Collaborative Dissemination and Implementation of Evidence Based Practice

Collaborative Dissemination and Implementation of Evidence Based Practice in Social Work Agencies. Sarah E. Bledsoe Jennifer Bellamy Lin Fang Catherine Coppolino Jennifer Crumpley Julia Jean-Francios Edward J. Mullen Columbia University, School of Social Work, Musher Center Supported in part by National Institute of Health Doctoral Training Program in Mental Health Services Research #5 T 32 MH 14623 -24/25 & the Willma & Albert Musher Center at Columbia University

Background • Comprehensive and unified approach to EBP: – – – – Share resources between agencies and practitioners Increase buy-in and ownership at all levels Increase quality continuing education Make research more user-friendly Provide tools Attach meaningful signposts Protect time (Bellamy, Traube & Bledsoe, 2004)

Literature Review Barriers: • Lack of Knowledge & Skills for EBP • Lack of Fit to Agency Practice • Suspicion of Researchers & EBP • Limited Resources for EBP (Bellamy, Traube & Bledsoe, 2004)

Current Strategies for EBP Implementation 1. Bottom-up: Teaching professionals to be evidence-based, lifetime learners (Sackett, 2000; Gibbs & Gambrill, 2002; Gibbs, 2003; Gray, 2001) 2. Top-down: Tool kits/application kits/manuals/guidelines (Mueser, Torrey, Lynde, Singer and Drake, 2003) 3. Top-down/bottom-up: Combining evidence & consensus (Cook, 2004) 4. Combine focus on practitioner training & organizational development: A. Interactive staff training (Mc. Cracken & Corrigan, 2004) B. Outcomes & objectives orientation (Rosen, Proctor, Morrow-Howell, Auslander, & Staudt, 1993) • Targeting the Social Work Profession – Objectives-Focused Multilevel Strategy (Proctor, 2004)

Pilot Study • Pilot study aim: – Design-pilot-refine strategy for implementing EBP in social work agencies • Multi-site to permit comparison

Main Research Question: How can social work organizations & practitioners be engaged & helped to adopt & implement evidence-based practice?

Social Intervention Research Design ü Phase one Review literature, interview experienced EBP researchers ü Phase two Select partner agencies, design study ü Phase three Implement and modify intervention, evaluate outcomes

Findings from Initial Meetings • Agency-university RELATIONSHIP is key • Evidence based practice is an relatively unfamiliar term • Preference for a team approach • Resources may be limited (e. g. computers, time and scheduling)

More Findings • Agencies want trainings in EBP, but not to be told how to practice • Staff have varying levels of expertise and education • It’s a struggle to find the “perfect” question

Process of Initial Meetings • Understanding problem formulation -large agencies with diverse programs -continual narrowing of focus -process vs. outcome interest • Team building -creative, innovative, or change oriented staff -midlevel administrator interest

Team Formation Team 1 Staff Members 3 Housing Supervisors and 1 Administrator Children and Families Programs Small neighborhood focused Program Area Adult Housing for Dual Diagnosis Large and diverse 2 3 Agency Type 6 Casework Supervisors, 2 Administrators Health/Mental Health Clinic 4 Clinical Social Workers, 1 Social Work Student, 1 Administrator, 2 Case managers

Overview of the Model Curriculum • Based largely on Gibbs’ book: Evidence Based Practice for the Helping Professions • Multi-session, multi-module flexible design • Reflects Gibbs’ seven stages of evidence based practice

First Step: Motivation Rapport building at Pre-implementation • Initial meetings Knowledge gathering (Baseline data) • Module 1: Focus group and questionnaires • Module 2: Overview of EBP including history and motivation for use

Second Step: Question Formulation Module 3: • Components of a researchable question (COPES) • Question types • Brainstorming question • Selection of team question

Third Step: Tracking Down Evidence Module 4: • Types of research evidence Module 5: • Search tools (search terms and electronic resources) • Team searching plan • Hands-on computer lab searching

Step Four: Appraising the Evidence Module 7: • Trouble-shooting the search (homework) Module 8: • Review of research evidence • General discussion of quality and quick tips • Formal assessment instruments

Step Five: Applying the Results Module 9: Group discussion format Module 10: Synthesis of findings (along with practitioner knowledge)

Step 6: Evaluation of the experience by the team- debriefing Formal Evaluation • Focus groups • Questionnaires • Feedback on Instruments

Step 7: Teaching Module 11: Agency action plan • Training to others • Reporting findings/experience to wider agency • Adding resources • Duplication and continuation of model

Preliminary Findings (Barriers) 1. Validated barriers: • Lack of Knowledge & Skills for EBP • Lack of Fit to Agency Practice • Suspicion of Researchers & EBP • Limited Resource for Doing EBP (Bellamy, Traube & Bledsoe, 2004) 2. New Barriers: Agency culture, Larger community environment

Preliminary Findings (Knowledge) Knowledge 1. Some exposure to EBP 2. Varied and partial definitions of EBP 3. Little Pressure to Use EBP

Preliminary Findings (Promoters) 1. Administrative leadership (time, culture, etc. ) 2. Partnership with researchers 3. Incentives to use EBP 4. Acknowledge the humanity and art of practice 5. Value agency philosophy 6. Research evidence that’s useful

Preliminary Findings (Curriculum) • Practitioners are motivated to use EBP • Practical tools and hands-on training experiences are most helpful • There is not enough time to learn all that is necessary to use EBP • Two agencies plan to incorporate components of the training into existing agency processes

For More Information Betsy Bledsoe seb 2108@columbia. edu Jennifer Bellamy jlb 2109@columbia. edu