Strategies Employed to Implement Evidence-Based Practices

The concept of evidence-based practices is generally received enthusiastically because of the fit with accountability, hopes for improved quality and outcomes of services, and the opportunity to strengthen the interface between research and practice. However, integrating evidence-based practices into service delivery systems has presented many challenges.

Several research projects, including CMHQA’s survey of the 50 states’ adult and child mental health directors, the MacArthur Foundation’s qualitative study of the Dartmouth “Toolkit” project, and other research seek to pinpoint factors that facilitate or inhibit the adoption of EBPs, implementation with fidelity, and sustaining the practices through time while linking back to performance measurement and quality improvement.

As EBPs are being integrated into the mental health service system, a great challenge is aligning the infrastructure of the system with the organizational structure, policies and procedures, and resources necessary to support this new type of practice. The information provided across the following linked pages are the most current thinking on strategies concerning the implementation of EBPs.

Key Factors in Developing Infrastructure

• Implementation Research: A Synthesis of the Literature is a monograph from the University of South Florida's Louis de la Parte Florida Mental Health Institute that summarizes findings from the review of the research literature on implementation and proposes a framework for understanding effective implementation process.
  
  
• Vijay Ganju presented on Lessons Learned: Taking it Statewide at the 2006 CMHQA Conference, Lessons Learned: Embedding EBPs in Statewide Transformation.
  
  
• For a Powerpoint presentation of lessons learned in the course of EBP implementation and dissemination, click here.



• Results of a Survey of State Directors of Mental Health Regarding EBP Implementation can be found here.



• The reports regarding state mental health efforts to support and facilitate EBP implementation are based on a series of site visits sponsored by the MacArthur Foundation to document activities occurring in states involved in SAMHSA's National EBP Demonstration Project. Staff of the NRI Center for Mental Health Quality and Accountability participated in the site visits and the development of the reports. The following state reports are available:
• Vermont
• Kansas
• Indiana
• Maryland
• New Hampshire
• New York
• Ohio
• Oregon

Consensus Building

Arriving at consensus among all stakeholder groups is a great challenge for leaders of EBP implementation teams. Following are some links that offer strategies toward consensus building. While some of these articles do not relate specifically to mental health, the theories behind system-wide consensus building apply.

In 1999, The Policy Consensus Initiative group published its book, A Practical Guide to Consensus, by Jim Arthur, Chris Carlson, and Lee Moore. This book is a practical guide to the public policy consensus process. The abbreviated version of the book is available online, highlighting the important elements of the book, and serving as a good review edition for people considering the purchase of the book.

The William and Flora Hewlett Foundation has been involved with consensus building and conflict resolution for state-level offices for years. Their Web Page entitled, "State-level Consensus Building", offers some interesting tips and links to groups that have successfully assisted state agencies in the consensus building process.

The Massachusetts Institute of Technology has posted on its website an article entitled, "Short Guide to Consensus Building."

Change Management

Since EBPs are a significant change to usual care, the area of change management is currently being explored to provide model(s) on how to foster this change for sustainability in a productive and successful manner.

CMHQA recently hosted a meeting with leading experts in the field of change management. Please visit our Change Management Conference page to view the presentations given at the conference. In addition, the University of Texas has posted a useful resource on Tools to Explore Change Management.

Budgeting / Planning

NASMHPD Research Institute recently commissioned Anthony Broskowski, Ph.D., and Bill Barton of Pareto Solutions and Christina Thompson, Ph.D., of Heart of the Matter Consulting, Inc., to prepare a Budgeting and Planning Model for implementation of Supported Employment. While this report is specific to one particular evidence-based practice, its structure and approach provide an adaptable model for the budgeting and planning of other evidence-based practices as well.

SAMHSA's Implementation Resource Kits

In 2001, SAMHSA's Center for Mental Health Services (CMHS) and the Robert Wood Johnson Foundation supported the National EBP Demonstration Project (or Dartmouth "Toolkit" Project), which focused on six specific practices for individuals with a severe mental illness, and created comprehensive guides to standardize the practices for widespread dissemination and implementation that across sites would be consistent and faithful to the specific practice (Drake et al, 2001). The Toolkit Project involved eight states implementing six evidence-based interventions across 55 sites. Click here for more information on this initiative, and other EBP initiatives by SAMHSA and NIMH. Follow the State Initiatives link for more information on their EBP-related activities. In August 2004, SAMHSA's Center for Mental Health Services' Newest Versions of the Six Toolkits were made available in pdf format on the Web.

Measurement

The Measurement Page lists approaches for fidelity and outcomes.