session 3 tampa 2015 bertram and kerns - cmh...

28th Annual Research & Policy Conference on Child, Adolescent and Young Adult Behavioral Health Tampa

March 22‐25, 2015

WHO WE ARE An international consortium, a rich

and growing community of faculty, implementation specialists, program administrators, developers, practitioners, and researchers.

WHAT WE DO Consortium members collaborate in

technical assistance & research dissemination. We promote networks of learning about evidence‐based practice, workforce development, & program implementation

OUR PURPOSE Improving the lives of children,

youth and families through effective program selection, implementation, and workforce development.

Sessions organized by Child & Family Evidence Based Practice Consortium

Session 3: Workforce development: Integrating academic & behavioral health care program responsibilities

Session 14: Statewide quality improvement: Enhancing fiscal viability of child & adolescent mental health clinics

Session 36: MST building stronger families: The power of partnership with child welfare

Sessions organized by Child & Family Evidence Based Practice Consortium

Session 47: Using implementation science to address child welfare trauma & behavioral health needs in 4 states

Session 57: Centers of Excellence: Dissemination & implementation of evidence based practices within systems of care

Session 67: Building the evidence for the RENEW Transition Model: Theoretical & methodological development

Session 77: Implementation science applications to integrate evidence based practices into complex systems

Some of our research & disseminationEBP selection, implementation, research & policy

Bruns, E.J., Hoagwood, K.E., Rivard, J.C., Wotring, J., Marsenich, L., & Carter, B. (2008). State implementation of evidence‐based practice for youth: Recommendations for research and policy. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 499‐504.

Bertram, R.M., Kerns, S.E.U., Bernstein, D., Mettrick, J., Marsenich, L., Kanary, P.J., & Choi, S.W. (2015). Evidence‐informed practice in systems of care: Misconceptions and facts. Technical Assistance Network for Children’s Behavioral Health, Baltimore, MD.

Bertram, R.M., Kerns, S.E.U., Bernstein, D., Mettrick, J., Marsenich, L., Kanary, P.J., & Choi, S.W. (2015). Evidence‐informed practice in systems of care: Frameworks and funding for effective services. Technical Assistance Network for Children’s Behavioral Health, Baltimore, MD.

The Child and Family Evidence‐Based Practice Consortium

Some of our research & disseminationWorkforce development

Survey of North American behavioral health care administrators & supervisors (Barwick, 2011)

Survey of EBPs in North American MSW programs (Bertram, Charnin, Kerns, & Long (in press)

MSW faculty webinars begin April 7, 2015

Survey of North American Marriage & Family Therapy programs begins April 2015


Participate at: http://ebpconsortium.com

EBP Workforce DevelopmentTo what extent is evidence‐based practice taught

in graduate courses & field instruction?

Are implementation frameworks included in graduate curricula & applied at field sites?

Evidence Based Practices in North American MSW Curricula

Rosalyn M. Bertram PhD and Leia Charnin MAUniversity of Missouri‐Kansas City

School of Social Work

Suzanne E. U. Kerns PhDUniversity of Washington

Department of Psychiatry and Behavioral Sciences Division of Public and Behavioral Health and Justice Policy

Anna C. J. Long PhDLouisiana State University

School Psychology, Department of Psychology

Research on Social Work Practice (in press)

Exploratory SurveySeries of EBP Consortium calls to develop survey

Support from National Association of Deans & Directors

Follow‐up to Barwick (2011) exploration of EBP preparedness with North American behavioral health care leaders

EBP definition identical to Barwick (2011) Defined elements, activities, phases Proven effective with specific populations in RCTs

Included Barwick (2011) EBP readiness questions

Exploratory Survey of MSW programsN=58

Geographic location

Number of students

Number of faculty by position

Number of faculty by position that teach EBPs

Which EBPs are taught

To explore extent to which each EBP is taught, survey focused through NIRN intervention component framework

Qualitative exploration of supports, barriers, implications

Comparison to Barwick (2011)Results

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

SkillNecessary

Skill Evidentat Hire

Skill LearnedPost Hire

Extent SkillAddressed by

MSW Programs

Perc

enta

ge

Necessity & Presence of Scientific Approach Skills

Somewhat

Thoroughly

Barwick (2011)Results

EBP in MSWCurricula Study



0%10%20%30%40%50%60%70%80%90%

100%

SkillNecessary




MSW Programs

Perc

enta

ge

Necessity & Presence of Critical Appraisal Skills

Somewhat

Thoroughly





0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

SkillNecessary




MSW Programs

Perc

enta

ge

Necessity & Presence of Search Skills

Somewhat

Thoroughly




Some Results

43 of 58 programs identified EBPs that met study definition:

Mostly CBT, Motivational Interviewing, or family‐centered models

Less taught: Assertive Case Management, Solution‐based Casework

Sixteen practices incorrectly identified as evidence‐based

Seven small programs did not teach EBPs

Theory of change often not taught

Effectiveness with specific populations often not taught

EBPs Taught

0

5

10

15

20

25

30

Total

n=1N= 1Assertive case managementBehavior activationBehavioral parent trainingBrief solution focused txEmotion Focused Therapy EMDRExposure based trauma txFamily group conferencing Function‐based interventionsMindfulness stress reductionMultidimentional Foster CareSchema Focused therapy

Perceived Positive Implications

0

2

4

6

8

10

12

14

16

18

20

Funding Access Client Benefits ProfessionalCredibility

WorkforcePreparation

Tota

l R

espo

nses

Skill Building

AcademicPreparation

Workforce Preparation Key


Faculty Teaching EBPs


0

5

10

15

20

25

30

Full Professor Associate Professor Assistant Professor Instructor Adjunct Faculty

TotalFaculty

TeachingSpecificEBPs

The Continuing EBP Debate in Social Work

Questions regarding definition of EBP

Concerns about client diversity & client choice

Eclectic practice: Practitioner creativity vs. defined model

Implementation concerns

Ability of MSW faculty & programs to teach EBPsFaculty Knowledge

Faculty GovernanceField Practicum Site Limitations

Limitations of Required Curriculum

Barriers to Teaching EBPs

0

5

10

15

20

25

30

35

40

FieldPlacement

CurriculumDevelopment

EBP Definition Faculty

Tota

l R

espo

nses


Faculty‐Related Barriers

0

2

4

6

8

10

12

14

Faculty not versedin EBPs

Definitionalconfusion or

disagreement

Resistance tochange

Adjunct facultylimitations


What Stalls Curricula InnovationFalse beliefs That specific EBPs have not been tested with diverse populationsThat treatment guidelines limit creativity or client choiceThat applying a blend of different theory bases & techniques is effective

False dichotomy EBP as a process vs. specific evidence‐based practices

False notion Service organizations can effectively support eclectic EBP cannibalization

The “private practitioner assumption”That eclectic practice is possible when most graduates are employed by agencies that increasingly are expected to deliver specific EBPs.


Janus Webinar Series GoalsTo develop a technical assistance & research network in which we:

Identify challenges & receive assistance to promote evidence based practice in academic & field curriculum

Share examples of successful inclusion of evidence based practice in academic & field curriculum

Pursue research, funding, & publishing opportunities

Beginning with the end in mind

Benefits of Evidence Based Practice

For MSW programs Funding, research & publishing opportunities

Integrated curriculum via implementation frameworksImproved program reputation attracts students & productive faculty

For MSW studentsConfidence & competence in defined well implemented services

Marketable knowledge & skills


Webinars Address EBP Misconceptions

• EBPs are a ‘cookbook’ approach to very complex issues

• EBPs don’t account for or engage practitioner expertise

• EBPs ignore client values & preference

• EBPs don’t take into account issues of client diversity

• EBPs disregard the importance of the therapeutic alliance

Webinars actively present, explore & develop:

Challenges experienced advocating integration of EBPs in MSW Curricula

Successful strategies for integrating EBPs in MSW Curricula

Webinar blog creates network of TA & scholarship

Evidence‐Based Practice: A Disruptive Innovation

Innovation in a product or service disrupts markets & organizations Disruptive innovations create new markets & value networks

(social & structural resources & knowledge) Value networks are interdependent

(academic & behavioral health care programs) With common frameworks in the new value network,

organizations can not only survive, but thrive


NIRN Frameworks: Common Elements for New Networks?

Child & Family Evidence Based Practice Consortium

Janus Curricula Innovations Connecticut, New York, & Massachusetts MSW programs integrate

EBP electives with behavioral health care provider organizations

Interdisciplinary program at University of Washington’s School of Medicine for behavioral health care graduate students

Washington University George Warren Brown School of Social Work’s infusion of EBPs throughout BSW and MSW curricula

UMKC MSW program evaluation course MSW students (n=40) learn & focus through NIRN frameworks to evaluate program implementation at their field placement sites (n=34) Bertram, King, Pederson & Nutt, 2014

Each multi‐method evaluation examined Intervention components Competency drivers Organization drivers

NIRN Intervention Components

Model definition

Theory base(s)

Target population characteristics

Theory of change

Alternative models (why they were rejected)

NIRN Implementation Drivers

UMKC students & field sites are learning

All organizations are designed intentionally or unwittingly to achieve precisely the results they get.

Necessity of clarifying practice model: Activities, elements, participants, phases & theory base(s)

Research should support its application with client population

Understanding & actively using its theory of change

Adjusting implementation drivers to support practice model

Contributes to students critically questioning MSW curriculum

UMKC NCWWI University Partnership GrantSince 2014‐15, systematically applied via 5 year NCWWI grant to transform MSW curricula & Missouri child protection services

We examine & refine workforce selection & development

Public & Private PartnersMissouri Children’s Division

UMKC MSW programCornerstones of Care

Child Protection Center

UMKC NCWWI University Partnership GrantKey Elements

Seek diverse, life experienced trainees, not necessarily from child welfare Receive full scholarship & post graduate employment Intensive academic & field cohort experience Medical‐school style 8 week field rotations in public & private child welfare Weekly seminar integrates & evaluates academic & field learning experiences Weekly field portfolio tracks activities/fidelity to field learning plan Field learning plan actively injects peer reviewed lit into field instruction

UMKC NCWWI University Partnership GrantKey Elements

Principal investigator serves as liaison to field instructors & trainees

Instructor Academy every 4‐6 weeks (field instructors & principal investigator) Reviews use of weekly field portfolios Reviews introduction of peer‐reviewed literature Reviews trainees’ evaluation of program implementation at each site Shares instruction/trainee development strategies/activities Prepares & facilitates trainee rotations Develops individual trainee profiles for post‐grad employment

End of semester trainee focus group & instructor focus group evaluations Data inform curriculum and field activity refinements Tim Decker, state director of MO Children’s Division actively participates

Post‐grad trainees participate in annual grant evaluations & orientations

UMKC NCWWI University Partnership GrantWorkforce Excellence Award

Missouri is one of 3 sites selected for three years of evaluation, training & TA

Transformation of climate/culture Middle management transformation/development (LAMM)Supervision transformation/development (LAS)

Re‐definition of Family‐Centered Service Model & its implementation includes:Elements of Solution‐Based Casework, Family Group Conferencing, Five Domains of Well‐Being, Strengthening Families Framework, and use of fit‐circle multi‐systemic assessment, etc.

New model may be tested as initial & continuing point of contact with families

Kansas City serves as one of four transformation zones, then scale up across state

The Child and Family Evidence‐Based Practice Consortium 40

Contact Informationhtpp://ebpconsortium.com

Rosalyn M. Bertram PhDUniversity of Missouri‐Kansas City School of Social Work Principal investigator NCWWI university partnership grant

Co‐director Child & Family Evidence Based Practice [email protected]

Suzanne Kerns, PhDUniversity of Washington

Principal investigator EBPs in MFT Curricula study Department of Psychiatry and Behavioral Sciences

[email protected]

The Child and Family Evidence Based Practice Consortium

session 3 tampa 2015 bertram and kerns - cmh...

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