Meeting Summary

Planning Science and Services: A Technical Assistance Workshop for State and Mental Health Agencies

August 16, 2004
Rockville, Maryland

On August 16, 2004, the National Institute of Mental Health (NIMH) and the Center for Mental Health Services (CMHS) of the Substance Abuse and Mental Health Services Administration (SAMHSA) co-sponsored a meeting entitled "Planning Science and Services: A Technical Assistance Workshop for State Mental Health Agencies." The meeting provided the opportunity for a one-day discussion of lessons learned from State RFA MH-03-007: "State Implementation of Evidence-Based Practices (EBPs) — Bridging Science to Services."

The purpose of the meeting was to bring together the current grantees to discuss activities related to the state implementation of EBPs, to highlight challenges and share problem-solving solutions, and to identify potential action steps to further the science of implementing evidence-based practices at the state-level.

Current State Activities Related to Implementation of Evidence-Based Practices

Each state grantee described their current projects, existing infrastructures, and strategies for implementing evidence-based practices. While many of the states have experienced systemic reform, budgetary constraints, and divestment of services, each has developed a distinctive approach for successfully implementing EBPs in order to bridge science with services in their respective states. This summary captures the discussion of nine different state grantees.

Grant Activities

State grantees discussed activities related to implementation of EBPs, which existed before the RFA planning grants began. To these efforts, states added a series of planning activities to advance their unique agendas. For example:

One state had an existing infrastructure around evidence-based practices, specifically related to family psychoeducation, Assertive Community Treatment (ACT), and supportive employment. The investigators composed an internal workgroup to organize an EBP conference, to develop a plan for statewide implementation, and to recruit implementation sites. Additionally, they incorporated fidelity measurements into licensing of state mental health providers.
Another state embedded EBPs at the core of its system to serve consumers across the lifespan. Previously focused on medication algorithms, this state chose to examine Cognitive Behavioral Therapy (CBT) for Depression. To supplement the state's infrastructure, the state legislature developed and implemented a benefit-design to allow counseling and a rehabilitation options to be covered by ambulatory care through Medicaid.
One state convened a panel of experts to develop a conceptual framework and preliminary typology for identifying organizational features that would influence effective and efficient integration of EBPs into child service systems. The investigators subsequently refined their conceptual model through focus groups with key stakeholders currently receiving or implementing selected interventions. The framework consisted of a set of models (medication management, functional family therapy, etc) and provided the basis for developing an instrument to assess stakeholders' perceptions of readiness to implement EBPs.

Common Planning Activities to Facilitate Evidence-Based Practice Implementation

Several common activities were conducted by multiple state grantees, including:

Further development of existing state partnerships and/or infrastructure focused on specific evidence-based practices.
Expert stakeholder panels involving clinicians, administrators, treatment developers, and family advocacy groups.
Internal workgroup/committees (consumers, university faculty, policy makers, researchers, agency administrators, and providers) to support coordination for implementing EBPs.
Involvement of multiple sectors, including mental health, substance abuse, child welfare, juvenile justice, and medical assistance.
Use of focus groups with key stakeholders (consumers, family members, treatment foster parents, agency directors; providers from various disciplines, such as case workers, counselors, and psychologists)
Development of strategies for assessing the organizational culture and level of readiness to implement EBPs.
Development of methods to create sustainability and incorporate fidelity measurement of EBPs into implementation efforts.

Lessons Learned and Challenges to Implementing Evidence-Based Practices

The grantees discussed the lessons learned and challenges to implementing evidence-based interventions into practice within their respective states. Grantees emphasized the importance of the following areas:

Partnerships
Research and community stakeholder collaborations are essential to fostering a network of individuals who can highlight the challenges, benefits, and successes associated with EBP implementation.
Training/Education
State grants can be used to develop EBP educational trainings/tools for academic, field, and clinical researchers. These trainings could provide technical assistance for EBP implementation and serve as a method for educating consumers on how to better access the mental health services.
Supplemental Care and Coverage
In collaboration with Centers for Medicaid and Medicare Services, states have established methods for providing supplemental payment via Medicaid for mental health EBPs (i.e., home-based care for serious emotional disorders).
Organizational Infrastructure/System Change
States can develop ways to increase academic involvement on state projects for systems change, reduce tensions between researchers and the state, improve relationships with treatment provider organizations, and develop public relations campaigns for EBPs.
Surveillance and Data Measurement
State agencies can develop surveillance and data monitoring tools used to track/measure fidelity, to capture lessons learned from EBP implementation, and to survey states focused on the use of research to influence best practice.
State/Consumer Needs
States need to develop strategies that will enhance dissemination of information to consumers about their treatment options and the evidence that supports EBPs for general and special populations. In addition, it would be useful to map out a process for balancing the needs of populations and the EBP interventions.

Next Steps

The grantees were provided an opportunity to share major next steps in their evidence-based practice efforts. The group discussion centered on systematic approaches that would enhance current intervention strategies; measurement of implementation; sustainability; ability to reach special populations and ethnic and racial minorities; the need to provide technical assistance on systems change for federal, state and local regulation; establishment of state consensus; and development positive quality improvement (QI) with individual QI plans.

Finally, the grantees discussed appropriate ways to build awareness to transfer knowledge on implementation of EBPs. These included: presentations and workshops, publications in research journals, conference calls, and listservs to continue dialogue.

For more information, please contact Dr. David Chambers, Chief, Dissemination and Implementation Program, NIMH, at dchamber@mail.nih.gov.