Center celebrates 25 years of advancing workforce development for behavioral healthcare in Ohio—and beyond

The Center for Evidence-Based Practices at Case Western Reserve University’s Jack, Joseph and Morton Mandel School of Applied Social Sciences understands the worlds of policy, research and community-based practice. Now in its 25th year, the Center continues to maintain and advance an essential knowledge base within Ohio, in other states across the nation and in other countries. The Center assists organizations with responding to daily challenges of behavioral healthcare service delivery, such as:

• Changes in federal, state and local policies that govern practice
• Fluctuations in funding and reimbursements 
• Disruptions in client-clinician working alliance and service continuity, caused by staff turnover

Crises in the lives of clients because of symptoms of mental illness and substance use and exposure to violence, trauma, and biopsychosocial conditions that contribute to unemployment, poverty, homelessness, and involvement in the criminal justice system

To help communities address these challenges, the Center provides training and technical assistance services via consultation and evaluation to help behavioral health organizations. This work focuses on reviewing programs to see how well they use practices that are proven to help the people they serve. After the review, the team offers hands-on guidance and training, using their real-world experience to help staff and leaders improve services, put the model into practice and solve problems as they arise.

National and international impact

Since the Center’s inception, policymakers and leaders of state, national, and international organizations from a variety of systems have sought its training and technical assistance. Examples include:

• Behavioral healthcare authorities
• Health and behavioral health organizations
• Courts and criminal justice systems
• Primary healthcare and hospital systems
• Veterans Affairs medical centers 
• U.S. Substance Abuse and Mental Health Services Administration 

The Center has contributed to evidence-informed initiatives in 36 states including Ohio. It also participates in an international consortium of Assertive Community Treatment programs.

In its home state of Ohio, the Center has worked with nearly all 88 counties and 700+ organizations in a variety of rural, suburban and urban communities—from Portsmouth to Cleveland; Athens to Toledo; Ashtabula to Cincinnati, and Warren to Dayton. The Center has also partnered with several state-level departments:

• Ohio Department of Behavioral Health
• Ohio Department of Medicaid
• Ohio Department of Public Safety, Office of Criminal Justice Services

Community-based practice and research

The Center was formed in December 1999 as a partnership between Case Western Reserve’s Mandel School,  the Department of Psychiatry at the School of Medicine, the Ohio Department of Mental Health, and the Ohio Department of Alcohol and Drug Addiction Services. The Center began providing technical assistance services to the State of Ohio and nine community-based evidence-based practice pilot programs in January 2000. It joined the Mandel School’s Begun Center for Violence Prevention, Research and Education in 2020.

In 2023, the Ohio Department of Behavioral Health partnered with the Center to establish the Ohio Substance Use Disorders Center of Excellence to address the learning needs of treatment professionals responding to the statewide crisis of addiction and unintentional drug-overdose deaths. This initiative:

• Offers integrated solutions for substance use, mental illness and primary health conditions
• Empowers professionals to meet complex needs of various populations
• Functions as a core partner in Ohio’s evidence-informed response to the addiction crisis

The Center provides technical assistance for best practices that improve outcomes for people with mental health and substance use challenges, including those who are most at-risk of homelessness, psychiatric crisis and hospitalization, and involvement in the criminal justice system. Examples of practice models include the following:

• Assertive Community Treatment 
• Dual Diagnosis Capability in Addiction Treatment and Mental Health Treatment 
• Forensic Assertive Community Treatment
• Motivational Interviewing
• Integrated Dual Disorder Treatment 
• Substance Use Disorders Center of Excellence 
• Supported Employment/Individual Placement and Support 
• Cognitive Behavioral Therapy 
• Medications for Opioid Use Disorders 
• Contingency Management 
• Integrated Behavioral Health and Primary Care Models

Technology transfer

According to Center Director Ric Kruszynski (SAS ’93), the Center has gained a national reputation for technology transfer—the translation of research into practice—because of its systematic method of providing training, consultation and evaluation services. The success is also built upon the quality of its multidisciplinary staff, which includes consultants, trainers and evaluators from the fields of social work, counseling, community mental health, chemical-dependency treatment and vocational rehabilitation. Staff members have many years of experience as direct service providers, clinical supervisors, program managers and administrators. 

Kruszynski explained that the Center developed its method of technical assistance from evidence-based implementation research and practice experiences of its staff, who have identified five stages of organizational change. Each stage in the Center’s method contains multiple action steps that help organizations fulfill incremental goals during the implementation process. This stage-wise approach is important because it sets a realistic, manageable pace for achieving and sustaining high fidelity to best practices and produces improved outcomes over time. 

“Implementation science tells us there are factors that can support your initiatives and those that can interfere with it,” Kruszynski said. “We help organizations and systems take time to understand the factors that will facilitate positive outcomes and to identify and address barriers that could derail their efforts.” 

Kruszynski adds that much of the success of technology transfer boils down to assessing and fostering readiness to change and willingness to invest. Are agency executives and individual staff members ready to apply new knowledge to change what they do? Are systems and organizations ready to commit the human resources and financial resources to professional development that will advance the best practices?

Workforce development in Ohio

Throughout its history, the Center has been a facilitator of organizational change, best practice implementation and workforce development. Kruszynski recalls the founding directors of the Center explaining that, in 1999, the Ohio Department of Mental Health helped create the Center to establish, maintain and advance a knowledge base for nine evidence-based practice pilot programs. The Center was also created to provide leadership to expand evidence-based practice implementation and workforce development in Ohio, where annual staff turnover rates in community mental health organizations and state psychiatric hospitals was approximately 30% in many facilities. Estimates for staff attrition since COVID-19 are even higher in the state’s community behavioral health system.

Ongoing training in cutting-edge, evidence-informed practice and focused clinical supervision are essential for implementing and sustaining practice innovations, Kruszynski explained. In supervision, more experienced clinicians provide mentoring relationships that enable newer clinicians to develop their knowledge and skills and build confidence with lifelong learning on-the-job. This prepares them to produce meaningful recovery outcomes.

“As the supervision goes, so goes the program,” Kruszynski said. “Show me a quality supervisor who knows how to listen closely to their team members, reflect with them, and provide feedback, and there will be a successful community program. Organizations that commit to accessible, formal, and systematic clinical supervision tend to retain and advance their workforce over time.” 

Outcomes research in the community

The Center has entered a new era of innovation by offering behavioral healthcare systems access to experts in outcomes research and evaluation from its parent organization, the Begun Center for Violence Prevention, Research and Education.

The Begun Center provides research, evaluation and evidence-informed practices that improve systems, organizations, communities, and quality of life for individuals and families across the lifespan. Over the years, the Begun Center’s work has expanded in breadth and depth by integrating a multidisciplinary and cross-disciplinary approach. 

According to Director Dan Flannery, PhD, the Dr. Semi J. and Ruth Begun Professor at the Mandel School, the Begun Center has always engaged its customers as collaborators in the community. Its staff brings rigorous scientific methods to help its partners investigate real-world challenges and needs. 

“The Center for Evidence Based Practices is an essential extension of The Begun Center’s philosophy, mission and approach.” Flannery said. “Together, we develop and implement evidence-informed policy and interventions that enable individuals, families, and communities to discover and develop their full, life-affirming potential—in safe and trusting relationships for generations to come.”