Implementation of Evidence-Based Treatment

An introduction to the topic from Teresa Huizar, Executive Director, National Children's Alliance.

Key Points for CAC Directors to Know

How Does a CAC Decide Which Evidence-Based Treatment (EBT) to Implement?

The decision process is critical to successful implementation and should be approached by determining the needs of the clients being served by the CAC and matching an EBT that meets these needs. The California Evidence-Based Clearinghouse for Child Welfare (CEBC) is a registry with information on EBTs that includes a helpful roadmap to walk organizations through this process. In Implementation Science, the Exploration Stage is when the CAC forms an Implementation Team to explore what EBT might best solve the clinical or service problem while considering the opportunities and challenges within the community as well as the CAC. They should also consider any federal or local policies, funding, and mandates that may impact the process. The Implementation Team should ask detailed questions about the identified clinical or service problem to determine the root cause. Once the root cause is determined, the Implementation Team can review treatments that will address this cause.  It is important to focus on finding the best fit among evidence-based treatments and, while ensuring the research base is solid before proceeding, to carefully weigh all of the relevant factors before investing in implementation. 

What is the Process for Engaging the Community and Multi-Disciplinary Team Partners in the Decision-Making and Implementation Process?

To facilitate the selection process, the CAC should form an Implementation Team which should consist of agency staff at different levels (both leadership and those who will be supervising and providing the chosen treatment) as well as community stakeholders, including family/client representation, contractors, and any other appropriate partners.  Involving community and multi-disciplinary team members from the beginning of the decision-making process can facilitate their engagement and ongoing support of the process. Involving family/client representatives also provides the Implementation Team an opportunity to ensure the new practice is compatible with the culture, norms, and values of the target population. Implementation Teams should contact the program representative/developer if any concerns arise and discuss potential solutions. The Implementation Team should also work to create an effective referral process for the chosen treatment and work to educate the referral sources about the new treatment so that they can make appropriate referrals.

What is Fidelity and Why is it Important?

Fidelity refers to the extent to which an intervention is implemented as intended by the designers of the intervention. Thus, fidelity refers not only to whether or not all the intervention components and activities were actually implemented, but whether they were implemented in the proper manner. Maintaining fidelity thus can directly impact the success of desired outcomes. Evidence-based treatments should offer measurement tools for continuous monitoring of program fidelity. Fidelity tools are used to monitor the administration of the required treatment components and parameters, such as dosages, duration, timeframes, and specific activities and interactions between clinical staff and clients. Fidelity monitoring can include clinician self-assessment checklists, observations of treatment sessions conducted by a trained staff member or the program developer/representative, review of audio/video recordings of treatment sessions by a trained staff member or the program developer/representative, or a combination of the three methods.

How do You Implement an EBT with Fidelity?

Fidelity should be considered when selecting an EBT and plans for monitoring fidelity should be developed before beginning implementation.  One of the elements to consider when choosing an EBT, is what supports are available for implementing the EBT with fidelity.  Some EBTs have very structured training and coaching programs and well-developed measures while others may just have a manual to follow and some consultation available.  Depending on the level of support, more work on the part of the CAC may be required to implement the EBT with fidelity.  Note that the level of available training and consultation associated with an EBT may also have implications on price and the CAC must weigh this in their decision-making process. Once the CAC has chosen an EBT, it is important to work with a representative of the program to ensure that the program is implemented with fidelity, using available fidelity tools and supports from the EBT or, if need be, creating fidelity checklists and ensuring that supervisors or internal coaches (who provide peer support) are well trained in the EBT and monitoring fidelity.  Program adjustments or modifications also threaten the fidelity and sustainability of the program. It is critical that the Implementation Team work with the program representative if the implementation of the program requires adjustments or modifications prior to making those changes.

How Can the CAC Ensure the Sustainability of the EBT?

CAC’s need to be thinking about sustainability from the beginning of the decision-making process and throughout the entire implementation process.  CAC’s should consider factors that impact sustainability such as the ongoing funding for the EBT, fidelity monitoring once the initial implementation is complete, measuring outcomes, training for new staff, and how refinements to all of these processes will be made over time. All of these elements should be discussed by the Implementation Team throughout the decision-making and implementation process.

 

Questions and Answers

Q: How do You Get Staff Buy-in for Implementing an EBT?

Chris Newlin, Executive Director of the National Children's Advocacy Center Shares important information on how to help staff see the benefits of implementing an EBT in the CAC.

 

 

Length of the video - 0 minute and 58 seconds

Q: What Role Do the Different Members of the CAC Play in the Implementation Process?

In this clip Chris Newlin, Executive Director of the National Children’s Advocacy Center describes how  leadership, supervisors and clinical staff all play critical, but distinct roles in the implementation process of EBTs.
 
 

 

Length of the video - 1 minute and 09 seconds

Q: What Is the Role of the Senior Leader?

In this clip, Chris Newlin, Executive Director of the National Children’s Advocacy Center describes the “champion” role of the Senior Leader in the implementation process.

 

 

Length of the video - 2 minute and 13 seconds

 

Additional Resources

Click here to download a printable summary of the information on this page.

Selecting and Implementing Evidence-Based Practices: A Guide for Child and Family Serving Systems: This guide provides concrete information that systems across the nation can use to evaluate their needs, identify what programs are currently being used, make decisions about which new programs, if any, to add, and plan for implementation activities.

Information about evidence-based practices listed on the Child Welfare Information Gateway

The California Evidence-Based Clearinghouse for Child Welfare: A registry with information on EBTs that includes a helpful roadmap to walk organizations through this process.

Implementation Resources Section of the California Evidence-Based Clearinghouse for Child Welfare: Provides information and resources about the implementation of Evidence-Based Practices (EBPs).

http://www.cebc4cw.org/files/RoadmapToSelectingAnEBP.pdf: Roadmap for how to select an EBP.

http://www.cebc4cw.org/files/WorkingwithProgramDevelopers-onlinelinked-E9.pdf: Information on questions to ask developers can be found here

http://www.cebc4cw.org/files/CEBCSelectionGuideEBPSChildWelfare-onlinelinked-E7.pdf: Information on how to compare programs can be found here

http://www.cebc4cw.org/topic/trauma-treatment-client-level-interventions-child-adolescent/: A list of evidence-based trauma treatments for children and adolescents may be found here

http://www.cebc4cw.org/files/AssessingFidelity-onlinelinked-F3.pdf: More information to consider regarding assessing  fidelity can be found here