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The Practitioner Education and Decision

Support (PEDS) Initiative

2013 Learning CommunityAndrew Cleek, PsyD

CTAC Team

Agenda Welcome and Introduction What is PEDS? What is MAP? Why is it important? What is a Learning Community? The nuts and bolts of joining this Learning

Community Activities and Timeframe Q & A

As partners in this most important effort, we extend a warm welcome to all of you who have joined us to explore the value of resources designed to support clinical staff

You are contributing to our collective knowledge that will help move the field forward

We are excited to partner with you over the next year.

Welcome

Which of the following methods do you use most often in making decisions about treatment? Talk to my supervisor Talk to my colleagues Review research literature Rely on previous experience None of the above

Polling Question:

Introduction: What problem are we

attempting to address There are several hundred evidence-based

protocols that cover a variety of common child mental health diagnoses.◦ Not feasible to learn all of these protocols◦ Some are costly to be trained in and implement

Many of these EBPs share common approaches, practices, and decision points

Our goal in this project is to explore the value of a decision support tool to practitioners, supervisors and clients in a way that is practical and sustainable.

Our initiative is designed to explore, adapt and evaluate an online decision support tool called MAP.

MAP stands for Managing and Adapting Practices

MAP was developed by Bruce Chorpita and Eric Daleiden of UCLA.

It is currently being used in a variety of children’s clinical treatment settings in a number of states including LA county, California

What is Practitioner Education and Decision

Support (PEDS)?

Practitioner Education refers to the integration of the decision support tool with clinical guidelines and education in a number of key clinical areas: depression, anxiety. conduct problems, and trauma

PEDS (continued)

The PEDS Learning Community: What is it?

A year-long partnership across 20 clinics in New York State, involving a combination of supervisors and practitioners.

The learning community is designed to:◦ Engage practitioners and supervisors in evaluating and adapting the

MAP approach to: Support clinical decisions related to the formulation of treatment

needs Select interventions that are evidence informed Monitor treatment goals and objectives

◦ Establish an ongoing partnership with clinics and practitioners to identify the most useful components of Practice Wise

◦  

◦ Explores the impact of streamline training and education on the successful application and utilization of the Practice Wise system.

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What is Managing and Adapting Practice (MAP)?

A system that allows practitioners to manage and adapt practice to meet the needs of children receiving mental health treatment.

The system is not a single treatment model. Rather, it involves several decision and practice support tools to assist in the selection, review, adaptation, or construction of promising treatments to match particular child characteristics based on the latest scientific findings.

It consists of three online tools designed to guide and support practitioners in clinical decision making, service planning and progress monitoring (Practice Wise).

MAP is designed to improve the quality, efficiency, and outcomes of children’s mental health services

Decision support tools and resources address the need for more reliable, easily accessible, timely information, and resources to support clinical decisions.

What is MAP (con’t)

The role of practitioner friendly decision support tools to promote effective practices that demonstrate measurable outcomes are increasingly critical.

MAP assists practitioners to coordinate and supplement the use of evidence-based practices for children’s mental health.

Practitioners often need additional tools to support the clinical decisions that are made on a daily basis.

There is a focus on ‘common elements’ that can help practitioners utilize the best practices for their clients.

Why is MAP Important?

Components of MAP1. PracticeWise Evidence-Based Service Database: (PWEBS) online database that can make recommendations about formal evidence-based programs OR about specific components of evidence-based treatments (based on client characteristics)2. Practitioner Guides: Provides user-friendly measurement tools and clinical protocols 3. Clinical Dashboard: Tracks outcomes and practices on a graphical clinical dashboard

Evidenced based youth mental health literature database

Easy to use & searchable by problem type (dx), age/grade, gender and or ethnicity

MAP: PWEBS

PWEBS Database

PWEBS Database: Search Select the strength of the evidence

◦ Level 1: Best Support◦ Level 2: Good Support◦ Level 3: Moderate Support◦ Level 4: Minimal Support◦ Level 5: No Support

Select youth characteristics:◦ Problem Type (diagnosis)◦ Age or Grade◦ Gender◦ Ethnicity

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PWEBS Database: Results Types of treatments that have been shown

effective

Practice elements that make up the treatments

Settings of where the treatment was delivered

Format treatment was delivered

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Practitioner Guides Practice Guides

◦ A step-by-step guide on how to deliver common practice elements found in evidence-based treatments for youth

Process Guides◦ Provides framework for clinician to make

decisions related to care and treatment These guides are accessible online and can

be downloaded to your desktop.

Practice Guide Example

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The Clinical Dashboard Tracks client progress and treatment practices

in a graphical representation over time. The dashboard has 6 components:

◦ Instructions◦ Presentation Results: Provides a snapshot of case

progress◦ Notes◦ Data Progress: Client assessment tracking◦ Data Practices: Tracks practice elements used in

sessions◦ Data Client Information: Client demographics

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The PEDS Learning Community Expectations,

Activities, and Timeframes

Why is a Learning Community Important?

◦ Builds on the collective knowledge and real world experiences of participants

◦ Social networking and shared learning encounters are energizing

◦ Efficient and effective method to support widespread practice improvement

◦ Ensures that the common and unique concerns, challenges and needs are addressed

What you get by joining the Learning Community

◦ Each clinic will be provided: Three subscriptions that provides 1 supervisor and 2

practitioners access to the  Practice Wise Evidence-Based Service database, Practitioner Guides, and Clinical Dashboards 

Supervisors and practitioners will receive a 1 day in-person training on the Practice Wise system

Optional follow-up consultation call after the training There are 4 quarters to this LC: each quarter will focus on a

clinical treatment area (depression, anxiety, conduct disorders, and trauma)

Each quarter will provide a minimum of 1 web-based training and 2 small group calls designed to promote an exchange of ideas and collective problem solving

Monthly contact- may be clinical topic focused webinars (depression, anxiety, conduct disorders, and trauma), small group consultation calls

Educational webinars on key clinical treatment topics (depression, anxiety, conduct difficulties, trauma) that are archived and open to all members of the participating clinic’s workforce

Learning community meetings at 6 mos and 12 mos that will last about 3 hours.

What you get by joining the Learning Community

(con’t.)

Your Resource Team

Provides all members of the learning community with the technical, clinical,

social, organizational and logistical support to successfully utilize, evaluate

and modify the Practitioner Education and Decision

Support (PEDS) Process

Your Resource Team Members

Anthony Salerno, Ph.D., Sr. Consultant McSilver Institute, NYU

Kara Dean-Assael, LMSW Clinical Consultant/ TrainerClinic Technical Assistance Center

Andrew Cleek, Psy.D.,Exec. OfficerMcSilver Institute, NYU

Lydia Franco, LMSW Clinical Consultant/ TrainerClinic Technical Assistance Center

Anil Chacko, Ph.D. Assistant Professor Queens College, CUNY

Ashley Fuss, LMSWResearch Coordinator/Data ManagerClinic Technical Assistance Center

Micaela Mercado, Ph.D.,Data Analytics OfficerMcSilver Institute, NYU

Thomas Jewell, Ph.D.,Sr. ConsultantCoordinated Care Services, Inc.

Julie Gutowski, MA, CASAC, LMHCManaging DirectorSpectrum Human Services

Supervisors Supervision focused on clinical treatment and

decision support is often challenging◦ Multiple demands◦ Time pressures◦ Multiple staff to supervise◦ Ambiguity of clinical treatment and outcomes - exclusive

reliance on practitioner experience and recall This system has been designed to support and

promote practical, efficient, and effective supervision

Your participation is integral in the PEDS process Webinar focused on Educational Supervision:

◦ The key role of supervisors in promoting successful implementation of the PEDS initiative

Follow-up small group discussion calls

Evaluation of PEDS> Your Resource Team will support members to measure

key performance indicators that help answer the question……

In what way has the PEDS approach: ….added value to your services? ….enhanced your professional satisfaction? …. increased your sense of accomplishment? …. helped to address the needs of particularly challenging children and caregivers? …. addressed your felt need for support in

making treatment decisions?

The resource team offers members the opportunity to have their performance indicators data analyzed and organized

The Evaluation Process Formal and informal survey of practitioners and

supervisors that focus on the pros and cons of the Practice Wise system

Number of practitioners who employ the system in a clinically meaningful manner

Number of supervisors who employ the system as part of the supervisory process

Identification of components of Practice Wise that are sustainable and valued by supervisors and practitioners

Usefulness and satisfaction with the clinical practice trainings, webinars, and calls

Clinical outcomes: Submission of 1 dashboard per clinical topic area (anxiety, depression, conduct difficulties, and trauma)

PEDS Performance Indicators

1. Client Level Data Submission of dashboard

2. Practitioner Level Data Online surveys throughout LC Focus groups at end of LC

3. Supervisor Level Data Online surveys throughout LC Focus groups at end of LC

PEDS Performance Indicators Client

◦ Demographics (age, gender, race, diagnosis)◦ Attendance◦ Scores on assessments ◦ Practice elements ◦ Progress notes

Practitioner◦ Experience with training of MAP ◦ LC experience◦ MAP implementation◦ Experience using MAP

Supervisor ◦ Experience with training of MAP ◦ LC experience◦ Experience using MAP in supervision

New York City/Downstate - ◦ Located at the McSilver Institute for Poverty,

Policy, and Research, 41 East 11th Street, NY, NY, 7th Floor

◦Choose a date that works best for you: May 20, May 22, or June 5, from 9:30am-4pm. Registration will be limited each day and we recommend that staff from the same clinic attend together.

Upstate -◦ June 5 - Located at Hutchings Psych Center,

Syracuse, NY, from 9:30am-4pm

More detailed future meeting schedule will be distributed at the above trainings

Upcoming Events: One Day Training

Full day from 9:30-4pm Focus on navigating Practice Wise System Please bring in an actual case to use in

learning the system. Optimal cases include:◦ A child with a primary diagnosis of depression◦ Relatively new case◦ A case that you will likely have for at least 3

months Please bring your own laptop Lunch will be provided

One Day Training

What are your initial impressions of the PEDS process? It will be…

Very useful Somewhat useful Not useful at all Not sure yet

Polling Question:

What do you think will be the most challenging aspect about this project?

Learning to use the Practice Wise tools Time pressures/multiple demands Complexity of cases we see Getting enough support Other challenge Not sure yet

Polling Question:

The Learning Community is dynamic!

The proposed structure, process, and content of the Learning Community is a

starting point!

The experience, needs and wants of Learning Community members helps to

shape how the Learning Community evolves over time!

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Q & A

Andrew Cleek Anthony Salernoandrew.cleek@nyu.edu anthony.salerno@nyu.edu Anil Chacko Lydia Francoanil.chacko@mssm.edu lydia.franco@mountsinai.org Micaela Mercado Ashley Fussmicaela.mercado@nyu.edu Ashley.fuss@nyu.edu Kara M. Dean-Assael Tom Jewellkara.dean@nyu.edu tjewell@ccsi.org

Julie Gutowski gutowskij@shswny.org

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