an introduction to - policywise

AN INTRODUCTION TO

THE MAP SYSTEMMANAGING AND ADAPTING PRACTICE

AND

MATCH ADTCMODULAR APPROACH TO THERAPY FOR CHILDREN W/

ANXIETY DEPRESSION TRAUMA CONDUCT PROBLEMS

Mapping a Vision

Youth &Family Life

Mapping a Vision

Youth &Family Life

DirectService

Mapping a Vision

Youth &Family Life

Progress & Preference

Practice

DirectService

Mapping a Vision

Youth &Family Life

Supervision &Consultation


Practice

DirectService

Mapping a Vision

Youth &Family Life



Performance& Preference

Practice Prof. Dev., Case Guidance,

Support

DirectService

Mapping a Vision

Youth &Family Life

DirectService





Support

Knowledge Management

Mapping a Vision

Youth &Family Life

DirectService


Program Progress & Preference



Support


Mapping a Vision

Youth &Family Life

DirectService



Program

Mapping a Vision

Youth &Family Life

DirectService



Program

Operations

Mapping a Vision

Youth &Family Life

DirectService


Training, Development,

& Selection


Program

Operations

Mapping a Vision

Youth &Family Life

DirectService


UtilizationManagement

PerformanceManagement


& Selection


Program

Operations

Mapping a Vision

Youth &Family Life

DirectService





& Selection

Revenue &Contract

Management


Program

Operations

Mapping a Vision

Youth &Family Life

DirectService





& Selection

Revenue &Contract

Management


Policy

Program

Operations

Mapping a Vision

Youth &Family Life

DirectService





& Selection

Revenue &Contract

Management


Policy

ExternalInformation

External Requirements

Program

Operations

Mapping a Vision

Youth &Family Life

DirectService





& Selection

Revenue &Contract

Management


Policy

ExternalInformation

External Requirements

Program

Operations




Support

Youth &Family Life

DirectService


MAP Direct Services

MAP System


MATCH-ADTCYouth &Family Life

DirectService


EBT Program(s)

Youth &Family Life

DirectService


EBT Program

MATCH-ADTC

Summary So Far…

MAP – A system for organizing care in mental health service organizations; has direct service component

MATCH-ADTC – A flexible, multi-problem treatment program with emerging empirical support

ACMEEvidence-Based Treatment Manual

ACME

Evidence-

Based

Treatment

Manual

ACME

Evidence-

Based

Treatm

ent

Manual

Questions Raised

“How can I learn enough EBTs? “How do they fit with what I was doing before?” “How will what I learn stay current?” “Are there EBTs for all the different kinds of kids I

see?” “What do I do if there are not?” “What do I do if a child does not respond to an

EBT?” “Aren’t there other forms of evidence?”

The Bottom Line

Youth in the community have more than one problem

EBTs are generally built for a single problem

Not feasible to train everyone on everything

Need for a common-sense means to guide treatment using traditional clinical expertise paired evidence base about what works in general and what is working for your case now

What is MAP?

A system for providing evidence-informed care Includes a variety of models to support assessment and

planning & monitoring of care for a variety of problems Include coordination of care for cases with multiple problems

Includes tools that help you manage and adapt practiceWebsite updated to most current research Practitioner guides representing the most common practices

based on the research literature A tool to track your treatment plan and client outcomes

How does MAP fit in?

EBPs are usually treatment programs for specific populations

MAP is an evidence-informed approach MAP is ideal when…

Programs don’t exist at your agency for a particular case

You have cases that don’t fit the programs you do have High comorbidity High requirement for flexibility

Now let’s learn some of theMAP models and tools

Model 1: EBS Model

Tool 1: PWEBs

Tool 2: The Practitioner Guide

Tool 3: The Clinical Dashboard

Case example

Maggie 14 years old, female, African American Presents with Depressive Sxs (irritability, frequent

crying outbursts, suicidal ideation, lack of interest in peers), Anxiety Sxs (separation fears, cannot sleep alone, worries about family members and future), and Disruptive Behavior (“attitude”, non-compliance with adult commands, aggressive behavior towards younger sibs)

History of trauma and recent assault by male classmate who “touched her private parts”

The Evidence-Based System Model(AKA the EBS Model)

Evidence-Based System Model

This is the “big picture”, it is how an agency or a system is structured to provide informed and efficient care For example, Alberta or Your Agency

This is also the way that we can think about how we formulate a case, and the data that we use to inform our decisions in client care

Decisions in any system/agency…

Where should we treat the client?

ServiceSetting

How should we treat the client?

TherapeuticPractices

ServiceSetting

Are we providing quality service to the client?


ServiceSetting

TreatmentIntegrity

Is the client getting better?


ServiceSetting

Who should treat the client?


ServiceSetting

How should we manage the treatment?


ServiceSetting

ClientProgress

TreatmentIntegrity

Treatment programs formalize these elements


ServiceSetting

Selecting a program structures other decisions

Tx ProgramSelection


ServiceSetting

Selecting a program structures other decisions

Tx ProgramSelection


ServiceSetting

CBITS: Cognitive Behavioral Intervention for Trauma in Schools

School-Based/Clinic Based

Child PSTD Symptom Scale &

CDI

CBITS

Consulting Supervisor

Psychoed,Cognitive…

CBITS Fidelity Measure

How should we select a program?

Tx ProgramSelection


ServiceSetting

What evidence do we use to make these choices?

GeneralServicesResearch Therapeutic

Practices

ServiceSetting

Tx ProgramSelection

Evidence-Based Services Model


Case-SpecificHistorical

Information

CausalMechanismResearch


ServiceSetting

Tx ProgramSelection

Individualized Case Conceptualization Model


LocalAggregateEvidence


Information


ServiceSetting

Tx ProgramSelection

Practice-Based Evidence Model

Full System Model

GeneralServicesResearch



Information



ServiceSetting

Tx ProgramSelection

What Works in Children’s Mental Health?

TOOL #1: THE PW DATABASE




Information


Maggie

How do I know what parts of the evidence-base are relevant to her? Problem types Age Gender Ethnicity

Maggie

FIRST STEP IN USING MAP

Get ideas using the PWEBS DATA BASE!

This will help us build our treatment plan To be considered in context of treatment team, inclusive

of family, supervisor, other stakeholders

General Services Research: A Closer Look

Summary of the Children’s Treatment Research 464 research papers 44 years 1,205 study groups 864 treatment protocols 46,171 youth participants Automated for practitioners

How did we organize the findings?

Levels of support

Guided by standards set by APA Division 12

Help to break down levels of evidence / amount of evidence

Our best method so far to help guide a basic analysis of what has been tested

Best Support: Level 1

Two or more studies showing Treatment was better than another treatment or placebo

OR Equal to an established treatment (with n > 30 per group)

Treatment manual needed Sample characteristics clearly specified Multiple investigator teams

Good Support: Level 2

Two or more studies showing Treatment was better than waitlist or no

treatmentOR One study with Manuals

AND Treatment was better than another

treatment or placeboOR

Equal to an established treatment (with n > 30 per group)

Moderate Support: Level 3

One study shows… Treatment is

Better than another treatment or placeboOR Equal to established treatment (with n>30 per group)

3

Minimal Support: Level 4

One study shows… Treatment is better than a waitlist or no treatment

control group

No Support: Level 5

Tested in at least one study, but failed to meet criteria for levels 1 through 4.

And the Winners Are…

196 protocols,

28 treatment families

ANXIETY

Results: Anxiety

CBT (47) Exposure (43) Modeling (9) Cognitive Behavior Therapy

with Parents (4) Education (4) Cognitive Behavior Therapy

and Meds (2)

Relaxation (3)

Assertiveness Training (1)

CBT for Child and Parent (1)

Family Psychoeducation (1)

Hypnosis (1)

Best Support Good Support

29 protocols,


TRAUMATIC STRESS

Results: Traumatic Stress

Cognitive Behavior Therapy (7)

Cognitive Behavior Therapy with Parents (5)


67 protocols,


DEPRESSION

Results: Depression


Cognitive Behavior Therapy with Parents (4)

Cognitive Behavior Therapy and Medication (3)

Family Therapy (2)

Interpersonal Therapy (3) Expressive

Writing/Journaling (2) Client Centered Therapy

(2) Relaxation (2)


102 protocols,


ATTENTION & HYPERACTIVITY

Results: Attention & Hyperactivity

Self verbalization (5) Behavior Therapy and

Medication (3)

Parent Management Training (7) Contingency Management (3) Physical Exercise (3) Biofeedback (2) Education (2) Parent Management Training and

Teacher Psychoeducation (2) Social Skills and Meds (2) Parent Management Training and

Problem Solving (1) Relaxation and Exercise (1) Working Memory Training (1)


226 protocols,


DISRUPTIVE BEHAVIOR

Results: Disruptive Behavior

Parent Management Training (45)

Multisystemic Therapy (11)

Anger Control (9)

Social Skills (9)


Assertiveness Training (5)

Parent Management Training and Problem Solving (3)

Problem Solving (7)

Communication Skills (5)

Contingency Management (5) Functional Family Therapy (2)

Parent Management Training and Classroom Contingency Management (2)

Relaxation (2)

Rational Emotive Therapy (2)

Therapeutic Foster Care (2)

Transactional Analysis (1)


Also in the PWEBS Database:

Substance Abuse Eating Disorders Autism Spectrum Mania Suicidality

Dealing with Data Overload

“Good to see you, Maggie. As soon as I finish reading these papers, we can start our session today.”

PWEBs Hand-on Practice

PracticeWisePracticeWiseRegistration and User Guide Registration and User Guide for for www.practicewise.comwww.practicewise.com

How to Register: www.practicewise.com

Click on Register to go to Registration page

Go to Web Address www.practicewise.com

71

Registration PageNote: Required fields are noted by and must be completed.

(2) Complete Registration page, make sure to provide response for required fields.

Required Fields: User name, First name, Last name, Display name, Email address, Password (and confirm), Security code, Address (Street, City, Region, Postal Code)

(3) Note: Scroll down the page to view required address fields. When all fields are filled in, click “Register” at bottom of page.

(1) Before Registering, you must read and agree to the Service Use Agreementfor PracticeWise. If you do not agree to the terms of the agreement, you must not use PracticeWise services or software.

72

How to Log On

Web address http://www.practicewise.com

Note: Click on the “Home”button to return to the main page at any time.

Enter Logon information

User Name:

Password:

73

After Logging On for the First Time…

Click on Manage Services

74

RSVP Codes

Enter your RSVP Code after selecting Manage Services. Click the Subscribe button, located to the right of the RSVP code box, to subscribe to services.

Note: You MUST use your mouse to click the Subscribe button, pressing Enter will not work.

75

After Entering and Submitting Your RSVP Code…

You will need to Log Out in order for your subscribed services to appear

When you Log back In, you will be able to view the services (e.g., Clinical Dashboards, Practitioner Guides, PWEBs) you are subscribed to

76

Your RSVP Code for 1-Day Access

BCCALGARY

Will provide access to PWEBS Database and Clinical dashboards, which is what we plan to use for some exercises today

Managing your Account and Accessing your Services

My Account: Use these options to edit and update your Account Profile. i.e., credentials, password, profile, and services.

LogoutMy Services: Use either of these links to navigate to the MATCH Manual

78

Exercise #1

Let’s find what treatment families (i.e., broad classes of treatment protocols) are relevant to Maggie Problem only search (level 2 or better) PAGE search (level 2 or better) PAGE search (level 1)

How many studies are summarized in each search?

Maggie is 14, with depression, African-American, Female

Exercise #1

Now…using the “advanced search features” Suppose we were looking for a school-based

treatment for Maggie What is returned? What do we do know?

Are there valid alternatives to picking a program?




Information



ServiceSetting

Tx ProgramSelection







Information



ServiceSetting





Information


Targets & Goals


ServiceSetting




Building a Treatment

from High Quality Parts

The MAP approach to practice

General Services Research:An alternative Look

Common Elements Approach

We identified components of evidence-based treatments

The approach complements traditional integrated program approach

GeneralServicesResearch Local

AggregateEvidence


Information


Is there a different level of analysis?

Protocol Protocol Protocol

Family


IncredibleYears PCIT Defiant

Children

Parent Training


Protocol Protocol Protocol

Family

PracticeElement

PracticeElement

PracticeElement

PracticeElement

PracticeElement

PracticeElement


IncredibleYears PCIT Defiant

Children

ParentTraining

Commands CommandsAttending

Time Out

Rewards

Time Out

These are the practice elements.

Which Practice Elements Should We Learn?

Among all the evidence-based treatments for a given problem, which are the most common?

Anxiety

TraumaticStress

Depression

Disruptive BehaviorYounger Children (<=12)

Disruptive BehaviorOlder Children (>=13)

Demo of identifying practice elements in PWEBs

Exercise #2

Run a search for Miguel 11 year old Latino boy with anxiety Try a level 2 and above using PAG only

What are the top 4 practice elements? What if Miguel has OCD?

Try a level 2 and above using PAG only

Exercise #3

View the supporting papers on OCD Select the POTS randomized trial

What was the IQ requirement for study entry? Were pregnant teens allowed in study? What were the primary findings on the main study

measure?

Can we determine what the literature says to do for an entire service population?

Relevance Mapping

Context: The invisible problem of coordinated selection

Evidence Consolidation Coordination Implementation Practice

Children and Families

General services research(e.g., RCTs)...

General services research(e.g., RCTs)...

Lists:SAMHSA NREPP,APA Div 12 & 53,...

Lists:SAMHSA NREPP,APA Div 12 & 53,...

Training,Consultation,Eval & feedback,...

Training,Consultation,Eval & feedback,...

Relevance Mapping

Relevance Mapping

The basic idea: Combine study data and service organization data to see

how well the studies apply to the kids served.

...

Treatments from the Literature

EBTs

...

EBTs

P Depression

A 13‐17

G F & M

E Caucasian

S Clinic

P Anxiety

A 8 years old

G Male

E Hispanic

S School

...

EBTs

P Anxiety

A 8‐10

G F & M

E Caucasian

S Clinic

P Anxiety

A 8 years old

G Male

E Hispanic

S School

Match Table:Child x Treatment

...

EBTs

P Anxiety

A 8‐10

G F & M

E Caucasian

S Clinic

P Anxiety

A 8 years old

G Male

E Hispanic

S School


P ...

A ...

G ...

E ...

S ...

...

EBTs

P Anxiety

A 8 years old

G Male

E Hispanic

S School


... ...

Reports

P ...

A ...

G ...

E ...

S ...

Relevance Mapping, cont.

Answers questions like:

Who is and is not covered?

What practices are most important to learn?What treatments together cover the most kids?What treatments could we add given what we already

have?


A flexible framework, not a specific set of recommendations or assumptions


A flexible framework, not a specific set of recommendations or assumptions Can choose any matching criteria P roblem A ge G ender E thnicity S etting

Can choose any standard of evidence Can choose any way of defining treatment

Exploring early results

Exploring early results:Hawaii CAMHD youth not covered (NC)

Matches Required For Coverage

P PAG PAGES

Problem type N % NC % NC % NC

Disruptive behavior 612 0% <1% 64%

Depression 268 0% 0% 97%

Attention/hyperactivity 264 0% 48% 98%

Traumatic stress 125 0% 2% 99%

Substance use 68 0% 0% 100%

Anxiety 54 0% 0% 87%

Autism spectrum 19 0% 42% 100%

Eating disorders 1 0% 0% 100%

Other/missing 370 100% 100% 100%

Total 1,781 21% 29% 86%

Exploring early results:Hawaii CAMHD youth (matching on PAG)

Exploring early results:Hawaii CAMHD youth (matching on PAG)

1 Treatment Program 4 Treatment Programs 8 Treatment Programs

Percentage of Children Covered: 33.6% 60.7% 68.6%

NREPP ProgramIn best set?

Case Application

In best set?

Case Application

In best set?

Case Application

A‐Community Reinforcement Apprch 4.3% 4.3%

Adolescent Coping W/ Depression 15.0% 15.0%

Brief Strategic Family Therapy 4.3% 4.3%

Children's Summer Treatment Prgrm 1.9%

Coping Cat 2.9%

Family Behavior Therapy 4.3% 4.3%

Incredible Years 2.8%

Multidimensional Family Therapy 4.3% 4.3%

MST for Juvenile Offenders 33.6% 33.6% 33.6%

Trauma Focused CBT 7.8% 7.8%

Triple P‐‐Positive Parenting Prgrm 0.5%

Relevance Mapping Summary

Selection can be empirically informed at the system level as well as at the client level

Relevance mapping can find “optimal” solutions

How Do We Learn These Practice Elements?

HOW ABOUT A CONVENIENT

SET OF INSTRUCTIONS?

Maggie

Now we know what is in the evidence base for her, but how do we know what those practices look like in the protocols?

Maggie

STEP 2 IN MAP

Look up Practice Element Instructions in the PRACTITIONER GUIDE

This is a “generic” set of instructions for the most common practices from the evidence based treatments

TOOL #2: THE PRACTITIONER GUIDES

Example from a Practitioner Guide

Objectives: to increase the amount of positive attention provided to the child, even if the child has misbehaved

at other times during the day

to teach the caregiver to attend to positive behaviors

to promote the child’s sense of self-worth Steps:

Provide rationale Emphasize the importance of providing positive attention to the child. Elicit the caregiver’s opinion about how attention affects behavior and

people’s motivation to do a good job. Have the caregiver describe his or her best and worst “managers”

and the caregiver’s motivation to work for each. Lead the caregiver to recognize that how he or she was treated

affected the caregiver’s desire to work. Discuss how the child’s behavior may be affected by the caregiver’s

behavior towards the child and how the child’s desire to behave can be increased by improving the caregiver-child relationship.

Set aside one-on-one time for caregiver and child

Encourage the caregiver to set aside a block of time (e.g., 10 minutes) each day devoted to joining the child in an activity the child has chosen.

Teach caregiver to provide positive and descriptive commentary

Show the caregiver how to demonstrate sincere interest in the child’s activities while they are playing.

Instruct the caregiver to provide enthusiastic descriptive (e.g., “You are drawing a tree”) and/or positive (e.g., “I like the way you stacked the blocks”) commentary and praise regarding the child’s behavior.

Encourage caregiver to engage in child’s activity

Suggest that the caregiver become actively involved in the play activity by imitating the child’s behavior in order to demonstrate approval.

Restrict criticism, questions, and commands

It is important that the child lead the activity; that is, the caregiver should refrain from making suggestions, asking questions, and criticizing the child.

Allow the child to use his or her imagination (e.g., coloring the green or making up new rules to a game) without caregiver input about the “correct” way to do things.

Anticipate difficulties When the procedure is initially implemented, the child may engage in negative behavior that characterizes the usual caregiver-child interaction. When this occurs, the caregiver should:

consistently ignore negative behavior by looking away; refrain from scolding the child so as to avoid providing negative

attention for misbehavior; end one-to-one time if disruptive behavior continues or is

dangerous. Over time, however, it is expected that consistent positive attending will result in decreased negative behavior and increased positive caregiver-child interactions.

Attending

Use This When:

To improve the quality of the caregiver-child relationship.

Practitioner Guide

For CaretakerFor Caretaker

Practitioner Guides demo

We Need Recipes

Not just ingredients…

Clinical Event Structure Basic Within-Session Format


Opening

• Check In• Review Earlier Skills/Homework• Set Agenda


Opening

• Check In• Review Earlier Skills/Homework• Set Agenda

Working

• Teach• Rehearse• Repeat

Putting Practices Together

Connect-Cultivate-Consolidate

Focus-Interference Framework

Putting Practices Together

Focus

Connect ConsolidateCultivate

Interference

Anxiety Example

Focus

Connect

EngagementPsychoeducation

Consolidate

Maintenance

Cultivate

CognitiveProblem SolvingExposure…

Interference

Low Motivation: RewardsComplaining and Irritability: Active Ignoring

Tantrums: Time Out…

Exercise #3 (if time)

Based on a search of treatment options for Maggie, design a preliminary sketch of a treatment using the CCC framework sheet

BREAK

Download a dashboard during the break The one that says “MAP Training”

Maggie

How do we know if what we are doing is working? That is, what is the EVIDENCE that it is working for our

client?

How do we know if what we are doing is working?

TOOL #3: THE CLINICAL DASHBOARD




Information


The Full System Model




Information


Targets & Goals


ServiceSetting

Case Specific History

Clinical Dashboard

Progress

Practices

Individual Case Supervision Form Case Number: 6

Age: 12 Diagnosis: Generalized Anxiety Disorder Gender: M

Child Mother Father Other

Progress Measure:Fear rating

RewardsCommands

Time OutPraise

Problem SolvingParent Monitoring

Response Cost Ignoring/DRO

Stimulus Control/AntecedentsAttending/Directed Play

ModelingCognitive

Parent PsychoeducationSelf-Monitoring

RelaxationExposure

MaintenancePsychoeducation

Activity SchedulingSkill BuildingSocial Skills

Self MonitoringOtherOtherOtherOtherOtherOtherOtherOther

Days Since First Event

0 10 20 30 40 50 60 70 80 90 100

0

1

2

3

4

5

6

7

8

0 10 20 30 40 50 60 70 80 90 100




Information


Excel Comfort Scale

10—Extreme comfort “I wrote code for Excel”

7—Moderate comfort “I use Excel with ease.”

5—Some comfort “I have used Excel some.”

3—Little comfort “What is Excel?”

0—No comfort “Which one is the computer?”

Let’s Practice with Dashboards!

GO DASHBOARDS!!

What is the “MAP”?

The MAP is a map of clinical decisions that we make during clinical care

An important skill in of the MAP therapist is knowing WHERE you are on the MAP

ClinicalProgress?

Clinical Dashboard:Progress Pane

Continue plan until goals met

NotEngaged?

Crisis?

Poor Attendance,Complaints, etc.

Pursue engagement;Take appropriate action

yes

no

no

yes

no

yes

no

yes

Clinical Dashboard:Practice Pane, PW DB

Prob. w/ TxSelection?

TreatmentIntegrity?

Practitioner Guide,Clinical and

Quality ReviewConsider adding consultation or

training supports

Identify barriers and revise plan

Options1. Increase supports

2. Change Intervention3. Further Consultation

4. Add intervention

PW DB, Local Best Practices, Tx Team

New Case?

no

yes Select Evidence-Based Service (EBS)

PWDatabaseStart

The MAP

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

no

yes



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Decisions

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

no

yes



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Actions

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

no

yes



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Guiding Information

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

no

yes



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Selecting a Treatment Approach

This tells you the treatment types that work for this problem.

This tells you the practice elements associated with those treatment types.

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

no

yes



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Getting on Track

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

no

yes



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Treatment Going Along Well





RewardsCommands

Time OutPraise




ModelingCognitive


RelaxationExposure





0 10 20 30 40 50 60 70 80 90 100

0

1

2

3

4

5

6

7

8

0 10 20 30 40 50 60 70 80 90 100





RewardsCommands

Time OutPraise




ModelingCognitive


RelaxationExposure





0 10 20 30 40 50 60 70 80 90 100

0

1

2

3

4

5

6

7

8

0 10 20 30 40 50 60 70 80 90 100

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

yes



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Treatment Not Going So Well

no





RewardsCommands

Time OutPraise




ModelingCognitive


RelaxationExposure





0 10 20 30 40 50 60 70 80 90 100

0

1

2

3

4

5

6

7

8

0 10 20 30 40 50 60 70 80 90 100

Do the practices fit the problem?Individual Case Supervision Form Case Number: 6




RewardsCommands

Time OutPraise




ModelingCognitive


RelaxationExposure





0 10 20 30 40 50 60 70 80 90 100

0

1

2

3

4

5

6

7

8

0 10 20 30 40 50 60 70 80 90 100

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

no



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Service Quality and Treatment Integrity

yes

Consultation Can Be Fun!

ClinicalProgress?



NotEngaged?

Crisis?



yes

no

no

yes

no

yes

no

yes



TreatmentIntegrity?



training supports




4. Add intervention


New Case?

no


PWDatabaseStart

The MAP: Getting Unstuck…

MAP Summary

Makes use of several tools or “knowledge appliances” to guide care

Strengths: very broadly applicable, very flexible, efficient and economical to train (esp with Relevance Mapping

Drawbacks: not an EBP (but a way to coordinate EBPs and to extend beyond those), higher uncertainty about outcomes

Youth &Family Life

DirectService


MAP Direct Services

MAP System


MATCH-ADTCYouth &Family Life

DirectService


EBT Program(s)

Youth &Family Life

DirectService


EBT Program

MATCH-ADTC

MATCH Protocol

Coordinated library of evidence based procedures Available online and trained online to therapists

Online Demo

Three ways to navigate: Menus Table of Contents Guided Protocol

Unlike MAP, has structured coordination modules (flowcharts to guide care in a more detailed manner) The four “recipes”

Features

Configurable display (can turn on and turn off details) Principle of “information hiding”

Handouts and worksheets Multi-language support Relaxation scripts can be downloaded by or for clients

(relax.practicewise.com) Updatable library (just added trauma modules) Has MATCH-specific dashboard Available in paperback book as well…

Big things I did not talk about, but I do very much care about…

Professional Development Model Supported Users, Therapists, Agency Supervisors,

Training Professionals

Clinical Process Issues Alliance, relationship Socratic method

Embracing Diversity Adapting content, style

Clinical Rehearsal

Resources

Home page: www.practicewise.com Questions: [email protected] Group/institutional orders: order.practicewise.com Academic programs: www.practicewise.com MATCH information site: match.practicewise.com Relaxation scripts: relax.practicewise.com

Thank You!

an introduction to - policywise

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