Presentation:
"Measuring Sustainment of Multiple EBPs Fiscally Mandated in Children's Mental Health Services: Knowledge Exchange on Evidence-based Practice Sustainment (4KEEPS) Study"
Speaker:
Lauren Brookman-Frazee
Southern California Regional Dissemination, Implementation and Improvement Science Webinar Series
June 1, 2016
Sponsored by UCLA CTSI
Collaborative care models for management of mental and behavioral health conc...Marion Sills
Kwan BM, Miller BF, Sills MR, Hamer MK, Schilling LM. Collaborative care models for management of mental and behavioral health concerns in Federally Qualified Health Centers. Society of Behavioral Medicine. Philadelphia, April 2014.
For more information about SAFTINet, please see http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/COHO/saftinet/Pages/default.aspx
Paying for performance to improve the delivery of health interventions in LMICsReBUILD for Resilience
This presentation from Sophie Witter & Karin Diaconu of Queen Margaret University, UK outlines the findings from a Cochrane review undertaken by the team on paying for performance to improve the delivery of health interventions in low and middle-income countries.
Collaborative care models for management of mental and behavioral health conc...Marion Sills
Kwan BM, Miller BF, Sills MR, Hamer MK, Schilling LM. Collaborative care models for management of mental and behavioral health concerns in Federally Qualified Health Centers. Society of Behavioral Medicine. Philadelphia, April 2014.
For more information about SAFTINet, please see http://www.ucdenver.edu/academics/colleges/medicalschool/programs/outcomes/COHO/saftinet/Pages/default.aspx
Paying for performance to improve the delivery of health interventions in LMICsReBUILD for Resilience
This presentation from Sophie Witter & Karin Diaconu of Queen Margaret University, UK outlines the findings from a Cochrane review undertaken by the team on paying for performance to improve the delivery of health interventions in low and middle-income countries.
Performance-based financing presentation to the Health Financing AcceleratorReBUILD for Resilience
A presentation to the Health Financing Accelerator and the Global Fund in March 2021 on the challenges and opportunities for international agencies investing in performance-based financing and direct facility financing in fragiole and conflict-affected settings and low income settings. By Sophie Witter, Maria Bertone & Karin Diaconu of Queen Margaret University, UK.
Annual Results and Impact Evaluation Workshop for RBF - Day Five - Simultaneo...RBFHealth
A presentation from the 2014 Annual Results and Impact Evaluation Workshop for RBF, held in Buenos Aires, Argentina.
Examples from Nigeria, Zambia and Zimbabwe.
Planning, monitoring & evaluation of health care programarijitkundu88
this presentation is for the basic idea of planning monitoring and evaluation of health care programs. the details steps of planning is covered. i hope it will help all the persons interested in public health and different health programs.
An introduction to RESYST research on Incentives resyst
Presentation from Dr Duane Blaauw (from the Centre for Health Policy) on incentives and payment system research.
The presentation was given during the RESYST 3rd annual meeting, hosted by the Health Strategy and Policy Institute in Hanoi, Vietnam.
The meeting began with a workshop - attended by representatives from the Ministry of Health in Vietnam, which shared international experiences on provider payment reforms for universal health coverage.
Anbrasi Edward, PhD, MPH, MBA, MSc, Associate Scientist, Johns Hopkins University Bloomberg School of Public Health and Jennifer Winestock Luna, MPH, Director of M&E Services for Realizing Global Health describe Program Evaluation Models and use a case study of a program in Yemen to lead participants through an example of monitoring and evaluation practices.
Great Basin Primary Care Association: Overview of Patient Centered Medical Home - Standards and Preparation to obtain recognition. This presentation is targeted toward federally qualified health centers and safety net providers (primary care practices) in Nevada. Information current as of 02.25.13.
A presentation from a workshop held at The University of St Mark & St john in November, 2014. The session was an information exchange session on the new NICE guidelines PH54 (exercise referral schemes to promote physical activity)
Findings from a 5-year Research Project on Pathways to Treatment for Substanc...Bernie McCann
Findings from a 5-year Research Project on Pathways to Treatment for Substance Use Disorders - Implications for EAPs - Keynote Presentation to the MA/RI EAPA Annual Symposium May 13, 2011
Electronic Health Records: Implications for IMO State's Healthcare SystemMichael Loechel
Very high level overview and benefits of Electronic Health Records systems and a multi-phased approach to implementation. By Michael Loechel & Joy Gupta.
Performance-based financing presentation to the Health Financing AcceleratorReBUILD for Resilience
A presentation to the Health Financing Accelerator and the Global Fund in March 2021 on the challenges and opportunities for international agencies investing in performance-based financing and direct facility financing in fragiole and conflict-affected settings and low income settings. By Sophie Witter, Maria Bertone & Karin Diaconu of Queen Margaret University, UK.
Annual Results and Impact Evaluation Workshop for RBF - Day Five - Simultaneo...RBFHealth
A presentation from the 2014 Annual Results and Impact Evaluation Workshop for RBF, held in Buenos Aires, Argentina.
Examples from Nigeria, Zambia and Zimbabwe.
Planning, monitoring & evaluation of health care programarijitkundu88
this presentation is for the basic idea of planning monitoring and evaluation of health care programs. the details steps of planning is covered. i hope it will help all the persons interested in public health and different health programs.
An introduction to RESYST research on Incentives resyst
Presentation from Dr Duane Blaauw (from the Centre for Health Policy) on incentives and payment system research.
The presentation was given during the RESYST 3rd annual meeting, hosted by the Health Strategy and Policy Institute in Hanoi, Vietnam.
The meeting began with a workshop - attended by representatives from the Ministry of Health in Vietnam, which shared international experiences on provider payment reforms for universal health coverage.
Anbrasi Edward, PhD, MPH, MBA, MSc, Associate Scientist, Johns Hopkins University Bloomberg School of Public Health and Jennifer Winestock Luna, MPH, Director of M&E Services for Realizing Global Health describe Program Evaluation Models and use a case study of a program in Yemen to lead participants through an example of monitoring and evaluation practices.
Great Basin Primary Care Association: Overview of Patient Centered Medical Home - Standards and Preparation to obtain recognition. This presentation is targeted toward federally qualified health centers and safety net providers (primary care practices) in Nevada. Information current as of 02.25.13.
A presentation from a workshop held at The University of St Mark & St john in November, 2014. The session was an information exchange session on the new NICE guidelines PH54 (exercise referral schemes to promote physical activity)
Findings from a 5-year Research Project on Pathways to Treatment for Substanc...Bernie McCann
Findings from a 5-year Research Project on Pathways to Treatment for Substance Use Disorders - Implications for EAPs - Keynote Presentation to the MA/RI EAPA Annual Symposium May 13, 2011
Electronic Health Records: Implications for IMO State's Healthcare SystemMichael Loechel
Very high level overview and benefits of Electronic Health Records systems and a multi-phased approach to implementation. By Michael Loechel & Joy Gupta.
Cheryl Davenport, Director of Health and Care Integration at Leicestershire County Council, talks about how simulation is helping to evaluate how emergency hospital admissions can be reduced.
This presentation offers guidance to those hospitals that are rolling out a new pharmacy program as well best practices for maintaining and continuously improving current programs. Take a look and find out why annual program reviews are highly recommended.
Similar to Measuring Sustainment of Multiple EBPs in Children's Mental Health Services (20)
What Next: When You are not Funded on the First Round - 2023UCLA CTSI
CTSI R Workshop: What Next: When You are not Funded on the First Round.
Scott G. Filler, MD
Professor of Medicine at Lundquist Institute/Harbor-UCLA and UCLA
Leader, CTSI Pilot Translational and Clinical Studies Program
Co-Leader, CTSI KL2 Institutional Development Core
How to Write the “Specific Aims” Section - 2023UCLA CTSI
CTSI R Workshop: How to Write the “Specific Aims” Section of a Grant Application.
Tannaz Moin, MD, MBA, MSHS
Associate Professor of Medicine at UCLA
AssociateDirector, UCLA Specialty Training and Advanced Research (STAR) Program
How to Structure the “Approach” Section (Basic Science)UCLA CTSI
CTSI R Workshop: How to Structure the “Approach” Section of a Grant Application
Scott G. Filler, MD
Professor of Medicine at Lundquist Institute/Harbor-UCLA and UCLA
Leader, CTSI Pilot Translational and Clinical Studies Program
Co-Leader, CTSI KL2 Institutional Development Core
How to Craft the "Significance” & "Innovation" [Filler] - 2023UCLA CTSI
CTSI R Workshop: How to Craft the "Significance” & "Innovation" Sections of a Grant Application.
Scott G. Filler, MD
Professor of Medicine at Lundquist Institute/Harbor-UCLA and UCLA
Leader, CTSI Pilot Translational and Clinical Studies Program
Co-Leader, CTSI KL2 Institutional Development Core
How to Craft the "Significance” & "Innovation" - 2023UCLA CTSI
CTSI R Workshop: How to Craft the "Significance” & "Innovation" Sections of a Grant Application
William Parks, PhD
Professor of Medicine at Cedars-Sinai Medical Center and UCLA
Associate Dean for Graduate Research Education
Scientific Director, Women’s Guild Lung Institute
A Tactical Approach to Writing Your Grant Application (HSR) - 2023UCLA CTSI
CTSI R Workshop: A Tactical Approach to Writing Your Grant Application (HSR)
Tannaz Moin, MD, MBA, MSHS
Associate Professor of Medicine at UCLA
Associate Director, UCLA Specialty Training and Advanced Research (STAR) Program
A Tactical Approach to Writing Your Grant Application - 2023UCLA CTSI
CTSI R Workshop: A Tactical Approach to Writing Your Grant Application
William Parks, PhD
Professor of Medicine at Cedars-Sinai Medical Center and UCLA
Associate Dean for Graduate Research Education
Scientific Director, Women’s Guild Lung Institute
How to Write the “Specific Aims” Section of a Grant Application (Basic Scienc...UCLA CTSI
CTSI R Workshop: How to Write the “Specific Aims” Section of a Grant Application (Basic Science
Scott G. Filler, MD
Professor of Medicine at Lundquist Institute/Harbor-UCLA and UCLA
Leader, CTSI Pilot Translational and Clinical Studies Program
Co-Leader, CTSI KL2 Institutional Development Core
How to Anticipate and Plan for an R Grant Application - 2023UCLA CTSI
CTSI R Workshop: How to Anticipate and Plan for an R Grant Application.
Presented by Carol M. Mangione, MD, MSPH
Barbara A. Levey MD & Gerald S. Levey MD Endowed Chair
Chief, Division of General Internal Medicine and Health Services Research
Professor of Medicine and Public Health at UCLA
Leader, UCLA CTSI Workforce Development
NIH Loan Repayment Program (LRP) Info Session - 9/26/23UCLA CTSI
The UCLA CTSI and DGSOM Office of Physician Scientist Career Development held this webinar to provide information on the NIH Loan Repayment Program (LRP). This funding is designed to recruit and retain highly qualified health professionals into biomedical or biobehavioral research careers. The LRPs counteract financial pressure by repaying up to $50,000 annually of a researcher's qualified educational debt in return for a commitment to engage in NIH mission-relevant research.
Writing the NIH K Award – Research Plan
Presented by
Sumeet S. Chugh, MD
Price Professor and Associate Director, Smidt Heart Institute
Director, Division of Artificial Intelligence in Medicine
Cedars-Sinai Medical Center
Considerations in Applying for a K99 Award: the NIH "Pathway to Independence"...UCLA CTSI
Considerations in Applying for a K99 Award: the NIH "Pathway to Independence"
Presented by Christopher Evans, PhD
Professor of Psychiatry and Biobehavioral Sciences at UCLA
Co-Director, UCLA CTSI KL2 Program
Navigating the NIH K Award Process and Choosing Your Mentorship Team (2023)UCLA CTSI
Navigating the NIH K Award Process and Choosing Your Mentorship Team
Presented by
Carol M. Mangione, MD, MSPH
Barbara A. Levey MD & Gerald S. Levey MD Endowed Chair
Professor of Medicine and Public Health at UCLA
Chief, Division of General Internal Medicine and Health Services Research
Leader, UCLA CTSI Workforce Development
K Awards – Common Pitfalls and UCLA CTSI KL2 Resources (2023)UCLA CTSI
K Awards – Common Pitfalls and UCLA CTSI KL2 Resources
Presented by Elizabeta Nemeth, PhD
Professor of Medicine at UCLA
Director, UCLA Center for Iron Disorders
Co-Director, UCLA CTSI KL2 Program
Writing the NIH K Award – Candidate Information and Career Development Plan, ...UCLA CTSI
Writing the NIH K Award – Candidate Information and Career Development Plan,
How Reviewers Evaluate K Awards, and Common Critiques from NIH K Study Sections
Presented by O. Kenrik Duru, MD, MSHS
Professor of Medicine at UCLA
Investigator (Disparities), UCLA CTSI Special Populations
How to Anticipate and Plan for an R Grant Application. (2022)UCLA CTSI
Carol M. Mangione, MD, MSPH
Barbara A. Levey MD & Gerald S. Levey MD Endowed Chair
Chief, Division of General Internal Medicine and Health Services Research
Professor of Medicine and Public Health at UCLA
Leader, UCLA CTSI Workforce Development
K99 Award: the NIH "Pathway to Independence"UCLA CTSI
UCLA CTSI K Workshop - July 28, 2022
Considerations in Applying for a K99 Award: the NIH "Pathway to Independence" presented by Dr. Christopher Evans, PhD
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Biological screening of herbal drugs: Introduction and Need for
Phyto-Pharmacological Screening, New Strategies for evaluating
Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
for Anti-inflammatory, Antiulcer, Anticancer, Wound healing, Antidiabetic, Hepatoprotective, Cardio protective, Diuretics and
Antifertility, Toxicity studies as per OECD guidelines
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Measuring Sustainment of Multiple EBPs in Children's Mental Health Services
1. Measuring Sustainment of Multiple EBPs
Fiscally Mandated in Children’s Mental
Health Services: Knowledge Exchange on
Evidence-Based Practice Sustainment
(4KEEPS) Study
Lauren Brookman-Frazee
Southern California Regional Dissemination,
Implementation and Improvement Science Webinar Series
June 1, 2016
2. Objectives
1. Provide an overview of system driven EBP
implementations and community context and the
4KEEPS Study.
2. Describe study methods and initial findings:
• Characterizing sustainment outcomes
• Characterizing potential inner context determinants of
sustainment outcomes
3. Public Mental Health Care System (Local, State)
Organizations contracted to provide MH Care
Therapists providing direct services to consumers
Exploration
Phase
Preparation
Phase
Implementation
Phase
Sustainment
Phase
Phases and Levels of EBP
Implementation
Adapted from Aarons, Hurlburt & Horwitz, 2011
4. Public Mental Health Care System (Local, State)
Organizations contracted to provide MH Care
Therapists providing direct services to consumers
Exploration
Phase
Preparation
Phase
Implementation
Phase
Sustainment
Phase
Sustained Delivery of Multiple EBPs in
System-Driven Implementation
Efforts
Adapted from Aarons, Hurlburt & Horwitz, 2011
6. Los Angeles County
• Nation’s largest county
mental health
department
• 75 directly operated sites
• 288 contracted agencies
(120 with child MH
services)
• 8 Service Provision Areas
range from rural to inner
city communities
• Serves an ethnically
diverse, disadvantaged
population
Hispanic/Latino
Asian/Pacific Islander
African American
12. 4KEEPS Study Aims
• A neutral, observational study investigating the
sustainment of original 6 practices with
implementation support.
• Aim 1: Characterize sustainment outcomes
• EBP Concordant Care
• Volume/penetration of each practice over time
• Aim 2: Use mixed methods to characterize inner
context factors and early implementation conditions
that potentially predict EBP sustainment.
• Aim 3: Identify inner context and early implementation
conditions that determine sustainment outcomes
Funded by NIMH Grant # R01 MH100134
MPI Anna Lau and Lauren Brookman-Frazee
13. Multiple Sources of Data
LACDMH
Administrative
Claims Data
LACDMH Site
Visit
Documents
Online Surveys
of Program
Leaders and
Therapists
Semi-
Structured
Interviews
Session
Recordings
Sustainment outcomes and potential inner context determinants of outcomes
15. Sustainment outcomes
• # & % agencies continuing to be reimbursed for the practice
• # & % Therapists continuing to claim to the practice
• # & %Unique clients served by the practice
• # $ % Units of services being provided within each practice
Practice
Volume/Penetration
• Degree to which a therapist’s practice resembles the essential
strategies one would expect within an evidence-based
protocol for a given problem focus.
EBP Concordant Care
17. Cumulative # of Claims Per
Practice
• MAP = 905,395
• TF-CBT = 662,184
• Seeking Safety = 515,208
• Triple P = 140,147
• CPP = 105,231
• CBITS = 2835
18. Volume Over Time
Initial increases in raw volume
for most practices in the first
quarters with peak and leveling
off after the initial few years
Highlight the rapid impact of a
fiscal policy change restricting
reimbursement to specific
practices and training in these
practices
19. Gross Penetration Over Time
During the initial ramp-up
period, some practices
ramped up more quickly than
others.
Reordering and stabilization
after 2 years
MAP, TF-CBT, SS > Triple P,
CPP, CBITS
20. Characteristics of Practices
Higher Penetration (MAP, TF-
CBT, CPP)
• Apply to a broad age range of
clients
• Can be delivered in multiple
settings
• Addresses common
presenting problem -trauma
• MAP also covers a range of
presenting problems
• Train-the-trainer capacity
(MAP, SS)
• Minimal training required for
billing (SS)
Lower Penetration (Triple P,
CPP, CBITS)
• Apply to a narrower age
range of clients (CPP, CBITS)
• Restrictions on
settings/format
• Group (CBITS, Triple P)
• School setting (CBITS)
• Caregiver directed (CPP,
Triple P)
• Additional requirements to
deliver such as MOAs
between programs and
schools (CBITS)
21. Sustainment outcomes
• # & % agencies continuing to be reimbursed for the practice
• # & % Therapists continuing to claim to the practice
• # & %Unique clients served by the practice
• # $ % Units of services being provided within each practice
Practice
Volume/Penetration
• Degree to which a therapist’s practice resembles the essential
strategies one would expect within an evidence-based
protocol for a given problem focus.
EBP Concordant Care
22. Measuring Sustainment: EBP
Concordant Care
Addresses concerns about the feasibility and
appropriateness of using traditional fidelity instruments to
asses ongoing delivery of multiple EBPs
23. EBP Concordant Care Assessment
(ECCA) Development Process
Reviewed existing practice inventories.
Adapted/selected/generated items (strategies).
Collected data from practice experts about how
essential/interfering strategies are to their practice.
Delphi rating system used to determine item selection for
therapist-report ECCA (alpha version).
Collected data from large sample of therapists using ECCA
(alpha version).
Examine the properties of the therapist-report ECCA (alpha
version).
Validate therapist-report ECCA with observational coding
system.
Finalize therapist-report ECCA based on #6 and 7.
24. Current ECCA
Purpose Assesses the extent to which a
therapist delivered individual
psychotherapeutic strategies
considered essential for a given EBP
Target
Online
Versions
Session (therapist report, observer
rated) and Bi-monthly (therapist
report)
Items 38 psychotherapeutic content and
techniques
EBP Targets #Content #Techniques
Conduct 18 9
Trauma 10 5
Anxiety 7 7
Depression 9 6
25. ECCA Data Collection To Date
• 710 therapists from 54 agencies
completed a Bi-Monthly ECCA
Full Sample
• 71 therapists submitted 459
Session ECCAs with corresponding
audio recordings of sessions as
well as Bi-Monthly versions for
each client
Validation
Sub-Sample
26. ECCA Preliminary Findings
High internal consistency for each EBP Target Composites
for Anxiety, Conduct, Depression and Trauma (alphas ranged
from .86 to .95; M=.90).
Discriminant validity of the scales supported by significant
differences in EBP Target composites by EBP delivered
When therapists delivered an EBP that targeted Conduct or Trauma,
their ratings on the content items from the corresponding
composite were significantly higher than for other EBP targets
Construct Validity supported by Item Response Theory
Analyses indicating that items with high item difficulty
appeared to include strategies that reflect high integrity EBP
concordant care (Ignoring/Differential Reinforcement of
Other Behaviors > Praise)
27. ECCA Preliminary Findings
Continued
Concordance between Session and Bi-monthly
version supporting by significant and large
correlations between the average Session ECCA
with the Bi-Monthly version on the EBP Target
composites (range= .62 to .71; M=.68).
Concordance between therapist report and direct
observation in process
Early data based on a small subset of therapist reports
with corresponding observer ratings indicate greater
concordance for strategies that are part of the practice
type being delivered.
28. Next Steps
1) Finish validation of therapist-report ECCA with
observational coding system
1) Projected sample of 1080 sessions with therapist report
and observer ratings
2) Examine inner context factors associated with
ECCA composite scores.
3) Refine ECCA instrumentation based on
concordance analysis and end user feedback on
utility.
29. Potential Inner Context
Determinants of Sustainment
• Changes in state regulatory requirements
• Changes in implementation strategies used
• Adoption, de-adoption of EBPs over time
System Level
• Implementation support
• Organizational climate
• Early implementation condition
Organizational
Level
• Therapist attitudes: perceptions of
effectiveness and fit
• Therapist clinical adaptations to practices
Therapist Level
30. Therapist and Practice Characteristics
as Facilitators of Multiple EBP
Implementation
Practices Therapists
• The PEI Context and fiscal
mandate for EBP reform
presents a unique context
• EBP vs. Practice as Usual
• EBP1 vs. EBP2 vs. EBP3…
• Allows for parsing the
variance in attitudes
associated with
• Therapists and therapist
characteristics
• Practices and practice
characteristics
31. Demographics M (SD) or %
Age 37.00 (9.28)
Gender (female) 88%
Hispanic 43%
Race
White 50%
Asian/ Pacific Islander 11%
African American 7%
American Indian/Alaska Native 1%
Multiracial 8%
Other 23%
Deliver Services in >1 Language
Spanish 47%
Other Language 10%
Survey: Therapist Characteristics
(n=790)
Training Background M (SD) or %
Years Practiced as Therapist 7.21 (6.16)
Years Worked at Current Agency 5.12 (4.56)
Current # Clients 14.65 (10.48)
MH Discipline
MFT 55%
Social Work 30%
Clinical Psychology 11%
Counseling 2%
School Psychology <1%
Other 2%
32. Measuring Therapist Attitudes
Practice-Specific Attitudes General Attitudes towards EBP
Perceived Characteristics of Intervention Scale, Cook et
al., 2014
• Relative Advantage
• Complexity
• Compatibility
• Potential for Reinvention
• Total
Evidence-Based Practice Attitudes Scale, Aarons,
2004
• Openness
• Divergence
33. Attitudes Differ by Practice
F b
Intercept (grand mean) 9667.23*** 3.29***
TF-CBT 183.10 *** .45***
CPP 29.73*** .28***
Triple P 11.77** .16**
MAP 5.28* .08*
SS 11.47** -.12**
CBITS 117.16*** -.84***
*p<.05; **p<.01; ***p<.001
35. Therapist Attitudes Differ by
Practice Characteristics
1
2
3
4
5
Prescribed Session Content/
Order
Consultation Required Narrow Age Range
PCISITEMMEAN
PRACTICE CHARACTERISTIC
Yes
No
* **
* = p < .001
Very Great
Extent
Not at All
36. • Use sequential QUANqual
design to understand:
• The types of adaptations that
therapists make in community
mental health settings.
• Which therapist
characteristics predict types of
adaptations (fidelity
consistent vs. inconsistent).
• The reasons therapists make
adaptations.
Therapist Adaptations
Fidelity
Consistent
Modify
presentation
Integrate
supplemental
content
Lengthen/exten
d Pacing
Fidelity Inconsistent
Remove/skip
components
Shorten/condense
pacing
Adjust order of
sessions/components
38. Types of Adaptations
• Therapists reported more
fidelity consistent adaptations
(EMM= 9.30; SE = 1.79) than
fidelity inconsistent (EMM=
5.88; SE = 1.79) adaptations
• F(1, 1,075.59) = 1,332.00, p <
.001
• Therapist-reported attitudes
towards a practice:
• Did not predict fidelity
consistent adaptations B = -
.02, t = -1.47, p = .14
• Did predict fidelity
inconsistent adaptations
• B = -.07, t = -5.67, p < .001 0
1
2
3
4
5
6
7
8
9
10
Fidelity Consistent Fidelity Inconsistent
MeanComposite
CBITS CPP SS TFCBT TP
39. Reasons for Adaptations
Culture
Crises
Adjust Order
Extend Pacing
Modify Presentation
Omit
Developmental
Level I think the length of treatment is part of that too,
especially with the Hispanic families. Like you can’t just
jump right in; you need to spend a little more time
building rapport.
Some of the examples that they have there I think, you
know, might not necessarily fit like this particular culture
so I’ll find something that they could relate to a little bit
better, a situation they can relate to a little bit better.
I did work with one client that was developmentally
delayed. So for some of the cognitive behavioral piece it
was just really difficult to understand…I did my best to
teach it, but I didn’t feel like I focused a lot on it because
dude wasn’t really understanding it.
Oh, we’ll still go back to some of the relaxation
components, or we’ll kind of focus on what we can do to
manage our anxiety about it and whatnot.
You know, with people that are developmentally
delayed or whether there needs to be more repetition,
I’ll repeat it more.
I think it’s just different working with a child that young.
So we do a lot of art. So instead of like a trauma
narrative, we’ve been doing a lot of art on the
chalkboard.
You do have those clients that maybe might become
homeless, or maybe parents are having a really hard time,
maybe with other kids, older kids. So you might have a lot
of crises that might surface throughout treatment, and that
might postpone certain parts of it
40. Summary of Preliminary Findings
The scope and size of the PEI transformation provides a critical
opportunity to examine multiple EBP implementation in a large
and diverse natural laboratory
Sustainment varies by practice and over time
Inner context factors are critical to examine within EBP
implementation efforts
• Therapist attitudes vary across practices.
• Therapists report more extensive fidelity consistent adaptations than fidelity
inconsistent adaptations