implementing evidence-based practices

Implementing Evidence-Based

Practices

Implementing Evidence-Based

Practices

The Addiction Technology Transfer Center Network

Funded by Substance Abuse and Mental Health Services Administration

1. Systems change model• Definitions• Principles• Strategies• Activities• Steps

2. Case study3. Discussion

OverviewOverview

• Policies that accommodate evidence-based practices

• Supportive system administrators• Willing agency directors• Skilled clinical supervisors• Opinion leaders who are convinced• Skilled service providers• Opportunities for staff/client input

A Comprehensive Strategy IncludesA Comprehensive Strategy Includes

Barriers Can IncludeBarriers Can Include

• Administrative philosophy

• Organizational policy

• System structure

• Unclear literature

• Agency staff

• Client population

????????So, how do you decide what to do?

So, how do you decide what to do?

• Principles • Strategies • Activities • Steps

The Change BookThe Change Book

• Relevant

• Clear

• Multifaceted

• Bi-directional

Change Initiatives Must Be

Change Initiatives Must Be

The PrinciplesThe Principles

• Timely

• Credible

• Continuous

• Multifaceted

• Continuous

• Bi-directional

Don’t Forget the Last ThreeDon’t Forget

the Last Three

The PrinciplesThe Principles

Creating Your Blueprint

The Ten Steps

Creating Your Blueprint

The Ten Steps

1. Identify the problem

2. Organize a team

3. Identify an outcome

4. Assess your organization

5. Assess your audience

The StepsThe Steps

Ten Steps of EffectiveChange Initiatives

Ten Steps of EffectiveChange Initiatives

6. Identify the approach

7. Design action and maintenance plans

8. Implement the plans

9. Evaluate your plans

10. Revise your plans

The StepsThe Steps

Ten Steps of EffectiveChange Initiatives

Ten Steps of EffectiveChange Initiatives

• Administrative/structural• Bi-directional dialogue• Information dissemination • Education• Person to person• Evaluation

Types of ActivitiesTypes of Activities

Systems Change:A Case Study

Systems Change:A Case Study

• Chronic substance abusers with extensive criminal histories and serious psychological and social deficits

• Hardcore poly-drug users who began using drugs at 17; most still using 15 years later at treatment entry

Women’s Residential Center: Client Characteristics

Women’s Residential Center: Client Characteristics

• Heavily involved in criminal activity – 73% arrested at least 5 times as an adult

• Victims of physical and sexual abuse in adulthood – 75% physically abused by a partner and 45% sexually abused

• In poor health, lack education and work experience, and have serious mental health problems

Women’s Residential Center: Client Characteristics

Women’s Residential Center: Client Characteristics

• Completed treatment 1999 - 48%

• Did not complete 1999 - 26% 0

5101520253035404550

1999

Comp

Non-Comp

VOA Women’s Program No Arrests After One Year VOA Women’s Program

No Arrests After One Year

• Completed treatment1999 - 48%

2001 - 86%

• Did not complete1999 - 26%

2001 - 67%

0

10

20

30

40

50

60

70

80

90

1999 2001

Comp

Non-Comp

VOA Women’s Program No Arrests After One Year VOA Women’s Program

No Arrests After One Year

Precontemplation Always assess and re-assess

readiness to change and develop a plan based on stages of change

Bi-directional

Contemplation Preparation

Develop a vision that everyone understands and supports

Clear

Bi-directional

Relevant

Timely

Stage of Change Action Principle

Action Build on what you have and what is already in place

Integrate what you know with the technology you want to apply

Relevant

Credible

Clear

Our Change Process - Lessons Learned

Our Change Process - Lessons Learned

Preparation

Action

It is a process

It’s a long-term effort achieved by meeting short-term objectives

Multi-faceted

Action “Wrap it pretty” Use incentives and

reinforcements What comes off the plate

when new responsibilities are added?

Multi-faceted

Continuous

Stage of Change Action Principle

Our Change Process - Lessons Learned

Our Change Process - Lessons Learned

LSILSI --RRLevel of Service I nventory – Revised

The LSI–R is a quantitative survey of attributes of offenders and their situations. The LSI -R is useful

for identifying dynamic and static risk factors related to recidivism.

Developed by D.A. Andrews, Ph.D. and James L. Bonta, Ph.D.

For More I nformation Contact:MULTI -HEALTH SYSTEMS

P.O. Box 950 North Tonawanda, NY 14120-0950

1-800-456-3003www.mhs.com

• 26-session program for female offenders

• Help women identify and mobilize personal and community resources

• Educational and cognitive skill building

• Delivered in small groups or individually

Marilyn Van Dieten, Ph.DPatricia Mac Kenna, M.A.

416-539-9300vandieten@aol.com

Moving OnMoving On

Action

Maintenance

Comprehensive and long-term effort

Utilize training, manuals, supervision, consultation

Use a variety of methods to present information

Build partnerships with customers, funders, stakeholders

Capitalize on staff strengths

Establish a systematic problem-solving process

Multi-faceted

Continuous

Bi-directional

Credible

Stage of Change Action Principle

Our Change Process - Lessons Learned

Our Change Process - Lessons Learned

Maintenance

Relapse

Anticipate barriers and relapse

• Respond with strength-based approaches and interventions based on the stages of change

• Back to precontemplation and contemplation

Continuous

Bi-directional

Stage of Change Action Principle

Our Change Process - Lessons Learned

Our Change Process - Lessons Learned

In SummaryIn Summary

• Assess and address staff and organizational readiness for change

• Check assumptions of all stakeholders as project begins

• Secure staff buy-in

Knowledge Adoption – Lessons Learned

Knowledge Adoption – Lessons Learned

• Utilize researcher and provider collaboration throughout the project

• Implement a design tailored to the realities of the agency

• Develop a plan sufficient to accomplish your objectives

• Have an on-site champion

Knowledge Adoption – Lessons Learned

Knowledge Adoption – Lessons Learned

• No system change works without a process

• Effective strategies are multi-faceted, bi-directional and continuous

• Representation of all stakeholder groups in decision-making facilitates buy-in and adoption

• Continuous promotion, training and mentoring builds top-of-mind awareness and consistent use

Final TipsFinal Tips

Implementing Evidence-Based

Practices

Implementing Evidence-Based

Practices

The Addiction Technology Transfer Center Network

Funded by Substance Abuse and Mental Health Services Administration