Presentation on theme: "What does this mean for you?"— Presentation transcript:
1What does this mean for you? 3/28/2017Meeting the Challenges in Implementing Evidence-Based Practices and Treatments in OntarioWhat does this mean for you?
2Presentation Objectives 3/28/2017Presentation ObjectivesIntroduction to Evidence-Based PracticeWhat is it?Why use it?What is needed?Evidence to practice processRole of the Centre of Excellence in the uptake of Evidence-Based Practice
33/28/2017Truth or Dare …If you’ve been doing something for twenty years and we tell you that what you’re doing is not effective – or may even cause harm – would you change your practice?WHY or why not?What if we can show you strong evidence?What kind of Evidence would convince you?Would you then?Those who would not change?What’s preventing you?
7…Do we have the evidence to back our beliefs? 3/28/2017…Do we have the evidence to back our beliefs?
8Evidence-Based Practice It’s not simple, either… 3/28/2017Evidence-Based Practice It’s not simple, either…What is evidence?Would you recognize evidence if it was right in front of you?What exactly does “evidence” mean to you?How can you possibly know when you are using it?
93/28/2017You are not alone…At the Centre, we are also grappling with defining models of construct relating to evidence-based practice. There is no universal definition when it comes to evidence as it relates to child & youth mental health. What do we mean by…EffectiveModelEvidence- informedPromisingEvidence- basedEvidenceEmerging
103/28/2017Every child and youth has the right to demand that anyone involved in practice decisions knows what is most likely to work for them, their families and their caregivers.“That’s the best I can do. If you’d like to see another child psychologist …”
11Limitations of Evidence-Based Practice 3/28/2017Limitations of Evidence-Based PracticeEvidence does not always existEvidence derived from a lab in one place does not necessarily apply elsewhereMany promising practices have never had the opportunity to be evaluated in such a way as to elevate them to EBPEvidence can be developed/tested on homogeneous samples that do not reflect real lifeAn effective intervention may not be feasible/appropriate in certain communities and with certain populations
12Culturally Sensitive Approaches 3/28/2017Culturally Sensitive ApproachesHow best do you approach the treatment of clients whose characteristics and problems may differ from those of samples studied in research?(Especially those from minority or marginalized populations.)gender gender identity ethnicity race social class disability status sexual orientation religion disability status rural urban group association (i.e. deaf culture) family context
13Definition of Evidence: CHSRF 3/28/2017Definition of Evidence: CHSRFEvidence is information that comes closest to the facts of a matter. The form it takes depends on context. The findings of high-quality, methodologically appropriate research are the most accurate evidence. Because research is often incomplete and sometimes contradictory or unavailable, other kinds of information are necessary supplements to or stand-ins for research. The evidence base for a decision is the multiple forms of evidence combined to balance rigour with expedience—while privileging the former over the latter.WEIGHING UP THE EVIDENCEMaking evidence-informed guidance accurate,achievable, and acceptableA summary of the workshop held on September 29, 2005JANUARY 2006
14Evidence Based Programs U.S. Perspective 3/28/2017Evidence Based Programs U.S. PerspectiveSAMHSA defines evidence-based programs according to three categories
16Most Common Evidence-Based Practices?* 3/28/2017Most Common Evidence-Based Practices?*According to Children’s Mental Health OntarioCognitive behaviour therapy (65%)COPE (42.7%)Wraparound (42.5%)Behavioural parent training (41.2%)Brief strategic family therapy (39.2%)Narrative therapy (38.8%)“The Incredible Years” (36.4%)Multisystemic therapy (35.9%)“Stop Now and Plan” (32.4%)“Right from the Start” (29.3%)What has been your motivation for using these interventions or therapies?* Defined by CMHO as “a treatment that has been developed through research, is supported by the results of controlled treatment studies, and has guidelines and procedures related to its implementation”
18individual, organizational, systemic 3/28/2017Breakout Evidence-based Practice: Why or Why Not?In groups discuss the pro’s and cons of integrating Evidence-Based Practices into your practice:If you are using an EBP in your organization name itIf you are using EBP or notWhat are the barriers?What are the facilitators?What do you think are the key elements in creating a culture that encourages and supports Evidence-Based Practice?Consider 3 levels:individual, organizational, systemic
19Barriers to Evidence-Based Practice 3/28/2017Barriers to Evidence-Based PracticeLimited access to relevant information/modelsEvidence does not fit for my communityResearch done on pure samplesResearch done on different samplesIntervention as researched is not feasible in my communityInnovation does not equal evidence-based practice
20Barriers to Evidence-Based Practice 3/28/2017Barriers to Evidence-Based PracticeCulture may not support this approachChange is difficult at the best of timesOften viewed as an add-on that takes time away from direct provision of serviceResources/expertise is often lackingAccess to training and ongoing supportWhat are we missing?
26Evidence Source Checklist 3/28/2017Evidence Source ChecklistThere’s no simple way to gather evidence:Look to credible sourcesWhat are peers saying?Look for reliable methodslarge samples have power to generalize resultscontrol groups – where possible and ethicalWhere has this been published?Is there a consensus?Look for results over timeIs the entire process transparent and re-producible?Is there a meta-analysis or systematic review?Is there open discussion of results and gaps?
27Evaluating What You Find 3/28/2017Evaluating What You FindOnce you’ve gathered evidence you need to evaluate it:Can it be implemented?Was random assignment applied?Is it based on effective principles?What was the longitudinal impact?Was there multiple site replication?Has dosage analysis been conducted?Were comparison groups used?What about meta-analysis, expert review and consensus?Were clients satisfied?Did the program change something?D. Andrews, C. Buettner. Evidence-based Practice: Evaluating Supporting Evidence
28Evaluating Feasibility: Can it be implemented? 3/28/2017Evaluating Feasibility: Can it be implemented?Is a particular intervention or therapy a good fit for your organization based on:AvailabilityAffordabilityFeasibilityD. Andrews, C. Buettner. Evidence-based Practice: Evaluating Supporting Evidence
29How Can We Best Meet Your Needs? 3/28/2017What you told us:Research and DevelopmentRelevant, evidence-based information, geared to a variety of audiencesBest/promising practicesPractical information (e.g., about funding sources)Funding creative, relevant research and building research capacity“Facilitate knowledge dissemination”Access to information and research was the number one need identified by regional conference participants.When it came to what’s needed in research and development, groups told us they want relevant, evidence-based information that can be understood by a variety of audiences. In addition, they want to be kept abreast of promising practices that may not have yet been clinically proven. They want practical information about where and how they can secure funding for research, and help in developing research capacity.
30EBP at the Centre of Excellence 3/28/2017EBP at the Centre of Excellence
31How Can We Best Meet Your Needs? 3/28/2017What you told us:Consulting services (Intervention)Connecting people with expertsConsulting on projectsAdvising on program developmentProviding trainingHelping “natural leaders” develop to their full potentialConsulting and mentoring was the second most common need identified by regional conference participants.“Provide leadership”Through our consulting services they want expert advice on projects, program development and training – and support for natural leaders to help them develop to their full potential.
32How Can We Best Meet Your Needs? 3/28/2017What you told us:Partnerships and NetworksFacilitate and enhance existing and new partnerships and networksCreate opportunities to connect and networkOver one half of regional conference participants identified the need to develop linking, networking and partnerships.“Play a proactive role in partnership building”They want the centre to play a proactive role in partnership building by facilitating and enhancing existing and new partnerships and networks and by creating opportunities for agencies and individuals involved in child and youth mental health to get together.
33Researchers Directory 3/28/2017*Datalife…Finding that perfect partner!Researchers DirectoryLaunched October 19, 2005Open to CYMH researchers in OntarioMust have, or be working on, a PhDOver 100 entriesService Provider DirectoryLaunched February 20, 2006Open to CYMH service providers in OntarioOver 145 entries* With apologies to LavaLife!
34How Can We Best Meet Your Needs? 3/28/2017What you told us:Education and TrainingBest practicesMore CYMH in more university programsMore training for frontline CYMH workersMore CYMH training in other sectors (e.g., justice)More opportunities to learn from each other“Enhance training all the way down the line”One third of regional conference participants identified education and training needs.When it comes to education and training, participants want more courses relating to child and youth mental health in university programs. They need additional training for “frontline” child and youth mental health-care workers such as therapists, counselors and social workers, and increased awareness-raising and training for professionals such as lawyers, judges, physicians, ministry officials and teachers.They also want the Centre to support training for parents to help them meet the needs of their children.
35You can still support good research by: 3/28/2017Don’t have research capacity? (… or have better things to do?)You can still support good research by:Consuming researchFacilitating researchPartnering around researchIdentifying relevant applied questionsThe Centre seeks to increase capacity in order to increase Evidence-Based Practice
363/28/2017Where do we go from here?The process of implementing evidence-based practice starts 1 step at a time – today is that first step.You’re not alone – this is why developing a community of practice around this issue is so important. The Centre is part of this – as well as other organizations.Working together, we can create a tipping point and make things happen.