Collaborative Dissemination and Implementation of Evidence Based Practice in Social Work Agencies.

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Collaborative Dissemination and Implementation of
Evidence Based Practice in Social Work Agencies.

• Sarah E. Bledsoe
• Jennifer Bellamy
• Lin Fang
• Catherine Coppolino
• Jennifer Crumpley
• Julia Jean-Francios
• Edward J. Mullen
• Columbia University, School of Social Work,
  Musher Center
• Supported in part by National Institute of Health
  Doctoral Training Program in Mental Health
• Services Research 5 T32 MH14623-24/25 the
  Willma Albert Musher Center at Columbia
  University

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Background

• Comprehensive and unified approach to EBP
• Share resources between agencies and
  practitioners
• Increase buy-in and ownership at all levels
• Increase quality continuing education
• Make research more user-friendly
• Provide tools
• Attach meaningful signposts
• Protect time
• (Bellamy, Traube Bledsoe,2004)

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Literature Review

• Barriers
• Lack of Knowledge Skills for EBP
• Lack of Fit to Agency Practice
• Suspicion of Researchers EBP
• Limited Resources for EBP
• (Bellamy, Traube Bledsoe,2004)

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Current Strategies for EBP Implementation

• Bottom-up
• Teaching professionals to be evidence-based,
  lifetime learners
• (Sackett, 2000 Gibbs Gambrill, 2002 Gibbs,
  2003 Gray, 2001)
• Top-down
• Tool kits/application kits/manuals/guidelines
• (Mueser, Torrey, Lynde, Singer and Drake, 2003)
• Top-down/bottom-up
• Combining evidence consensus
• (Cook, 2004)
• Combine focus on practitioner training
  organizational development
• A. Interactive staff training
• (McCracken Corrigan, 2004)
• B. Outcomes objectives orientation
• (Rosen, Proctor, Morrow-Howell, Auslander,
  Staudt, 1993)
• Targeting the Social Work Profession
• Objectives-Focused Multilevel Strategy
• (Proctor, 2004)

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Pilot Study

• Pilot study aim
• Design-pilot-refine strategy for implementing EBP
  in social work agencies
• Multi-site to permit comparison

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Main Research Question

• How can social work organizations
  practitioners be engaged helped to adopt
  implement evidence-based practice?

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Social Intervention Research Design

• Phase one
• Review literature, interview experienced EBP
  researchers
• Phase two
• Select partner agencies, design study
• Phase three
• Implement and modify intervention, evaluate
  outcomes

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Findings from Initial Meetings

• Agency-university RELATIONSHIP is key
• Evidence based practice is an relatively
  unfamiliar term
• Preference for a team approach
• Resources may be limited (e.g. computers, time
  and scheduling)

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More Findings

• Agencies want trainings in EBP, but not to be
  told how to practice
• Staff have varying levels of expertise and
  education
• Its a struggle to find the perfect question

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Process of Initial Meetings

• Understanding problem formulation
• -large agencies with diverse programs
• -continual narrowing of focus
• -process vs. outcome interest
• Team building
• -creative, innovative, or change oriented staff
• -midlevel administrator interest

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Team Formation
Team   Agency Type   Program Area   Staff Members
1 Large and diverse Adult Housing for Dual Diagnosis 3 Housing Supervisors and 1 Administrator
2 Small neighborhood focused Children and Families Programs Children and Families Programs 6 Casework Supervisors, 2 Administrators
3   Small neighborhood focused   Health/Mental Health Clinic   4 Clinical Social Workers, 1 Social Work Student, 1 Administrator, 2 Case managers
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Overview of the Model Curriculum

• Based largely on Gibbs book Evidence Based
  Practice for the Helping Professions
• Multi-session, multi-module flexible design
• Reflects Gibbs seven stages of evidence based
  practice

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First Step Motivation

• Rapport building at Pre-implementation
• Initial meetings
• Knowledge gathering (Baseline data)
• Module 1 Focus group and questionnaires
• Module 2 Overview of EBP including history and
  motivation for use

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Second Step Question Formulation

• Module 3
• Components of a researchable question (COPES)
• Question types
• Brainstorming question
• Selection of team question

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Third Step Tracking Down Evidence

• Module 4
• Types of research evidence
• Module 5
• Search tools (search terms and electronic
  resources)
• Team searching plan
• Hands-on computer lab searching

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Step Four Appraising the Evidence

• Module 7
• Trouble-shooting the search (homework)
• Module 8
• Review of research evidence
• General discussion of quality and quick tips
• Formal assessment instruments

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Step Five Applying the Results

• Module 9 Group discussion format
• Module 10 Synthesis of findings (along with
  practitioner knowledge)

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Step 6 Evaluation

• Evaluation of the experience by the team-
  debriefing
• Formal Evaluation
• Focus groups
• Questionnaires
• Feedback on Instruments

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Step 7 Teaching

• Module 11 Agency action plan
• Training to others
• Reporting findings/experience to wider agency
• Adding resources
• Duplication and continuation of model

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Preliminary Findings (Barriers)

• 1. Validated barriers
• Lack of Knowledge Skills for EBP
• Lack of Fit to Agency Practice
• Suspicion of Researchers EBP
• Limited Resource for Doing EBP
• (Bellamy, Traube Bledsoe,2004)
• 2. New Barriers Agency culture, Larger community
  environment

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Preliminary Findings (Knowledge)

• Knowledge
• 1. Some exposure to EBP
• 2. Varied and partial definitions of EBP
• 3. Little Pressure to Use EBP

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Preliminary Findings (Promoters)

• 1. Administrative leadership (time, culture,
  etc.)
• 2. Partnership with researchers
• 3. Incentives to use EBP
• 4. Acknowledge the humanity and art of practice
• 5. Value agency philosophy
• 6. Research evidence thats useful

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Preliminary Findings (Curriculum)

• Practitioners are motivated to use EBP
• Practical tools and hands-on training experiences
  are most helpful
• There is not enough time to learn all that is
  necessary to use EBP
• Two agencies plan to incorporate components of
  the training into existing agency processes

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For More Information

• Betsy Bledsoe
• seb2108_at_columbia.edu
• Jennifer Bellamy
• jlb2109_at_columbia.edu