How will target children/families be
  identified and gain access to the designated
  services?
  
• Agency expectations--Are caseload standards
  compatible with productivity standards?
  
• Compliance--Are practice activities compatible
  with Medi-Cal standards?
  
• Financial--Can the practice be funded? Is it
  cost-effective?

14
Preventing Drift

• Staff are not enthusiastic about the practice
• Not enough training and supervision
• Failure to adhere to practice caseload standards
  and program components

• Select staff with interest based on an
  understanding of the practice
  
• Make use of all training and supervision
  activities
  
• Understand the practice, commit to caseload
  standards and program fidelity

15
Preventing Drift

• Practitioners have competing duties
• Insufficient within and between agency
  coordination involving referrals and funding
  
• Mid-managers do not proactively support the
  practice

• Understand time commitments and staff
  accordingly
  
• Plan thoroughly in advance
• Involve mid-managers so they understand and
  support the practice

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Preventing Drift

• Expect and prepare for replacement training
• Synchronize training and referrals
• Prioritize and monitor fidelity from the outset
• Implement with adherence and demonstrate positive
  outcomes before making adjustments

• Attrition of trained practitioners
• Delays between training and using the practice
• Insufficient attention to fidelity
• Eagerness to expand and adapt the practice before
  it is well established

17
Preventing Drift

• Do not over sell the practice
• Be sensitive to practitioners feeling
  scrutinized
  
• Document results (positive outcomes are
  empowering)
  
• Evaluate new and existing practices (all programs
  are being scrutinized)

• Unrealistically high expectations
• Increased scrutiny and accountability

18
Preventing Drift

• Numerous agency demands and initiatives

• Designate a single responsible administrator

19
Technical Assistance Possibilities

• Information--helping you understand a practice
  (level of effectiveness, for whom and how it
  works)
  
• Link to developers--contact information and
  preparation for working with developers
  
• Ordering materials--discount rates in purchase of
  materials when part of a CIMH initiative
  

20
Technical Assistance Possibilities

• County specific planning--technical assistance in
  developing implementation plans
  
• Development teams--comprehensive training and
  technical assistance for sustainable model
  adherent implementation

21
Development Teams

• Development Teams are a training and technical
  assistance process to promote adoption of a
  practice
  
• Consisting of a team of counties/agencies
  committed to adopting a practice in common
  
• Combines three features
• Expert training
• Site specific planning
• Peer-to-peer assistance

22
Development Teams

• Clinical training and consultation provided by
  practice developers
  
• Implementation planning and technical assistance
  provided by CIMH associates
  
• Channels of communication to support peer-to-peer
  assistance (conference calls, listserv)
  

23
Development Teams

• Individualized technical assistance
• CIMH associates respond to implementation (system
  and program level) issues
  
• Support with outcome evaluation
• Tracking of fidelity
• Collection, analysis, interpretation and
  reporting of outcomes across agencies
  
• Scheduled conference calls (monthly)
• Share successes, raise concerns, and offer
  solutions
  
• Listserv
• Support communication between Team members

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Contact Information

• Lynne Marsenich, LCSW
• lmarsenich_at_cimh.org
• [phone]