Adherence University of Washington Department of Psychiatry and Behavioral Sciences Sarah Cusworth Walker PhD Georganna Sedlar PhD Jessica Leith LMFT Lucy Berliner MSW Cathea Carey BS Eric Trupin ID: 676948
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Slide1
Breaking Down Evidence-Based Practices for State Policy: Using a Common Elements Approach in Progress Note Documentation as an Indicator of Adherence
University of Washington Department of Psychiatry and Behavioral Sciences
Sarah Cusworth Walker, PhD
Georganna Sedlar, PhD
Jessica Leith, LMFT
Lucy Berliner, MSW
Cathea Carey
, BS
Eric Trupin,
PhD
Washington State Department of Behavioral Health and Recovery
Paul Davis, MS
Felix Rodriguez, PhDSlide2Slide3
The Evidence Based Practice Institute is a intermediary organization that supports EBP translation and implementation efforts with the WA State Department of Social and Health Services Division of Behavioral Health and
Recovery (DBHR)
for children’s mental health
. . Slide4
State Fiscal Year 2017 30%
b
enchmark for EBP services in children’s mental health
(not an inconsiderable challenge with the national average for EBP use in children’s public
m
ental health at 1-3%; Bruns, Kerns, Pullmann et al., 2013)Slide5
Defining Evidence Based Practice
Source
Purpose
Level of description
Legislative
General description
References the need for rigorous research design
Washington State
Institute for Public Policy/Evidence Based Practice Institute (EBPI)
For
inventory review
Specifies the need
for cost-benefit, heterogeneity in race/ethnic sampling, translational capacity and identifies treatment categories based on meta-analysis
Department of Behavioral Health and Recovery (DBHR)/
EBPI
For provider guidance and monitoring
Outlines the clinical components
in the research-based treatment categoriesSlide6
Monitoring the use of multiple EBPs in a cash-strapped system
2013
2013
2016 instituted after initial estimates because . . .Slide7
Without reporting guidance, numbers were suspect
EBP benchmarks are based on
encounters
rather than clients
The state error rate for reporting EBPs was 38% with a range across regions of
9 – 83%
Error was defined by
Reporting non EBP practices for children’s mental health
Reporting practices under unrelated encounter typesSlide8
Designing Reporting Guides
Challenge 1
: How to establish “good intent” to deliver an EBP
Challenge 2: How to allay provider concerns about whether their individualization/modifications of EBPs were eligible for reporting
Challenge 3
: How to minimize burden and paperwork by keeping all reporting within existing channels (billing and routine progress reporting)Slide9
Challenge 1: Establishing “good intent”Slide10
Challenge 2: Allaying provider concerns about fidelity
Diebold
et al. (2000) suggest that innovation must reflect what they call "
assimmodation
," a balance of assimilation of innovations to existing structures and accommodation of those structures to incorporate key elements.
(Elias et al., 2003)
If the state was allowing only a few interventions, questions about adaptation could be fairly well-managed with expert consultation. However, in a complex system with multiple programs, implementation is considered “good enough” for
counting
if the core philosophy and strategy of the treatment is maintained. This reflects and draws from efforts to identify core components to develop flexible treatment strategies adaptable to real world contexts:
Elias, M. J., Zins, J. E.,
Graczyk
, P. A., &
Weissberg
, R. P. (2003). Implementation, Sustainability, and Scaling up of Social- Emotional and Academic Innovations in Public Schools.
School Psychology Review, 32
(3), 303-319.
Kendziora
, K., &
Osher
, D. (2016). Promoting
Childrens
’ and Adolescents’ Social and Emotional Development: District Adaptations of a Theory of Action.
Journal of Clinical Child and Adolescent Psychology, 45
(6), 797-811. doi:10.1080/15374416.2016.1197834
FOR REPORTING PURPOSES ONLY, NOT INTENDED TO BE CLINICAL ADVICESlide11
Identifying Components
Began with treatment categories as identified by WSIPP in meta-analyses indicated as research-based on the state inventory
e.g., CBT for Anxious Children
Reviewed available taxonomies, meta-analytic studies and dismantling studies of clinical components for these categories (e.g. below)
Chorpita
, B.,
Daleiden, E., & Weisz, J. (2005). Identifying and selecting the common elements of evidence based interventions: A distillation and matching model. Mental Health Services Research, 7(1), 5-10. Weisz, J. R., Chorpita
, B. F.,
Palinkas
, L. A.,
Schoenwald
, S. K., Miranda, J.,
Bearman
, S. K., . . . Gibbons, R. D. (2012). Testing standard and modular designs for
psychotherapy
treating depression, anxiety, and conduct problems in youth: A randomized effectiveness trial.
Archives of General Psychiatry, 69
(3),
274-282
.
doi:10.1001/archgenpsychiatry.2011.147
Wright, C., Catty, J., Watt, H., & Burns, T. (2004). A systematic review of home treatment services.
The International Journal for Research in Social and Genetic
Epidemiology
and Mental Health Services, 39
(10), 789-796.
doi:10.1007/s00127-004-0818-5Consulted with clinical experts to validate and refine the components“Essential” are 1) designated components that are in at least 80% of effective treatment programs for that category, 2) are reasonably distinct from other treatment category practices, 3) appear to be independently effective. “Allowable” are clinical components common to effective treatment categories that may or may not cross multiple treatments (e.g., problem solving).Slide12
Challenge 3: Minimize reporting burden and paperworkSlide13Slide14
Feasibility Evaluation
2017-2018 Evaluation Plan
Adherence:
EBPI will roll out up to 12 regional trainings on using the Reporting Guides. Participating sites (anticipating 12-15) will be asked to provide 10-20 randomly drawn cases subsequent to the training which will be scored for adherence with the RG standard.
Acceptability
Following in person trainings, EBPI will send a survey to participants containing the EBP Attitudes Scale and questions about the acceptability of the Reporting Guides in practice
.Knowledge: An instructional web video (link below) will be disseminated through the children’s mental health network with all subcontracted agencies encouraged to have providers view and take a short knowledge-based quiz.
Anticipating 100-300 responses for assessing knowledge of how to document practice.
All participants in the live training will take the same quiz (anticipated 50-100), allowing for an assessment of training context on knowledge. Slide15
Thank you!
For inquiries:
Sarah Cusworth Walker
secwalkr@uw.edu
Acknowledgments:
Division of Behavioral Health and Recovery
Behavioral Health Organization child care coordinatorsThe Washington State Institute of Public Policy (
WSIPP/
Marna
Miller)
Ron
Gengler and staff (Comprehensive)
Melissa
Gorsuch-Clark and staff (Catholic Family and Child Services)
Suzanne Kerns
Eric Bruns
Greg
Endler