Breakout I – May 16, 2013
1. Matching Training to Setting: A New Implementation Model for Dialectical Behavior Therapy
Presenter: Helen Best, MEd
Authors: Helen Best, MEd,Treatment Implementation Collaborative, Katherine Anne Comtois, PhD, MPH, University of Washington, Nancy A. McDonald, MS, CADC, LPC, Chester County Department of Human Services, Jamie F. Edwards, LCSW, CMFSW, Community Care Behavioral Health
Abstract: While Dialectical Behavior Therapy has been widely disseminated, most large scale system initiatives have focused on training DBT to adherence and how to integrate the EBP into standard system structures. The Treatment Implementation Collaborative, LLC, is testing a new model of implementation that is organized in terms of how systems implement a new treatment rather than how to train clinicians in the treatment. It is no accident that DBT skills training is the component most often misconstrued as comprehensive DBT, by clinicians and consumers, as it is the component of DBT that is most accessible to a broad audience. With this in mind, the implementation model being tested by TIC focuses first on laying a solid foundation on administrative orientation for leadership in conjunction with a solid base in DBT skills training for clinicians and programs. Once this core component is in place, clinicians and teams are trained to implement all modes of comprehensive DBT. This presentation will highlight TIC’s model for implementation using a case example and data from the implementation of DBT across 11 teams in three counties in PA, including Chester County.
2. User-Centered Design & the Implementation of Evidence-Based Interventions
Presenter: Aaron R. Lyon, PhD
Author: Aaron R. Lyon, PhD, University of Washington
Abstract: A well-documented “research-to-practice gap??? exists in which evidence-based interventions (EBI) are unlikely to be adopted by mental health practitioners working in community settings, limiting their public health impact. This presentation discusses how the design of EBI is detracting from their ability to be effectively implemented on a large scale. Although EBI frequently produce robust effects for well-specified problems, their design is characterized by excessive complexity, inflexibility (e.g., fidelity requirements), and steep learning curves. In this way, EBI can be said to be very well engineered (functional and able to produce their intended outcome), but badly designed.
This presentation will draw from the literature on user experience and user-centered design to address EBI design as a key implementation issue. To date, the mental health research community has done relatively little to ensure that existing EBI are appealing and accessible to their target audience. A variety of design heuristics and principles of good design will be applied to the construction of EBI with the goal of better meeting the needs of the end user (i.e., mental health practitioners). These include building EBI that are more readily learnable, demonstrate functional minimalism, decrease a user’s cognitive load, and exploit the natural constraints of the context of use. Examples drawn from ongoing projects initiated to create contextually-appropriate and usable supports for quality improvement in school-based mental health will also be presented.
3. Designing an Implementation Strategy to Support the Multi-site Scale-Up of an Evidence-Based, Culturally Appropriate Practice Model for Intensive Family Support Services Across the Northern Territory, Australia
Presenter: Robyn Mildon, PhD
Authors: Robyn Mildon, PhD, Knowledge Exchange & Implementation, Parenting Research Centre, Fiona Arney, PhD, Australian Centre for Child Protection, University of South Australia
Abstract: In recent years, we have seen a growth in Australia of funding and delivery of “Intensive Family Support Services??? for vulnerable families in an effort to improve health, safety and wellbeing of children and prevent family involvement in our child protection system, including out of home care. Despite this trend, few services adopt a coherent, evidence-based program model, effective and full implementation is rarely reached or sustained, and little evaluation is done in child protection and family support on any large scale.
Family support service providers and policy makers seeking an evidence-based Practice Model will find that there is little written for a community service setting about how to go about making the critical decision of choosing and refining a comprehensive Model with the potential for significantly impacting child and family outcomes. Furthermore, there are relatively few comprehensive guidelines on quality implementation of practice specific to intensive family support. A framework based on the Quality Implementation Framework (Meyers, Durlak & Wandersman, in press) and the work of the National Implementation Research Network (NIRN), is being applied to support the scale-up of a purpose built, evidence-based, culturally appropriate Practice Model in multiple health and child welfare service delivery sites across the Northern Territory, Australia.
This paper will describe in detail the implementation framework being applied, implementation support strategies being utilized to date to achieve early practice change and the effect these have had, and the conceptual model being used to guide the evaluation of this work.