Implementing Evidence-Based Practice in Massachusetts: The Provider Perspective

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Implementing Evidence-Based Practice in
Massachusetts The Provider Perspective

• Elizabeth Funk, M.B.A.
• President/CEO, Mental Health Substance Abuse
• Corporations of Massachusetts
• Chairman, Board of Directors, National Council
  for
• Community Behavioral Healthcare

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• It is one thing to say with the prophet Amos,
  Let justice roll down like mighty waters, and
  quite another to work out the irrigation system.
• William Sloane Coffin
• (social activist and clergy
  member)

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Why change now?

• Federal government driving field Presidents
  New Freedom Commission
• Demand from stakeholders and consumers for
  cost-effective treatments
• Desire to spend less money for more clients
• Need to defend expenditures re outcomes

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Utilize Knowledge About Implementation

• Science of Implementation
• Utilize body of research and literature on
  science of implementation
• Applies across industries manufacturing, human
  resources, other
• Stages of change and implementation are known
• Address change needed at all levels
• Clinician
• Provider organization Management, Supervision
• System of Care
• State/payer policies
• Federal policies
• 
  Implementation What Research and
  Experience Can Tell Us
• Karen Blasé Dean
  Fixsen, Univ. of Southern Florida, June 2005

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Example of system change MHSACM Outcome
Measurement Project

• Different route originated from provider field
• 1995 Spurred to initiate project under
  federal/other pressure
• Active role in development
• Ownership of project
• Adaptation of instrument, implementation to
  specific needs, settings, populations
• Used group of initial providers as Purveyor
  Individual or group of individuals representing
  a program or practice who actively work to
  implement that practice or program with fidelity
  and good effect (Fixsen Blasé, U. of S.F.,
  2005).

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Outcome Measurement Project - Purveyors

• Celebrated and recognized for their efforts
• Serve as role models other seek to emulate
• Spread the message
• Teach
• Assume leadership
• Work out bugs
• Serve as advisory body recommend changes,
  revise tools, processes

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Outcome Measurement Project Learning is
Multi-Faceted

• Providers learned about outcome measurement in
  multi-faceted approach
• Disseminating written information and doing
  trainings alone are ineffective
• Peer presentations (experiential)
• User groups, discussion, coaching, use of group
  members to review, coach, advise, including
  on-site, etc.

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Outcome Measurement Project Ongoing Processes
Required

• Sustainability requires ongoing support,
  involvement, oversight
• Ongoing processes are essential for review,
  monitoring, evaluating, revisions, improvements
• One-time effort, limited attention will result in
  falling-off of models/initiative

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Outcome Measurement Project Dissemination/Incorpo
ration Into System of Care

• MHSACM broadly advocated for the project with
  providers, state agency officials, numerous payer
  representatives, policymakers
• Efforts made to more widely disseminate the
  initiative and incorporate it into policies of
  state and other payers
• Sought funding to assist with loss of revenue and
  additional expense that accompany any change of
  practice

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How can we work together to deliver more EBPs?

• Strengthen and expand current initiatives
• Providers already working with state and payers
  to utilize Evidence-Based Practices such as
• PACT (Program of Assertive Community Treatment)
• DBT (Dialectical Behavior Therapy)
• Motivational Interviewing (Substance Abuse)
• Other Promising Practices are in early
  development
• Collaboration in Primary Care
• Child wraparound services
• Co-Occurring Substance Abuse and Mental Health
  treatment
• State Substance Abuse Strategic Plan emphasizes
  greater use of Evidence-Based and Promising
  Practices

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EBP- Early Feedback

• Clinicians excited at positive results with
  clients for whom other treatments unsuccessful
• Gratified to learn new skills and have new tools
  to use with clients
• Continuously refining implementation
• Still learning together with purchasers to adapt
  models to specific settings, populations,
  environments without sacrificing critical
  elements of the models.

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Outstanding concerns broad-scale implementation

• Are Federal/State expectations unrealistic?
• Are providers able to deliver this change
  expeditiously?
• Providers cannot accomplish change alone
• Workforce cannot be transformed overnight- will
  take years
• General workforce issues add challenges
  recruitment, retention, diversity, skills -
  Presidents New Freedom Commission urges
  workforce strategic plan

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Implementation (continued)

• Current professional training does not address
  EBPs or prepare clinicians for new clinical
  framework role of universities, medical
  schools, professional training programs
• Rates must be built around the models
• Hard to accomplish in under-resourced system
• Models must include processes for continued
  review of goals/objectives, outcomes, and
  financing