Mental Health Evidence Based Practices in Washington State

Dennis McBride, PhDWilliam Voss, PhDHeather Mertz, PhDTerri VillanuevaGenevieve De Nevers

The Washington Institute for Mental Health Research & TrainingUniversity of Washington, Seattle

For further information contact Dennis McBride: dmcb@u.washington.edu or (253) 756-2335www.wimirt.washington.edu

THE WASHINGTON INSTITUTE FOR MENTAL HEALTH RESEARCH & TRAINING

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Goal of the EBP Survey

To identify and assess the use of mental health EBPs from publicly funded social service agencies in Washington State

Information collected is intended to inform state policymakers, providers, consumers, and other stakeholders about:– Current planning and programming efforts– Provide baseline for tracking future EBP implementation

Participants*

– Mental Health Division (MHD) – Division of Alcohol and Substance Abuse (DASA)

– Juvenile Rehabilitation Administration (JRA)

– Children’s Administration (CA)

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* Aging and Disability Services Administration (ADSA) was invited to participate but did not.

Definition

• Evidenced Based Practices – “means employing clinical interventions that research has shown to be effective in helping consumers recover and achieve goals.”

Drake, R. E., Merrens, M. R., & Lynde, D.W. (2005) Evidenced-Based Mental Health Practice. WW Norton & Co. p.67.

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EBP Identification

Initial EBP Selection

Family Members

Researchers

Mental Health Consumers

Service Providers

Literature Search

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Nine Key Sources Containing Definitions and Rating Criteria for Mental Health EBPs

1. WIMIRT Literature Review and Resource Guide on Evidence Based Best and Promising Mental Health Practices;

2. SAMHSA Data Infrastructure Grants (DIGS);

3. SAMHSA EBP Tool Kits;

4. SAMHSA National Registry of Evidence Based Practices;

5. SAMHSA Model Programs;

6. Transformation Grant's Evidence/Consensus Based/Promising/Emerging practices (ECBPEP) Supplemental Report on EBPs;

7. Children's Mental Health EBP Expert Panel report;

8. Alcohol and Drug Abuse Institute's (ADAI) EBP database; and

9. Washington State Institute for Public Policy (WSIPP).

Level of Evidence

Over 350 Practices were selected from the Nine Sources. Each Practice was rated by each source to be one of the following:

1. Emerging Practices2. Promising Practices3. Evidence Based Practices

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Selected EBPs and Definitions (Appendix B)

1. The number of times the practice was endorsed by the nine sources;

2. The level of evidence that each practice received; and

3. Whether or not the practice was currently offered in Washington State.

34 Practices were selected from the 350 based upon the following criteria:

EBP Scoring

Score3 Number of EBP (3) Selections

Score2 Number of

"Promising" (2) Selections

Score1 Number of

"Emerging" (1) Selections

Total_Count Total Number of Endorsements

Numeric_Score Total Score

Washington Currently offered

in Washington State

Aggression Replacement Training

2.00 .00 .00 2.00 6.00 1

Assertive Community Treatment (ACT/PACT)

5.00 .00 1.00 6.00 16.00 1

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Total Score = SUM (Number of sources that endorse each EBP X Level of Evidence).

Minimum score of 6 if not offered in Washington;Minimum score of 5 if offered in Washington.*

* 2 practices (peer Support and Supported Housing) did not meet these criteria but were included.

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Selected EBPs and Definitions (Appendix B)

Cognitive Behavior Therapies (CBT)A form of psychotherapy focusing on decreasing symptoms and improving quality of life by changing a person’s thoughts and behaviors.  The treatment involves a collaborative agreement on treatment goals which the patient tracks each week, learning and practicing new skills and ways of thinking in the treatment session and practicing via homework assignments throughout the week. Many EBP's on this list are based on CBT.  For this survey, only rate this if CBT is used in your site separate from another EBP in this list.

Motivational InterviewingMotivational interviewing is a directive, client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence.

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EBP Survey ContentAppendix C

• UTILIZATION OF EBPS • FIDELITY

• TRAINING

• TARGET POPULATION • IMPLEMENTATION SUCCESS • EBP EFFECTIVENESS

• FUTURE EBP UTILIZATION

• BARRIERS

• MOST NEEDED ASSISTANCE TO ADOPT EBPS

• POPULATION SERVED BY NO KNOWN EBPs

• INTEREST IN EBP IMPLEMENTATION

• EBP INITIATIVES

• SYSTEMATIC ASSESSMENT OF EBP EFFECTS

• CLIENT COUNTS

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Data Collection

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Sample Frame

• 156 MHD Agencies

• 239 DASA Agencies

• 17 JRA Agencies

• 15 CA Agencies

• 427 Total Agencies

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Response Rates

96

154

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Sample Size

MHD

DASA

JRA

CA

Total Response Rate: 65.8%

Agency Response Rate

MHD 61.5%

DASA 64.4%

JRA 100%

CA 93.3%

N = 281

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MHD Map

(6)

North Central RSN

Peninsula RSN

CLALLAM

JEFFERSON

GRAYS HARBOR

North Sound RSN

WHATCOM

SNOHOMISH

King RSN

KING

Pierce RSN

PIERCE

Thurston-Mason RSN

THURSTON

MASON

LEWISWAHKIAKUM

Timberlands RSN Greater Columbia RSN

North Central RSN

Chelan-Douglas RSN

Spokane RSN

Southwest RSN

Clark RSN

COWLITZ

CLARK

KLICKITAT

YAKIMA

SKAMANIA

KITTITAS

BENTON

WALLA WALLA

COLUMBIA

FRANKLIN

GARFIELD

WHITMAN

GRANT

OKANOGAN

LINCOLN

CHELANDOUGLAS

FERRY

STEVENS

PEND

OREILLE

ADAMS

KITSAP

PACIFIC

SKAGIT

(4) (3)

(2)

(2) (4)

(2)(2)

(3)(13)(20)(2)

(2) (2)

(4) (5)

(8)

(3)

(2)

(3)

(3)

(8) (13)

(2)

Grays Harbor RSN

(3)

Not complete Complete

Asotin

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Agency Characteristics

• Services Provided - Intake, assessment and referral services 87.5%- Chemical dependency treatment 67.6%- Mental health treatment 56.6%

- Co-occurring Disorders (COD) 47.7%

• Service Area Population< 5,000 11.0% 5,001 – 50,000 18.9%

50,001-500,000 41.3% > 500,000 28.8%

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0.0% 20.0% 40.0% 60.0% 80.0%

Aggression Replacement TrainingAssertive Community Treatment …

Behavioral Treatment for Substance …Brief Strategic Family Therapy

Cognitive Behavior Therapies (CBT)Contingency Management (Co-occurring)

Dare to be YouDialectical Behavioral Therapy (DBT)

Eye Movement Desensitization & …Family Integrated Transitions

Family PsychoeducationFunctional Family Therapy

Gatekeeper ProgramIllness Self-Management/Illness …

Incredible YearsIntegrated Dual Disorders

Interpersonal TherapyMedication Management

Motivational Enhancement Therapy (MET)Motivational Interviewing

Multi-Family Group Treatment (MFG)Multidimensional Family Therapy

Multidimensional Treatment Foster CareMultisystematic Therapy Nurse-Family Partnership

Parent-Child Interaction TherapyPeer Support

Promoting Alternative Thinking Strategies …Second Step

Seeking Safety: A Psychotherapy for …Strengthening Families Program (SFP)

Supported EmploymentSupported Housing

Therapeutic Foster CareOther (Specify:) Other (Specify:)

Not applicable-do not provide EBPs

MHD (n = 96) DASA (n = 154)

0.0% 20.0% 40.0% 60.0% 80.0%

Aggression Replacement TrainingAssertive Community Treatment (ACT/PACT)

Behavioral Treatment for Substance Abuse in …Brief Strategic Family Therapy

Cognitive Behavior Therapies (CBT)Contingency Management (Co-occurring)

Dare to be YouDialectical Behavioral Therapy (DBT)

Eye Movement Desensitization & …Family Integrated Transitions

Family PsychoeducationFunctional Family Therapy

Gatekeeper ProgramIllness Self-Management/Illness …

Incredible YearsIntegrated Dual Disorders

Interpersonal TherapyMedication Management

Motivational Enhancement Therapy (MET)Motivational Interviewing

Multi-Family Group Treatment (MFG)Multidimensional Family Therapy

Multidimensional Treatment Foster CareMultisystematic Therapy Nurse-Family Partnership

Parent-Child Interaction TherapyPeer Support

Promoting Alternative Thinking Strategies …Second Step

Seeking Safety: A Psychotherapy for …Strengthening Families Program (SFP)

Supported EmploymentSupported Housing

Therapeutic Foster CareOther (Specify:) Other (Specify:)

Not applicable, do not provide EBPs

JRA (n = 17) CA (n = 14)

In the list below, please indicate which of the following evidence based practices your

agency currently provides.

Top 5 EBPs* Currently in UseMHD & DASA

18*Only the top 5 EBPs per agency are listed.

Top 5 EBPs* Currently in UseJRA & CA

19*Only the top 5 EBPs per agency are listed.

Average Number of EBP’s Offered Per Site by Agency Type

N Min. Max. Mean

MHD 96 0 22 6.0208

CA 14 0 2 1.1429

JRA 17 0 3 1.5882

DASA 154 0 18 3.6039

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Fidelity

Fidelity refers to whether a program or practice is being implemented as intended according to established guidelines or manuals (e.g., SAMHSA Fidelity Scales).

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Indicate whether program fidelity is assessed or monitored for those practices you are currently providing, and if so, what fidelity measure or method are you using.

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Are there any EBPs that you are NOT currently using but want to use in the future?

Top 6 Future Use EBPs *MHD & DASA

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* Not now in use

*Only the top 6 EBPs per agency are listed.

Top 6 Future Use EBPs *JRA & CA

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* Not now in use

*Only the top 6 EBPs per agency are listed.

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For the practices your agency currently provides, please indicate which mechanisms are used to provide

training.

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For the practices your agency currently provides, please indicate which target populations you are

providing the EBP for.

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For the practices your agency currently provides, please indicate how successful your agency has been in

implementing the EBPs.

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For the practices your agency currently provides, how effective do you think the EBP is at producing positive

client outcomes?

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Please indicate whether any of the barriers listed below interfere with your agency in providing EBPs you are using

or want to use.

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What type of assistance is most needed by your agency to help facilitate the adoption and implementation of

evidence-based practices?

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Does your agency serve populations or address specific client needs for which there are no known

or available evidence-based practices?

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Please rate your agency’s interest in continuing/ beginning to implement EBPs into your treatment

program?

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What initiatives, if any, is your agency implementing to promote the adoption of

evidence-based practices (EBPs)?

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Is your agency conducting any systematic assessment of the effects of the evidence-based interventions that you

are using?

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Average Number of Clients Served Per Agency in Fiscal Year 2007

*

* Client counts for Fiscal Year 2007 could not be obtained from CA Agencies and are not included in this figure.

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Number of Clients Receiving EBPs Across All Sites

33 EBPs were offered 636 times across 281 agencies in 2007.

On average, 192 clients received an EBP each time it was offered.

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Summary• 34 of ~350 practices were selected as EBPs for this study.• 33 of these 34 practices are being offered in the state of Washington. • The 33 EBPs were offered 636 times across 281 agencies in 2007. On

average, 192 clients received an EBP each time it was offered.

• Most agencies report that they are successful in implementing their EBPs, and that the EPBs offered by their agency are highly effective in producing positive outcomes for their clients.

• Over 90% of all agencies say they are interested in continuing EBPs use in the future. Most want to use EBPs that they are not now using.

• More than one-third of the agencies report that they serve clients whose needs are not met by currently available EBPs.

• A shortage of an appropriately trained workforce and financing issues are the most often cited barriers to implementing EBPs as well as the most needed assistance to facilitate the adoption and implementation of EBPs.