Training and Implementation

Page Contents:

• The NCCTS Learning Collaborative Model for Improving Adaption and Dissemination of Evidence-Based Treatments
• Definition of Quality Collaborative Models

The NCCTS Learning Collaborative Model for Improving Adaptation and Dissemination of Evidence-Based Treatments

The NCCTS Learning Collaborative (LC) Model was adapted from the Institute for Healthcare Improvement’s 1995 Breakthrough Series Collaborative (BSC) Model. Learning Collaboratives (including BSCs) are used extensively in healthcare and child welfare to support improvement efforts.

Since 2004, the NCCTS has been expanding the use of Learning Collaboratives within the mental health arena and, in partnership with NCTSN clinical experts, has conducted over 30 Learning Collaboratives, Learning Communities, and Breakthrough Series Collaboratives. The NCCTS Learning Collaborative Model focuses on clinical competence in a selected evidence-based treatment and on implementation principles.
 
When implemented with fidelity, the NCCTS Learning Collaborative Model for the Adoption and Implementation of Evidence-Based Mental Health Treatments addresses the following:
1)    The gap between the design of evidence-based treatments and their adoption and implementation in community settings
2)    The limitations of the training-as-usual approach
3)    The organizational change barriers critical to implementing a new practice

Tackling Limitations of Conventional Training Models

Limitations of Didactic Clinical Training
Studies have demonstrated that didactic clinical training alone is ineffective at producing high fidelity practitioner use of interventions and full implementation and sustainability of new interventions in practice.

• The single exposure (i.e., “train and hope”) approach to training is ineffective at enhancing provider skills and implementation.
• Didactic workshop training models can be effective in disseminating information and can increase in provider knowledge, but are limited in the extent to which they produce consistent or sustained behavior change.

Importance of Coaching
Coaching can increase the fidelity with which the intervention is implemented by practitioners.

• Coaching has been found to be essential to ensure transfer of training. Other identified benefits may be less tangible, such as organization cultural shifts and increases in collaborative learning.
• A study of expert coaching within the context of Multi-Systemic Therapy (MST) found that high-quality coaching was related to clinician adherence to the intervention protocol and indirectly, via therapists, to youth outcomes.

Organizational Variables and Changes Effect Sustainability of a New Practice
Organizational variables play a role in how an intervention is implemented and whether or not the intervention is sustained over time.

• Organizational readiness is widely thought of as an essential precursor to successful implementation of change in social service organizations.
• Implementation of effective interventions and programs with fidelity may require adaptations to service system and organization policies, processes, and structure as the social and organizational context can influence the process of implementation.
  

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Definition of Quality Collaborative Models

Learning Collaborative
Learning Collaboratives provide high-quality training to clinicians in a specified evidence-based treatment while simultaneously coaching agency teams to improve their existing organizational processes—many of which may prevent or limit the implementation of new interventions—in order to support effective, sustainable implementation of the practice in the agency.
 
There are three main phases of a Learning Collaborative: Initiation, Planning, and Executing and Monitoring. Click here to access. [6]
 
Learning Community
The Learning Community model encourages collaborative learning by bringing participants together to actively engage in learning a specific topic. In the past, the NCCTS has conducted Learning Communities for promising practices that need flexibility in duration, meeting schedules, and participation. Whereas a Learning Collaborative relies on the components described in the NCCTS Collaborative Key Elements document, Learning Communities are more flexible in their use of these elements.
 
The NCCTS Collaborative Key Elements document provides an in-depth look at the necessary components of a Learning Collaborative, and offers a starting place for those intending to create a Learning Community. Click here to access [7].
 
Breakthrough Series Collaborative
The NCCTS adapted the Breakthrough Series Collaborative (BSC) Model from the methodology of the same name developed by the Institute for Healthcare Improvement and Associates in Process Improvement. NCCTS BSCs focus on testing, adapting, spreading, and sustaining practices and processes across multiple settings. Agencies involved in NCCTS BSCs comprise teams that include clinicians, supervisors, agency leaders, consumers, and community partners—all of whom have critical roles throughout the project. For example, in 2010 the NCCTS conducted a BSC on improving foster care placement stability in partnership with child welfare agencies across multiple states.

To access resources that support this section, click here [8].
 

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