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Implementing Evidence-based Practice (EBPs) in Mental Health Service Delivery
 

Implementing Evidence-based Practice (EBPs) in Mental Health Service Delivery

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>Implementing Evidence-based Practice (EBPs) in Mental Health Service Delivery. This presentation looks at the potential for identification and implementation of EBPs to bring significant

>Implementing Evidence-based Practice (EBPs) in Mental Health Service Delivery. This presentation looks at the potential for identification and implementation of EBPs to bring significant
improvement to delivery of mental health services

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    Implementing Evidence-based Practice (EBPs) in Mental Health Service Delivery Implementing Evidence-based Practice (EBPs) in Mental Health Service Delivery Presentation Transcript

    • Implementing Evidence-Based Practice (EBPs) in Mental Health Richard H. Beinecke Suffolk University Department of Public Management 8 Ashburton Place, Boston, MA 02108 617-573-8062, rickdeb61@aol.com American Public Health Association December 12, 2005
    • Sources
      • Ongoing literature review.
      • Study of mental health EBPs in England during sabbatical, spring 2004.
      • Brandeis/Suffolk forum, “Implementing Evidence-Based Practices and Performance Measures for Massachusetts Mental Health Services”, co-sponsored with Mass DMH and DPH and funded by CMHS, September 28, 2005.
    • Evidence-Based Practices
      • “ A quality improvement process that provides accountability through the monitoring of the practices to models that have been demonstrated by research to be effective.” (Goldman et al, 2001)
      • “ The purchase of treatments and services that have been scientifically confirmed to improve outcomes.” (Lehman et al, 2004)
    • Status of EBPs
      • Mental health (and health) systems are in shambles. Much improvement in care is needed (e.g., effective care for depression only 57% of the time; for alcohol dependence only 10% of the time). Need to change yourself, your program, and your environment.
      • Many EBPs are now known but are not being implemented, e.g.
      • Supportive Employment Programs
      • Assertive Community Treatment
      • Integrated treatment for mental health and substance use disorders
      • Family PsychoEducation
    • Calls for Implementing EBPs
      • Crossing the Quality Chasm (IOM 2001)
      • Four areas for redesigning health systems: “Applying evidence to the delivery of health services.”
      • President’s New Freedom Commission (2003)
      • “ Goal: Advancing evidence-based practices.”
      • Committee on Crossing the Quality Chasm Adaptation to Mental Health and Addictive Services (IOM, 2005)
      • Call for “Better dissemination and adoption of evidence through the use of evidence-based approaches to knowledge dissemination and uptake.”
    • Factors for Successful Implementation
      • Implementation: “ A specified set of activities designed to put into practice an activity or program of known dimensions. (Fixsen et al, 2005)
      • Success depends upon
      • Scientific study of what works or is not effective. Effectiveness of the intervention practices or policies.
      • Compilation, distribution, and use in practice of this information. Effectiveness of the implementation practices.
    • Elements Important to Organizational Change (Redesign Process) (Fixsen et al, 2005)
      • Commitment of leadership to the implementation process.
      • Involvement of stakeholders.
      • Creation of an implementation task force with stakeholders.
      • Suggestions for “unfreezing” current organizational practices.
      • Resources for extra costs, effort, materials, recruiting, access to expertise, retraining.
      • Alignment of organizational structures to integrate staff selection, training, performance evaluation.
    • Core Implementation Components (Fixsen et al, 2005)
      • Communication and feedback from the source of the innovation to those who will implement it.
      • Pre-service training.
      • Staff and program evaluation.
      • Consultation and coaching.
      • Also organizational components, e.g.:
      • Administrative supports
      • Information technologies.
      • Financing.
      • Organizational Culture and climate
      • External Influences: Social, economic, and political.
      • Strong leadership and powerful champions.
    • Seven Task Clusters to Promote State EBPs ((Rapp et al, 2005)
      • Strategic planning.
      • Involve stakeholders.
      • Focus on outcomes that clients value.
      • Have design and task specifications in the regulatory standards.
      • Create incentives and disincentives.
      • Maximize funding.
      • Provide workforce development
    • Stages of the Implementation Process (Catalytic Leadership) (Luke, 1998)
      • Focus attention by elevating the issue.
      • Engage people in the effort.
      • Stimulate multiple strategies and options for action.
      • Sustain action and maintain momentum.
    • Stages of Change (Lynde, 2005)
      • Pre-contemplation (information sharing)
      • Contemplation (needs assessment)
      • Preparation (leadership and stakeholder engagement)
      • Action (planning, training, consultation, communication and feedback, policies and regulations, funding)
      • Maintenance.
      • Must fully involve consumers, family members, providers).
    • Degrees of Implementation (Fixsen, 2005)
      • Paper Implementation: Put into place new policies and procedures.
      • Process Implementation: Putting new procedures into place to conduct training, supervision, change reporting forms, etc.
      • Performance Implementation: Procedures and processes of change are used to good effect for consumers (outcomes, real performance measurement).
    • State Initiatives to Promote EBPs (Ganju, 2005)
      • All states offering at least one EBP and 23 offering at least six. But few states are implementing EBPs in a comprehensive way.
      • State Approaches:
      • Awareness/training/support for clinicians; Centers of Excellence.
      • Building consensus.
      • Incorporating EBPs into contracts.
      • Fidelity monitoring.
      • Modifications to information systems.
      • EBP budget requests and financial incentives .
    • Future of Behavioral Health EBPs (Leff, 2005)
      • EBPs identified by national registries (e.g. NREPP) and venues for meta-analyses (e.g. Cochrane Collaboration).
      • Explicit criteria for recognizing practices.
      • Convergence of Federal, state, and private payer listings.
      • Listings as “Arbiters of Value.”
      • This will alter the nature of mental health services, favor some practices and not others, and make favored practices more consistent and expensive.
    • Status in Massachusetts
      • Some EBPs being supported by the state.
      • “ Expanding and sharing evidence-based and best practices and convening evidence-based practice training for providers is one of the goals in the state Department of Mental Health plan.
      • Introductory forum September 2005.
      • Committee of stakeholders being formed.
      • Delays now due to possible restructuring of the Medicaid Behavioral Health Plan.
    • Discussion
      • Lessons and application to other public sector change initiatives and business innovation