Readiness and Implementation of the GAIN and 7 Challenges

At NorthKey Community Care

In the beginning . . . In 2005-2006 NorthKey received a

grant from the Health Foundation of Greater Cincinnati to determine our readiness to implement evidence-based practices.

The ‘Players’ Were . . . Children’s Intensive Services

(CIS) Substance Abuse Services (SA) Family and Children Services

(FC)

Children’s Intensive Service NorthKey’s mental health inpatient unit

knew that many of their adolescents had co-occurring disorders of mental health and substance abuse, yet were only assessing for and treating mental health.

Substance Abuse Services SA had received a grant from the Center on

Substance Abuse Treatment (CSAT) to expand our adolescent drug courts and to implement EBPs.

Family and Children’s Services FC had received the Kentuckians

Encouraging Youth to Succeed (KEYS) grant that required implementation of EBPs for co-occurring disorders.

Additional Considerations More funding

sources are requiring EBPs for programs that they will fund

Increasing quality of care

Requirements of the HF Grant All staff in the three

service areas participated in an online survey sponsored by the Texan Christian Institute

Focus groups were then held with the staff to clarify results from the survey and to obtain more information on their readiness to change

Additionally, 2 Committees were formed . . . A committee

composed of management level staff from each of the 3 service areas

A committee composed of direct service staff from each of the three service areas

Purpose of the Committees Research EBPs most appropriate for our

clients and staff Choose most appropriate EBPs Discuss possible barriers to implementation

and solutions to these barriers

Research and other activities Therapy and assessment models chosen for

consideration were those that had evidence they were effective with youth with co-occurring disorders

Two local programs who had implemented EBPs were visited

Consultation occurred with other agencies who had implemented EBPs

Cont. Consultation occurred with creators of

therapy and assessment models 4 NorthKey administrators attended a 3-

day Change Management seminar

Problems Encountered CIS direct service staff did not attend mtgs. Most of the SA staff who participated left

the agency None of the FC staff who participated were

in KEYS Some members of the management team

“talked the talk” but did not “walk the walk”.

Results of the Readiness Assessment CIS – decided that staffing issues

prohibited them from doing the staff training and supervision needed for implementing EBPs.

SA – (IOPs) decided to implement 7 Challenges

CF (KEYS) – decided to implement 7 Challenges and the GAIN

Two Health Foundation Grants Were Awarded to NorthKey One to implement

7 Challenges in KEYS and the IOPs

One to implement the GAIN in KEYS

The grants paid for the following costs to be incurred within a year of implementation Training Materials (i.e. 7 Challenges journals,

laptops for the GAIN, etc.) Staff time lost in additional training and

supervision

And then came implementation

Challenges with 7 Challenges Within the SA IOPs Resistance from certain professions to implement

to fidelity – lack of executive leadership Dr. Schwebel’s ‘fluid’ fidelity measures The time needed for training, supervision and

reading journals Lack of respect to the Change Facilitator who

was not a clinician

Our Solutions Develop a Master

Clinician Plan (not an original idea but stolen from KY River)

Keep communication open with Dr. Schwebel

Challenges with 7 Challenges in KEYS Most of the population presently served are

too young for 7 Challenges Only 1 staff person trained This staff person is implementing 7Cs on

an individual basis until he has enough clients to form a group

Challenges with the GAIN in KEYS Personnel issues – not enough staff to train

in the appropriate settings Wrong people were given infrastructure

information on operationalizing the GAIN Most of the population presently served are

too young for 7 Challenges

Our Solutions This is a work in

progress

Challenges for Both EBPs Resistant staff Sustainability

Cannot bill Medicaid or private insurance for the time needed to provide the service

Time needed to train and supervise The agency as a whole does not like

change and has trouble with creative problem solving

Conclusions You can never be too prepared to

implement EBPs Change Management techniques are

crucial in making the implementation and sustainability successful

Never implement EBPs when most of your administrative staff is preparing for retirement

Conclusions (cont.) Most agencies need financial resources to

prepare their administrations and staffs for integrating EBPs

Most agencies need technical assistance in order to implement and sustain EBPs

Change is difficult and this process will take time