Intersecting Evidence-Based Practice and Cultural Competence: Methods, Models, and Tools

1. Intersecting Evidence-Based Practice and Cultural Competence: Methods, Models, and Tools Oregon Juvenile Department Directors’ Association Annual Conference Jennifer L. Bellamy

2. Agenda • Methods, Models, and Tools • EBP Process Training and Tools • BEST • EBBP.org • Consolidation Resources • Campbell Collaboration • PWISE • Intervention Adaptation Models • PAA • DEBI • Common Elements Questions and Conversations

3. Toward a Comprehensive Model of EBP General Services Research: Interventions, Cultural Competence Local Aggregate Evidence Case-Specific History Clinical Theory • SAMHSA NREPP • Campbell and Cochrane Reviews • Californita Evidence Based Practice • PracticeWise EBS Database • Etc… Training Coaching and Consultation Evaluation and Feedback Administrative Supports Evidence-based programs Evidence-informed care Evidence Consolidation Coordination Implemen-tation Practice Adaptation MAP Toolkit Common Elements Children and Families Adapted from Chorpita July 2010

5. Evidence Resources • BEST: Bringing Evidence for Social Work Training (BEST) Project • Edward J. Mullen, DSW • Willma & Albert Musher Program • Columbia University School of Social Work • To Get to the Website Search for: “EBP Musher”

6. BEST • Hands-on EBP team training • 3 New York City agencies • 4-6 Team participants per agency • Clinicians, supervisors, administrators and one student • Researchers as team members • Process model of EBP (Gibbs, 2003; Sackett et al. 2000)

7. Project Overview Continued • 10 Modules following EBP-related “steps” • Worksheets, Online resources • Provider-driven problem or question • Evidence search • Evidence evaluation

8. Quick Link to Website • Evidence Based Practice & Policy Website

9. Learning • EBP Process attitudes, skills, etc. can be improved • Evidence can be found and evaluated, but there is little to guide the implementation process- including what to do when the evidence does fit culture/context • Long-term partnership with technical assistance from researchers is needed

10. Evidence Resources • Evidence Based Behavioral Practice • Goals • Promote communication about EBP traditions across disciplines • Disseminate concepts, methods, tools • Provide educators with tools • Help interventionists acquire skills • Mental Health Focused

12. Development • Multidisciplinary Team • Social Work • Psychology • Medicine • Nursing • NIMH Funded- Behavioral Health Focused • Advanced Content and High Production Value

13. Educational Modules • EBBP Process Module • Search for Evidence Module • Systematic Review Module • Critical Appraisal Module • Randomized Controlled Trials • Shared Decision Making • Clients • Communities

14. Quick Link to Site • Evidence Based Behavioral Practice

15. Toward a Comprehensive Model of EBP General Services Research: Interventions, Cultural Competence Local Aggregate Evidence Case-Specific History Clinical Theory • SAMHSA NREPP • Campbell and Cochrane Reviews • Californita Evidence Based Practice • PracticeWise EBS Database • Etc… Training Coaching and Consultation Evaluation and Feedback Administrative Supports Evidence-based programs Evidence-informed care Evidence Consolidation Coordination Implemen-tation Practice Adaptation MAP Toolkit Common Elements Children and Families Adapted from Chorpita July 2010

17. Consolidation Resources • Campbell Collaboration • Mission • Help people make well-informed decisions by preparing, maintaining, and disseminating systematic reviews in education, crime, and social welfare • http://www.campbellcollaboration.org/library.php

18. Systematic Review • Sums up the best available evidence on a specific question • Why Campbell does it better • Clear protocol • Search of published and grey literature • Includes other languages • Teams of peer and editorial reviews • Updates reviews

19. Reviews of Interest • Opportunities for preventing youth gang involvement for children and young people • Serious juvenile offenders: A systematic review of treatment effectiveness in secure corrections • Effects of early family/parent training programs on antisocial behavior and delinquency

20. Reviews of Interest • Cognitive behavioral treatment for antisocial behavior in youth in residential treatment • Multisystemic therapy for social, emotional and behavioral problems in youth 10-17 • Scared straight and other juvenile awareness programs for preventing juvenile delinquency

21. Consumer Synopsis • Programs like 'Scared Straight' involve organized visits to prison facilities by juvenile delinquents or children at risk for becoming delinquent. The programs are designed to deter participants from future offending by providing first-hand observations of prison life and interaction with adult inmates. Results of this review indicate that not only does it fail to deter crime but it actually leads to more offending behavior. Government officials permitting this program need to adopt rigorous evaluation to ensure that they are not causing more harm to the very citizens they pledge to protect.

22. Campbell Reviews • Limited info on racial and ethnic diversity and whether or not this impacts outcomes • Reflection of the literature • Slow going in developing reviews • Expense (few funding sources) • Time

23. Quick Link to Website • The Campbell Collaboration

25. Consolidation Resources • California Evidence Based Clearninghouse • Provides child welfare professionals with easy access to vital information about selected child welfare related programs based on research evidence • http://www.cebc4cw.org/

26. Reviews Level 1: Well supported No risk or harm Manualized 2 RCTs Sustained effect (at least one year) in 1 RCT Reliable and valid measures Overall “weight” of evidence shows benefit

27. Reviews Level 2: Supported No risk or harm Manualized At least one RCT Sustained effect (at least one year) Reliable and valid measures Overall “weight” of evidence shows benefit

28. Reviews Level 3: Promising No risk or harm Manualized Some study using a control group Overall “weight” of evidence shows benefit Level 4: Failed to demonstrate effect Level 5: Concerning NR: Not Rated

29. Topic Areas of Interest • Child and adolescent anxiety treatment • Child and adolescent disruptive behavior treatment • Adolescent substance abuse treatment • Trauma treatment for children • Youth transitioning into adulthood

30. Quick Link to Website • The California Evidence-Based Clearinghouse

31. California Evidence Based Clearinghouse • Provides information as to which racial and ethnic groups have been included in research • Includes languages available • Information about training and other resources, including references on culture and evidence-supported interventions

32. Toward a Comprehensive Model of EBP General Services Research: Interventions, Cultural Competence Local Aggregate Evidence Case-Specific History Clinical Theory • SAMHSA NREPP • Campbell and Cochrane Reviews • Californita Evidence Based Practice • PracticeWise EBS Database • Etc… Training Coaching and Consultation Evaluation and Feedback Administrative Supports Evidence-based programs Evidence-informed care Evidence Consolidation Coordination Implemen-tation Practice Adaptation MAP Toolkit Common Elements Children and Families Adapted from Chorpita July 2010

33. Planned Adaptation (Lee et al. 2008) • Emphasizes researchers’ role in identifying the core intervention components- and partnership with practitioners • Technical assistance from developers, disseminators, and other middle persons • Very often this is not based on empirical evidence • May be based on a logic model

34. 4 Steps of Planned Adaptation • Examine the Theory of Change • What are the core components responsible for change • What are the moderators that enhance or diminsh outcomes • Identify Population Differences • Can the key program processes be generalized across populations? • Adapt Program Content • Maintain the core elements, but modify other intervention pieces • Adapt Evaluation Strategy • Are you getting the outcomes you would expect?

36. Diffusion of Effective Behavioral Interventions (DEBI) • Began in 2002 in response to an Institute of Medicine report urging CDC transfer of HIV prevention to practice • Goals: Training, Technical Assistance, and Capacity building to service providers to support implementation and adaptation of evidence-based interventions • Brought together: providers, intervention developers, trainers, and various other technical assistance and support for evaluation, capacity building etc.

37. DEBI • Implemented multiple interventions • Lessons from traditional implementation • Providers are suspicious of “efficacious” interventions • DEBI interventions as competition for local interventions • Intervention developers vary in terms of their preference to maintain control over their interventions • Fear of letting go and facing claims that the intervention didn’t work, when in fact implementation was poor • Very little research on how to implement interventions

38. DEBI • Marketing • Conferences, presentations • Training • Organizational capacity to deliver a given intervention, • Population needs, and • Relative advantages compared to current programming.

39. Quick Link to Website • Diffusion of Effective Behavioral Interventions

40. A Compliment to Top Down and Bottom Up EBP • Common Elements Approach • PWISE

41. Toward a Comprehensive Model of EBP General Services Research: Interventions, Cultural Competence Local Aggregate Evidence Case-Specific History Clinical Theory • SAMHSA NREPP • Campbell and Cochrane Reviews • Californita Evidence Based Practice • PracticeWise EBS Database • Etc… Training Coaching and Consultation Evaluation and Feedback Administrative Supports Evidence-based programs Evidence-informed care Evidence Consolidation Coordination Implemen-tation Practice Adaptation MAP Toolkit Common Elements Children and Families Adapted from Chorpita July 2010

43. Search for Research by Population and Setting • Problem • Age • Gender • Ethnicity • Setting • Strength of Evidence

44. What the Evidence Supported Interventions Parent Training Incredible Years PCIT Defiant Children Commands Attending Commands Time Out Commands Time Out Rewards These are the practice elements.

45. Building a Treatment from High Quality Parts Common Elements Approach

46. A Complimentary Approach • Common Elements Approach • Identified components of evidence-based treatments • Complements traditional integrated program approach

47. A Different Level of Analysis Family Protocol Protocol Protocol

48. A Different Level of Analysis Parent Training Incredible Years PCIT Defiant Children

49. A Different Level of Analysis Family Protocol Protocol Protocol Practice Element Practice Element Practice Element Practice Element Practice Element Practice Element

50. A Different Level of Analysis Parent Training Incredible Years PCIT Defiant Children Commands Attending Commands Time Out Time Out Rewards These are the practice elements.