Enhancing Evidence-Based Practice Consultation in a Large Care System
Providing ongoing consultation in evidence-based practices (EBPs) across a large dispersed care system is crucial for ensuring high-quality behavioral health services for military personnel, veterans, and their families. The Center for Deployment Psychology focuses on training mental health providers to deliver effective deployment-related services, emphasizing the use of EBP psychotherapy protocols through face-to-face workshops and online platforms. However, training workshops without coaching or consultation can lead to limited implementation and varied fidelity to protocols, highlighting the importance of ongoing support in maintaining treatment effectiveness and ensuring competence in service delivery.
- EBP consultation
- Deployment Psychology
- Training Workshops
- Military Health Providers
- Behavioral Health Services
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Providing Ongoing EBP Consultation Across a Large Dispersed Care System Experiences from The Center for Deployment Psychology Experiences from The Center for Deployment Psychology David Riggs, Ph.D. David Riggs, Ph.D.
Center for Deployment Psychology Mission 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 Goals Increase Increase the number of mental health providers prepared to treat military personnel and their families Train Train providers to use evidence-based psychotherapy Educate Educate providers on the unique stress of deployment Prepare Prepare civilian providers to treat military personnel 3
Training in Evidence Based Psychotherapy Protocols as CDP Face Face- -to to- -Face Workshops Face Workshops Mobile Training Teams 20-25 Multi-day workshops annually (peak 40-45 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 4
Training in Evidence Based Psychotherapy Protocols as CDP Online Workshops 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 5
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 6
Coaching and Consultation In a Large and Dispersed System Low Cost Low Cost Broad Distribution Broad Distribution | | | | | | | | | | | | | | | | High Cost High Cost Narrow Distribution Narrow Distribution PRN Coaching PRN Coaching Drop Drop- -in Coaching in Coaching Regular (monthly?) Coaching Regular (monthly?) Coaching Drop Drop- -in coaching + Expert in coaching + Expert Weekly Expert Consultation Weekly Expert Consultation Weekly Expert Consultation + Weekly Expert Consultation + Sessions Review Sessions Review 7
Coaching and Consultation Efforts at the CDP PRN Expert Coaching PRN Expert Coaching Telephonic/email Q & A Telephonic/email Q & A Office Hours Office Hours Drop Drop- -in Expert Coaching in Expert Coaching Refresher Classes Refresher Classes Regular (monthly?) Coaching Regular (monthly?) Coaching EBP Champions EBP Champions Local Coaching + Expert Local Coaching + Expert Advanced Proficiency Project / Advanced Proficiency Project / BBTI Training for Imbedded Providers BBTI Training for Imbedded Providers Weekly Expert Consultation Weekly Expert Consultation Weekly Expert Consultation + Weekly Expert Consultation + CBT for Depression Pilot CBT for Depression Pilot Sessions Review Sessions Review 8
Low-Cost Options: Coaching When You Want (Need) It PRN Coaching Drop-In Coaching Telephonic and/or online support Expert response in a short time (24-48 hours) Allows posting of FAQs 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 9
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 10
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 Patient Response 85 Overall Rating of Readiness to Deliver PE 68 11 PTSD Checklist Expert 9 51 6.7 7 34 Proficient 5 17 2.4 Pre Post 3 1 Novice Pre Post 11
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 12
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 13
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) Percent of PTSD Cases Treated with EBP Percent of Providers Reporting EBP Use 100 100 80 80 60 Always Use EBP Never Use EBP Baseline Mid End 60 40 20 40 0 20 Baseline Mid End 0 14
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 Barriers - Resources Clinic administration Training in consultation skills champions and experts 15
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 16
