January 24, 2007

TRANSFORMING COMMUNITIES

Center for Evidence-Based Practices provides technical assistance, promotes mental health, recovery & employment

—by Paul M. Kubek

Editor's note: This story first appeared in the Winter 2007 issue of MSASS Action, the newsletter for alumni and friends of the Mandel School of Applied Social Sciences, Case Western Reserve University.

 Cleveland, OH—People with severe mental illness and their families in communities throughout Ohio, several other states, and two countries are experiencing an improved quality of life, in part, because of the work being done by the staff of the Center for Evidence-Based Practices (EBPs).

The Center for EBPs is a technical-assistance organization that promotes knowledge development and the implementation of evidence-based service innovations for the treatment and recovery of people with severe mental illness. The Center's core services include service-systems consultation, program consultation, clinical consultation, training and education, and research and evaluation.

The Center functions as an umbrella entity for two organizations that disseminate two different yet related EBPs. The Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence (Ohio SAMI CCOE) disseminates the Integrated Dual Disorder Treatment (IDDT) model, which helps people with co-occurring severe mental illness and substance use disorders reduce and eventually eliminate their substance use and manage symptoms of both disorders simultaneously. The Ohio Supported Employment Coordinating Center of Excellence (SE CCOE) disseminates the evidence-based Supported Employment (SE) model, which helps people with mental illness find competitive jobs in their communities with rapid job-search and placement services.

A PRACTICAL HANDS-ON APPROACH

By design, the Center for EBPs (and its two CCOEs) utilizes comprehensive strategies that social work professionals expect from an agent of social change. First, it is multidisciplinary: it is a partnership between the Mandel School of Applied Social Sciences and the Department of Psychiatry at the Case School of Medicine. Among its staff members are psychiatrists and licensed social workers, mental health counselors, and addictions counselors. Second, the Center is a public-academic partnership: it is supported by the Ohio Department of Mental Health and the Ohio Department of Alcohol and Drug Addiction Services. Third, the Center is research-based: it is disseminating two service models that have been proven effective through rigorous study.

Fourth, the Center supports and promotes holistic biopsychosocial interventions, because IDDT and SE acknowledge the importance of treating people within their social environments with multidisciplinary service teams. Fifth, the Center takes a practical hands-on approach: its consultants and trainers are experienced administrators, service providers, and researchers who offer personal attention and customized training and consultation throughout the implementation of IDDT and SE. They understand that every service system and organization exists within a unique social, political, and economic context. Therefore, they work closely with each to adapt IDDT and SE to the unique culture of the local community, while maintaining fidelity to the design of each EBP.

STAGES OF CHANGE & IMPLEMENTATION

According to Patrick E. Boyle, MSSA ('89), (PhD candidate), LISW, LICDC, director of implementation services, the Center for EBPs conducts outreach through its two CCOEs primarily with service systems and organizations that intend to improve outcomes of their services. Yet, the Center also conducts outreach with community stakeholders that collaborate to make those innovations possible and sustainable.

 "The Center recognizes that change often occurs gradually over time," Boyle says. "Therefore, it has adapted a clinical model known as stages of change and an organizational model known as stages of implementation to help initiate, facilitate, and maintain successful implementation of IDDT and SE. Outreach with key stakeholders occurs primarily during the consensus-building and motivating stages of implementation."

 According to Ric Kruszynski, MSSA ('93), LISW, LICDC, director of consultation and training for the SAMI CCOE, each stage of change/implementation is divided into eight to 12 practical action steps that help implementation teams fulfill incremental goals.

"The stage-wise approach is the hallmark of our consultation process," Kruszynski says. "It sets a realistic, manageable pace for achieving high fidelity to each EBP, as well as improved outcomes."

FIDELITY & CREATIVITY

EBPs are service models that research has demonstrated to generate improved consumer outcomes, program outcomes, and systems outcomes. Research shows that organizations which maintain fidelity to the design of each EBP achieve and sustain the best outcomes. To assess program fidelity, the Center for EBPs utilizes a fidelity scale from each EBP that contains required organizational components and treatment components. Consultants and trainers use these instruments as a framework to help organizations with implementation.

According to Barbara L. Wieder, MSSA ('89), Ph.D. ('98), director of research and evaluation at the Center, the fidelity scales for IDDT and SE are the foundation for success.

"These instruments provide structure, yet they also allow for flexibility," Wieder says. "Each organization must consider how the guidelines of the EBP match its own culture and clients. Our job at the Center is to assist organizations in achieving a good fit while staying faithful to the principles of the model. We have learned a great deal about what facilitates or challenges this process."

Center Co-Director Lenore A. Kola, Ph.D., associate professor of social work at the Mandel School, explains that the fidelity scales provide a quality-assurance mechanism that, in the past, service organizations and systems did not have. She emphasizes that the fidelity scales encourage creativity.

"IDDT and SE have also been designed to appreciate cultural differences and consumer choice," Dr. Kola says. "So organizations can and must be creative, but the fidelity scales set some limits, some boundaries. They help everyone stay focused."

Co-Director Robert J. Ronis, M.D., MPH, L. Douglas Lenkoski Professor and Interim Chair of the Department of Psychiatry at the Case School of Medicine, explains that the multidisciplinary component of the IDDT and SE fidelity scales support and promote interventions that are truly holistic and client centered.

"There is a formal mechanism for psychiatrists and social workers and other service providers to share their observations and opinions about treatments for clients," Dr. Ronis says. "These EBPs require teams to help clients express their goals for daily living. So treatments are designed specifically to help patients achieve their goals."


OHIO SAMI CCOE

In December 2000, the Ohio SAMI CCOE was created with a grant from the Ohio Department of Mental Health (ODMH) to provide technical assistance for the implementation of the IDDT model to service systems, organizations, and direct-service providers. The CCOE began serving 9 community-based organizations. Below is a list of the SAMI CCOE's current constituents:

In Ohio

  • 40 community-based mental health and
    substance-abuse service organizations
  • 9 state inpatient psychiatric hospitals
  • Many county mental health and substanceabuse
    services boards
  • 55 service teams

Outside Ohio

Service systems, mental health and substance abuse authorities, and teams of direct-service providers nationally and internationally:

  • Colorado
  • New Mexico
  • Hawaii
  • North Carolina
  • Indiana
  • North Dakota
  • Kentucky
  • Wisconsin
  • Maine
  • Australia
  • Michigan
  • The Netherlands
  • Missouri

OHIO SE CCOE

The Ohio SE CCOE has its roots in an initiative that began in October 2003 when the Ohio SAMI CCOE implemented a grant that ODMH received from the Substance Abuse and Mental Health Services Administration to help four programs in Ohio implement the evidence-based SE model.

The Ohio SE CCOE was created in July 2005 to respond to a growing demand for technical assistance that supports SE implementation. Below is a list of the Ohio SE CCOE's current constituents in Ohio:

  • 13 community-based mental health organizations
  • 13 SE service teams
  • 13 county mental health boards
  • 13 offices of the Ohio Rehabilitation Services Commission

SOURCES & RESOURCES

Stages of Change
James O. Prochaska, John C. Norcross, Carlo O. DiClemente (1994). Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York: Harper Collins.

Stages of Implementation
Pamela S. Hyde, Kathryn Falls, John A. Morris, Sonja K. Schoenwald (2003). Turning Knowledge into Practice: A Manual for Behavioral Health Administrations and Practitioners about Understanding and Implementing Evidence-Based Practices. Boston: Technical Assistance Collaborative (TAC).


Paul M. Kubek, MA, is director of communications at the Center for EBPs at Case Western Reserve University.