Bringing in Evidence-Based Bringing in Evidence-Based Practice: How Do We Make Practice: How Do We Make

EBP TAU?EBP TAU?

Ben Saunders, Ph.D., LISW-CPBen Saunders, Ph.D., LISW-CPProfessor and Director, Family and Child ProgramProfessor and Director, Family and Child Program

National Crime Victims Research and Treatment CenterNational Crime Victims Research and Treatment CenterDepartment of PsychiatryDepartment of Psychiatry

Medical University of South CarolinaMedical University of South CarolinaCharleston, South CarolinaCharleston, South Carolina

National Crime Victims Research and Treatment Center

Keynote address at Keynote address at The Leadership Symposia on Evidence-Based Practice in the Human Services 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 sponsored by The California Social Work Education Center, The Child & Family Policy Institute of California, California, and and the California Department of Social Services, January 30, 2009, San Diego, CA.the California Department of Social Services, January 30, 2009, San Diego, CA.

BBringingringing EEvidencevidence SSupportedupported TTreatments to South Carolina Children reatments to South Carolina Children

and Familiesand FamiliesCoordinating CentersCoordinating Centers

The Dee Norton Lowcountry Children’s CenterThe Dee Norton Lowcountry Children’s CenterCharleston, SCCharleston, SC

National Crime Victims Research and National Crime Victims Research and Treatment CenterTreatment Center

Medical University of South CarolinaMedical University of South Carolina

Project BESTProject BEST is funded by Grant Appropriation No. 1582-SP from The Duke Endowment is funded by Grant Appropriation No. 1582-SP from The Duke Endowment

Project BEST Planning Project BEST Planning TeamTeam

Elizabeth Ralston, Ph.D.Elizabeth Ralston, Ph.D.

Ben Saunders, Ph.D.Ben Saunders, Ph.D.

Rochelle Hanson, Ph.D.Rochelle Hanson, Ph.D.

Monica Fitzgerald, Ph.D.Monica Fitzgerald, Ph.D.

Michael de Arellano, Ph.D.Michael de Arellano, Ph.D.

Elizabeth Ciesar, Ph.D.Elizabeth Ciesar, Ph.D.

Jan Koenig, M.Ed.Jan Koenig, M.Ed.

Mission of Mission of Project BESTProject 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.”

Why Use Evidence Why Use Evidence Supported Treatments?Supported Treatments?

Usain BoltUsain Bolt

“…“…when he looked around and realized when he looked around and realized he was all clear with 30 metres to go, he he was all clear with 30 metres to go, he coasted and still set a world record of coasted and still set a world record of 9.69 seconds.”9.69 seconds.” The New Zealand Herald 8/17/08The New Zealand Herald 8/17/08

““Bolt grabbed another gold, running the 200 in 19.30, two-Bolt grabbed another gold, running the 200 in 19.30, two-hundredths of a second faster than Michael Johnson's hundredths of a second faster than Michael Johnson's previous record, set at the Atlanta Olympics in 1996.” previous record, set at the Atlanta Olympics in 1996.” The Seattle Times 8/21/08The Seattle Times 8/21/08

Why Use Evidence Why Use Evidence Supported Treatments?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 RunyonDamon Runyon

Large Gap Between Large Gap Between Scientific Knowledge and Scientific Knowledge and Front-line PracticeFront-line Practice

KnowledgeKnowledge

PracticePractice

Goal…reduce

this gap.

17 years

Great Thoughts About Great Thoughts About EBPEBP

“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

One dayworkshop Use Tx with

appropriateclients

Therapist

Common Continuing Common Continuing Education Dissemination Education Dissemination ModelModel

Book

Administrative Leadership and Support for EBTAdministrative Leadership and Support for EBT

Community/Consumer Support for EBTCommunity/Consumer Support for EBT

TrainingTraining

SupervisionSupervision

Use EST withUse EST withappropriateappropriate

clientsclientsTherapistTherapist

Supportive Supportive Implementation ModelImplementation Model

MaterialsMaterials

ObtainObtainclientclient

feedbackfeedback

ExpertExpertConsultationConsultation

Te

chn

ical

Ass

ista

nce

Te

chn

ical

Ass

ista

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Learning Collaborative Learning Collaborative Emphasis Over TimeEmphasis Over Time

Lea

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-3L

earn

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Lea

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Lea

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Per

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-3A

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Pre

-Wo

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re-W

ork

ImplementationImplementation

TrainingTraining

12-14 Months12-14 Months

““Brokers” of Mental Brokers” of Mental Health ServicesHealth Services

Make a determination (on some basis) that their clients Make a determination (on some basis) that their clients need to be referred for mental health services.need to be referred for mental health services.

Select mental health treatment providers to refer their Select mental health treatment providers to refer their clients to.clients to.

Refer their clients for mental health services (or even Refer their clients for mental health services (or even mandate they go to mental health services.)mandate they go to mental health services.)

Monitor the progress of their referred clients in treatment.Monitor the progress of their referred clients in treatment. Monitor the outcomes of treatment for their referred Monitor the outcomes of treatment for their referred

clients.clients. Take action concerning their referred clients based Take action concerning their referred clients based

on the outcomes of treatment.on the outcomes of treatment.

Referral

Critical Role of Brokers of Critical Role of Brokers of Mental Health ServicesMental Health Services

Dept. ofDept. ofSocialSocial

ServicesServices

MedicalMedicalServicesServices

VictimVictimAdvocatesAdvocates GuardianGuardian

Ad LitemAd Litem

Rape Rape Crisis Crisis CenterCenter

Bro

kers

Bro

kers

MH

Providers

MH

Providers

Dept. ofDept. ofMentalMentalHealthHealth

NonprofitNonprofitMHMH

Services Services

UniversityUniversityMH ServicesMH Services

Private Private PractitionersPractitioners

Community Supply and Community Supply and Demand for TF-CBTDemand for TF-CBT

TherapistsTherapistsBrokersBrokers

Building Community Building Community CapacityCapacity

TherapistsTherapists knowledgeable knowledgeable and skilled and skilled andand using TF-CBTusing TF-CBT

BrokersBrokers knowledgeable knowledgeable

about about andand referring for referring for

TF-CBTTF-CBT

Needed Community Capacity for TF-CBTNeeded Community Capacity for TF-CBT

Current Community SituationCurrent Community Situation

Responsibilities of Responsibilities of Brokers of Mental Health Brokers of Mental Health ServicesServices

Brokers have a responsibility to be Brokers have a responsibility to be reasonablyreasonably familiar familiar with the evidence-based mental health interventions that with the evidence-based mental health interventions that are appropriate for the problems their clients often have.are appropriate for the problems their clients often have.

Brokers have a duty to obtain appropriate, evidence-Brokers have a duty to obtain appropriate, evidence-based treatments for their clients from providers who are based treatments for their clients from providers who are trained, knowledgeable, and skilled in their use.trained, knowledgeable, and skilled in their use.

Brokers have a responsibility to know what types of Brokers have a responsibility to know what types of treatment their clients are getting and to monitor client treatment their clients are getting and to monitor client progress on treatment goals.progress on treatment goals.

Because they take actions based upon treatment Because they take actions based upon treatment progress and outcome:progress and outcome:

Key Elements of a Key Elements of a Community-Based Learning Community-Based Learning CollaborativeCollaborative

Development of a Community Change TeamDevelopment of a Community Change Team● Therapists, clinical supervisors, senior leadersTherapists, clinical supervisors, senior leaders● Brokers, supervisors, senior leadersBrokers, supervisors, senior leaders

Multiple training events over timeMultiple training events over time● Adult learning principles and active learning techniquesAdult learning principles and active learning techniques● Web-based learning Web-based learning ● Promotion of team-building, collective responsibility, and effective Promotion of team-building, collective responsibility, and effective

interaction as well as learning the new practices.interaction as well as learning the new practices. Action periods to implement the new practicesAction periods to implement the new practices

● Practice the new practice with expert consultationPractice the new practice with expert consultation● Expose barriers to implementation and sustainability, find solutionsExpose barriers to implementation and sustainability, find solutions

Promote Collaborative learningPromote Collaborative learning● Discussion board, Resource LibraryDiscussion board, Resource Library● Expert consultation, Peer consultation statewideExpert consultation, Peer consultation statewide● Involvement of prior participants in subsequent learning collaborativesInvolvement of prior participants in subsequent learning collaboratives

Monitor community, agency, and individual outcomesMonitor community, agency, and individual outcomes

Community Change TeamCommunity Change Team

15-20 mental health professionals and brokers15-20 mental health professionals and brokers● Complete all training and implementation activities together.Complete all training and implementation activities together.● Champion the implementation and sustained use of TF-CBT in their Champion the implementation and sustained use of TF-CBT in their

communities. communities.

CCT members include:CCT members include:● Mental health professionals from multiple agencies.Mental health professionals from multiple agencies.

• public mental health agencies, private nonprofit organizations, private public mental health agencies, private nonprofit organizations, private practice.practice.

● Brokers from multiple agencies.Brokers from multiple agencies.• child protective service and child welfare workers, victim advocates, child protective service and child welfare workers, victim advocates,

guardians ad litem, juvenile justice workers, nonclinical CAC workers. guardians ad litem, juvenile justice workers, nonclinical CAC workers.

● Senior leaders, supervisors, and frontline professionals from all these Senior leaders, supervisors, and frontline professionals from all these agencies.agencies.

● Consumers of mental health and broker services.Consumers of mental health and broker services.● Other community stakeholders (?)Other community stakeholders (?)

CBLC Curriculum AreasCBLC Curriculum Areas

Clinical Clinical TrackTrack

TF-CBTTF-CBT

Broker Broker TrackTrack

EBTPEBTPEBCMEBCM

Senior LeaderSenior Leader

SupervisorSupervisor

Common Material and ActivitiesCommon Material and ActivitiesClinicians and BrokersClinicians and Brokers

Team Team BuildingBuilding

JointJointCommunityCommunity

ResponsibilityResponsibility

LearningLearningItIt

DoingDoingItIt

Principles Guiding a Principles Guiding a Community-Based Learning Community-Based Learning CollaborativeCollaborative

Promote collective community responsibility for abused Promote collective community responsibility for abused and traumatized children and their families.and traumatized children and their families.

Build the capacity of Build the capacity of communitiescommunities to deliver ESTs, not to deliver ESTs, not just one agency or set of providers.just one agency or set of providers.

Build the “supply” of therapists who use ESTs properly. Build the “supply” of therapists who use ESTs properly. Build “demand” for ESTs from brokers through use of Build “demand” for ESTs from brokers through use of

EBTP and EBCM.EBTP and EBCM. Build cooperative, sustainable linkages between brokers Build cooperative, sustainable linkages between brokers

and therapists and agencies.and therapists and agencies. Promote organizational and community change as well Promote organizational and community change as well

as individual learning and practice change.as individual learning and practice change. Cultivate local expertise in ESTs.Cultivate local expertise in ESTs.

Lessons LearnedLessons Learned

Brokers are critical to sustained use of ESTs by a community!

Knowledge Knowledge about ESTsabout ESTs

Learning Learning EBTPEBTP

Empowerment Empowerment View of View of jobjob

Questions to Questions to ask Therapistsask Therapists

Tx CriteriaTx Criteria

Implementing Implementing EBTPEBTP

Tx ComponentsTx Components

Lessons LearnedLessons Learned

Marketing (internal/external), Branding, and Style are Marketing (internal/external), Branding, and Style are important. important.

Bottom up, organic spread over time, strategically build Bottom up, organic spread over time, strategically build demand.demand.

How to make it theirs, ownership.How to make it theirs, ownership. Gain state leadership permission and soft, behind the Gain state leadership permission and soft, behind the

scenes encouragement. Avoid directives.scenes encouragement. Avoid directives.

Lessons LearnedLessons Learned

You get what you monitor.You get what you monitor. Well-communicated, simple, directly useful metrics on Well-communicated, simple, directly useful metrics on

multiple levels of implementation are critical. multiple levels of implementation are critical. Tie metrics directly to outcomes.Tie metrics directly to outcomes. Publicize positive anecdotes.Publicize positive anecdotes. Use technology to make it easier: Google Groups, Use technology to make it easier: Google Groups,

Google Apps, Survey Monkey (FREE)Google Apps, Survey Monkey (FREE) Have surprises.Have surprises. Primary attention to cultivating relationships, interaction, Primary attention to cultivating relationships, interaction,

team building.team building.

Process Role of Senior Process Role of Senior LeadershipLeadership

Committed senior leadership is necessary but not Committed senior leadership is necessary but not sufficient.sufficient.

Goal is to change the fundamental way we do business Goal is to change the fundamental way we do business as an organization even as personnel comes and goes.as an organization even as personnel comes and goes.

Senior leadership rolesSenior leadership roles● Interest, commitment, leadershipInterest, commitment, leadership● ParticipateParticipate● Encouragement and tangible rewardsEncouragement and tangible rewards● Offer timeOffer time● Offer resourcesOffer resources● Find solutions to barriersFind solutions to barriers● Avoid directivesAvoid directives

Time to Dive In!Time to Dive In!