Excited today to hear from @APA @ArthurCEvans at the #SIRC2019 conference. One thing I love about #ImpSci is how interdisciplinary it is!
You: Are you going to Live Tweet it?
Me, poised eagerly at my laptop: Do you even know me?
Me, poised eagerly at my laptop: Do you even know me?
Imagine "John" - a difficult, chronic hospital patient. But interventions focused on John's goals and how providers could move him toward those goals got John to a place where he could be discharged. This is what happens when we use Evidence-Based Practices (EBPs)
EBPs help people with a disease get out of the criminal justice system (where they do NOT belong) and also reduce recidivism. TBH, as a policy-maker, @ArthurCEvans says he isn't that interested in fidelity. He needs to spend $ in ways that make lives better.
The goal of implementation science is to help people, who are often marginalized in multiple ways. & this perspective is important when considering lessons learned from his work in Philidelphia.
Philidelphia had created a single-payer behavioral health system. @ArthurCEvans was the director of this first-ever center to administer services from one entity (finances & service delivery). At the time, EBPs weren't part of the lexicon.
Conceptual clarity, tactics & strategies, and questions for future work are the three areas where lessons were learned to get from nowhere to EBPs at every level of care (multi-level, multi-system).
says an important experience is being family-member to someone who doesn't understand why they are receiving a particular type of care and/or "doesn't get the science".
A lesson learned: implementing EBPs is about probability - they increase the likelihood of getting the impact we want.
Providers/systems think "are you saying what I'm doing is wrong"? This sets up an unhelpful dynamic. So FRAMING matters. #SIRC2019
Not everything that leads to good outcomes is captured by the EBP. Thus, it's an important conceptual shift that the EBP is about increasing the likelihood of good outcomes (rather than the be-all/end-all (ONLY) good practice). #SIRC2019
Invest time in conceptualizing, learning, & strategizing. People want to jump into action but @ArthurCEvans emphasizes a need to THINK first. #SIRC2019
Need "right" people at the table, spend time in discussion, have a conversation at multiple levels (not just how we get it done, but also how do we think about the issues, and how does thinking change over time). #SIRC2019
Leaders need to do the work of showing how EBPs are not at odds with a philosophy around treatment. Blending research and values is critical. Look for ways to integrate opportunities with values. #SIRC2019
Lesson Learned: Take a systems perspective. Examples: homelessness, trauma, child welfare. #SIRC2019
Think about EBPs from "system of care" - goals are about having an evidence-based system of care, not just having individual practices use EBPs. #SIRC2019
Ex: Homelessness in Philidelphia. Most people suffering from homelessness have mental health issues or substance use issues or both. We can provide all the treatment in the world, but if we don't give people homes, they will still be homeless. #SIRC2019
But we do need to treat the behavioral health issues to keep people in their homes. Build multiple pathways for recovery, have an evidence-based STRATEGY, not just a single intervention, and design programs based on research. And policy w/partners to get people housing #SIRC2019
89% of the folks helped by community-based management teams were successful in getting into homes. Average cost/day to the city before this program: $85, cost goes up initially, but then down to $18/day once people have housing. #SIRC2019
This group of people was chronically homeless (> 10 years). Win-win. #SIRC2019
Next example: Trauma. People traditionally think of trauma as an individual issue but let's take a public health approach (think of trauma as contagion). This allows for intervention on a continuum - immediate aftermath; educating communities and systems. #SIRC2019
e.g., most people who get shot are not hospitalized. Bandaged up and sent home. No attention paid to the psychological impact of that experience. #SIRC2019
Philidelphia Alliance for Child Trauma Services - children now screened in primary care and then referred to these providers trained to treat trauma. #SIRC2019
Next example: Child Welfare. In Philidelphia there was an over-reliance on residential programs and children were being sent as far away as Utah. No evidence-base for this. This required systems-level change #SIRC2019
Strategies: educating judges, creating programs, new evaluation methods. Also implemented EBP centers in the community that children could be referred to. This has significantly reduced the number of children in residential care and very few being sent out of state. #SIRC2019
Cultural Competence AND EBP (rather than cultural competence v. EBP, typical frame). #SIRC2019
A common argument is "these EBPs haven't been tested on my population, so I shouldn't use them". But also incorrect is "My EBP tested in this population is good for all populations". #SIRC2019
Cautious and thoughtful implementation of EBPs, even when not tested in a specific population, can still be beneficial. #SIRC2019
Another conceptual piece: How do we think about partnerships? "The Primacy of Partnerships" - relationships are critical across providers, purveyors, and policymakers. #SIRC2019
Not effective to see researchers as importing "what providers should do" into practice. Everyone is learning together, everyone on equal footing. It isn't about "getting them to do the thing". #SIRC2019
Academic partners critical: multiple roles beyond imp, developers of EBPs, eval/research, considering meta issues ("think tank"), post-doc training (in policy dev), surveying literature (frees up time for others on the team), tech assistance, joint faculty appointments #SIRC2019
The richer the relationships, the more impactful the work can be. #SIRC2019
Create a learning environment around implementation. EBP & Innovation Center had the sole purpose of ensuring work in one area was informing the work in other areas. Helps with being intentional and also informing the literature. #SIRC2019
Next lesson: Shift to a focus on sustainability. @ArthurCEvans - as a policymaker overseeing systems - would argue we need a "Sustainability Science". Less about getting providers to do the thing, more about how do we support them in continuing to do the thing. #SIRC2019
Behavioral change may be easier than lifestyle change. There are many ways in which sustainability is distinct from implementation. #SIRC2019
Lesson Learned: Institutionalizing EBPs and using All Available Levels; When EBPs are baked into the way the whole system functions, even the "unglamorous operations" will continue - Dr. Ronnie Rubin #SIRC2019
Looking to the Future: We have to skate to where the puck is going, not where it has been. (paraphrase from Wayne Gretsky). #SIRC2019
Important to focus on where we are today, but we also really need to think about the future. Population Health is an area @ArthurCEvans identifies as a future direction. #SIRC2019
Final Lesson Learned: We have to take the long view; systems and orgs evolve over decades. So the notion that we can radically change them overnight is not realistic. #SIRC2019
How are we measuring success? )Absolute capacity to deliver EBPs, culture change). How do we ensure funding for sustaining D&I? What does it mean to view D&I through a "change management" lens? #SIRC2019
Remember WHY and FOR WHOM we do implementation. Fidelity is important but not key to the goal of GETTING PEOPLE BETTER. Much of what we need to do to have max impact is antithetical to what we do as scientists. EBPs are a means, not the end. #SIRC2019
describes how people come for help when they feel valued and respected. A direct parallel to my work as an instructor with students who also do best when they are respected and valued. #SIRC2019
