Implementing Evidenced-based PracticesSeptember 17, 2014

Beth Ann Rosica, PH.D Francis Mendez, J.D., MSW

About Us

NTTAC ( www.nttac.org) is a central source for accessing the Office of Juvenile Justice and Delinquency Prevention’s (OJJDP) Training and Technical Assistance (TTA) resources; serves as a one-stop shop for requesting the full array of TTA services offered by OJJDP; and supports the OJJDP TTA Network through trainings and leveraging of virtual TTA.

VisionQuest ( www.vq.com) has over 40 years of experience delivering highly successful innovative programs to at-risk and juvenile youth. Over the last 10 years, VisionQuest has made a commitment to evidence-based practices, and all programs utilize at least evidence-based model.

Advancing Evidence Based Practice

(www.advancingebp.org) is a nonprofit association working to promote evidence-based programs for at-risk youth.

How to Identify EBPs?

• Blueprints for Healthy Youth Development

• WSIPP• Coalition for Evidence Based Policy• CrimeSolutions.gov/Model Programs

Guide

Best Proven Model Programs*• Brief Alcohol Screening and Intervention for College

Students (BASICS)• Functional Family Therapy (FFT)• LifeSkills Training (LST)• Multidimensional Treatment Foster Care (MTFC)• Multisystemic Therapy - Problem Sexual Behavior

(MST-PSB)• Multisystemic Therapy® (MST®)• New Beginnings (Intervention for children of divorce)• Nurse-Family Partnership• Positive Action• Project Towards No Drug Abuse• Promoting Alternative Thinking Strategies (PATHS)*Blueprints Model

Programs

Advantages of Proven EBPs

• Reduced crime• Reduced cost to

taxpayers• Save lives• Training, Manuals, QA

EBP Implementation: Getting Customer Buy-In

• Convincing stakeholders of the value and benefits of implementing EBPs- Moving from WHY to HOW.

• Leveraging existing resources as a strategy to introduce EBPs.

• Navigating concerns that EBP implementation comes at the expense of local grass roots programs.

• Overcoming obstacles when there is a disconnect between the state and local jurisdictions.

EBP Implementation: Facing Agency Challenges• The Adoption of EBPs is challenge for providers,

especially large agencies• Requires commitment from the highest levels of

management and a philosophical change within the agency

• Many staff are often threatened as they see their approach as the best

• Human Services professionals are often reluctant to trust research

• The process requires education, re-education and continual reassurances to staff that EBPs are the right thing to do

• Implementing EBPs costs more money than traditional services/programs

• Family Engagement can be a challenge

Components that need to be present to successfully implement evidence-based practices and programs: Competency Drivers (Staff selection, Pre-

service and in-service training, Ongoing consultation and coaching & Staff and program evaluation)

Organization Drivers (Facilitative administrative support, Systems interventions & Decision Support Data System)

Leadership Drivers (Technical & Adaptive) Source: National Implementation Research Network

EBP Implementation: Key Drivers

EBP Implementation: Embedding EBPs in a Juvenile Justice Agency

• Launch EBPs as a collaborative effort with ownership by the Agency.

• Establish a data collection framework.• Integrate EBP referrals into objective decision-

making.• Jointly address referral and engagement

issues.• Establish formal communication protocols at

the case level and system level.

• Family lives out of service area

• Youth is a sex offender

• Youth is too aggressive

• Youth refused treatment

• Incomplete referral packet

• Youth not age appropriate

• AWOL• Youth has

unmanageable psychiatric Issues

• Other• Referral or

funding source rescinded

• Already received EBP services

• Youth placed out of home/detained

• Parents unwilling/unavailable

• No slots available

Referral & Engagement Issues: Data Collection

Data Collection Example

Youth has unmanageable medical issues English is not the primary language

Family lives out of service areaNo slots available

Referral or funding source rescindedAWOLOther

Already received MST services Incomplete referral packet

Youth not age appropriate Youth has unmanageable psychiatric issues

Youth placed out of home/detained Parent unwilling/unavailable 36%

12%

9%10%

7%

7%

5%

3%

3%

2%

2%

2%

1%

0% 10% 20% 30%

Percentage of MST Referrals40%

n=182

Source: FY11 MD State Annual Reports for MST & FFT

Family lives out of service area Youth is a sex offender Youth is too aggressive

Youth refused treatment Incomplete referral packet Youth not age appropriate

AWOLYouth has unmanageable psychiatric Issues

OtherReferral or funding source rescinded

Already received FFT servicesYouth placed out of home/detained

Parents unwilling/unavailable 44%

11%

8%

9%

5%

6%

3%

4%

4%

1%

1%

1%

2%

0% 10% 20% 30% 40% 50%

n=406Percentage of FFT Referrals

Analyzing Family Engagement BarriersContext conducive to engagement• The rationale, benefits, and structure of program

have been explained to the family;• Family strengths have been identified and

acknowledged; • The therapist and the referral organization have

taken a collaborative approach towards engaging the family;

• The family has contributed to the development of the treatment goals; and

• Engagement services are provided at a time that is convenient for the family.

Source: Engaging Multiproblem Families in Treatment: Lessons Learned Throughout the Development of Multisystemic Therapy PHILLIPPE B. CUNNINGHAM., SCOTT W. HENGGELER. July 2004

Family Engagement StrategiesExamples of engagement strategies that can be applied to the FFT and MST referral process are: • Building a relationship prior to first

call/appointment;• Leveraging existing supportive relations;• Using strategic and strengths-based

marketing; and• Identifying, addressing and removing

participation barriers.SOURCE: PRINCIPLES FOR ENGAGING AND RETAINING FAMILIES IN SERVICES

Train and select

probation staff for

EBP referrals

Communication Feedback

Loop b/w program and

probation

Case management

process that is aligned with EBP program

Tracking outcomes and quality

improvement

Joint responsibility for identifying and

problem solving issues

Coordinated and collaborative

process

Tracking of referral

outcomes and analysis

Systems interventions

that integrate

family engagement

Goals

Systems intervention to

address identified barriers

EBP Implementation: Inter-operability Framework

EBP Implementation: Funding & Sustainability• Once you have committed to doing EBPs, there is as

much work in sticking to the model as making the decision to do it.

• High level of discipline to maintain fidelity. Most programs offer supervision/support calls, but the agency needs an infrastructure to support it too.

• Staff turnover presents problems - takes awhile to get staff trained, decreases revenue, decreases customer satisfaction.

• Successful EBPS requires a high level of collaboration between the provider, funder and placing agency.

• EBPs are typically  more expensive at the front end but save dollars on the back end.

EBP Implementation: State Review

Delaware Pennsylvania Maryland North Carolina Louisiana California Connecticut Texas

YOUR QUESTIONS

Contact Info

New and improved site coming soon

Beth Ann Rosica, PH.D Francis Mendez, J.D., MSW beth.rosica@vq.com fmendez@nttac.org

610-486-2280,ext. 3250 1-703-225-2391