Executing EVIDENCE-BASED PRACTICES .


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CIMH EBP Dissemination . 20 Counties
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Executing EVIDENCE-BASED PRACTICES 2005 Leadership Symposium on Evidence-Based Practice in Human Services Bill Carter LCSW

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CIMH EBP Dissemination 20 Counties & 10 Private Provider Agencies 5 New Projects for FY 2005/2006 Featured Practices: Incredible Years (IY) Aggression Replacement Training (ART) Functional Family Therapy (FFT) Multidimensional Treatment Foster Care (MTFC) SAMHSA Toolkits – (Adult MH/AOD) CalMAP (Medication Algorithm) IDDT (Integrated Dual Diagnosis Treatment)

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IMPLEMENTING EVIDENCE-BASED PRACTICES Section 1: Selecting a Practice Section 2: Stakeholder Concerns Section 3: Implementation & Maintenance Section 4: The Irresistible Urge to Drift

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Section 1 Selecting a Practice

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Selecting a Practice Specific to neighborhood needs and objectives Consistent with customer/family (social) convictions and qualities Endorsed, upheld or esteemed by office staff Cost to utilize Cost to learn Level of science

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Definitions No Consensus Definition of EBP Every Practice Wants to be an EBP Be Skeptical Become a Knowledgeable Consumer of EBP Information

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Levels of Evidence Effective - accomplishes youngster/family results, in light of controlled research (irregular task), with free replication in regular care settings Efficacious - accomplishes tyke/family results, in view of controlled research (arbitrary task), autonomous replication in controlled settings Not powerful - huge confirmation of an invalid, negative, or destructive impact Promising - some positive research prove , semi trial, of achievement or potentially master accord Emerging - unmistakable as a particular practice with "face" legitimacy or sound judgment test

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Finding EBPs Office of the Surgeon General http://www.surgeongeneral.gov/index.html Strengthening America\'s Families (OJJDP & CSAT) http://www.strengtheningfamilies.org SAMHSA Model Programs http://www.modelprograms.samhsa.gov

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Finding EBPs Evidence-Based Practices in Mental Health Services for Foster Youth – California Institute for Mental Health http://www.cimh.org/downloads/Fostercaremanual.pdf National Clearinghouse on Child Abuse and Neglect Information http://nccanch.acf.hhs.gov/The California Child Welfare Clearinghouse for Evidence-based Practice http://www.chadwickcenter.org/Clearinghouse.htm

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Finding EBPs SAMHSA\'s National Mental Health Information Center (Adult MH Toolkits) http ://www.mentalhealth.org/cmhs/communitysupport/toolboxs/A Roadmap to Mental Health Services for Transition Age Young Women: A Research Review – California Women\'s Mental Health Policy Council http://www.cimh.org/downloads/TAY_Final_Report_4-21-05.pdf/National Institute of Mental Health http://www.nimh.nih.gov/publicat

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Finding EBPs The Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (Public Health Resources) http://www.the communityguide.org/Promising Practices Network on Children, Families and Communities http://www.promisingpractices.net CIMH MHSA Matrix – In Hand Outs

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Finding Practices Look past the mark or the "pitch" What is the quality of the examination? Is there a correlation assemble? Is there arbitrary task? What was the setting? Normal care setting? Consistently customers and specialists? Prohibitive incorporation criteria and specialists? Has it been autonomously imitated? Has it been actualized effectively in different spots?

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Fidelity Adopting - Implementing with loyalty to the program standards and practices Most liable to bring about results like those announced in research Adapting - Applying the practice with alterations from the recommended program Adopt—Validate—Adapt—Evaluate

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Section 2 Stakeholder Concerns Or 101 Reasons to Hate EBPs

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Practitioner Challenges to EBP That may work for them however not us. How would you realize that what we are doing isn\'t working? We as of now do that. They are excessively recommended, manualized and unyielding What we do is an ART not a SCIENCE. It is only a trend.

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Top 4 Concerns Limits Consumer/Practitioner Choice Devalues Professional Expertise Inconsistent with Consumer-Driven, Recovery Oriented, Family-Driven, Strengths-based Services Are Not Culturally Competent

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Limits Consumer/Practitioner Choice Devalues Professional Expertise Do confirm based practices constrain customer and family decision? Do prove based practices restrict specialist decision? Do confirm based practices degrade proficient aptitude?

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Limits Consumer/Practitioner Choice Devalues Professional Expertise. Focuses for Consideration . . . What is our involvement in other medicinal services fields, when confirmation based practices are executed well?

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Defining Evidence Based Practices … the joining of the best research confirm with clinical skill and patient qualities ( Institute of Medicine )

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Inconsistent with Consumer-Driven Services or Recovery? Imagine a scenario where Evidence-based Practices. . . Disgrace and Blame? Isolate Families? Are correctional? Advance Hopelessness/Helplessness? Are contradictory with what Consumers and Families need?

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Inconsistent with Consumer-Driven Services Points for Consideration . . . EBPs for Consumers: Are Family and Community Based Identify Engagement as a Critical Phase Create Hope Identify Engagement as the duty of the Interventionist, not the Consumer Focus upon Skills Building Structured Flexibility/Individually Tailored

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Are Not Culturally Competent "Ethnic minority" populaces have been mishandled in logical trials Most research incorporates the constrained social, ethnic, sexual orientation populaces There is worry that practices examined just with the lion\'s share populace, will be constrained upon different groups to their weakness

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Are Not Culturally Competent Points for Consideration . . . Advocate for a Culturally Competent research plan. Inspect look into supporting an EBP painstakingly re: culture/ethnicity/and so forth. Confirm based practices ought to be accessible, as a choice , for all people paying little heed to ethnicity or culture, unless there is confirmation despite what might be expected. (CIMH Draft Recommendation)

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LV HE Level of Scientific Evidence LE Values Driven Evidence-Based Practices high science low esteem high science high esteem Values Driven Evidence-Based Practices low science low esteem low science high esteem LV HV Values

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P (ease) P (ease) LV HC HE high science low esteem high science high esteem Values Driven Evidence-Based Practices Values Driven Evidence-Based Cost Effectiveness Level of Scientific Evidence (x) (execution) low science low esteem low science high esteem LC P (ease) LE HC LV HV CIMH Values (y) (Importance) California Institute for Mental Health Values Driven Evidence-Based MH Practices

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Section 3 Implementation and Maintenance

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Funding How will the preparation be subsidized? By what method will the practice be supported? Will it be new subsidizing, or re-tooling of existing financing? Is the financing on-going? Are there charging or different necessities? Are the people in charge of charging required in the arranging?

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Integrating Into the Local Service System Where will the practice fit into the administration framework? Will\'s identity alluded? Will\'s identity in charge of making referrals, and under what conditions? Who will give the administration? Will the administration be given autonomously of, notwithstanding, or rather than different administrations?

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Staffing Who will be the experts? In what capacity will they be chosen? Will they have a decision? Will they have sufficient energy to take in the practice? Will they have show follower workloads?

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Learning the Practice Who will give the preparation and conference? What amount of preparing and counsel is required? By what method will you know whether the practice has been educated? In what capacity will the ability to prepare to the practice be kept up?

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Training & Fidelity Training alone does not bring about high constancy usage. The level of preparing changes by practice yet commonly includes: Intensive preparing (2-3 days) Booster trainings Daily/every contact information & week after week supervision Evaluation of devotion Evaluation of results

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Supervision Who will be in charge of protecting that the referrals are made? Will\'s identity in charge of safeguarding that the practices are utilized? Who will bolster professionals in their initial endeavors to take in the practice? By what method will they be chosen? Will they have a decision? Will they be included, given adequate time, and be strong of the practice?

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Monitoring and Evaluation How will you know whether the practice is being utilized with constancy? In what capacity will you know whether the practice is working (accomplishing tyke and family results)

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Administrative Oversight Who at the regulatory level took an interest in execution arranging? Who at the managerial level is focused on ensuring that everything happens? Who at the managerial level will audit constancy and result reports and regulate any required redresses? In what capacity will developing interest for the practice be overseen? By what means will staff whittling down be overseen?

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Section 4 The Irresistible Urge to Drift

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Drift Insufficient preparing or supervision Practitioners have different or contending obligations Little or no thoughtfulness regarding constancy observing Failure to cling to practice particular caseload models

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Drift Insufficient intra-and between organization coordination around referrals, financing, et cetera The mid-chiefs/administrators are careful, excessively occupied, or not steady of the practice Staff are not inspired by/restrict the practice

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Drift Increased investigation and responsibility (" on the off chance that it doesn\'t work then… .

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