1. Providing Ongoing EBP Consultation Across a Large Dispersed Care System
Experiences from The Center for Deployment Psychology
David Riggs, Ph.D.

3. Center for Deployment Psychology
Mission
Train military and civilian mental health providers to deliver high-quality deployment-related behavioral health services to military personnel, veterans and their families
Goals
Increase the number of mental health providers prepared to treat military personnel and their families
Train providers to use evidence-based psychotherapy
Educate providers on the unique stress of deployment
Prepare civilian providers to treat military personnel

4. Training in Evidence Based Psychotherapy Protocols as CDP
Face-to-Face Workshops
Mobile Training Teams
20-25 Multi-day workshops annually (peak annually)
Held at DoD facilities Throughout US, Europe, Asia
Teach protocols and basic skills
Combines didactic instruction, demonstration, skill rehearsal
Data indicate increased knowledge, confidence, readiness

5. Training in Evidence Based Psychotherapy Protocols as CDP
Online Workshops
Three online platforms
12-15 Multi-day workshops annually
Replicate the material & delivery of face-to-face workshops
Teach protocols and basic skills
Combines didactic instruction, demonstration, skill rehearsal
Data indicate increased knowledge, confidence, readiness
Gains are comparable to face-to-face workshops

6. Limited implementation
Training workshops in the absence of coaching and/or consultation leads to …
Limited implementation
Protocols used but not with all appropriate cases
Protocols not used at all
Mixed fidelity to protocols
Omitting elements from the protocol
Adding in elements not originally in the protocol
Unknown competence in treatment delivery
Borah et al., 2013; Wilk et al, 2013

7. Coaching and Consultation In a Large and Dispersed System
Low Cost –
PRN Coaching
Broad Distribution |
Drop-in Coaching
Regular (monthly?) Coaching
Drop-in coaching + Expert
Weekly Expert Consultation
High Cost –
Weekly Expert Consultation +
Narrow Distribution
Sessions Review

8. Coaching and Consultation
Efforts at the CDP
PRN Expert Coaching
Telephonic/ Q & A
Drop-in Expert Coaching
“Office Hours”
Regular (monthly?) Coaching
Refresher Classes
Local Coaching + Expert
EBP Champions
Weekly Expert Consultation
Advanced Proficiency Project /
BBTI Training for Imbedded Providers
Weekly Expert Consultation +
Sessions Review
CBT for Depression Pilot

9. Coaching When You Want (Need) It
Low-Cost Options:
Coaching When You Want (Need) It
PRN Coaching
Telephonic and/or online support
Expert response in a short time (24-48 hours)
Allows posting of FAQs
Drop-In Coaching
Regularly scheduled telephonic coaching sessions
Providers call in when they wish to
Can call as often as they desire
Infrequently used
Few providers call repeatedly
Refresher Courses
Regularly scheduled webinars
Didactic presentation to reinforce workshop lesson
Discussion of case material
increased attendance with CEU for didactic material

10. Coaching When You Want (Need) It
Low-Cost Options:
Coaching When You Want (Need) It
PRN Coaching Drop-in Coaching Refresher Courses
Positive – Expert is available to answer questions when they arise
Allows providers dispersed around the system to consult
Limited commitment of time for both provider and expert
Providers learn and find it helpful
Negative – Lack of continuity
No easy way to establish fidelity/competence
Providers’ may not call when they might benefit most
“Dead” time for experts
Barriers - Time
Lack of provider awareness
Willingness to ask for help
Limited number of expert

11. All (Most) of the Bells and Whistles
High End Options:
All (Most) of the Bells and Whistles
Advanced Proficiency Project
Regularly scheduled expert consultation (face-to-face or telephonic)
Experts located at clinic or centrally
19 providers treated 1 or 2 cases
Consultants provided ratings of proficiency

12. All (Most) of the Bells and Whistles
High End Options:
All (Most) of the Bells and Whistles
CBT-D Consultation Project
Regularly scheduled expert consultation (telephonic)
Experts located centrally
Attendance at 75% of calls was required (20/26)
20 Providers identified
Support from clinic management
Recordings of sessions submitted for review/ratings of competency
Outcome
Only 4 of 20 providers attended required number of consultation calls
5 providers did not attend any consultation calls
The 4 providers who attended 75% of calls were all rated as competent – as were 3 others who did not attend the required number of calls
Required > 400 hours of expert time

13. All (Most) of the Bells and Whistles
High End Options:
All (Most) of the Bells and Whistles
Advanced Proficiency Project / BBTI Training for Imbedded Providers / CBT for Depression Pilot
Positive – Continuity in provider-consultant relationship
Able to establish fidelity/competence
Allows providers to exchange information
Providers learn and find it helpful
Negative – Significant time commitment particularly for expert
Scheduling challenges with dispersed workforce
Providers drop out/miss sessions
Barriers - Time
Limited number of experts
Limits on sharing sessions materials
Patient availability

14. Looking for the Sweet Spot
Blended Models:
Looking for the Sweet Spot
EBP Champion Program
Champion-Consultant placed in clinic
Champion trained in one EBP as well as basic consultation skills
Champion supported by small network of EBP experts (central)
Champion promotes use of EBPs
Champion provides “first-line” of consultation (usually PRN)
Champion can consult with expert (or refer provider to expert)

15. Looking for the Sweet Spot
Blended Models:
Looking for the Sweet Spot
EBP Champion Program
Positive – Consultant is available to answer questions when they arise
Allows expertise to be distributed across the system
Increases implementation
Does not require expert in each EBP at each clinic
Negative – Requires substantial coordination among champions
Requires network of EBP experts
Requires infrastructure to support communication between champions and experts
Barriers - Resources
Clinic administration
Training in consultation skills

16. So What Do We Think We Have Learned
Consultation / Coaching can serve to …
promote the adoption and use of an intervention
promote fidelity and (potentially) efficacy of intervention
assess and understand barriers to adoption/use
assess and understand modifications to intervention
No single model of consultation/coaching will fit all situations
Consultation/coaching may be a significant rate limiting factor
Consultation/coaching has its own barriers
that must be addressed
Across large distributed care systems multiple models
may be necessary