SAMHSA’s Enhancing State Prevention Systems for Children & Youth:

National Webinar Series Presents:

“Effective Implementation of Evidence Based Practice Policy through Legislative Action and Community Engagement”

September 9, 2013 Eric Trupin, PhD

Effective Implementation of Evidence Based Practice Policy

Through Legislative Action and Community Engagement

Eric Trupin, Ph.D. Professor and Vice Chair, University of Washington School of Medicine

Division of Public Behavioral Health and Justice Policy

Evidence Based Practice Institute

Seattle, WA

September 09th, 2013

PRESENTATION OUTLINE

Role of University of Washington and the Washington State Institute for Public Policy in Legislation and Policy Development

Timeline

Definitions, Inventory

Partners

“Heterogeneous” Population Requirement

Definitions

Community Engagement

Collecting Community Wisdom (Promising Practice Process)

Technical Assistance

Fidelity

Take-Aways

110 Fifth Avenue Southeast, Suite 214 Olympia, WA 98504-0999 (360) 586-2677 www.wsipp.wa.gov

Washington State Institute for Public Policy:

Origins and Governance

The Washington State Institute for Public Policy (WSIPP) conducts non-partisan

policy research for the state of Washington. Originally conceived in 1982, the

organization’s governance structure and operating practices have evolved over time.

This paper reviews the history of the Institute’s structure and mission.

BACKGROUND

The Institute was initiated in 1982 by a House of Representatives’ resolution

directing the Council for Postsecondary Education to study “the potential of focusing

higher education resources in assisting state government” (see Appendix A).1 The

Council was directed to report its findings to the 1983 Legislature.2

The Council’s six-year plan, published the following January, stated that The

Evergreen State College (Evergreen) “should strengthen its relationship to Olympia

and the seat of state government located there through the establishment of a state

government policy research resource center….”3

SUMMARY

Created in 1982 by a House resolution, the

Washington State Institute for Public Policy was

established as a non-partisan research group to

carry out practical research, at legislative

direction, on issues of importance to Washington

State.

This paper describes the evolution of the

Institute, including changes to its mission,

governance, and staffing.

Many organizations inside and outside state

government conduct research. The Institute’s

structure and purpose can be distinguished from

many policy research organizations by the

following characteristics:

• The legislature selects and funds the research

topics.

• The governing board includes representatives

from the legislature (ten), executive branch

(two), and higher education (four). Legislators

serve as chairs. Legislative members are

equally representative of the two bodies and

two parties.

• Publications are written for readers without

research expertise.

• The staff is altogether nonpartisan, following

the model of legislative committee staff.

The Institute does not promote its work or

advocate for policy solutions.

Washington State Institute for Public Policy

Updated Inventory of Evidence-Based, Research-Based, and

Promising Practices » 2013 June. EBPI & WSIPP. #E2SHB2536-3.

Updated Inventory of Evidence-Based, Research-Based, and

Promising Practices »

2013 January. EBPI & WSIPP. #E2SHB2536-2.

Chemical Dependency Treatment for Offenders: A Review of

the Evidence and Benefit-Cost Findings » 2012 December. Elizabeth Drake. #12-12-1201.

Inventory of Evidence-Based, Research-Based, and Promising

Practices » 2012 September. EBPI & WSIPP. #E2SHB2536.

Return on Investment: Evidence-Based Options to Improve

Statewide Outcomes April 2012 Update » 2012 April. Stephanie Lee, Steve Aos, Elizabeth Drake, Annie

Pennucci, Marna Miller, Laurie Anderson. #12-04-1201.

Multisystemic Therapy Outcomes in an Evidence-Based

Practice Pilot » 2011 April. Jim Mayfield. #11-04-3901.

Watching the Bottom Line: Cost-Effective Interventions for

Reducing Crime in Washington 1998 January. Steve Aos, Robert Barnoski, Roxanne Lieb. #98-01-1201.

Washington State Institute for Public Policy

House Bill 1088

and the Children’s

Evidence Based Practice Institute

The mission of the Washington State Evidence Based Practices Institute is to improve the health and well-being of children,

families, and adults served by the mental health, chemical dependency, child welfare, and justice systems. We accomplish this

mission by implementing, supporting, and informing effective interventions, training, and collaborative research.

EBPI Infrastructure To conduct its core functions, the EBPI relies upon: A Board of Youth and

Family Advisors

That provides guidance, sets

priorities, and reviews products

and strategies to ensure quality

of our work and relevance to

consumers, youth, and families

A National Community

of Practice

The EBPI is connected to

developers of empirically

supported treatments and other

leading scholars and advocates

nationwide

Effective Communication

Including regular statewide forums

as well as a website that provides

access to information and materials

plus opportunities for state

stakeholders to share information

and network

Direct Relationships

with State Decision-

Makers

The EBPI is charged through

state legislation to serve as a

resource to Washington State.

Core Faculty and

Staff

The EBPI is housed in the

UW Medical School. It is led

by over a dozen faculty

members with nationally

renowned expertise in

service delivery for

individuals with complex

needs

Actively supporting

implementation of

effective practice

EBPI actively supports or

directly implements:

• Trauma-Focused

Cognitive-Behavioral

Therapy (TF-CBT)

• Multisystemic Therapy

(MST)

• Wraparound

• CBT Plus

• Triple P

•SafeCare

• Family Integrated

Transitions (FIT)

Increasing capacity

to deliver effective

practices EBPI supports capacity

through:

• Graduate coursework

• Monthly lecture series

• Training Institute

collaboration

• Networking with provider

agencies

• Survey of community

mental health providers

• Project FOCUS

Supporting

legislation and

policy

EBPI assists policy

initiatives:

• Consultation with

Children’s Administration

• Transformation Grant

activities

• Incentivize use of

effective practice

• Juvenile Rehab.

Administration policy

• Partnership Access Line

Core Functions The EBPI accomplishes its mission through:

Promoting community,

family, and youth voice

EBPI promotes community voice

through:

• Developing Youth Voice in JRA

• Family & Youth Advisory Board

• Collaborations and grant writing with

community orgs

• Juvenile Justice 101

• Partnerships for Success (PfS)

• Parent Empowerment Program (PEP)

training

• Website resources

Researching effective

practices

EBPI works to inform effective

practices through:

• Report on Emotional &

Behavioral Disorders in Youth

• Evaluation and effectiveness

trials (FIT, Wraparound, Family

treatment court)

• Partnerships for Success

evaluation

• Fostering Hope

DEVELOP REVISED CHILDREN’S MENTAL

HEALTH BENEFIT PACKAGE

Strong consideration given to:

Developmentally appropriate evidence-based and research-based practices

Family-based interventions

The use of natural and peer support

Community support services

Review of other states’ efforts

Recommend revisions to legislature by January 1, 2009

IMPROVE MEDICATION MANAGEMENT

AND CARE COORDINATION

Develop and implement policies to improve prescribing practices

Improve quality of children’s mental health therapy

Improve communication and care coordination btw primary care and mental health providers

Prioritize care in the family home

Identify children with emotional/behavioral disturbances who may be at high risk due to a variety of reasons

Review and evaluate appropriateness of psychotropic medications given to children under 5 years of age

Track prescriptive practices with goal of reducing use of psychotropic medication

FACILITATING MEDICAID ELIGIBILITY

When youth are released from confinement, their medical assistance coverage will be fully reinstated on the day of their release

The department shall establish procedures for coordination between department field offices, JRA institutions, and county juvenile courts that result in prompt reinstatement of eligibility for youth who are likely to be eligible for medical assistance services upon release

The department shall adopt standardized statewide screening and application practices and forms designed to facilitate the application of a confined youth who is likely to be eligible for a medical assistance program

HEALTHY OPTIONS

Expansion from 12 to 20 visits for a child per year for both

managed care plans and fee for service plans

Expansion in providers to licensed mental health

professionals

EVIDENCE-BASED PRACTICE INSTITUTE GOALS

Improve implementation of evidence-based and research-based practices

Continue successful implementation of “Partnerships for Success” process for implementing EBPs

Develop a series of information sessions, literature and online resources for families

Participate in identification of outcome-based performance measures and partner in statewide effort to implement statewide outcomes monitoring and quality improvement processes

Serve as a stateside resource on child and adolescent evidence-based, research-based, promising, or consensus-based practices for children’s mental health treatment

Implement a pilot program to support primary care providers

Evaluate implementation and impact of wraparound pilot

MEDICATION AND MH

(FY ’04)

44%

received outpatient

mental health care

18,028 children

56%

received NO outpatient mental health care* 22,498 children

Drug classes include:

Antidepressant

Antipsychotic

Antianxiety

Antimania

ADHD

House Bill

1088

Revise Access to

Care Standards

Revise Benefit Package

Improve Medication

Management

Convene RSN’s,

CMHC’s

Medicaid Eligibility

Expand Healthy Options

Evidence-Based

Practice Institute

IMPLEMENTATION

CHALLENGES

Clinical Cultural adaptations

Change familiar practices/tension around manualized treatment

Systemic Changing administrative processes

Workforce development

Salaries don’t support staff retention

Financial Often takes new funding for start up

Mechanics of reimbursement

HOUSE BILL 2536

ROLE OF DSHS/HCA

By June 30, 2013 compile a baseline assessment of the utilization of evidence-based and research-based practices in child welfare, juvenile rehabilitation and children’s mental health services.

Prioritize the assessment of promising practices identified in the inventory with the goal of increasing the number of practices that meet the standards of evidence-based and research-based practices.*

By December 30, 2013; 2014 and 2015 produce reports for the Governor and the Legislature that include:

ROLE OF DSHS/HCA, CONT’D.

Recommended strategies, times and cost for increasing the use

of evidence-based and research-based practices

Distinguish between the reallocation of existing funding and new

funding to support the recommended strategies

Expectation that there will be substantial increases above the

baseline assessment of the use of evidence-based and research-

based practices.

WASHINGTON STATE INSTITUTE

FOR PUBLIC POLICY AND THE UNIVERSITY OF

WASHINGTON EVIDENCE BASED PRACTICE INSTITUTE

2ESHB 2536, directed the WSIPP and UW EBPI - by September 30,

2012 - to:

Task 1: Publish descriptive definitions of evidence-based, research-

based and promising practices

Task 2: Create an inventory of interventions of interest to child welfare,

juvenile rehabilitation and children’s mental health

Department of Social and Health Services Implementation Timeline - HB 2536

Legislation to Define Evidence Based Practices and Programs

2012

Legislative

Session

May/June 2012

EBP Administration

Subcommittees

formed

Sept 30, 2012 Report to

Legislature

WSIPP on

Definitions and

Menu Programs

December 30, 2014

DSHS Report

Legislature Update

December 30, 2015

DSHS Report

Legislature Update

2012

2013

Legislative

Session 2013 2014 2015 2016 2017

April/May 2012,

DSHS EBP Oversight

Committee Convened

June 30, 2013

DSHS and HCA

complete Baseline

Assessment $

Medicaid

December 30, 2013

The DSHS and HCA

Report to Legislature -

Strategies, timelines,

cost, etc. for

increasing use of EBP.

2015-2019

Department Implements if directed

by the Legislature or on its own.

LIST OF ACRONYMS:

DSHS – Department of Social and Health Services WSIPP – Washington State Institute for Public Policy. The institute represents the legislature, governor, and public universities and carries out practical, non-

partisan research – at legislative direction – on issues of importance to Washington State.

HCA – Washington State Health Care Authority. The Health Authority oversees eight Washington State health care programs including, Basic Health, Medicaid and Medical Assistance Programs, and the Prescription Drug Program.

EBP – Evidence based program.

TASK 1: PUBLISH DEFINITION OF

EVIDENCE-BASED PRACTICES

Current law defines EBP to include:

At least 2 random-assignment trials

Tested across heterogeneous populations

Proposed definition

Permits well-controlled comparison group studies

Requires program benefits to exceed the cost

Requires a program manual

Defines heterogeneity

TASK 1: PUBLISH DEFINITION OF

RESEARCH-BASED AND PROMISING

PRACTICES Research-Based

Current law definition:

“Some evidence” not to the standard of EBP

Proposed:

At least one randomized or well controlled study, with sustained outcomes

Promising Practices

Current law definition:

Program has potential

Proposed:

Well-established theory of change

TASK 2: CREATE THE INVENTORY

Used available WSIPP findings

September report had few programs identified as “promising”

UW EBPI promising practice applications

January 2013 report added 21promising practices

Washington State Institute for Public Policy E vid en ce-B as e d P r act ic e Ins t itute

June 2013 Report

http://depts.washington.edu/ebpi/downloads/June%20Report2.pdf

Washington State Institute for Public Policy E vid en ce-B as e d P r act ic e Ins t itute

June 2013

http://depts.washington.edu/ebpi/downloads/WSIPP%20EBP%20Final%20Inventory%20June%202013.pdf

Inventory of Evidence-Based, Research-Based, and Promising Practices

PROMISING PRACTICES APPLICATION

Need a score of 1 to qualify. Points deducted if the program uses methods

known to be harmful or the approach is inappropriate for the target

population as judged by reviewer consensus.

PROMISING PRACTICE APPLICATION

• Is the proposed practice/program an intervention that targets

outcomes of interest to DSHS child-serving agencies?

• Child abuse, neglect, need for out of home placement;

crime; children’s mental health; education; or employment

• OR, changes in protective/risk factors known to be

associated with these outcomes.

PROMISING PRACTICES APPLICATION

• Does it have initial evidence of effectiveness?

• Pre-post test indicating changes

• Well designed qualitative data

PROMISING PRACTICES APPLICATION

• Does it have a “well-established theory of change?”

• Logic model that rests on empirically supported correlates of change

• Uses the general principles or model of an existing EBP

• Is an EBP that is being used for a purpose other than its evidence-base.

TECHNICAL ASSISTANCE OVERVIEW

EVALUATION TA FOCUS AREAS

Tiered support that addresses unique needs of programs.

Tier 1

Written and archived media that addresses foundational topics: logic models, internal

research capacity, EBP definitions and development.

Tier 2

Interactive resources for small to large group audiences: webinars, workshops,

trainings.

Tier 3

One on one support that supports a program’s development toward

research/evidence-based by putting them in a better position to secure funding for

sophisticated evaluation .

TA: PROGRAM EVALUATION

• Program fills out application

• Assign priority level (Guided by DSHS and WA State needs)

UW contacts for initial TA consultation

• Determine program’s interest in TA opportunities

• Assign to Evaluation TA or Implementation TA

Develop TA Plan • TA plan is specific and

time-limited

• Plan will include recommendations for sustainable support

TA Ends

TIER 3: ONE ON ONE SUPPORT

Program priority will be informed by DSHS priorities

Goal for TA will be to move eligible programs to promising practice

status focusing on one of the areas below:

Assist with logic models

Assist with internal research capacity

Assist with conducting preliminary research

EVALUATION TA: PROGRAM NEXT STEPS

Can the TA establish a program as Evidence-Based?

The Evaluation TA will be primarily focused on building a foundation for moving

towards more sophisticated evaluation. Current resources are not sufficient to

conduct the kinds of evaluation necessary for a research/evidence-based designation.

However, the goal is to put programs in a better position to secure additional funding

and/or clarify agency goals in regards to EBP implementation in general.

EBP IMPLEMENTATION ASSISTANCE FORM

Complete if:

Your agency would like assistance with organizational readiness, training, implementation,

sustainability, or adaptation of an existing EBP

Form Includes:

Opportunity to describe Implementation/Adaptation needs

Initial organizational readiness screening

Questions about referral stream and QA

Caveat:

Completion of form does not guarantee assistance

PBHJP has limited resources and may be able to help your agency identify additional

resources or partners through which your request may be filled

TA: IMPLEMENTATION

Areas of assistance available currently:

Organizational Readiness Assessment

Learning about EBPs and training opportunities

Decision making re: best EBP fit

Cultural enhancements

Maximizing implementation efforts

TA: IMPLEMENTATION

Forms of support can include:

Tier 1

Linkages to information on specific EBPS, training opportunities, cultural

enhancements/adaptations

Tier 2

Interactive resources for small to large group audiences (depending on need)

Tier 3

One-on-one Implementation or Adaptation support

Competence, Fidelity and Outcomes

ASSESSING COMPETENCE, FIDELITY, AND OUTCOMES:

BALANCING RESOURCE RESTRICTIONS WITH THE GOLD STANDARD

8 of 9

Competence Fidelity Outcome

Monitoring

Direct

Methods

Observe live session

(1st case)

Observe live session

(in-person, phone,

skype, video)

Ongoing client

assessment/clinical

measures

Indirect

Methods

Role-playing,

Detailed/Targeted

Clinical Supervision

and/or Consultation

Session checklists,

Case notes, client

reporting

Solution Toolkit Build checklists/

reminders into EMR,

Random case note

audits

Dashboard (Hawaii

CAMHD)

TAKE-AWAYS

Intent of legislation is to increase use of evidence based and research based

practices across systems in WA state

DSHS, HCA, WSIPP, and UW have distinct but complimentary roles in

implementation

DSHS will complete its baseline assessment by June 30, 2013

WSIPP will publish an updated inventory on January 31st to include promising

practices

UW will offer technical assistance beginning January 31st . Our goal is to

assist agencies and providers as they adjust to this legislation.

“Vision without action is a daydream.

Action without vision is a nightmare.”

~ Japanese proverb

Eric Trupin, Ph.D. Professor and Vice Chair, University of Washington School of Medicine

Division of Public Behavioral Health and Justice Policy Evidence Based Practice Institute

Please visit our website and Facebook page:

http://depts.washington.edu/pbhjp/

https://www.facebook.com/PBHJP

2815 EASLAKE AVENUE EAST, SUITE 200 SEATTLE, WA 98102 Phone: 206.685.2085