As a contact-level practitioner, I am able to provide staff training and development on evidence-based practices that involve practitioner skills for guiding dialog to promote changes in behaviors necessary for recovery of critical life functions lost to disabling symptoms and conditions. Engagement, commitment to change, follow-through, participation, etc. are all in the choice and control of an individual. In the State of Michigan, I am responsible to ensure that practitioners are using the most effective evidence-based practices for Adult Mental Health Services provided by the public health system. That includes providing regional, local, and state-wide training and consulting for a variety of evidence-based practices, providing evaluation of practice, and funding opportunities for improvement through Federal and State Grant funding.
I first became interested in evidence-based approaches when I noticed that most practitioners use intuitive approaches that are not very effective for engineering changes in behaviors of persons who are receiving necessary care. In fact, in some cases the intuitive approaches actually seemed to push recipients to the passive role, and discount other factors of readiness as a barrier to following simple advice.
I currently focus on strength-based approaches such as Motivational Interviewing, Cognitive Behavioral Therapy, Person-Centered, Self-Determination, Case-Management, Co-occurring Mental Health and Substance Use Disorders, and Trauma Focused EBPs.
For agencies, I would recommend developing a system of tracking both Process and Treatment Outcomes to be used as “evidence” to know the degree to which the practices (supports and services) they provide are effective, and to locate areas that create both positive and negative outcomes. Use the evidence to develop strategies to normalize areas of strength and target areas not achieving outcomes for improvement continuously.
Further, develop a quality improvement team to study the specific evidence-based programs, methods, practices, and practitioners to determine which are best practices for the population and pathologies they intend to treat/serve. Adopting those EBPs will require implementation strategies that involve staff training and development to achieve certifications or high fidelity, evaluation of practice, and ongoing activities such as training and consultation to sustain and enhance skills. Use of EBP self-evaluation toolkits used for periodic evaluation of the degree to which EBPs are implemented and practiced with high integrity should be part of this process.
Often an agency identifies an EBP that they wish to implement, hires a trainer, or sends staff to be trained. Upon completion of this step, the EBP is implemented as one of the agency’s services. The challenge comes in when time lapses between the initial training and follow-up activities to ensure that the program is still being applied with fidelity to the method. Without a system for tracking process outcomes and fidelity, drift from the elements of the EBP that were determined by clinical trials to be necessary to achieve the outcomes happens quickly and erodes effectiveness. Elements for reinforcing and enhancing the EBP are as important as the initial training and certification.
The most memorable success has involved the Medication Assisted Treatment Programs in some of our Michigan Agencies. In the past opioid addiction and the people afflicted with it have been very deficit based with very punitive and confrontive approaches to the individuals who struggle with compliance. Using intensive training on Motivational Interviewing and Strength-based Treatment Planning (person-centered), participation, retention, and compliance have increased. Individuals achieve accountability with an assistive-collaborative partner.
The basic function of a practitioner Code of Ethics is the idea that anyone who is the recipient of supports and service from a professional must be able to benefit from the care that is provided. To that end, all the practitioner’s behaviors must have beneficence at that highest level. That will require all practitioner approaches to be rooted in a solid knowledge of the way the brain works in an inter-personal dialog. More emphasis will be placed on that knowledge, including training, certification, fidelity review of skills, etc.
As an individual practitioner, as well as an agency, the quality of supports and services will be a product of the effort made to develop around evidence-based practices, methods, programs, and interventions. Equally, evidence can be derived from the macro level of ascertaining data to guide the process of implementation and the quality of service as it relates to outcomes. Of course, the data is only evidence. The agency or practitioner must use the data to determine the course of improvement.
That’s how I see us all evolving.
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