Bringing in Evidence-Based Practice: How Do We Make EBP TAU?

1. National Crime Victims Research and Treatment Center Bringing in Evidence-Based Practice: How Do We Make EBP TAU? Ben Saunders, Ph.D., LISW-CP Professor and Director, Family and Child Program National Crime Victims Research and Treatment Center Department of Psychiatry Medical University of South Carolina Charleston, South Carolina Keynote address at The Leadership Symposia on Evidence-Based Practice in the Human Services sponsored by The California Social Work Education Center, The Child & Family Policy Institute of California, and the California Department of Social Services, January 30, 2009, San Diego, CA.

2. BringingEvidenceSupportedTreatments to South Carolina Children and Families Coordinating Centers The Dee Norton Lowcountry Children’s Center Charleston, SC National Crime Victims Research and Treatment Center Medical University of South Carolina Project BEST is funded by Grant Appropriation No. 1582-SP from The Duke Endowment

3. Project BEST Planning Team Elizabeth Ralston, Ph.D. Ben Saunders, Ph.D. Rochelle Hanson, Ph.D. Monica Fitzgerald, Ph.D. Michael de Arellano, Ph.D. Elizabeth Ciesar, Ph.D. Jan Koenig, M.Ed.

4. Mission of Project BEST “The long-term goal of this project is to ensure that all South Carolina children and their families, who are identified as having experienced abuse and resulting trauma, receive appropriate, empirically supported mental health assessment and psychosocial treatment services. To achieve this goal, Project BEST will substantially increase the capacity of every community in South Carolina to deliver them.”

5. Why Use Evidence Supported Treatments? “…when he looked around and realized he was all clear with 30 metres to go, he coasted and still set a world record of 9.69 seconds.” The New Zealand Herald 8/17/08 Usain Bolt “Bolt grabbed another gold, running the 200 in 19.30, two-hundredths of a second faster than Michael Johnson's previous record, set at the Atlanta Olympics in 1996.” The Seattle Times 8/21/08

6. Why Use Evidence Supported Treatments? “The race is not always won by the swift, nor the contest by the strong, but the smart man bets that way.” Damon Runyon

7. Large Gap Between Scientific Knowledge and Front-line Practice Practice 17 years Knowledge Goal… reduce this gap.

8. Great Thoughts About EBP “What do I think of Western civilisation? I think it would be a very good idea.” Mahatma Gandhi “New ideas pass through three periods: 1) It can't be done. 2) It probably can be done, but it's not worth doing. 3) I knew it was a good idea all along!” Arthur C. Clarke

9. Common Continuing Education Dissemination Model One day workshop Use Tx with appropriate clients Therapist Book

10. Supportive Implementation Model Administrative Leadership and Support for EBT Obtain client feedback Supervision Technical Assistance Expert Consultation Use EST with appropriate clients Therapist Training Materials Community/Consumer Support for EBT

11. Learning Collaborative Emphasis Over Time Implementation Pre-Work Learning Session-1 Action Period-1 Learning Session-2 Action Period-2 Learning Session-3 ActionPeriod-3 Training 12-14 Months

12. “Brokers” of Mental Health Services • Make a determination (on some basis) that their clients need to be referred for mental health services. • Select mental health treatment providers to refer their clients to. • Refer their clients for mental health services (or even mandate they go to mental health services.) • Monitor the progress of their referred clients in treatment. • Monitor the outcomes of treatment for their referred clients. • Take action concerning their referred clients based on the outcomes of treatment.

13. Critical Role of Brokers of Mental Health Services Medical Services Nonprofit MH Services Rape Crisis Center Dept. of Mental Health Referral Dept. of Social Services MH Providers Brokers Private Practitioners Victim Advocates University MH Services Guardian Ad Litem

14. Community Supply and Demand for TF-CBT Brokers Therapists

15. Building Community Capacity Needed Community Capacity for TF-CBT Therapists knowledgeable and skilled and using TF-CBT Brokers knowledgeable about and referring for TF-CBT Current Community Situation

16. Responsibilities of Brokers of Mental Health Services Because they take actions based upon treatment progress and outcome: • Brokers have a responsibility to be reasonably familiar with the evidence-based mental health interventions that are appropriate for the problems their clients often have. • Brokers have a duty to obtain appropriate, evidence-based treatments for their clients from providers who are trained, knowledgeable, and skilled in their use. • Brokers have a responsibility to know what types of treatment their clients are getting and to monitor client progress on treatment goals.

17. Key Elements of a Community-Based Learning Collaborative • Development of a Community Change Team • Therapists, clinical supervisors, senior leaders • Brokers, supervisors, senior leaders • Multiple training events over time • Adult learning principles and active learning techniques • Web-based learning • Promotion of team-building, collective responsibility, and effective interaction as well as learning the new practices. • Action periods to implement the new practices • Practice the new practice with expert consultation • Expose barriers to implementation and sustainability, find solutions • Promote Collaborative learning • Discussion board, Resource Library • Expert consultation, Peer consultation statewide • Involvement of prior participants in subsequent learning collaboratives • Monitor community, agency, and individual outcomes

18. Community Change Team • 15-20 mental health professionals and brokers • Complete all training and implementation activities together. • Champion the implementation and sustained use of TF-CBT in their communities. • CCT members include: • Mental health professionals from multiple agencies. • public mental health agencies, private nonprofit organizations, private practice. • Brokers from multiple agencies. • child protective service and child welfare workers, victim advocates, guardians ad litem, juvenile justice workers, nonclinical CAC workers. • Senior leaders, supervisors, and frontline professionals from all these agencies. • Consumers of mental health and broker services. • Other community stakeholders (?)

19. CBLC Curriculum Areas Common Material and Activities Clinicians and Brokers Clinical Track TF-CBT Broker Track EBTP EBCM Learning It Doing It Joint Community Responsibility Team Building Supervisor Senior Leader

20. Principles Guiding a Community-Based Learning Collaborative • Promote collective community responsibility for abused and traumatized children and their families. • Build the capacity of communities to deliver ESTs, not just one agency or set of providers. • Build the “supply” of therapists who use ESTs properly. • Build “demand” for ESTs from brokers through use of EBTP and EBCM. • Build cooperative, sustainable linkages between brokers and therapists and agencies. • Promote organizational and community change as well as individual learning and practice change. • Cultivate local expertise in ESTs.

21. Lessons Learned Brokers are critical to sustained use of ESTs by a community! Learning EBTP Knowledge about ESTs Tx Criteria Questions to ask Therapists Implementing EBTP Empowerment View of job Tx Components

22. Lessons Learned • Marketing (internal/external), Branding, and Style are important. • Bottom up, organic spread over time, strategically build demand. • How to make it theirs, ownership. • Gain state leadership permission and soft, behind the scenes encouragement. Avoid directives.

23. Lessons Learned • You get what you monitor. • Well-communicated, simple, directly useful metrics on multiple levels of implementation are critical. • Tie metrics directly to outcomes. • Publicize positive anecdotes. • Use technology to make it easier: Google Groups, Google Apps, Survey Monkey (FREE) • Have surprises. • Primary attention to cultivating relationships, interaction, team building.

24. Process Role of Senior Leadership • Committed senior leadership is necessary but not sufficient. • Goal is to change the fundamental way we do business as an organization even as personnel comes and goes. • Senior leadership roles • Interest, commitment, leadership • Participate • Encouragement and tangible rewards • Offer time • Offer resources • Find solutions to barriers • Avoid directives

25. Time to Dive In!