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What does this mean for you? Meeting the Challenges in Implementing Evidence-Based Practices and Treatments in Ontario.

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Presentation on theme: "What does this mean for you? Meeting the Challenges in Implementing Evidence-Based Practices and Treatments in Ontario."— Presentation transcript:

1 What does this mean for you? Meeting the Challenges in Implementing Evidence-Based Practices and Treatments in Ontario

2 Presentation Objectives Introduction to Evidence-Based Practice What is it? Why use it? What is needed? Evidence to practice process Role of the Centre of Excellence in the uptake of Evidence-Based Practice

3 Truth or Dare … If youve been doing something for twenty years and we tell you that what youre 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? Those who would not change? Would you then? Whats preventing you?

4 Critical Decision-Making: How do you make decisions in your practice? Think about a recent client (child, young person, family) youve worked with where you made a significant decision about their care/support. What criteria did you use to make this decision? Your intuition (gut feel) about what will work for them. What you have heard from other professionals in informal exchanges. Your previous experience with similar cases. Data about outcomes from alternative care / support options. What is usually offered by your service / agency. Feedback from other similar clients about what is helpful. What you are most familiar / comfortable with. What you know about cases like this from reading research / theory. What you learned to do in your own training (no matter how long ago) © 2005, Research in Practice: Teamwise: Using Research Evidence

5 Critical Decision-Making: How do you make decisions in your practice? NOW… imagine you have a potentially serious medical problem and you seek help from a doctor to recommend a treatment. What criteria would you like the doctor to use to make this decision? His/her intuition (gut feel) about what will work for you. What he/she has heard from other professionals in informal exchanges. His/her previous experience with similar cases. Data about outcomes from alternative treatment options. What is usually offered by the surgery / hospital / clinic. Feedback from other similar patients about what is helpful. What he/she is most familiar / comfortable with. What he/she knows about cases like this from reading research / theory. What he/she learned to do in his/her training (no matter how long ago). © 2005, Research in Practice: Teamwise: Using Research Evidence

6 Evidence-Based Practice How do we *know that what we do works? © 2005, Research in Practice: Teamwise: Using Research Evidence (*not just believe) Really!

7 …Do we have the evidence to back our beliefs?

8 Evidence-Based Practice Evidence-Based Practice Its 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?

9 You 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… Evidence Promising EffectiveModel Evidence- informed Evidence- based Emerging

10 Every 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. Thats the best I can do. If youd like to see another child psychologist …

11 Limitations of Evidence-Based Practice Evidence does not always exist Evidence derived from a lab in one place does not necessarily apply elsewhere Many promising practices have never had the opportunity to be evaluated in such a way as to elevate them to EBP Evidence can be developed/tested on homogeneous samples that do not reflect real life An effective intervention may not be feasible/appropriate in certain communities and with certain populations

12 Culturally Sensitive Approaches How 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

13 Definition of Evidence: CHSRF Evidence 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 expediencewhile privileging the former over the latter. WEIGHING UP THE EVIDENCE Making evidence-informed guidance accurate, achievable, and acceptable A summary of the workshop held on September 29, 2005 JANUARY 2006

14 Evidence Based Programs Evidence Based Programs U.S. Perspective SAMHSA defines evidence-based programs according to three categories

15 What is Evidence-Based Practice? What is Evidence-Based Practice? U.K. Perspective Sources: © 2003, Evidence Network: What Works for Children? © 2005, Research in Practice: Teamwise: Using Research Evidence In these models: Awareness of research findings alone is not enough Research evidence complements – not replaces – the many other forms of knowledge Its not a magic bullet And not simply about searching for the right answer Its about understanding options available and, with children and youth or their caregivers, choosing the course of action most likely to lead to a good outcome

16 Most Common Evidence-Based Practices?* According to Childrens Mental Health Ontario Cognitive 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

17 Beyond the Evidence Beyond the Evidence What else is Needed? Practitioners need to be willing and able to challenge themselves and others Organizations need to provide professional development opportunities and validate the need to read, reflect and debate Leaders need to promote critical thinking, improve access to research, identify and spread good practice across their agencies Teams should be able to tackle real practice dilemmas collectively © 2005, Research in Practice: Teamwise: Using Research Evidence

18 Breakout Breakout Evidence-based Practice: Why or Why Not? If you are using an EBP in your organization name it If you are using EBP or not What 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? In groups discuss the pros and cons of integrating Evidence-Based Practices into your practice: Consider 3 levels: individual, organizational, systemic

19 Barriers to Evidence-Based Practice Limited access to relevant information/models Evidence does not fit for my community Research done on pure samples Research done on different samples Intervention as researched is not feasible in my community Innovation does not equal evidence-based practice

20 Barriers to Evidence-Based Practice Culture may not support this approach Change is difficult at the best of times Often viewed as an add-on that takes time away from direct provision of service Resources/expertise is often lacking Access to training and ongoing support What are we missing?

21 Surveyed leaders and practitioners in 80 associated Child and Youth Mental Health Clinics across Ontario about utilization of research-based information and readiness for change Interviewed 12 experts in implementation science Made recommendations for system of care improvements © 2005, Childrens Mental Health Ontario

22 Resources Leadership Training Practice Change Readiness Multiple methods of support Culture of professional development Conclusion: To implement, transfer, deploy evidence-based best practices to the field, we need: © 2005, Childrens Mental Health Ontario

23 Active strategies, collaboration, leadership are important Sharing tacit knowledge face-to-face is powerful Resistance to change – from the system, leaders, and practitioners – needs to be recognized and addressed Change is complex and requires buy-in from a critical mass – create a tipping point! Distillation of research knowledge into practice guidelines is insufficient to create practice change Implementation requires a collaborative effort Strategize on multiple levels: practice, organization, system, nature of evidence, the support plan Literature Review Highlights: © 2005, Childrens Mental Health Ontario What does this look like for you?

24 Take It One Step at a time… Formulate an answerable question Identify search terms for each component of the question Appraise the evidence Apply the evidence Evaluate your practice © 2003, Evidence Network: What Works for Children?

25 Start With a Plan… What is the problem we need to solve? What is the question we need answered? Select first choice resource where an answer may be found (e.g. the Cochrane library) Design search strategy and carry out search Appraise and summarize the evidence Select second choice resource Poor or insufficient evidence Good Evidence Assess the relevance of the evidence to your local situation and target groups Consider implications for your practice and resources, and those of the organizations you work with Apply the evidence to practice Evaluate your practice No improvement Improvement The Evidence to Practice Process © 2003, Evidence Network: What Works for Children? What might be the role of the Centre or others in helping you do this?

26 Evidence Source Checklist Theres no simple way to gather evidence: Look to credible sourcesWhat are peers saying? Look for reliable methods large samples have power to generalize results control groups – where possible and ethical Where has this been published? Is there a consensus? Look for results over time Is the entire process transparent and re-producible? Is there a meta-analysis or systematic review? Is there open discussion of results and gaps?

27 Evaluating What You Find Once youve 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

28 Evaluating Feasibility: Can it be implemented? Is a particular intervention or therapy a good fit for your organization based on: D. Andrews, C. Buettner. Evidence-based Practice: Evaluating Supporting Evidence Availability Affordability Feasibility

29 Research and Development Relevant, evidence-based information, geared to a variety of audiences Best/promising practices Practical 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. What you told us: How Can We Best Meet Your Needs?

30 EBP at the Centre of Excellence

31 Consulting services (Intervention) Connecting people with experts Consulting on projects Advising on program development Providing training Helping natural leaders develop to their full potential Provide leadership Consulting and mentoring was the second most common need identified by regional conference participants. What you told us: How Can We Best Meet Your Needs?

32 Partnerships and Networks Facilitate and enhance existing and new partnerships and networks Create opportunities to connect and network Play a proactive role in partnership building Over one half of regional conference participants identified the need to develop linking, networking and partnerships. What you told us: How Can We Best Meet Your Needs?

33 Researchers Directory Launched October 19, 2005 Open to CYMH researchers in Ontario Must have, or be working on, a PhD Over 100 entries *Datalife…Finding that perfect partner! * With apologies to LavaLife! Service Provider Directory Launched February 20, 2006 Open to CYMH service providers in Ontario Over 145 entries

34 Education and Training Best practices More CYMH in more university programs More training for frontline CYMH workers More 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. What you told us: How Can We Best Meet Your Needs?

35 You can still support good research by: Consuming research Facilitating research Partnering around research Identifying relevant applied questions Dont have research capacity? (… or have better things to do?) The Centre seeks to increase capacity in order to increase Evidence-Based Practice

36 Where do we go from here? 1.The process of implementing evidence-based practice starts 1 step at a time – today is that first step. 2.Youre 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. 3.Working together, we can create a tipping point and make things happen.


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