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SAMHSA’s Enhancing State Prevention Systems for Children & Youth:
National Webinar Series Presents:
“Effective Implementation of Evidence Based Practice Policy through Legislative Action and Community Engagement”
September 9, 2013 Eric Trupin, PhD
Effective Implementation of Evidence Based Practice Policy
Through Legislative Action and Community Engagement
Eric Trupin, Ph.D. Professor and Vice Chair, University of Washington School of Medicine
Division of Public Behavioral Health and Justice Policy
Evidence Based Practice Institute
Seattle, WA
September 09th, 2013
PRESENTATION OUTLINE
Role of University of Washington and the Washington State Institute for Public Policy in Legislation and Policy Development
Timeline
Definitions, Inventory
Partners
“Heterogeneous” Population Requirement
Definitions
Community Engagement
Collecting Community Wisdom (Promising Practice Process)
Technical Assistance
Fidelity
Take-Aways
110 Fifth Avenue Southeast, Suite 214 Olympia, WA 98504-0999 (360) 586-2677 www.wsipp.wa.gov
Washington State Institute for Public Policy:
Origins and Governance
The Washington State Institute for Public Policy (WSIPP) conducts non-partisan
policy research for the state of Washington. Originally conceived in 1982, the
organization’s governance structure and operating practices have evolved over time.
This paper reviews the history of the Institute’s structure and mission.
BACKGROUND
The Institute was initiated in 1982 by a House of Representatives’ resolution
directing the Council for Postsecondary Education to study “the potential of focusing
higher education resources in assisting state government” (see Appendix A).1 The
Council was directed to report its findings to the 1983 Legislature.2
The Council’s six-year plan, published the following January, stated that The
Evergreen State College (Evergreen) “should strengthen its relationship to Olympia
and the seat of state government located there through the establishment of a state
government policy research resource center….”3
SUMMARY
Created in 1982 by a House resolution, the
Washington State Institute for Public Policy was
established as a non-partisan research group to
carry out practical research, at legislative
direction, on issues of importance to Washington
State.
This paper describes the evolution of the
Institute, including changes to its mission,
governance, and staffing.
Many organizations inside and outside state
government conduct research. The Institute’s
structure and purpose can be distinguished from
many policy research organizations by the
following characteristics:
• The legislature selects and funds the research
topics.
• The governing board includes representatives
from the legislature (ten), executive branch
(two), and higher education (four). Legislators
serve as chairs. Legislative members are
equally representative of the two bodies and
two parties.
• Publications are written for readers without
research expertise.
• The staff is altogether nonpartisan, following
the model of legislative committee staff.
The Institute does not promote its work or
advocate for policy solutions.
Washington State Institute for Public Policy
Updated Inventory of Evidence-Based, Research-Based, and
Promising Practices » 2013 June. EBPI & WSIPP. #E2SHB2536-3.
Updated Inventory of Evidence-Based, Research-Based, and
Promising Practices »
2013 January. EBPI & WSIPP. #E2SHB2536-2.
Chemical Dependency Treatment for Offenders: A Review of
the Evidence and Benefit-Cost Findings » 2012 December. Elizabeth Drake. #12-12-1201.
Inventory of Evidence-Based, Research-Based, and Promising
Practices » 2012 September. EBPI & WSIPP. #E2SHB2536.
Return on Investment: Evidence-Based Options to Improve
Statewide Outcomes April 2012 Update » 2012 April. Stephanie Lee, Steve Aos, Elizabeth Drake, Annie
Pennucci, Marna Miller, Laurie Anderson. #12-04-1201.
Multisystemic Therapy Outcomes in an Evidence-Based
Practice Pilot » 2011 April. Jim Mayfield. #11-04-3901.
Watching the Bottom Line: Cost-Effective Interventions for
Reducing Crime in Washington 1998 January. Steve Aos, Robert Barnoski, Roxanne Lieb. #98-01-1201.
Washington State Institute for Public Policy
House Bill 1088
and the Children’s
Evidence Based Practice Institute
The mission of the Washington State Evidence Based Practices Institute is to improve the health and well-being of children,
families, and adults served by the mental health, chemical dependency, child welfare, and justice systems. We accomplish this
mission by implementing, supporting, and informing effective interventions, training, and collaborative research.
EBPI Infrastructure To conduct its core functions, the EBPI relies upon: A Board of Youth and
Family Advisors
That provides guidance, sets
priorities, and reviews products
and strategies to ensure quality
of our work and relevance to
consumers, youth, and families
A National Community
of Practice
The EBPI is connected to
developers of empirically
supported treatments and other
leading scholars and advocates
nationwide
Effective Communication
Including regular statewide forums
as well as a website that provides
access to information and materials
plus opportunities for state
stakeholders to share information
and network
Direct Relationships
with State Decision-
Makers
The EBPI is charged through
state legislation to serve as a
resource to Washington State.
Core Faculty and
Staff
The EBPI is housed in the
UW Medical School. It is led
by over a dozen faculty
members with nationally
renowned expertise in
service delivery for
individuals with complex
needs
Actively supporting
implementation of
effective practice
EBPI actively supports or
directly implements:
• Trauma-Focused
Cognitive-Behavioral
Therapy (TF-CBT)
• Multisystemic Therapy
(MST)
• Wraparound
• CBT Plus
• Triple P
•SafeCare
• Family Integrated
Transitions (FIT)
Increasing capacity
to deliver effective
practices EBPI supports capacity
through:
• Graduate coursework
• Monthly lecture series
• Training Institute
collaboration
• Networking with provider
agencies
• Survey of community
mental health providers
• Project FOCUS
Supporting
legislation and
policy
EBPI assists policy
initiatives:
• Consultation with
Children’s Administration
• Transformation Grant
activities
• Incentivize use of
effective practice
• Juvenile Rehab.
Administration policy
• Partnership Access Line
Core Functions The EBPI accomplishes its mission through:
Promoting community,
family, and youth voice
EBPI promotes community voice
through:
• Developing Youth Voice in JRA
• Family & Youth Advisory Board
• Collaborations and grant writing with
community orgs
• Juvenile Justice 101
• Partnerships for Success (PfS)
• Parent Empowerment Program (PEP)
training
• Website resources
Researching effective
practices
EBPI works to inform effective
practices through:
• Report on Emotional &
Behavioral Disorders in Youth
• Evaluation and effectiveness
trials (FIT, Wraparound, Family
treatment court)
• Partnerships for Success
evaluation
• Fostering Hope
DEVELOP REVISED CHILDREN’S MENTAL
HEALTH BENEFIT PACKAGE
Strong consideration given to:
Developmentally appropriate evidence-based and research-based practices
Family-based interventions
The use of natural and peer support
Community support services
Review of other states’ efforts
Recommend revisions to legislature by January 1, 2009
IMPROVE MEDICATION MANAGEMENT
AND CARE COORDINATION
Develop and implement policies to improve prescribing practices
Improve quality of children’s mental health therapy
Improve communication and care coordination btw primary care and mental health providers
Prioritize care in the family home
Identify children with emotional/behavioral disturbances who may be at high risk due to a variety of reasons
Review and evaluate appropriateness of psychotropic medications given to children under 5 years of age
Track prescriptive practices with goal of reducing use of psychotropic medication
FACILITATING MEDICAID ELIGIBILITY
When youth are released from confinement, their medical assistance coverage will be fully reinstated on the day of their release
The department shall establish procedures for coordination between department field offices, JRA institutions, and county juvenile courts that result in prompt reinstatement of eligibility for youth who are likely to be eligible for medical assistance services upon release
The department shall adopt standardized statewide screening and application practices and forms designed to facilitate the application of a confined youth who is likely to be eligible for a medical assistance program
HEALTHY OPTIONS
Expansion from 12 to 20 visits for a child per year for both
managed care plans and fee for service plans
Expansion in providers to licensed mental health
professionals
EVIDENCE-BASED PRACTICE INSTITUTE GOALS
Improve implementation of evidence-based and research-based practices
Continue successful implementation of “Partnerships for Success” process for implementing EBPs
Develop a series of information sessions, literature and online resources for families
Participate in identification of outcome-based performance measures and partner in statewide effort to implement statewide outcomes monitoring and quality improvement processes
Serve as a stateside resource on child and adolescent evidence-based, research-based, promising, or consensus-based practices for children’s mental health treatment
Implement a pilot program to support primary care providers
Evaluate implementation and impact of wraparound pilot
MEDICATION AND MH
(FY ’04)
44%
received outpatient
mental health care
18,028 children
56%
received NO outpatient mental health care* 22,498 children
Drug classes include:
Antidepressant
Antipsychotic
Antianxiety
Antimania
ADHD
House Bill
1088
Revise Access to
Care Standards
Revise Benefit Package
Improve Medication
Management
Convene RSN’s,
CMHC’s
Medicaid Eligibility
Expand Healthy Options
Evidence-Based
Practice Institute
IMPLEMENTATION
CHALLENGES
Clinical Cultural adaptations
Change familiar practices/tension around manualized treatment
Systemic Changing administrative processes
Workforce development
Salaries don’t support staff retention
Financial Often takes new funding for start up
Mechanics of reimbursement
HOUSE BILL 2536
ROLE OF DSHS/HCA
By June 30, 2013 compile a baseline assessment of the utilization of evidence-based and research-based practices in child welfare, juvenile rehabilitation and children’s mental health services.
Prioritize the assessment of promising practices identified in the inventory with the goal of increasing the number of practices that meet the standards of evidence-based and research-based practices.*
By December 30, 2013; 2014 and 2015 produce reports for the Governor and the Legislature that include:
ROLE OF DSHS/HCA, CONT’D.
Recommended strategies, times and cost for increasing the use
of evidence-based and research-based practices
Distinguish between the reallocation of existing funding and new
funding to support the recommended strategies
Expectation that there will be substantial increases above the
baseline assessment of the use of evidence-based and research-
based practices.
WASHINGTON STATE INSTITUTE
FOR PUBLIC POLICY AND THE UNIVERSITY OF
WASHINGTON EVIDENCE BASED PRACTICE INSTITUTE
2ESHB 2536, directed the WSIPP and UW EBPI - by September 30,
2012 - to:
Task 1: Publish descriptive definitions of evidence-based, research-
based and promising practices
Task 2: Create an inventory of interventions of interest to child welfare,
juvenile rehabilitation and children’s mental health
Department of Social and Health Services Implementation Timeline - HB 2536
Legislation to Define Evidence Based Practices and Programs
2012
Legislative
Session
May/June 2012
EBP Administration
Subcommittees
formed
Sept 30, 2012 Report to
Legislature
WSIPP on
Definitions and
Menu Programs
December 30, 2014
DSHS Report
Legislature Update
December 30, 2015
DSHS Report
Legislature Update
2012
2013
Legislative
Session 2013 2014 2015 2016 2017
April/May 2012,
DSHS EBP Oversight
Committee Convened
June 30, 2013
DSHS and HCA
complete Baseline
Assessment $
Medicaid
December 30, 2013
The DSHS and HCA
Report to Legislature -
Strategies, timelines,
cost, etc. for
increasing use of EBP.
2015-2019
Department Implements if directed
by the Legislature or on its own.
LIST OF ACRONYMS:
DSHS – Department of Social and Health Services WSIPP – Washington State Institute for Public Policy. The institute represents the legislature, governor, and public universities and carries out practical, non-
partisan research – at legislative direction – on issues of importance to Washington State.
HCA – Washington State Health Care Authority. The Health Authority oversees eight Washington State health care programs including, Basic Health, Medicaid and Medical Assistance Programs, and the Prescription Drug Program.
EBP – Evidence based program.
TASK 1: PUBLISH DEFINITION OF
EVIDENCE-BASED PRACTICES
Current law defines EBP to include:
At least 2 random-assignment trials
Tested across heterogeneous populations
Proposed definition
Permits well-controlled comparison group studies
Requires program benefits to exceed the cost
Requires a program manual
Defines heterogeneity
TASK 1: PUBLISH DEFINITION OF
RESEARCH-BASED AND PROMISING
PRACTICES Research-Based
Current law definition:
“Some evidence” not to the standard of EBP
Proposed:
At least one randomized or well controlled study, with sustained outcomes
Promising Practices
Current law definition:
Program has potential
Proposed:
Well-established theory of change
TASK 2: CREATE THE INVENTORY
Used available WSIPP findings
September report had few programs identified as “promising”
UW EBPI promising practice applications
January 2013 report added 21promising practices
Washington State Institute for Public Policy E vid en ce-B as e d P r act ic e Ins t itute
June 2013 Report
http://depts.washington.edu/ebpi/downloads/June%20Report2.pdf
Washington State Institute for Public Policy E vid en ce-B as e d P r act ic e Ins t itute
June 2013
http://depts.washington.edu/ebpi/downloads/WSIPP%20EBP%20Final%20Inventory%20June%202013.pdf
Inventory of Evidence-Based, Research-Based, and Promising Practices
PROMISING PRACTICES APPLICATION
Need a score of 1 to qualify. Points deducted if the program uses methods
known to be harmful or the approach is inappropriate for the target
population as judged by reviewer consensus.
PROMISING PRACTICE APPLICATION
• Is the proposed practice/program an intervention that targets
outcomes of interest to DSHS child-serving agencies?
• Child abuse, neglect, need for out of home placement;
crime; children’s mental health; education; or employment
• OR, changes in protective/risk factors known to be
associated with these outcomes.
PROMISING PRACTICES APPLICATION
• Does it have initial evidence of effectiveness?
• Pre-post test indicating changes
• Well designed qualitative data
PROMISING PRACTICES APPLICATION
• Does it have a “well-established theory of change?”
• Logic model that rests on empirically supported correlates of change
• Uses the general principles or model of an existing EBP
• Is an EBP that is being used for a purpose other than its evidence-base.
TECHNICAL ASSISTANCE OVERVIEW
EVALUATION TA FOCUS AREAS
Tiered support that addresses unique needs of programs.
Tier 1
Written and archived media that addresses foundational topics: logic models, internal
research capacity, EBP definitions and development.
Tier 2
Interactive resources for small to large group audiences: webinars, workshops,
trainings.
Tier 3
One on one support that supports a program’s development toward
research/evidence-based by putting them in a better position to secure funding for
sophisticated evaluation .
TA: PROGRAM EVALUATION
• Program fills out application
• Assign priority level (Guided by DSHS and WA State needs)
UW contacts for initial TA consultation
• Determine program’s interest in TA opportunities
• Assign to Evaluation TA or Implementation TA
Develop TA Plan • TA plan is specific and
time-limited
• Plan will include recommendations for sustainable support
TA Ends
TIER 3: ONE ON ONE SUPPORT
Program priority will be informed by DSHS priorities
Goal for TA will be to move eligible programs to promising practice
status focusing on one of the areas below:
Assist with logic models
Assist with internal research capacity
Assist with conducting preliminary research
EVALUATION TA: PROGRAM NEXT STEPS
Can the TA establish a program as Evidence-Based?
The Evaluation TA will be primarily focused on building a foundation for moving
towards more sophisticated evaluation. Current resources are not sufficient to
conduct the kinds of evaluation necessary for a research/evidence-based designation.
However, the goal is to put programs in a better position to secure additional funding
and/or clarify agency goals in regards to EBP implementation in general.
EBP IMPLEMENTATION ASSISTANCE FORM
Complete if:
Your agency would like assistance with organizational readiness, training, implementation,
sustainability, or adaptation of an existing EBP
Form Includes:
Opportunity to describe Implementation/Adaptation needs
Initial organizational readiness screening
Questions about referral stream and QA
Caveat:
Completion of form does not guarantee assistance
PBHJP has limited resources and may be able to help your agency identify additional
resources or partners through which your request may be filled
TA: IMPLEMENTATION
Areas of assistance available currently:
Organizational Readiness Assessment
Learning about EBPs and training opportunities
Decision making re: best EBP fit
Cultural enhancements
Maximizing implementation efforts
TA: IMPLEMENTATION
Forms of support can include:
Tier 1
Linkages to information on specific EBPS, training opportunities, cultural
enhancements/adaptations
Tier 2
Interactive resources for small to large group audiences (depending on need)
Tier 3
One-on-one Implementation or Adaptation support
Competence, Fidelity and Outcomes
ASSESSING COMPETENCE, FIDELITY, AND OUTCOMES:
BALANCING RESOURCE RESTRICTIONS WITH THE GOLD STANDARD
8 of 9
Competence Fidelity Outcome
Monitoring
Direct
Methods
Observe live session
(1st case)
Observe live session
(in-person, phone,
skype, video)
Ongoing client
assessment/clinical
measures
Indirect
Methods
Role-playing,
Detailed/Targeted
Clinical Supervision
and/or Consultation
Session checklists,
Case notes, client
reporting
Solution Toolkit Build checklists/
reminders into EMR,
Random case note
audits
Dashboard (Hawaii
CAMHD)
TAKE-AWAYS
Intent of legislation is to increase use of evidence based and research based
practices across systems in WA state
DSHS, HCA, WSIPP, and UW have distinct but complimentary roles in
implementation
DSHS will complete its baseline assessment by June 30, 2013
WSIPP will publish an updated inventory on January 31st to include promising
practices
UW will offer technical assistance beginning January 31st . Our goal is to
assist agencies and providers as they adjust to this legislation.
“Vision without action is a daydream.
Action without vision is a nightmare.”
~ Japanese proverb
Eric Trupin, Ph.D. Professor and Vice Chair, University of Washington School of Medicine
Division of Public Behavioral Health and Justice Policy Evidence Based Practice Institute
Please visit our website and Facebook page:
http://depts.washington.edu/pbhjp/
https://www.facebook.com/PBHJP
2815 EASLAKE AVENUE EAST, SUITE 200 SEATTLE, WA 98102 Phone: 206.685.2085