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Targeted RECLAIM
Initiative
May 14, 2009
Center for Innovative
Practices
Institute for the Study and
Prevention of Violence
Kent State University
Acknowledgement to:
Karen A. Blase, Ph.D.
National Implementation Research Network
Frank Porter Graham Child Development
Institute at UNC- Chapel Hill
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Science supports outcomes
High level of training and coaching
Clear set of program standards
Support with implementation
Ultimately can be ‘cost effective’
All systems are moving to an ‘outcome
based’ approach to funding
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A program or practice that has been
demonstrated through scientific studies to
be effective in improving outcomes for a
specific population.
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Evidence-based programs have demonstrated
effectiveness through research
Promising practices have some evidence for benefits to
consumers
Common practices have no data to support their use but
over many years they have been built into a series of
laws, regulations, funding mechanisms, professional
and organizational accreditation standards, etc. that
sustain them
Harmful practices have evidence indicating harm to
clients but often still are supported as a common
practice
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No evidence
 Expert consensus
 Formal Evaluation
 Comparison studies
 Randomized clinical trials
 Meta-analysis
 Replicable in real world settings
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Some higher Level of Evidence of effectiveness
Reliability of Treatment Application
Treatment Manual and Uniform Training
Treatment Fidelity
Coaching, Consultation, Quality Assurance and
Support
Validity: Strong theoretical and research basis
Consumer responsiveness; Salience
True clinical sample of intended treatment
population
Ethical delivery of service
A balanced focus on strengths as well as needs
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Multisystemic Therapy = MST
 Intensive Home Based Treatment = IHBT
 Multidimensional Treatment Foster Care = MTFC
 Integrated Co-Occurring Treatment = ICT
 Wrap Around = WA
 Functional Family Therapy = FFT
 Cognitive Behavior Therapy = CBT
 Appropriate medication intervention
But all need to be based on:
 Multi factored Screening, Assessment, and
Diagnosis for MH and Substance Abuse
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MST-Intensive family based
intervention for youth with
externalizing behavior
IHBT-Intensive home based
treatment model for families with
youth with a wide range of
emotional and behavioral
disorders
Incredible Years-Parent and
Teacher modeling and behavior
management skills
Functional Family Therapy-Family
therapy and structure model for
youth with disruptive behaviors
disorders
Positive Behavior Supports-Youth
specific and environment general
techniques to minimize problem
behaviors
Multidimensional Treatment Foster
Care-Specialized foster care
linking foster and home to focus
on disruptive behaviors in youth
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Integrated Co-Occurring
Treatment-Intensive home and
community integrated MH & SA
treatment
Nurse-Family Partnership- Home
visiting model by RNs for
newborns focusing on child-parent
interaction and child development
WrapAround-A process technique
to develop en ecological treatment
plan for families with multiple
systems needs
Columbia Teen Screen-Science
based voluntary youth screening
tool for depression and other
mental health
School based Mental Health
Strategies-Specifically focusing on
school based approaches to
prevention and intervention
Strengthening Families: Ages 1014, designed to reduce substance
abuse and other problematic
behaviors in youth, is a seven week
course for parents and youth
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Provider
Counties Served
# of Teams
Crisis Intervention Center *
Family Resource Centers
Applewood Centers *
Family Life Counseling
Children’s Hospital *
Buckeye Ranch
Rosemont Center
Counseling Center
Family and Community Svcs
Justice Affairs
TBD
Stark
Hancock
Lorain and Cuyahoga
Richland
Franklin
Franklin
Franklin
Columbiana
Portage
Cuyahoga
Lucas
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1
2
1
2
2
2
1
1
1
1
Total
9 counties
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* (piloting an MST-PSB team)
Franklin, Stark, Lorain, Cuyahoga
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593 cases July 1Dec 31 2008
U.S Average
CIP Average
% of youth living at
home
84.1%
89.5%
% of youth in school
or working
83%
86.9%
% of families
completing
treatment
78.8%
86.3%
% of cases
discharged due to
lack of engagement
8.4%
4.4%
% of youth placed
during treatment
12.8%
8.4%
Average LOS
129.5 days
146 days
Ultimate Outcomes
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COST
LOS
PER DIEM
IHBT/MST
$7000-9000 5-6 months
$70-90.00
Secure Res
Tx
$122,000
12 months
$335.00
ODYS
$82,600
11.5 months $236.00
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Who are the key populations we are trying to
address
What are the key problem or challenge areas
we are trying to address
What is already in our continuum
What is the capacity of that continuum
Do we need more of the same
Do we need something different
Do we need to stop doing some things
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Assess the Potential Match Equation
Community Needs +
Cross System Support +
Community Resources +
Readiness +
Options for evidence-based/best practice
=
Decision to proceed (or not).
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What process do we use to identify the
possible service options
What other partners do we want/need at the
table
What role do other youth serving systems
have in our exploration
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What are the services, strategies, practices
that might address our identified needs and
build local continuum
What criteria do we use to ‘nominate’ or
identify potential services
What outcomes are the most important
What level of evidence do we want for
programs we select
What are the reliable lists/sources of
information on effective practices
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What services or practices ‘match’ our criteria
and targeted outcomes
 What details about the treatment do we need
information on:
 Cost
 Training
 Licensing requirements
 Coaching
 Level of research
 Workforce needs
 Feasibility factors
 Outcomes
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http://www.colorado.edu/cspv/blueprints/m
odelprograms.html
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Midwestern Prevention Project (MPP)
Big Brothers Big Sisters of America
Functional Family Therapy (FFT)
Life Skills Training (LST)
Multisystemic Therapy (MST)
Nurse-Family Partnership (NFP)
Multidimensional Treatment Foster Care (MTFC)
Olweus Bullying Prevention Program
Promoting Alternative THinking Strategies
(PATHS)
The Incredible Years: Parent, Teacher and Child
Training Series (IYS)
Project Towards No Drug Abuse (Project TND)
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ATLAS (Athletes Training and Learning to Avoid
Steroids)
Behavioral Monitoring and Reinforcement
Program
Brief Strategic Family Therapy (BSFT)
CASASTART
FAST Track BPP06
Good Behavior Game (GBG)
Guiding Good Choices (GGC)
I Can Problem Solve (ICPS)
Linking the Interests of Families and Teachers
(LIFT)
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Perry Preschool Project BPP12
Preventive Treatment Program (PTP)
Project ALERT
Project Northland
BASICS (Brief Alcohol and Intervention of
College Students)
Seattle Social Development Project (SSDP)
Strengthening Families Program For Parents
and Youth 10-14
Strong African American Families (SAAF)
Program
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Not an event but an ongoing process
Typically takes 2-4 years to take hold
The treatment effectiveness is in direct
proportion to the effectiveness of
implementation at ALL levels
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Effective intervention practices and programs
+
Effective implementation practices
=
Good outcomes for children and their families
No other combination of factors reliably produces
desired outcomes for children, families, and caregivers
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IMPLEMENTATION
Effective
INTERVENTION
Effective
Performance
Implementation
(High Fidelity)
NOT Effective
Paper & Process
Implementation
(Low or No Fidelity)
NOT Effective
It’s hard to land here and harder to stay here!
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What will implementation of an EBP mean to
the local system of care
What organizational changes will need to be
made to accommodate
What intersystem relationships/processes
need to be created/changed/modified
Can we identify the challenges that will be
inevitable
Do our system stakeholders have the patience
needed for successful implementation
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Can we afford it without ‘special’ funding
and/or when special funding ends
Can we identify ways to embed the service
within the local financing
Can we ‘repurpose’ existing funds
What is the collective public youth serving
systems’ investment strategy to keep their
money and keep their kids, at home
What is the cost-benefit
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Clinical & Programmatic
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Systemic
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Financial
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Changing practices for both clinicians
and organizations
Rigorous supervision/coaching;
ongoing training
Focus on Quality Improvement and
Assurance
Staffing; training; retraining
Outcomes driven
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The allure of ‘the list’
Identifying and selecting practices within
a context of a community planning
process
Shift to an outcomes /results based
(qualitative) system
Developing local evaluation capacity
Going to scale…making effective
practices the rule
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‘Bridge’ funding to finance start up
Reinvesting current resources to new
programs
Anticipating all the costs: what funds will
pay for what, e.g., Medicaid does not pay
for staff training
Mechanics of reimbursement and
limitations of fee for service
Potential ‘conflict’ with productivity
approach
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‘Over-promise’ of the intervention
Expectation of “instant” results
Lack of adequate advance strategic
planning
Provider is the only champion
Limited stakeholders at the table
High level of resistance to change
Workforce issues
Organizational issues
Short term plan for financing
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Interventions selected on solid data
Outcomes that impact JJ, BH and CW
Feasibility: what can and will the local
system support
 ‘Real world’ data to capture clinical and
cost effectiveness
 Diversion from more costly, more
restrictive level of care
 Systems that are ‘saving’ reinvest some
funds back into the program
 Full table of participants
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Investigate need
Identify change agents, stakeholders, and
champions
Identify Programs and Practices that look
promising to meet target needs
Establish key outcomes across stakeholders
Measure qualitatively and quantitatively, including
$$
Begin ‘sustainability planning’ from the beginning
Use multiple funding sources from multiple
systems
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Systems Can Trump Programs!
- Patrick McCarthy, Annie E. Casey Foundation
Goes on at:
 practice
 program
 agency
 and systems levels
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Center for Innovative Practices www.cipohio.org
National Center for MH/JJ
www.ncmhjj.org
 OJJDP Model Programs Guide
www.dsgonline.com/mpg_non_flash/mpg_index.ht
m
 Federation of Families
www.ffcmh.org
 NAMI
www.nami.org/youth
 CMHS-Center for
Mental Health Services
www.mentalhealth.org
 Surgeon General
www.surgeongeneral.gov
 Center for the Study and
Prevention of Violence
www.colorado.edu/cpsv
 OJJDP-Comp Strategies
www.ncjrs.org/strategy/index/html
 GAINS Center
www.prainc.com/gains
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Washington State Institute
of Public Policy
www.wsipp.wa.gov
 OJJDP Parent Resource
www.parentingresource.ncjrs.org
 Children’s Defense Fund
www.childrensdefense.org
 National MH Assoc.
www.nmha.org
 Annie E. Casey Foundation
www.aecf.org
 Center for Effective
Collaboration
www.air-dc.org/cecp
 Search Institute
www.searchinstitute.org
 Nat’l Academies of Science
www.academies.org
 Institute for the Study
And Prevention of Violence
www.kent.edu/violence
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Rand
www.promisingpractices.org
CWLA
www.cwla.org
MST
www.mstservices.org
Oregon Social Learning Center (Multidimensional TFC)
www.oslc.or
Functional Family Therapy
www.fftinc.com
SAMHSA Model EBP Project
www.modelprograms.samhsa.gov/template
Dept. of Ed
www.ed.gov
Nat’l Center on MH and JJ
www.ncmhjj.org
Center for Education, Disabilities and JJ
www.edjj.org
Data Trends (Resource Center)
www.rtc.pdx.edu/DataTrends
Georgetown Childrens MH TA Center
www.georgetown.ed/research/gucdc.cassp
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Florida MH Research Center
www.rtckids.fmhi.usf.edu
President’s Freedom Commission
www.mentalhealthcommission.gov
Chestnut AOD
www.chestnut.org
NIDA
www.drugabuse.gov/nidahome
Tech Assist Collab-TAC (EBP Manual)
www.tacinc.org
School Based Mental Health
http://smhp.psych.ucla.edu/resource.htm
State of New York articles on EBP:
http://www.omh.state.ny.us/omhweb/EBP/practicesforchildren.htm
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Date Trends Newsletter: http://www.childtrendsdatabank.org /
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DHHS Best Practices: http://www.osophs.dhhs.gov/ophs/BestPractice/
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SAMHSA Model Programs:
http://www.modelprograms.samhsa.gov/template.cfm?CFID=540873&C
FTOKEN=20095080
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Psychosocial therapies
Chambless and Hollon (1998). Defining empiricallysupported
therapies. Journal of Consulting & Clinical
Psychology, 66, 7-18
◦ Kazdin, Psychotherapy for children and adolescents
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Oxford, 2000
◦ Weisz & Jensen, Mental Health Services Research, 1999
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School-Based Interventions
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Psychopharmacology
◦ Rones & Hoagwood, School-based mental health services,
◦ Clinical Child and Family Psychology Review, 2000
◦ Journal of the Am. Academy of Child/Adol. Psychiatry special issue
on psychopharmacology, 1999
◦ Weisz & Jensen, Mental Health Services Research, 1999
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Community-based Interventions
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Surgeon General’s Mental Health Report, 1999
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Surgeon General’s Youth Violence Report, 2001
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Burns & Hoagwood (2002) Eds. Community treatments for
youth. Oxford University Press
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Burns, Hoagwood, & Mrazek (2000) Effective
treatments
for mental disorders in children and
adolescents. Child
Clinical and Family Psychology
Review, 2000
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Greenberg, et al., Review of the Effectiveness of Prevention
Programs, 1999 (CMHS)
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Olds et al., Review of Preventive Interventions, 1999 (CMHS)
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Patrick J. Kanary pkanary@kent.edu
Center for Innovative Practices
www.cipohio.org
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