intermediary organizations in implementing evidence -based...
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Intermediary Organizations in Implementing Evidence-based
Practices Robert P. Franks, Ph.D.
Jeffrey Vanderploeg, Ph.D. Connecticut Center for Effective Practice
Child Health & Development Institute
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Rationale for Using Evidence-based Practices
Changing “landscape” of practice in mental health, juvenile justice, education & health • Push for Accountability…”where is the data?” • Increased quality and relevance of research
Emergence of the concept “Best Practices”
• What is a best practice? • More than…”what we already do” • More than a theoretical approach
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Biases about EBPs “They are too rigid and cookbook” “Doesn’t apply to real world kids with real world, multi-problem
histories” “Developed in some lab” “Overly simplistic” “Too difficult to implement in community setting” “Just a band-aid and doesn’t address underlying issues and concerns” “Another passing fad” “My training and expertise are not valued”
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Economic barriers to implementing EBPs
• Little financial support for implementation • Community-based and independent providers “barely getting by” • No mechanism for supporting supervision and
training necessary for implementing EBP’s in a fee-for-service environment
• Providers do not see that up front investment will yield longer term gains
• Turnover is high • Medicaid and managed care do not routinely
reimburse or create incentives to deliver EBPs
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Workforce Barriers to Implementation
• Some clinicians may not share theoretical
perspective and see EBPs as incompatible with their worldview
• Neophyte clinicians may not receive adequate training and not sufficiently prepared exiting graduate programs
• Turnover is high and clinicians are underpaid • For some types of EBPs work can be intensive
and not “traditional” • Difficulty finding appropriate supervision • Lack of incentives or support to change practice
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• Practice Changes • Organizational Changes • Systems Changes • Continuous Quality Improvement • Outcome Evaluation • Consumer Involvement • Policy Changes • Adequate ongoing funding and
support
Elements necessary for successful implementation
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Bridging the gap
• Difficult to bridge the gap between science and practice
• Practitioners in community settings often feel that evidence-based models are developed in some laboratory and are both impractical and inaccessible in real world settings
• Systems of care often do not have the capacity or knowledge to effectively implement best practice or model programs
• Result is lack of innovation and improvement in community based settings
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Bridging the gap
• Organizations work “in between” treatment developers or researchers and providers in the community
• Help identify best practice models and adapt them to
community based settings • Fixsen (2009) identified these organizations as
“purveyor” or “intermediary” organizations
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Expanding the Definition
What is an “Intermediary Organization”???
How does it differ from a “Purveyor”?
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Purveyor and Intermediary Organizations
Purveyor Organizations An individual or group of individuals representing a practice that work to implement a model program with with fidelity and good effect Typically involved in the implementation of a specific evidence-based practice (e.g., MST)
Intermediary Organizations An individual or group of individuals that acts as a intermediary between two or more entities to promote the implementation of model programs with fidelity and good effect. Defined as having a broader role to promote implementation including building the capacity of providers or systems to implement and sustain best practice models.
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Expanding the definition
• Intermediary organizations do more than just purvey a specific program or programs
• Serve multiple roles and functions to build capacity, promote systems change and sustain best practice models
• Intermediary organizations are crucial to implement and sustain change
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Case Example of an Intermediary Organization
• The Connecticut Center for Effective Practice developed as an intermediary organization to promote the implementation and sustainability of best practices in children’s mental health in the State of Connecticut, USA
• Works with multiple national and local partners in a variety of capacities to implement best practice models and promote systems change
• Housed in a non-profit policy and research institute and funded by multiple sources
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Connecticut Center for Effective Practice
• An example of an intermediary organization
• Formed over 10 years ago to address the challenge of implementation of evidence-based and best practices within a state system of care
• Housed at a non-profit with strong collaborative relationships with state agencies and major universities
• Emphasis on partnerships and collaborative relationships
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Framework of the Intermediary Organization
Case example of the Center for Effective Practice 1) Identification, adoption and implementation of
evidence-based and best practice models in children’s healthcare
2) Research, evaluation, and quality assurance of new and existing services
3) Education and public awareness about evidence-based and best-practice models
4) Development of infrastructure, systems and mechanisms for implementation and sustainability
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7 Major Activities of the Intermediary Organization
1) Consultation Activities 2) Best Practice Model Development 3) Purveyor of Evidence-based Practices 4) Quality Assurance and Continuous Quality
Improvement 5) Outcome Evaluation and Research 6) Training, Public Awareness, and Education 7) Policy and Systems Development
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Consultation Activities
• Consultation to state agencies on systems development, implementation of model practices and practice improvement
• Consultation to provider organizations on workforce development, strategic planning, capacity building, organizational development, senior leadership and systems change
• Active participation in statewide forums, committees and task forces that promote systems change
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Best Practice Model Development
• Therapeutic Supports Services
• Extended Day Treatment Services
• Emergency Mobile Psychiatric Services
• School-based Diversion Initiative
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Purveyor of EBPs • Multisystemic Therapy
– 30 agencies over 4 years
• Trauma-focused Cognitive Behavioral Therapy – 16 agencies over 3 years through statewide learning
collaborative
• Community-based Wraparound
-Two pilot regions expanding to statewide dissemination
• Child FIRST
– 8 regions over three years through statewide learning collaborative
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Quality Assurance and Continuous Quality Improvement
• Help agencies develop quality improvement systems, use metric data, and monitor outcomes
• Training, capacity building and technical assistance
• Online data systems, analysis and continuous feedback
• Helping providers use data to promote organizational and systems change
• Example: Performance Improvement Center Emergency Mobile Psychiatric Services
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Outcome Evaluation and Research
• Promote systematic evaluation of all services and programs
• Build systems based on best practice models and established research
• Qualitative and quantitative methods
• User friendly reporting and use of data to inform clinical decision making
• Example: Statewide evaluation of MST
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Training, Public Awareness, and Education
• Provider trainings
• Family & consumer education
• State agency trainings & workforce development
• Local, state, national and international conference presentations and participation
• Comprehensive communications strategy including publications, briefs, web content and media relations
• Website development
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Many Examples of Success
• Development and implementation of best practice models of care resulting in improved outcomes for children and families (TSS, EDT, SBDI).
• Statewide dissemination and implementation of
evidence-based models: (MST, TF-CBT, Wraparound, Child FIRST, CONCEPT)
• Implementation methodology development (Learning Collaborative)
• Continuous Quality Improvement (PIC)
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Policy & Systems Development
• Advocacy efforts
• Leadership in statewide governance and advisory roles
• Ongoing engagement of state legislators
• Policy development
• Medicaid management and reform
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Challenges and Lessons Learned
• Ongoing funding (particularly in current economic environment) is challenging
• Training, implementation activities, evaluation and
quality improvement are first services to be cut • Systems level, organizational level and individual
readiness are key to successful implementation • Process of buy-in and sustainability are continuous
and never ending
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Lessons learned
“An organization cannot function as an intermediary if the entities among which it intermediates are not ready and do not have sufficient motivation and capacity for change.”
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Contact Information
Robert P. Franks, Ph.D. Vice President, CHDI
Director, Center for Effective Practice 860-679-1519
Jeff Vanderploeg, Ph.D. Associate Director, Center for Effective Practice
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Reference
Franks, R.P. (2010). Role of the intermediary organization in promoting and disseminating mental health best practices for children and youth: The Connecticut Center for Effective Practice. Emotional & Behavioral Disorders in Youth, 10 (4), pp.87-93.
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Please visit our websites:
www.chdi.org
www.kidsmentalhealthinfo.com