Implementation Strategy for Evidence-Based Practices

CIMH Community Development Team Model

Pam Hawkins, Senior AssociateAssociation for Criminal Justice Research (California)

October 24-25, 2013

Systems ChangeSystems Change

• New practices do not fare well in old organizational structures and systems

• System change is disruptive• System change requires new resources• System change requires courage• System change requires dogged

persistence

• Dean Fixsen & Karen Blasé, National Implementation Research Network (NIRN)

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Program Effectiveness• What we do• How well we do it• When outcomes are less than optimal

– How much is attributable to not selecting/using the most effective intervention

– How much is attributable to the complexity of mental health disorders

– How much is attributable to factors that impinge on clients

– How much is attributable to an effective intervention not being used well

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Program Effectiveness• Effectiveness research has drawn attention to

what we do• Dissemination research is drawing attention to

the importance of how well we do it• As our clinical work becomes increasingly

research informed, we want to be sure that our service systems are increasingly adherence (integrity)-focused

• What have we learned from work in California– 13 EBPs, 200+ sites, 41 counties, 150

agencies

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Community Development Teams

• Organizational development (dissemination) model

• Close the science-to-practice gap

• Currently the focus of an NIMH funded research trial

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Community Development Teams

• A training and technical assistance, dissemination and implementation process, to promote selection, installation and model-adherent sustainability of evidence-based intervention models

• Informed by implementation science• Development of internal (organizational) structures,

controls and processes• Designed for public mental health system, bringing

EBPs to scale, with focus on late-ish adopters, • The goal is model adherent and sustainable

programs

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Why CDT?• Implementing and sustaining innovative programs

is challenging• Deliberate (focused) ongoing organizational

support is needed to establish/sustain programs and achieve the full benefit of research informed practice

• Development Teams are particularly useful when first establishing a new program– If an agency has relatively little experience

sustaining EBPs– Would like some help in planning, starting,

supporting, sustaining

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CDT Phases• Pre-Implementation

– Engagement– Planning– Training protocol

• Implementation– Training– Practitioner competence– Achieving model adherence– Program performance evaluation

• Sustainability– Internal controls for insuring model adherence– Quality improvement activities linked to program

evaluation

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Development Team Features• Clinical training

– Provided by model developers or their designees

• Organizational supports– Provided by CIMH or County CDT staff– Implementation planning– Administrators calls– Program performance evaluation supports– Individualized technical assistance

• Peer-to-peer assistance

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CDT Processes

• Need-benefit analysis

• Planning

• Monitoring and support

• Technical investigation and problem solving

• Procedural skills

• Peer-to-peer support

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CDT Activities• CDT planning meetings• Administrators conference calls• Website supports• Site-specific (technical assistance) calls

and correspondence• Fidelity monitoring and program

performance evaluation protocols• Developer’s calls

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Organizational Support• Implementation planning

– Thorough understanding of the model, training protocols, and key implementation supports

• Individualized technical assistance– Address system and program level issues

• Program performance/outcome evaluation– Tracking service delivery– Preparation of database (Excel)– Analysis, interpretation and reporting of outcomes

• Monthly peer-to-peer administrators “champions” conference calls– Share successes, raise concerns, and offer solutions

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Sustainability

• Administrative champion

• Thorough pre-implementation planning

• Participation in full training protocols

• Routine use of program performance protocols

• Commitment to replacement training

• Commitment to refresher training

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CDT Projects• Aggression Replacement Training ®• CBT for Depression• Depression Treatment Quality Improvement• Early Detection and Intervention for the Prevention of

Psychosis (in development)• Functional Family Therapy• Incredible Years• Trauma Focused Cognitive Behavior Therapy• Managing and Adapting Practice• Multidimensional Family Therapy• Multidimensional Treatment Foster Care• Multisystemic Therapy• Triple P Parenting• (High Fidelity) Wraparound

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Cal-40 Study• Focus of NIMH trial

– Testing an implementation model (CDT) for promoting the scale-up of an EBP

– RTC• 60 sites (California and Ohio) randomized to CDT and

implementation as usual– Currently the only empirical test of an implementation model

• OutcomesOutcomes– System leaders engaged

CDT: 125IND: 96

– Clients enrolledCDT: 133IND: 51

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FFT in CaliforniaFFT in California

• Currently 41 FFT Teams in 15 California Currently 41 FFT Teams in 15 California CountiesCounties

• Largest implementation of FFT Largest implementation of FFT internationallyinternationally

• 90.5% retention rate of California FFT 90.5% retention rate of California FFT sites (loss of 5 teams since 2004)sites (loss of 5 teams since 2004)

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QuestionsQuestions

Pam Hawkins, Senior AssociatePam Hawkins, Senior Associate

California Institute for Mental HealthCalifornia Institute for Mental Health(916) 317-6318

phawkins@cimh.org

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