NAMI’s Leadership Institute

1. NAMI’s Leadership Institute Promoting Evidence-Based Practices in Children’s Mental Health Presented by: Darcy Gruttadaro Director, Child & Adolescent Action Center NAMI Convention - June 2007 - San Diego, CA

2. What exactly are EBPs? The term evidence-based practices has been defined as follows: • Treatment interventions, services and supports that have consistently shown positive outcomes for children and families through research studies. • The integration of best research evidence with clinical experience and consumer values. The Institute of Medicine – IOM NAMI Convention - June 2007 - San Diego, CA

3. Why are EBPs Important? • Promises to improve the quality of care provided to children and their families; • Promises to increase provider accountability and systems’ accountability; and • Promises to improve treatment outcomes (improved school performance, improved family and peer relationships, less involvement with law enforcement and more). NAMI Convention - June 2007 - San Diego, CA

4. Why are EBPs Important? • Reduce service and treatment costs because kids spend fewer days in more costly and restrictive settings and receive services in their homes and communities. • Significant reduction in juvenile detention through the broader implementation of home and community based EBP services. Presentation by Barbara J. Burns, Ph.D. for CMS, June 2006. NAMI Convention - June 2007 - San Diego, CA

5. The EBP Movement The EBP movement received a jolt forward with calls from national leaders for EBP dissemination: • We must close the gap between what we know from research works and what is practiced. Surgeon General’s Report, 1999 • The lag between discovering effective forms of mental health treatment and incorporating them into routine clinical practice is 15-to-20 years. Crossing the Quality Chasm, IOM, 2001. • Call for the closing of the research to science 15-to-20 year gap. Transforming Mental Health Care in America. Federal Action Agenda, 2005. NAMI Convention - June 2007 - San Diego, CA

6. The EBP Movement … Here is what the NFC had to say about EBPs: • Over the years, research has yielded important advances in our knowledge of the brain, behavior, and effective treatments and service delivery strategies for many mental illnesses. • An array of evidence-based interventions now allows successful treatment of most mental illnesses. • Despite these advances in science, many children and families are not benefiting from these research advances. New Freedom Commission Report, 2003. NAMI Convention - June 2007 - San Diego, CA

7. NAMI’s Focus on EBPs 2 recent NAMI grants secured on EBPs: • Grant funding from the MacArthur Foundation to build a family network to promote the broader dissemination of EBPs in three target states: Illinois, Louisiana and Pennsylvania. • CMHS grant to develop a family guide on EBPs. NAMI Convention - June 2007 - San Diego, CA

8. Building a Family Network Starts with Education and Information Developed family guide to provide education and information on EBPs. Worked with Barbara Burns, Ph.D., leading national expert on EBPs in children’s MH, on family guide. NAMI received input from stakeholders and families in developing the guide. NAMI Convention - June 2007 - San Diego, CA

9. Overview of the Family Guide Defines EBPs and Why They are Important; Cautions about EBPs: • Not widely available; • Providers not trained in EBPs and may resist change; • Challenge in establishing an EB for an intervention; • Limitations in studies in diverse communities, but evidence-base growing; • Limited research on co-occurring disorders; and • Research gaps for serious MI in children and adolescent – bipolar disorder and schizophrenia. NAMI Convention - June 2007 - San Diego, CA

10. Overview of the Family Guide Talking with Providers about Treatment Choices and EBPs; Current EBPs and the EBP Chart: • Psychosocial Interventions (CBT, Exposure Therapy, IPT, Behavior Therapy) • Family Interventions (BSFT, FFT, PMT, PCIT, Family Ed & Support) • Intensive Home and Community-Based Interventions (Wrap-around/ICM, MST, TFC, Mentoring, Respite) • Medication Interventions Other Promising Practices in Children’s Mental Health The Role of Families in Promoting EBPs Resources on EBPs NAMI Convention - June 2007 - San Diego, CA

11. The Role of Families in Promoting EBPs • Families learn about EBPs and create demand; • Families contact provider organizations and request training and incorporation of EBPs into provider practice, training and postgraduate training programs; • Employers and insurers hear about the need for broader insurance coverage of EBPs (good outcomes lead to lower overall costs); • Researchers involve families in design, implementation and dissemination of EBPs; NAMI Convention - June 2007 - San Diego, CA

12. Families Promoting EBPs • Advocate with legislators, children’s MH directors and other community leaders for EBPs; • Learn about the available services and gaps in the system, opportunities to bridge gaps with EBPs; • Where are children’s MH funds being spent – get the data and numbers to make the case for home and community-based EBPs. NAMI Convention - June 2007 - San Diego, CA

13. Why EBP Advocacy is Important Current Over Reliance on Institutional Care: • Hospital - beyond acute care, research findings favor community interventions; • Residential Treatment Centers – any gains from these facilities were equal to gains in treatment foster care at half the cost; • Group Homes – mixed findings, youth made some gains and experienced deterioration in arrest rates; • Boot Camps – negative outcomes; and • Detention Centers – negative outcomes. Presentation by Barbara J. Burns, Ph.D. for CMS, June 2006. NAMI Convention - June 2007 - San Diego, CA

14. EBPs Reduce Recidivism Reduces Recidivism Increases Recidivism 10% Boot Camps -25% Functional Family Therapy -31% Multi-Systemic Therapy -37% Multidimensional Treatment Foster Care -40% -30% -20% -10% 0% 10% 20% 30% 40% Effect of Program on Recidivism Rate SOURCE: Meta-analysis conducted by the Washington State Institute for Public Policy NAMI Convention - June 2007 - San Diego, CA

15. 98,740 66,000 44,000 National Use of Residential Treatment Facilities for Youth with Mental Illnesses 25,603 *Burns, 1991 **Warner & Pottick, 2003 ***Buck, 2006 Presentation by Barbara J. Burns, Ph.D. for CMS, June 2006. NAMI Convention - June 2007 - San Diego, CA

16. An Example of One State… Children’s Mental Health Services in North CarolinaExpenditure by Treatment Type for FY 2005 Community-Based Services25.20% Inpatient Hospital8.18% (6% of youth served) Outpatient Therapy 8.64% Other – 5.27% Residential Treatment 43.00% (9% of youth served) Case Management9.69% SOURCE: North Carolina Division of MH/DD/SAS Presentation by Barbara J. Burns, Ph.D. for CMS, June 2006. NAMI Convention - June 2007 - San Diego, CA

17. States and the EBP Movement State-wide initiatives for disseminating EBPs: Michigan – Cognitive behavioral therapy and Parent Management Training. Washington – Functional Family Therapy in Juvenile Justice. Georgia – Positive Parent Training in Juvenile Justice. Oregon – EBPs required for reimbursement of MH services (of concern to families). NY, CA and OH – developed training institutes on EBPs in children’s mental health. Presentation by Barbara J. Burns, Ph.D. for CMS, June 2006. NAMI Convention - June 2007 - San Diego, CA

18. NAMI’s Work in Targeted States On-Site Targeted Technical Assistance: • Illinois – Three meetings with Children’s MH Partnership, DMH/Child and Adolescent Network, Families and Advocacy Groups; • Louisiana – Meetings with Families, Children’s Cabinet, and Models for Change (MacArthur JJ Reform Initiative); • Pennsylvania – Planning underway for October meetings. NAMI Convention - June 2007 - San Diego, CA

19. Other Targeted Activity • Series of Fact Sheets for Families on EBPs – information on the interventions and how to effectively communicate with providers, policymakers, and community leaders about EBPs; • Dedicated section of the website on EBPs for children and their families (visit our recently update web section at www.nami.org/CAAC); • NAMI Beginnings focused on EBPs (Fall 2007); • Friday Conference Calls with Dr. Duckworth focused on EBPs (CBT, Behavior Therapy, MST, and more); • Other ideas – what will make the difference? NAMI Convention - June 2007 - San Diego, CA

20. What Else is Needed to Close the Science to Service Gap? Advocacy Leadership NAMI Convention - June 2007 - San Diego, CA

21. We’d Like to Hear from You! NAMI is pleased to be working on this EBP project to ultimately improve the services delivered to children and families. EBPs are not a panacea, much more is needed, but it is giant step forward. We look forward to working with families in promoting the broader dissemination of EBPs and would like to hear from you. NAMI Convention - June 2007 - San Diego, CA

22. NAMI’s EBP Project • Darcy Gruttadaro, Director, NAMI Child & Adolescent Action Center. Please contact Darcy with questions and comments about the EBP project (darcy@nami.org, 703-516-7965) • Also, visit the recently updated child and adolescent section of NAMI’s web site at www.nami.org/CAAC NAMI Convention - June 2007 - San Diego, CA