Technology transfer on main street; Effective implementation of evidence-based practices takes a greater commitment than what many programs expect.
There is a still-held belief that if addiction treatment agencies get a day or two of training on a particular evidence-based practice, they should be ready to adopt and implement that practice right away. Agencies and professionals often underestimate the time and effort needed not only to train, but also to implement and then achieve fidelity to the model. More often than not, an agency will organize a single training but fail to build in the support for the ongoing consultation needed to achieve the necessary shift to daily practice in the organization.
Agencies that provide training in this manner operate without understanding the rationale of technology transfer.
In an agency that lacks the infrastructure needed for successful technology transfer, it is common to hear a staff member report, "I was told I have to be at this training. I have no idea why I am here." The likelihood of successful implementation of the topic to be discussed wanes with each disengaged participant. It is important to examine the technology transfer process in order to erase common misperceptions about the effort needed for technology transfer and to offer an example of what an agency might reasonably expect in an actual technology transfer project.
The federal Center for Substance Abuse Treatment (CSAT) and the National Institute on Drug Abuse (NIDA) provide funding to 14 regional ATTCs, as well as the National Office. The ATTC network disseminates the most recent knowledge, skills, and attitudes regarding professional addiction treatment practice. The regional centers are tasked with bringing recent NIDA Clinical Trials Network findings and evidence-based practices to addiction professionals and programs in an expedited manner. Each ATTC has projects related to implementation of evidence-based practices that coordinate with regional needs.
Evidence-based practices have become a buzzword in the behavioral health world. In many ways, it is helpful that we are talking the same language, but in other ways, the term tends to get thrown around without much of a sense of definition. A definition used by the Oregon Office of Mental Health and Addiction Services identifies evidence-based practices as "programs or practices that effectively integrate the best research evidence with clinical expertise, cultural competence, and the values of the persons receiving the services. These programs or practices will have consistent scientific evidence showing improved outcomes for clients, participants, or communities. Evidence-based practices may include individual clinical interventions, population-based interventions, or administrative and system-level practices or programs."
The experience of one community treatment agency, the Prince William County (Virginia) Community Services Board, offers an idea of the effort involved in a comprehensive training plan. In this case, the evidence-based practice targeted for implementation in the organization was Motivational Interviewing (MI), a clinical practice with an extensive base of research support in its ability to engage clients in treatment.
MI was developed by William R. Miller and Stephen Rollnick as a counseling style, not just a set of techniques, designed to help explore and resolve ambivalence, reaching for internal motivators in the client. The approach has two parts: one is person-centered and the other is goal-directed. Because of MI's deceptive simplicity in description, addiction professionals often believe they do not need intensive training and therefore start its application right away. The training plan at the Prince William County organization was designed to avoid that common pitfall, which results in low competence in implementing the model.
The Community Services Board's staff working in adult and adolescent substance use treatment programs participated in an 18-month MI implementation project from November 2005 to May 2007. Prior to the training even being scheduled, a four-month discussion with the program manager ensured that the training and follow-up plan would reflect organizational and provider readiness. The program manager spent numerous hours formally and informally polling staff and establishing a change committee based on guidance from The Change Book. Great pains were taken to gather necessary support by involving upper management and the change committee in discussions of the proposed training design. Only after getting the necessary buy-in was the training series scheduled.
The hard work paid off, as the agency experienced at-capacity attendance at trainings. This set the stage for the infusion of MI into daily practice. The training design, overseen through the Mid-Atlantic ATTC, started with a six-hour overview of evidence-based practices that about 60 staff members attended. This was followed one month later by a six-hour MI overview, attended by around the same number. At this point, two 12-hour skills trainings were provided in small groups of 20, at two and five months from initiation of the project. The skills training targeted staff members who provide direct counseling and case management services in the multiple alcohol and other drug programs in Prince William County.
In order to build sustainability, 17 supervisors submitted taped samples of their work. They received written feedback, as well as an on-site coaching to enhance proficiency of their skill set. They then received a supervisory training developed by the NIDA/SAMHSA collaboration called Motivational Interviewing Assessment: Supervisory Tools for Enhancing Proficiency (MIA:STEP). Prince William County was the first pilot site in the country for a rollout of MIA:STEP. Three booster sessions were completed, with one being for supervisors only and two for all staff members originally trained in the skills training.
The table outlines the number of training hours the staff received, as well as the number of technology transfer hours invested in the process. The table does not capture the hours that agency staff expended in attending regular change committee meetings, developing a newsletter to support staff called The MISpirit, encouraging colleagues to submit tapes through an incentive program, and practicing MI skills. In all, the Prince William agency invested a minimum of 2,116 staff hours in the project. With an investment that hefty, the agency not only communicated its dedication to the technology transfer process, but also its commitment to employees through providing opportunities for workforce development.
The process of technology transfer requires planning, dedication, action, and skillful supervision to promote mastery of evidence-based practices. A well thought-out plan is needed to capitalize on the investment of time, money, and staff development. With those considerations, it is possible to take evidence-based practices from the training room to the therapy room.
Table. Prince William County board's Ml implementation Training Plan Hours of Hours of ATTC Time Frame Training Staff and Trainers Overview of EBPs 6 9 (6 face to face November and 3 prep) 2005 Overview of MI 6 9 (6 face to December face and 3 prep) 2005 MI skills training 24 (2 sessions@ 60 (2 trainers X 2 February and 12 hours each) sessions@ 12 hours May 2006 each + total of 12 prep hours for both trainers) MIA:STEP 12 18(12face to June 2006 (supervisory face and 6 prep) training) Booster for 6 9 (6 face to January supervisors face and 3 prep) 2007 Follow-up for staff 12 (2 sessions@ 15 (12 face May 2007 6 hours each) to face and 3 prep) Total hours taping, 50 July to listening to, and December rating tapes 2006 Total face to face 66 hours November 2005- May 2007 Total technology 168 November transfer hours 2005- invested in the May 2007 implementation process
Denise Hall, LPC, NCC, ASE, is a Project Coordinator with the Mid-Atlantic Addiction Technology Transfer Center and Endorsement Liaison for the Adolescent Specialty Committee ast NAADAC, The Association for Addiction Professionals. Her e-mail address is email@example.com.
Addiction Technology Transfer Center National Office. The Change Book: A Blueprint for Technology Transfer (2nd edition). 2004. Accessible at www.nattc.org/pdf/The_Change_Book_2nd_Edition.pdf.
Fixsen DL, Naoom SF, Blase KA, et al. Implementation Research: A Synthesis of the Literature. Tampa, Fla.: Louis de la Parte Florida Mental Health Institute; 2005.
Klein KJ, Knight AP. Innovation implementation: overcoming the challenge. Current Directions Psychol Science 2005; 14:243-6.
Rogers EM. Diffusion of Innovations (5th edition). New York City: Free Press; 2003.
Simpson DD, Flynn PM. Moving innovations into treatment: a stage-based approach to program change. J Subst Abuse Treat 2007'33:111-20.
BY DENISE HALL, LPC, NCC, ASE
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|Date:||Sep 1, 2008|
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