steve wiland, lmsw, icadc - dwmha pasquale vignola, ma, llp - vce sheila blair, aa – vce
TRANSCRIPT
Overcoming Barriers to Provide and Sustain
Evidence-Based, Best and Promising
Practices Through Technology-Supported
Workforce Development
Steve Wiland, LMSW, ICADC - DWMHA
Pasquale Vignola, MA, LLP - VCE
Sheila Blair, AA – VCE
The Challenge of Competence Complexity
Uses multiple skills simultaneouslyAdopts a multifactorial understanding
ApplicationSkills and understanding are applied to a
consumer situationApplication retains a sense of goal
achievement and consumer need Action
Practitioners must adopt an active response to create movement or resolution
Source: Eastern Michigan University
Dimensions of Competence
Source: Eastern Michigan University
The Problem with Graduates Policy makers insist on EBPs but practitioners
do not have requisite competencies (Sburlati et al., 2011)
Graduates from all types of university programs do not possess the necessary competencies for effective CMH practice (Biesma et al., 2010; Heiwe et al., 2005; Nelson & Graves, 2011; O’Donovan et al., 2005)
Graduate shortcomings are particularly acute in the areas of Evidence-Based Practices (Manuel et al., 2009; Sigel & Silovsky, 2011
Source: Eastern Michigan University
The Disconnect There is a disconnect between the teaching in
universities and the needs of community mental health (Biesma et al., 2008; Rugs et al., 2011)
University programs do not prioritize EBPs even though these are priority competencies in community mental health (Blumenthal et al., 2001; Hoge et al., 2002)
University programs are often reticent to change curriculum in response to shortcomings identified in the field (Akister, 2011)
Source: Eastern Michigan University
University Realities University systems undervalue teaching students
in favor of research and external funding (Hoge et al., 2002)
Universities tend to use knowledge transfer approaches to teaching rather than expecting students to demonstrate competencies (Crits-Cristoph et al., 1995; Nelson, 2001; Wilson & Kelly, 2010)
Universities rely on internship experiences for competence development but these experiences are not uniform or consistent (Heiwe et al., 2011; Lehman et al., 2011)
Source: Eastern Michigan University
The CMH Realities When graduates enter CMH agencies
CMH settings are under-resourced and overburdened making it hard to compensate for educational shortfalls (Heiwe et al., 2011; Lehman et al., 2011)
CMH providers may expect practitioners to have pre-requisite competencies for practice
New graduates tend to abandon school-based learning and rely on nearby colleagues (Lombardozzi & Casey, 2008)
Source: Eastern Michigan University
Common Responses Most common response is to provide
trainingProvider systems hire trainers to help the
workforce achieve basic competence levels
MDCH provides training to support the statewide workforce in providing effective interventions
Professional organizations mandate practitioners to continue development
University partnerships or technology transfer centers are used to support integration of EBPs Source: Eastern Michigan
University
Knowledge-Based Training
Lectures
Self-study: Journal articles and books
Auditing classes
Conversation with colleagues and experts
Attendance at interactive training events
(NOTE: all strategies transfer knowledge from the perceived expert to the practitioner) Source: Eastern Michigan
University
Online Knowledge-Based Learning
Relatively new format
Opportunity for disseminating up-to-date information without travel costs
Can be completed at work, home or anywhere with internet access
Work at own pace
With videos and interactive exercises can also develop skill elements
Source: Eastern Michigan University
Attitude-Based Training
Training events with videos and activities to challenge thinking
Experiential training events using emotional power to create dissonance between status quo and ideal situations
Typically learning strategies involve experience followed by group discussion
Source: Eastern Michigan University
Pseudo-Skills-Based Training Includes provision of knowledge coupled
with modeling and/or opportunities to practice skill elements
Modeling may involve use of video or live demonstrations of skills with discussion
Often involves breaking into groups, applying skill elements and then reporting back
Motivates participants to continue practicing the involved skillsSource: Eastern Michigan
University
Problems with Training Training is best for advancing knowledge
and attitudes, but typically unsuccessful at developing competence
There is an immediate drop-off in motivation and application within days
Competence development is a longer process requiring frequent input and support
While some training protocols with EBPs have such protocols, most training fails to extend input or support (aka “coaching”)
Source: Eastern Michigan University
Supervision to Develop Competencies
There is often an expectation that front-line supervisors promote competence
Supervisors believed to be assisting practitioners in developing knowledge and skills for effective practice
Supervisors are positioned to be the guarantor or to provide the organizational protection against sub-standard practice
Source: Eastern Michigan University
Types of Supervision
Clinical
Administrative
Supportive
Competence-based
Source: Eastern Michigan University
Clinical Supervision Support and teaching to develop
practitioner knowledge and competence.
Enables the practitioner to assume responsibility for their own practice.
Enhances consumer protection and the safety of care in complex clinical situations.
Source: Eastern Michigan University
Administrative Supervision Ensures that
work is performed,
paperwork is complied with,
billing and administrative procedures occur
Administrative supervision is crucial to agency functioning
In a busy environment, administrative functions can exert high demands on supervisors as the priority focus
Source: Eastern Michigan University
Supportive Supervision Operates concurrent with clinical and
administrative supervision
Individualized support
Decreases burnout
More mutuality in the relationship
It can be provided whenever the practitioner needs support, on an as-needed basis.
Source: Eastern Michigan University
Competence-Based Supervision
Observes the practitioner’s skill performance
Evaluates the performance based on accepted standards
Provides immediate feedback on the skill performance
Explores skill adjustments for subsequent improved applications
Source: Eastern Michigan University
Ideal Elements for All Types
Safe environment in which a supervisee can discuss thoughts and feelings
Trusting relationship modeling the openness of the helping alliance with consumers
Regular time frames with clear and respected expectations
Reflective feedback to think meaningfully about one’s work, one’s self
(Shahoom-Shanok, Gilkerson, Eggbeer & Fenichel, 1995)
Source: Eastern Michigan University
Supervisory Prerequisites
Pre-existing competencies to develop feedback
Ability to describe observations to avoid defensive reactions
An exploratory approach for developing alternatives with the supervisee
Development of reflective exchanges with supervisee
Source: Eastern Michigan University
Prerequisites Continued…
Ability to contribute new knowledge to the practitioner
Ability to motivate, and understand practitioner motivational needs
Ability to apply discussions back to practitioner situations
Ability to establish next steps and implementation plans
Source: Eastern Michigan University
Time Challenges in CMH
Ideal supervision requires time and mutual investment
Job demands can interfere with optimal supervision
Interference is likely to diminish the importance of developmental input
Developmental work shifts input to colleagues, which may represent less-than-optimal feedback
Source: Eastern Michigan University
Expertise Challenges with EBPs
Supervisor may not have the requisite information and skills for competence-development (credentialing issues)
Administrative and support functions are demanding
Often the EBP-related input is minimized, rendering it less important
Competence development suffers because of competing demands on supervisor and supervisee
Source: Eastern Michigan University
Managing Expertise• Administration• Organization• Some practices
• Some practices (especially EBPs)
• Specialized practices
• Self-capacities• Case load
• Overlapping training
• Some practices
Supervisor is Expert
Neither is Expert
Supervisee is Expert
Both are Expert
Source: Eastern Michigan University
When Supervisor is Expert
Uses expert knowledge to provide feedback and input
Relationship ideally identifies the supervisory expertise
Roles are clear regarding learner and teacher during supervision
Source: Eastern Michigan University
When Supervisee is Expert
Supervisor adopts administrative and supportive roles
Clinical supervision can be provided in general areas
Supervisee operates autonomously within the area of clinical expertise
Supervisee may operate as a mentor to other staff – elevates profile on the team
Administrative and legal requirements remain with the supervisor
Source: Eastern Michigan University
When Both are Expert
When topics of mutual expertise emerge exchange is collegial rather than hierarchical
Often different approaches lead to divergent thinking on consumer situations
Must have an agreement about how to handle differences
Requires high levels of maturity to manage the relationship
Source: Eastern Michigan University
When Neither are Expert
Consumer situations result in guessing and trial-and-error responses
Past practice becomes normative and habitual responses dominate
Expertise must come from outside the team or agency
Requires resources and advocacy to prioritize the expenditure
Source: Eastern Michigan University
Managing Challenges Without Compromise To ensure workforce competence,
development-related input is needed
It is unrealistic to believe that a supervisor can manage all elements
It is equally unrealistic to believe that training by itself will improve workforce development
Important shifts are needed in the work environment
Source: Eastern Michigan University
The Importance of Repeated Feedback Competence requires applied action
followed by immediate feedback
Feedback should be customized for each person to meet their developmental needs
Application and feedback should repeat multiple times with adjustment during each cycle
Source: Eastern Michigan University
Building Competence
Source: Eastern Michigan University
Structuring for Competence Pick your trainers well
Avoid one-time eventsEnsure application, observation and
feedback Level Specific Training Plans
Have plans for each level in the organization
Dovetail the plans to reinforce each other Scaffold your training plan
Develop training benchmarks and milestones
Use benchmarking to integrate training Identify activities between events to
reinforce competence
Source: Eastern Michigan University
Integrating Training & Practice Training should reflect work
Focus training opportunities (in-house?)Build training applications into supervision
agendasPair supervisors and workers in training
plans Infuse training content into agency
patterns Integrate training/teachable moments into
group supervision or team meetingsStructure innovation discussions into
meeting schedulesSource: Eastern Michigan University
Workforce Training Survey
• Survey of trainings selected by staff
• Conducted in 2011• 1000 surveys returned in the first
month• Average age = 46 years• Average years in the field = 14.16
Source: VCE Workforce Development Survey, 2011
Most Common Job Categories
Social Worker 41.9% Administrative 29.0% Case Manager 10.2% Direct Care/CMH 8.8% Professional Counselor 8.6% Psychologist 6.3%
Source: VCE Workforce Development Survey, 2011
License Type
Social Work (MSW) 50.8% Social Work (BSW) 17.6% Licensed Professional Counselor 13.0% Psychology 12.2% Certified Addictions Counselor 11.3% Nursing 4.5%
Source: VCE Workforce Development Survey, 2011
Types of Trainings Taken Recipient Rights (online/required) 79.1%
HIPAA (online/required) 75.3%
Person-Centered Planning (online/required) 64.2%
Medicaid Hearings etc (online/required) 59.0%
Ethics/Pain Management (SW licensing) 41.5%
Children’s Mental Health Grand Rounds 41.3%
Special Topics (online) 41.0%
Suicide Prevention Trainings 33.1%
Trauma Learning Series 27.7%
(NOTE – most focus in on required trainings or easy access)Source: VCE Workforce Development Survey, 2011
Institute for Medicine Recommendations
2001 Report “Crossing the Quality Chasm”
2005 Report “Improving the Quality of Health Care for Mental and Substance-Use Conditions”
Challenges in Training:
State requires specific Social Work credits, not NASW
Trainings are rarely relevant or provide new information
Work schedule and budget will not allow much training time or fees
Hard to keep track of credits when earned
Ensuring a Competent Workforce: From Training to Practice
Benefits of Online Knowledge-Based Learning:Opportunity for disseminating up-to-date
information without travel costsCan be completed at work, home or
anywhere with Internet accessWork at own paceCan include skill elements, with the use of
videos and interactive exercises
Source: Eastern Michigan University
Distance Learning:
Types offered: Live video conferencing capability with
five established sites and portable equipment to expand to 20 live sites
Synchronous web-streamingAsynchronous learning (credit and non-
credit) Popular distance learning websites:
College of Direct Support (Elsevier)Improving MI Practices Relias (formerly E-Learning)Virtual Center of Excellence (VCE)
Cost Benefit Analysis: Conducted by Plante Moran in 2011 Discoveries:
In 2011, VCE’s online training offerings saved Detroit Wayne Mental Health Workforce $1.6 MILLION in travel time and mileage; an additional amount saved that was not in this calculation was revenue lost when employees were unable to see clients because they were at a training
Cost per credit decreases over time as more people take trainings
Source: Plante Moran
Benefits of Combining Live and Online Training: Social Workers can only obtain 10 hours
of their 45 licensure hours online Some learners prefer a live format Some training formats that are very
audience interactive do not translate well into online trainings
VCE obtains Social Work credits for nearly all of its live trainings
VCE offers some live events in six or more locations at once for the convenience of participants
Continuing Education Credits (CECs): VCE is an approved provider of CECs for
licensed social workers (through MI-CEC), licensed professional counselors (through NBCC) and certified alcohol and drug counselors (through MCBAP.
Partner with WSU School of Medicine for CME
Partner with Hospice of Michigan for CNE Other credits available through VCE:
CRC MCOLES AFC
Fiscal Year 2012/2013:
61,700 individuals participated in VCE’s live and online trainings
75,628 Social Work Continuing Education Credits were earned
73,472.5 Counseling Credits were earned
44,848.5 CMHP Credits were earned 17,501.5 Medical Staff Education Credits
were earned 18,891 Substance Use Education Credits
were earned
Feedback Loop & Expertise:
Work with Universities Workforce Development Committees Workforce Surveys & Event Evaluations Establish curricula with non-university
organizations such as:Michigan Association for Infant Mental
Health (MI-AIMH)The Center for Self-DeterminationMichigan Public Health Institute (MPHI)
Learning Organizations Such as Elsevier, Improving Michigan Practices, Relias, and VCE
Live and Online: Annual required trainings by MDCH for CMH
employees Employer-required trainings, eliminating the
need to do so much in-house and new-hire training
Evidence-Based Practices Licensure-required trainings Discipline-based required training (TBI, Self-
Determination, etc.) Child Mental Health Professional Trainings
(get all 24 of your annual credits online) School-based trainings (subjects on bullying,
autism, suicide prevention, etc.)
REFERENCES Akister, J. (2011). Protecting children: The central role of
knowledge. Practice: Social Work in Action, 23(5), 311-323.
Becan, J., Knight, D., & Flynn, P. (2012). Innovation adoption as facilitated by a change-oriented workplace. Journal of Substance Abuse Treatment, 42(2), 179-190. doi:10.1016/j.jsat.2011.10.014
Biesma, R.G., et al. (2007). Using conjoint analysis to estimate employers’ preferences for key competencies of master level Dutch graduates entering the public health field. Economics of Education Review, 26(3), 375-386.
Biesma, R.G., et al. (2008). Generic versus specific competencies of entry-level public health graduates: Employers’ perceptions in Poland, the UK, and the Netherlands. Advances in Health Sciences Education, 13(3), 325-343.
REFERENCES Blumenthal, D., Gokhale, M., & Campbell, E.G. (2001). Preparedness for
clinical practice: Reports of graduating residents at academic health centers. Journal of the American Medical Association, 286(9), 1027-1034. Retrieved from: http://peds.stanford.edu/faculty-resources/documents/JAMA_resident_prep_2001.pdf
Committee on Crossing the Quality Chasm: Adaptation to Mental Health and Addictive Disorders Board on Health Care Services. (2006). Increasing workforce capacity for quality improvement (Chapter 7). Improving the Quality of Health Care for Mental and Substance-Use Conditions: Quality Chasm Series. Washington, D.C.: Institute of Medicine of the National Academies – The National Academies Press.
Crits-Cristoph, P., Chambless, D.L., Frank, E., Brody, C., & Karp, J.F. (1995). Training in empirically validated treatments: What are clinical psychology students learning? Professional Psychology: Research and Practice, 26, 514-522.
Hager, M., Russell, S., Fletcher, S.W., (eds.). (2007). Continuing Education in the Health Professions: Improving Healthcare Through Lifelong Learning, Proceedings of a Conference Sponsored by the Josiah Macy, Jr. Foundation; 2007 Nov 28 - Dec 1; Bermuda. New York: Josiah Macy, Jr. Foundation; 2008. Accessible at www.josiahmacyfoundation.org.
REFERENCES Heiwe, S., et al. (2011). Evidence based practice:
Attitudes, knowledge and behavior among allied health care professionals. International Journal for Quality in Health Care; 23(2), 198-209.
Hoge, M.A., Jacobs, S., Belitsky, R., & Migdole, S. (2002). Graduate education and training for contemporary behavioral health practice. Administration & Policy in Mental Health, 29(4-5), 335-357.
Lombardozzi, C. & Casey, A. (2008). The impact of developmental relationships on the learning of practice competence for new graduates. Journal of Workplace Learning, 20(5), 122-143.
Nelson, T.S. & Graves, T. (2011). Core competencies in advanced training: What supervisors say about graduate training. Journal of Marital & Family Therapy, 37(4), 429-451.
REFERENCES Rugs, D., Hills, H.A., Moore, K.A., Peters, R.H. A community
planning process for the implementation of evidence-based practice. Evaluation & Program Planning, 34(1), 29-36.
Sburlati, et al. (2011). A model of therapist competencies for the empirically supported cognitive behavioral treatment of child and adolescent anxiety and depressive disorders. Clinical Child & Family Psychology Review. DOI 10.1007/s10567-011-0083-6.
Shahmoon Shanok, R., Gilkerson, L., Eggbeer, & Fenichel, E. (1995). Reflective supervision: A relationship for learning. Washington, D.C.: Zero to Three, 37-41.
Sigel, B.A. & Silovsky, J. (2011). Psychology graduate school training on interventions for child maltreatment. Psychological Trauma Theory, Research, Practice, and Policy, 3(3), 229-234.
Simpson, D. D. (2009). Organizational readiness for stage-based dynamics of innovation implementation. Research on Social Work Practice, 19(5), 541-551.