Walton, Betty A.

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Using Transdisciplinary Knowledge to Implement Evidence-Based Practices with Support from Client-Level Outcome Measures Betty A. Walton, PhD, LCSWMay 19, 2014INDIANA UNIVERSITY____________________SCHOOL OF SOCIAL WORK4th International Conference on Sociology and Social WorkLos Angeles, CAIntroduction• Social work researchers, used to complex systems with focus on change (Brekke, 2012), arewell positioned to link research and practice (Nurius & Kemp, 2012).• Partnering with allied professions strengthens translational research (Nurius & Kemp) to improve lives of individuals. Need for Transdisciplinary Research & Practice• The gap between evidence-based practice (EBP) and usual community mental health services exemplifies need for transdisciplinary theory and research to improve practice(Beidas, et al., 2013; Commission on Mental Health, 2003).Implementation Science•Implementation of an EBP is a complex, incremental process (Fixsen, 2005). •After fitting an innovation (EBP) to an identified need, the innovation is modified to fit the organization; structures are altered (Rogers, 2003).  •Implementation theory and research support using client-level outcomes in public settings as a strategy to implement EBPs  (Raghavan, Bright, and Shadoin, 2008; Torrey, Bond, McHugo, & Swain, 2012). •To be effective, EBPs and outcome measures must be integrated into public system requirements, agency protocols, and every-day practice.Implementation of an EBP High Fidelity Requires… Local Context and ReadinessStaffSelectionTrainingSupervision and CoachingPerformance ManagementProgramEvaluationOrganizationalSupportsSystem SupportNational Implementation Research Network (NIRN, Fixsen et al., 2005)System-wide Outcome Measures Support Implementation of EBPs• Child and Adolescent Needs and Strengths (CANS, Lyons, 2009) and the Adult Needs and Strength Assessment (ANSA, Lyons) outcome measures• Client-level outcome measures support decisions, monitor progress, and help improve services (Lyons). Communimetric Tools (Lyons, 2009)CANS & ANSA:• Functional Assessments• 0-3 points rating scale• Common Language across service systems• Total Clinical Outcome Management (TCOM) Processes• Copyright: Praed Foundation, 1999Domains:  • Life Functioning • Strengths• Behavioral Health • Risks• Caretaker Strengths                  & Needs • Acculturation Using Assessment Information • Map identified needs to EBPS to support referral decisions• Partnership with state child welfare agency to map CANS information to EBPS.“DCS is still working on the service mapping process but that we plan to use the CANS in combination with other assessment tools and information gathered from the DCS case management system.”  (IN Department of Child Services, 2/2014)  Example:  Mapping PlanChild Parent Psychotherapy (CPP, Liberman, Van Horn, & Ippen, 2005) CANS Screening Items ExclusionsOther ConsiderationsAdjustment to Trauma (2,3) ANDSexual AbuseORDomestic ViolenceOR Traumatic GriefORDisasterORTerrorismORComplex TraumaOlder YouthParents not availableCaregiverParents InvolvedDepressionTrauma HistoryTrauma SymptomsChildAges Birth to 6Trauma ExposureDevelopmental Functioning“Mapping” Process• For whom was service intended?  Who benefits? (Literature Review)• Talk to purveyor of practice & experts.• Cross walk identified CANS or ANSA  needs, strengths, and relevant information (age, etc.) with EBP • Create decision model (algorithm)• Trial with clinical review• Implement with support of technology• Monitor and use information to improve practice• Refine algorithm0 No Recommendation 332 < 1%1 Outpatient 5,460 10%2 Outpatient with Occasional Case Management 1,576 3%3 Supportive Community Based Services 17,029 32%4 Intensive Community Based Treatment and Support 21,168 40%5 Intensive Community Based: AssertiveCommunity Treatment (ACT, Mancini, et al., 2009) 7,212 14%Behavioral Health Decision Model Recommendations7/1/2013 and 3/31/2014Initial Assessments Only (n=52,777)Report from DMHA’s  DARMHA 4/22/201419.538.252.544.434.410.219.2 20.1 18.44.40102030405060Rev BaselineJun-10Percentage of Actionable Behavioral Health Symptoms for Young Adults (n = 1164, duration = 12 months)(Israel, Lyons, Walton,& Friedman, 2013; Walton, Clark, Kim, & Haber, 2013)41.650.654.453.749.27767.161.266.153.850.445.90102030405060708090Rev BaselineJun-10Percentage Buildable/Identifiable Strengths for Young Adults (n=1164, duration = 12 months)(Walton, Clark, Kim, & Haber, 2013)Challenges• Purveyors often claim EBPs are effective for wide range of needs.• Algorithm may be linked to policy; need resources to monitor and adjust.• Workforce Development• Technology DevelopmentLessons Learned• Transdisciplinary and cross-system partnerships enrich knowledge, quality of research and application in practice.• Translational research to improve human services is enriched through such partnerships.ReferencesBeidas, R., Aaron, G., Barg, F., Evans, A., Hadley, T., Hoagwood, K. … Mandell, D.S.  (2013). Policy to implementation: evidence-based in community mental health—study protocol.  Implementation Science, 8(38), http://www.implementationscience.com/content/8/1/38.  Brekke, J. S. (2012). Shaping a science of social work. Research on Social Work Practice, 22(5), 455-464. Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M., & Wallace, F.  (2005). Implementation research: A synthesis of the literature. Tampa, Florida: University of South Florida.  Israel, N., Lyons, J. S., Walton, B. A., & Friedman. R. M. (2013, March). Taking Systems Change to Scale: Building Replicable Processes. Symposium at the Child Mental Health Research and Policy Conference, Tampa, FL: University of South Florida.Liberman, A.F., Van Horn, P., & Ippen, C.G. (2005). Toward evidence-based treatment: Child-Parent psychotherapy with preschoolers exposed to marital violence.  Journal of the American Academy of Child Psychiatry, 44(12), 1241-1248.Lyons, J.S. (2009).  Communimetrics: A Communication theory of measurement in human service settings. New York:  Springer. Mancini, A.D., Moser, L.L., Whitley, R., McHugo, G. J., Bond, G., Finnerty, M.T. Burns, B. J. (2009). Assertive community treatment: Facilitators and barriers to implementation in routine mental health settings.  Psychiatric Services, 60(2), 189-195.New Freedom Commission on Mental Health.  (2003). Achieving the promise: Transforming mental health care in America. Final report. DHHS Pub. No. SMA-03-3832. Rockville, MD: 2003.Nurius, P. S. &  Kemp, S. P. (2012). Social work, science, social impact: Crafting an integrative conversation.  Research on Social Work Practice, 22(5), 548-552.  Raghaven, R., Bright, C. L., & Shadoin, A. L. (2008). Toward a policy ecology of implementation of evidence-based practices in public mental health settings.  Implementation Science, 3(26), dol: 10.1186/1748-5908-3-26Rogers, E. M.  Diffusion of Innovation. (5th Ed.) New York:  Free Press.  Torrey, W. C., Bond, G.R., McHugo, G.J. and Swain, K. (2012). Evidence-based practice implementation in community mental health settings:  The relative importance of key domains of implementation activity. Administration and Policy in Mental Health and Mental Health Services Research, 39, 353-364.Walton, B. A., Clark, H., Kim, H., & Haber, M. (2013, November). Using Communimetric Tools with Transition-Age Youth & Young Adults. Presentation at the 9th Annual CANS Conference, San Francisco, CA.  Contact Information:Betty A. Walton, PhD, LCSWIndiana University School of Social Work  &Indiana Family & Social Services AdministrationDivision of Mental Health & AddictionIndianapolis, INbeawalto@iupui.eduBetty.Walton@fssa.IN.gov

Using Transdisciplinary Knowledge to Implement Evidence-Based Practices with Support from Client-Level Outcome Measures

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Using Transdisciplinary Knowledge to Implement Evidence-Based Practices with Support from Client-Level Outcome Measures

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