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Perspec’ves on Trauma Treatment, Brokering, and EBPs Lucy Berliner BEST Fest 2014 January 10, 2014

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Page 1: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Perspec'ves  on  Trauma  Treatment,  Brokering,  and  EBPs  

Lucy  Berliner  BEST  Fest  2014  January  10,  2014  

Page 2: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Consumer  Orienta'on  

•  Collabora've  approach    •  Psychoed  •  Rosters  

Page 3: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)
Page 4: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Psychotropics  Bench  Card  

Page 5: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

MH:  Sources  of  informa'on  regularly  received  by  mental  health  therapists  about  foster  children  for  case  assessment  and  planning    

S tatewide  weighted  

N   148  

Variable   %  

Foster  parent/kinship  caregiver   69  

FTDM,  shared  planning,  or  other  case  mee'ngs   45  

Consulta'on  with  caseworker   43  

Other  assessment   40  

Diagnosis  and  medica'ons  from  medical  professional   40  

Biological  parents   28  

BRS  or  CPA  staff   28  

CASA  reports   26  

Individual  service  and  safety  plans   25  

CHET  screening   7  

Page 6: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

 Types  of  informa.on  rou.nely  provided  to  case  workers  about  mental  health  treatment      

Statewide  weighted  

N   148  

Variable   %  

Diagnosis  and  treatment  recommenda'ons   82  

Treatment  progress  updates   78  

Crises  and  safety  plans   72  

Missed  appointments   58  

Recommenda'ons  regarding  current  living  situa'on   39  

Recommenda'ons  regarding  permanency   39  

Recommenda'ons  regarding  visita'on   33  

Other   25  

None  of  the  above   3  

Page 7: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

MH  and  CWS  Communica'on  

•  CWS  screen  and  facilate  access  •  Standards  for  communica'on  

– What?  – How  o[en?  – For  what  purpose?  

•  MH  assess  and  tx  

Page 8: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

What’s  Next  in  EBP?  

•  Models/packages  v  modular  •  Flexibility  within  fidelity  •  Treat  to  target  •  Alterna've  modes  

Page 9: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

EBP  in  the  Future  Mul'ple  EBTs   Modular  EBT  

and/or   and/or?  

Hawaii  

Page 10: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Hawaii  Model:  Pick  off  “Blue  Menu”,    Iden'fy  target,  Document  clinical  components  

Page 11: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)
Page 12: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Treat  to  Target  

Page 13: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Toolkit  Dashboard  

Page 14: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

The  Key:  Feedback  to  Client  

Page 15: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Supervision  Study-­‐Shannon  Dorsey  

Sx    Feedback  Monitoring  (SFM)  

SFM  +  Behavioral    Rehearsal  

Page 16: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)
Page 17: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)
Page 18: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Ra'ng  

Page 19: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Iden'fying  Competencies  (Beidas,  2010)  

Page 20: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Method   Competence   Fidelity  

Direct   Role play/BR  

Tapes  

Live observation  

Tapes  

Live observation  

Indirect     Detailed case discussion  

Provider checklists/

progress notes  

Client checklists/surveys  

Methods  of  Assessing  Competence  and  Fidelity  

Page 21: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

EBP   Purveyor  Controlled   Ini.al  Competence   Ongoing  Fidelity  Monitoring   Ongoing  Purveyor  

Requirement    

SafeCare   Yes   Approved  training  +live  coaching  with  

feedback  to  mastery  

Once  a  month  tape  review  +  coach  

self  report  adherence.  

Yes.  But  procedure  for  local  

trainer/consultant.  

MST   Yes   Approved  training  +   Detailed  supervisor  ra'ngs.  

Periodic  surveys  of  clients  re  9  

principles.  

Yes.  Training  and  fidelity  

monitoring.  

FFT   Yes   Approved  training  +Trainer  wrihen  

feedback  on  trainees  

 FFT  consultant  ra'ngs  of  thx;  thx  

completes  standard  note;  family  

and  thx  measures  at  periodic  

intervals  

Yes.  Training  and  fidelity  

monitoring.  

Triple  P   Yes.  Training.   Approved  training  +  knowledge  test  

and  role  play  rated  by  trainer  

No.   No.  

PCIT   No.  But  PCIT  

Interna'onal  sets  

standards.  

Approved  training  +  expert  cases  

consulta'on  and  tape  review  

Not  required  but  standard  set  by  

PCIT  Interna'onal.  consulta'on  x1/

month  with  Cer'fied  Master  Level  

Trainer,  Thx  adherence  checklist..    

Standard.  Ahendance  at  2  

na'onal  conferences  a  year.    

AF-­‐CBT   Yes.  Training;  

competence.    

Approved  training  +  12  expert  

consulta'on  sessions+  2  tapes.  

No.   Yes.  But  establishing  

procedures  for  local  trainer/

consultants.  

Examples  of  Competence  and  Fidelity  Measures  

Page 22: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Results  of  CBT+  Org  Survey  

Tend  to  do  this  MORE  for  interns;    not  staff  clinicians  

Page 23: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Everyday  Fidelity:  Progress  Note  

Prompts  for  EBP:    • Homework  Compliance  • Specific  Sx  • Components  • Scores  • Homework  Assigned  • Next  Session  

Page 24: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Delivery  Modali'es    

•  In-­‐person  visit  – Office,  in-­‐home,  school,  integrated  primary  care  

•  Phone  – Telemed    – Smart  phone  applica'ons  

•  Internet  (psychoeduca'on,  interven'on)    

 

Page 25: Lucy Berliner BEST Fest Slides - PART 2 - Medical University … · Mul’ple)EBTs) Modular)EBT) ... and/or?) Hawaii) Hawaii)Model:)Pick)off)“Blue)Menu”,))Iden’fy)target,)Documentclinical)components)

Thank  you  [email protected]  


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