Transcript recovery-oriented services - Mental Health America of Kentucky

THE NATIONAL EVIDENCEBASED PRACTICES PROJECT
Sponsored by Robert Wood Johnson Foundation, Center for Mental
Health Services, National Institute of Mental Health, West Foundation,
MacArthur Foundation, Johnson and Johnson Charitable Trust, and 8
State MH Departments
Mental Health America of Kentucky
May 20,2011
Our Outline
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Principles of Recovery
History of EBP’s
Fidelity – A QI Process
Sustainability of EBPs
Ideal Characteristics of a Mental Health
Practice
• Conclusion
Principles of Recovery
• Many pathways to recovery
• Self-directed and empowering
• Recognized need for transformation and
change
• Holistic and has cultural dimensions
• Exists on a continuum
Principles of Recovery
• Supported by peers and allies
• Involves hope, process of healing and selfredefinition
• Addresses discrimination and transcends
stigma
• Involves joining and building a life in the
community
EVIDENCE-BASED
MEDICINE
• DEFINITION OF EVIDENCE-BASED
MEDICINE:
The integration of the best available research in clinical practice in the context
of patient characteristics, culture, and preferences
• TRANSFER TO MENTAL HEALTH
CARE
• EVIDENCE BASED PRACTICES
PHILOSOPHY OF EVIDENCEBASED MEDICINE
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1. USE BEST AVAILABLE EVIDENCE
2. ADJUST FOR INDIVIDUALS
3. HONOR PATIENT PREFERENCES
4. EXPAND CLINICAL EXPERTISE
WHAT ARE EVIDENCEBASED PRACTICES?
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Standardized treatments
Controlled research
Objective outcome measures
More than one research group
VALUES AND ASSUMPTIONS
• People have a right to EBPs
• Recovery as a central theme
• Consumers and families as partners
• Cultural competence
PHASES OF THE EBP
PROJECT
• Phase I: conduct reviews, prepare
implementation packages (consultation,
training, resource materials), and establish
state implementation centers
• Phase II: field tests to refine procedures
and resource materials
• Phase III: national demonstration
PHASE I: IMPLEMENTATION
RESOURCE KITS
• MATERIALS, CONSULTATION,
TRAINING
• MULTIMEDIA
• 5 STAKEHOLDER GROUPS
• PREPARING, ENACTING, SUSTAINING
PHASE II: FIELD TEST
• 8 STATES, 55 SITES, 3 YEARS
• BASELINE CHARACTERISTICS,
IMPLEMENTATION STRATEGIES AND
BARRIERS, FIDELITY, CLIENT
OUTCOMES
Conceptual Framework for Implementing an Evidence-Based Practice
Families
Consumers
Implementation
Package
Mental
Health
Authority
Strategies
and
Barriers
EvidenceBased
Practice
Client
Outcomes
Administration
Program
Leader
Other
Factors
Practitioners
Community Mental
Health Center
Intervention
Stakeholders
Implementation
Process
Implementation
Outcome
PHASE III: NATIONAL
IMPLEMENTATION
• NASMHPD AND SAMHSA
• FEDERAL AND STATE GRANTS TO
PROMOTE IMPLEMENTATION
EVIDENCE-BASED PRACTICES
FOR SEVERE MENTAL
ILLNESS
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MEDICATIONS
ASSERT. COMMUN. TREAT.
SUPPORTED EMPLOYMENT
FAMILY PSYCHOEDUCATION
ILLNESS MANAGEMENT
INTEGRATED DD TREATMENT
COMMON FEATURES OF
EBP’S
• CONSUMER CHOICE AND
PREFERENCES
• INDIVIDUALIZATION
• SKILLS AND SUPPORTS
• AUTONOMY: SELF MANAGEMENT
• ADULT ROLES AND QUALITY OF LIFE
IMPLEMENTATION
GUIDELINES
• LITERATURE ON PROGRAM CHANGE
AND QUALITY IMPROVEMENT
• DEMONSTRATION PROJECTS
• FOCUS GROUPS WITH
STAKEHOLDERS
MATRIX APPROACH
• THREE STAGES OF CHANGE:
PREDISPOSING, IMPLEMENTING,
SUSTAINING
• INVOLVE FIVE STAKEHOLDER
GROUPS
• MULTIPLE STRATEGIES AT EACH
STAGE
MULTIPLE STRATEGIES
• FOR EACH STAGE AND EACH
STAKEHOLDER
• SEVERAL STRATEGIES IN EACH CELL
POLICY MAKERS
• TOP-DOWN SULUTIONS NOT
SUFFICIENT
• SOLVING ORGANIZATIONAL AND
FUNDING PROBLEMS NECESSARY
• MECHANISMS FOR FINANCING,
CONTRACTING, CREDENTIALING,
REGULATING, ETC.
PROGRAM LEADERS
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VISION
ADMINISTRATIVE WILL
LEADERSHIP
STRUCTURES
CLINICIANS/SUPERVISORS
• HEART OF CHANGE PROCESS
• NEW SKILLS, NEW BEHAVIORS
• MOTIVATED TO HELP CLIENTS
ATTAIN RECOVERY
FAMILIES
• IN THE MIDDLE
• INDIVIDUAL, LOCAL, AND SYSTEM
SOLUTIONS
CONSUMERS
• RECOVERY IS CENTRAL
• REAL LIFE IS MORE PERSUASIVE
THAN RESEARCH
• MANY ROLES
PRE-TOOLKIT STEPS
• SELECTING PRACTICES
• REVIEWING THE EVIDENCE
• ASSEMBLING THE TOOLKITS
PUBLIC POLICY
• ONLY FUND SOME EBP’S?
• ONLY FUND 6 EBP’S?
• HOW ARE RESOURCES ALLOCATED?
Fidelity
• Degree to which an intervention is delivered
as intended
• Working Hypothesis: Better implemented
programs (with higher fidelity to EBP) have
better outcomes
Dartmouth Approach to Fidelity
Assessment
• Relatively brief assessment by independent
assessors
• Based on model principles
• Incorporates both research and quality
improvement goals
Data Collection Procedures for EBP
Fidelity Scales
• Ratings made by two independent assessors
• Multiple data sources (interviews, chart
review, observation)
• Fidelity report (with narrative + ratings)
given to site leadership
Format for EBP Fidelity Items
• Items rated on a 5 point behaviorally
anchored continuum:
– 1 = Not Implemented…
– 5 = Fully Implemented
Program Fidelity = total score across items
Sustainability
• Factors in sustainability:
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Finance
Training
Supervision
Staff/Leadership Turnover
Skill and attitude of EBP Practioner
Feedback to Practioner about fidelity
Sustainability
– Agency Leadership
– State/County Mental Health Authority
Leadership
Sustaining Elements
• Reasons for sustaining:
– State Financing, State sponsored training,
agency/program leader
– Training and Supervision: Done regularly,
Training External, Supervision Internal
– Dissemination: State resources for new site
development
Ideal Characteristics of a Mental
Health Practice
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Well defined operationally
Reflect client goals
Consistent with societal goals
Effective
Minimum side effects
Positive long-term outcomes
• Incur Reasonable cost
• Relatively easy to implement
• Adaptable to diverse communities
Conclusions
• Discussion