Evidence Based Practices in Oregon: An Overview

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Evidence Based Practices in Oregon An Overview

• Oregon Department of Human Services
• Addictions and Mental Health Services (AMH)
• February, 2009

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ORS 182.515525 Compliance

• The five state agencies must demonstrate that
  program resources support EBPs in progressively
  increasing amounts
• Five Agencies include Department of
  Corrections, Oregon Youth Authority, Commission
  on Children and Families, Criminal Justice
  Commission and Addiction and Mental Health.
• 25 by 2007
• 50 by 2009
• 75 by 2011and thereafter

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ORS 182.515-525 Applies to Specific
Programs/Services

• Programs designed to reduce the propensity of a
  person to commit crimes
• Improve the mental health of a person with the
  result of reducing the likelihood that the person
  will commit a crime or need emergency mental
  health services
• Reduce the propensity of a person who is less
  than 18 years of age to engage in antisocial
  behavior with the result of reducing the
  likelihood that the person will become a juvenile
  offender

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What it does not include
Examples

• Medications on an individual basis
• Exercise
• Nutrition
• Safety
• Sleep
• Security
• Medical care of a non-clinical nature, i.e. cuts,
  heart disease, flu etc.

• An educational program or service that is
  required by state law.
• A program that provides basic medical services.

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It Creates an Opportunity for System
Transformation

• AMH strategy is to use legislation to transform
  the service system
• Increase the use of EBPs and improve outcomes
• AMH definition includes the entire service
  system, including prevention

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How Do We Define EBPs?

• A continuum of practices, based on level of
  research confidence
• Oregons nine Tribes are defining EBPs for use in
  those nations
• Ongoing discussions with stakeholders will
  continue to redefine EBPs

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Update of the Definition

• In September, 2007, AMH updated the EBP
  definition to 2 published peer reviewed journal
  articles instead of three and included a better
  definition for prevention programs

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2005 Survey Results

• Results indicate
• gt 25 fund utilization
• 56 of substance use treatment and prevention
  dollars
• 33 mental health treatment dollars
• Providers spent most implementing the following
  EBPs
• Mental Health Assertive Community Treatment
  (ACT)
• Substance Use Motivational Interviewing,
  American Society of Addiction Medicine (ASAM),
  Cognitive Behavioral Therapy (CBT)

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2008 Survey Results

• Results indicate 54 fund utilization.
• Most commonly implemented practices are the
  following
• Mental Health Cognitive Behavioral Therapy
  (CBT), Dialectical Behavioral Therapy (DBT),
  Solution-Focused Brief Therapy
• Substance Use Cognitive Behavioral Therapy
  (CBT), Motivational Interviewing and Motivational
  Enhancement Therapy, American Society of
  Addiction Medicine (ASAM)
• Substance Use Prevention Strengthening Families
  Program 10-14, Communities that Care, Project
  Alert

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Top Five Evidence Based Practices in Oregon
Clatsop
(2)
Columbia
Wallowa
Umatilla
(3)
Multnomah
Morrow
(3)
Hood River
(13)
(11)
(16)
(6)
(12)
Washington
Gilliam
Tillamook
(2)
(2)
Sherman
(3)
Wasco
Union
Yamhill
Clackamas
(2)
Marion
(2)
(2)
Polk
(5)
Wheeler
Baker
(3)
(2)
(4)
Lincoln
(5)
(7)
(5)
(5)
Grant
Jefferson
(2)
(5)
Linn
Benton
Crook
Deschutes
Lane
(2)
(7)
(2)
(5)
(2)
(6)
Malheur
Harney
(8)
Douglas
Coos
Lake
Klamath
(2)
Jackson
Curry
Josephine
(4)
(4)
(5)
(3)
(3)
(4)
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Nine Evidence Based Practices of Interest
Columbia
Clatsop
Umatilla
Wallowa
Multnomah
(2)
(2)
(6)
(6)
Morrow
Hood River
Tillamook
Washington
Gilliam
Union
Sherman
(9)
(5)
Yamhill
Clackamas
Wasco
Marion
Polk
Lincoln
Wheeler
Grant
(2)
(2)
Baker
(4)
Jefferson
(4)
Benton
(2)
(2)
Linn
(3)
Crook
Lane
(4)
Deschutes
Malheur
(2)
Harney
(4)
Douglas
Lake
Coos
Klamath
(2)
(2)
Curry
Josephine
(2)
(2)
(2)
Jackson
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The Top Three Prevention Evidence Based Practices
Implemented in Oregon (where three of them are
tied for third place)
Clatsop
Columbia
Umatilla
Washington
Hood River
Wallowa
Multnomah
Sherman
Tillamook
Morrow
Union
Gilliam
Yamhill
Clackamas
Wasco
Polk
Marion
Lincoln
Baker
Wheeler
Jefferson
Linn
Benton
Grant
Crook
Deschutes
Lane
Malheur
Douglas
Harney
Coos
Lake
Klamath
Curry
Jackson
Josephine
Strengthening Families Program (27 counties)
Life Skills (Botvin) (6 counties)
Project Northland (6 counties)
Communities That Care (9 counties)
Project ALERT (6 counties)
S. F. Tribal Program (2 counties)
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Provider Strategies to Meet Fidelity
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Implementation Phase- Early

• Identified the practice
• Outlined the implementation process
• Established a plan for improvement and
  sustainability

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Implementation Phase- Middle

• Trained staff in the practice
• Delivered the practice
• Completed an internal review and made revisions
• Had an external review completed and made
  revisions

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Implementation Phase- Late

• Have regular external reviews and made ongoing
  revisions
• Revised sustainability plan
• Provided technical assistance to others
• Are identified as a model program for that
  practice

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Improved Client Outcomes includes
abstinence/sobriety, completion/compliance,
retention/engagement, symptom
improvements Social Connectedness includes
increase partnerships, alternative activities,
parenting Reduced Acute Care Use includes
hospitalization, restraints, crisis driven
services System Improvements includes
increase staff training and EBP use, cost
effectiveness, decrease paperwork
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Native American Tribes

• Tribal Position Paper on Native American
  Evidence-Based Practices accepted by AMH
• On May 14th the Oregon Tribes held their 2nd
  Gathering of Tribal Researchers and Evaluators to
  define criteria
• The Tribes continue to work to establish
  procedures

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Does All of This Matter?

• Does implementing EBPs produce better system
  outcomes?
• Are we hitting the intended targets of the
  legislature under ORS 182.535?- Reduces
  propensity of a person to commit crimes-
  Improves mental health of a person with the
  result of reducing the likelihood that the person
  will need emergency mental health services-
  Reduces antisocial behavior and juvenile crime
• What does this amount to in financial terms?

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Example from PreventionStrengthening Families
Program 10-14

• Savings to society in criminal justice costs
  related to substance abuse are estimated to be
  5805 for each youth who participates in the
  Strengthening Families Program (Washington State
  Institute for Public Policy, 2003)
  
• To date, investing in the Strengthening Families
  Program has yielded a net benefit to Oregon of
  over a million dollars
• OREGONS COST SAVINGS
• 1,184,220

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Consider

• Limiting the scope of programs
• Using the Correctional Program Checklist (CPC) as
  a standard for serving criminal justice clients
• Identifying core components and protocols as EBPs
• Individualizing definitions, criteria and
  procedures for populations
• Systems organization, supervision and review
  processes as EBPs
• Performance measures and outcomes
• Investing in a data system

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EBP Haiku from evidence based caterpillar to
larvae practiced butterfly
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Resources

• Turning Knowledge Into Practice
  http//tacinc.org/cms/admin/cms/_uploads/docs/EBPm
  anual.pdf
• AMH EBP Website http//www.oregon.gov/DHS/mentalh
  ealth/ebp/main.shtml

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12 Steps of EBPs by Bonnie Malek

• We admitted we were powerless over SB267 and that
  our IT needs had become unmanageable.
• Came to believe that the right set of manuals
  could restore us to pre-morbid functioning.
• Made a decision to turn our program development
  and training resources over to SAMHSA before we
  understood why.
• Took inventories of everyone that voted for this
  bill (and in some cases their mothers and their
  dogs).
• Admitted to AMH and the Oregon Legislature that
  for the past 70 years, weve been running on
  sweat equity, imagination and rubber bands.
• Grudgingly agreed to do some reading and to keep
  an open mind.
• Swore all the way to the dumpster with our
  favorite videos and handouts.

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12 Steps of EBPs

• Made a list of all the practices that made sense
  to us and became willing to check at least some
  of them out.
• Agreed to learn at least one new thing as long as
  it didnt substantially add to our caseloads or
  paperwork.
• Continued to work on doing the impossible with no
  new resources and dreamed of deleting databases
  when no one was looking.
• Sought through outcomes data and SSRIs to improve
  our conscious contact with the legislature,
  praying only to prove that treatment works and
  were truly not sleeping at our desks.
• Having had a rude awakening as the result of
  these steps, we vowed to share our retention data
  with programs that were still pre-contemplative
  and to practice fidelity in all of our affairs.