– by Paul M. Kubek
Staff turnover in behavioral healthcare organizations has always been a challenge for sustaining service innovations that improve quality of life and other outcomes for people diagnosed with severe mental illness and addiction to alcohol, tobacco, opioids, and other drugs. Train a team of providers at an agency how to implement an evidence-based practice in year one and by year three—with an annual staff attrition rate of 30 percent—almost no one from that original team remains. The results? Loss of knowledge and skills within organizations; a potentially stalled initiative; unmet objectives; interruptions in safe and trusting relationships between service providers and clients that are essential for maximizing recovery.
One solution for ensuring service continuity in community agencies that has withstood the test of time is demonstrated by the Center for Evidence-Based Practices at Case Western Reserve University, which is celebrating its 21-year anniversary. The Center is a technical-assistance organization that provides consulting, training, and evaluation services to help behavioral healthcare organizations implement and sustain evidence-based practices, best practices, and other services innovations that improve outcomes for people with co-occurring mental illness and substance abuse challenges. The Center has been an ongoing partnership between the Jack, Joseph and Morton Mandel School of Applied Social Sciences at Case Western Reserve University and the Department of Psychiatry at the Case Western Reserve School of Medicine since 1999.
As a technical-assistance organization based at a university, the Center understands the world of practice, policy, and research. It keeps that knowledge-base intact and makes it available to organizations that work to manage day-to-day challenges of service delivery, such as changes in federal, state, and local policies that govern practice; fluctuations in funding and reimbursements from government and private insurance; crises in the lives of clients because of symptoms of mental illness and addiction; and, of course, a break in service continuity caused by staff turnover.
The Center actively promotes and supports inter-system collaborations among mental health services, addiction services, vocational rehabilitation, health, housing, residential services, consumer advocacy, and criminal justice, among others.
Since the Center’s inception in 1999, policymakers and leaders of state and regional behavioral healthcare authorities, service agencies, courts and criminal justice organizations, hospitals, and health clinics from 36 states and 5 countries—as well as Veterans Affairs (VA) medical centers in Ohio, Indiana, and Michigan—have sought technical assistance from the Center, which has also received requests for help from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). The Center is currently active supporting EBP initiatives in Ohio, Kansas, Iowa, North Dakota, Louisiana, California, Colorado, Wisconsin, Tennessee, Kentucky, Georgia, South Carolina, North Carolina, Virginia, Pennsylvania, Maryland, Massachusetts, New Hampshire, Texas and Maine.
In its home state of Ohio, the Center has worked with over 60 organizations in a variety of communities throughout the state’s 41,000 square miles, including urban centers in Toledo, Cleveland, Youngstown, Columbus, Cincinnati, and Dayton, as well as numerous suburban and rural communities in between. The Center is currently Ohio’s center of excellence for several best practices, including Assertive Community Treatment (ACT), an evidence-based practice that improves outcomes for people with severe mental illness who are most at-risk of homelessness, psychiatric crisis and hospitalization, and involvement in the criminal justice system.
The Ohio Department of Medicaid (ODM) provides support to the Center for its consulting, training, and evaluation services for ACT as part of Ohio’s Behavioral Healthcare Redesign initiative. The Center disseminates other evidence-based practices and best practices, including the following:
- Motivational Interviewing (MI)
- Integrated Dual Disorder Treatment (IDDT)
- Dual Diagnosis Capability in Addiction Treatment and Mental Health Treatment (DDCAT/DDCMHT)
- Supported Employment/Individual Placement and Support (SE/IPS)
- Tobacco: Recovery Across the Continuum (TRAC)
According to founding Co-Directors Lenore A. Kola, PhD, associate professor emerita of social work at the Mandel School, and Robert J. Ronis, MD, MPH, the Douglas Danford Bond Professor and Chairman of the Department of Psychiatry, the Center has gained a national reputation for technology transfer—the translation of research into practice—because of its systematic method of providing consultation, training, and evaluation services. The success, they add, is also built upon the quality of its multidisciplinary staff, which includes consultant-trainers, evaluators, and researchers from the fields of social work, psychiatry, community mental health, chemical-dependency treatment, and vocational rehabilitation. Staff members have many years of experience as direct-service providers, team leaders, program managers, and administrators.
According to Kola, the Center developed its method of technical assistance from the practice experiences of its consultant-trainers and from research that has identified five stages of organizational and behavior change: pre-contemplation, contemplation, preparation, action, and maintenance. 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 improved outcomes over time. The Center’s method is described in detail in two e-books available as free downloads from its website: “Implementing IDDT: A Step-by-Step Guide to Stages of Organizational Change” and “ACT | Timeline for Implementation.”
“So much of the success of technology transfer boils down to assessing and fostering readiness to change and willingness to invest,” Kola says. “Are agency executives and individual staff members ready to utilize new knowledge to change what they do? Are the people who manage systems and organizations ready to commit the human resources and financial resources and time so their staff members may learn the new knowledge and integrate it into practice?”
According to Ronis, the Center has always been an expert in organizational change, best-practice implementation, and workforce development. He recalls that in 1999 the Ohio Department of Mental Health (ODMH) helped create the Center for Evidence-Based Practices as a center of excellence to help organizations enhance services for people with co-occurring substance abuse and mental illness.
At the time, ODMH Director Michael Hogan, PhD, and Medical Director Dale Svendsen, MD, decided to use SAMHSA Block Grant dollars to create the Center and support it over time to provide leadership in EBP implementation and workforce development in Ohio where the staff turnover rate in state psychiatric hospitals and community mental-health organizations was approximately 30 percent annually in some facilities.
Drs. Hogan and Svendsen recognized the need for a source of constancy in the state mental health and addiction-services systems to support the implementation of evidence-based practices. They collaborated with Drs. Kola and Ronis and David E. Biegel, PhD, Henry L. Zucker Professor Emeritus at the Mandel School to establish a Center to provide ongoing consulting, training, evaluation, and education, not only among new hires but also among seasoned veterans seeking opportunities to improve their knowledge, skills, and clinical relationships.
“It’s an approach that still has traction today,” Ronis says, explaining that the Ohio Department of Medicaid has recognized the value of keeping the implementation knowledge-base available to service providers in the state. “Ohio has been a leader in sustaining EBPs, and other states have taken notice and reached out to make use of our expertise.”
Ronis and Kola explain that the initial grants from ODMH in 1999 supported a pilot project of nine Ohio behavioral health organizations—with additional support from the Ohio Department of Alcohol and Drug Addiction Services. Over the course of 20 years, the initiative expanded with support from the Ohio Department of Mental Health and Addiction Services (OhioMHAS) and Ohio Department of Medicaid (ODM) to include over 60 community-based organizations and all state psychiatric hospitals. The Center’s impact upon the service system in Ohio has been made possible by a dedicated staff of licensed social workers, counselors, addictions counselors, and psychiatrists under the leadership of Patrick E. Boyle, PhD, MSSA, LISW-S, who served as director of implementation services for 20 years and retired in December 2019.
The Center for Evidence-Based Practices at Case Western Reserve University is a technical-assistance organization that provides consulting, training, and evaluation services to help behavioral healthcare organizations implement and sustain evidence-based practice, best practices, and other service innovations that improve outcomes for people with co-occurring mental illness and substance abuse challenges.
- ACT | Assertive Community Treatment
- MI | Motivational Interviewing
- SAMI |Strategies for Substance Abuse and Mental Illness
- IDDT | Integrated Dual Disorder Treatment
- IDDT-Inpatient | Integrated Dual Disorder Treatment for Inpatient Settings
- DDCAT | Dual Diagnosis Capability in Addiction Treatment
- DDCMHT | Dual Diagnosis Capability in Mental Health Treatment
- SE/IPS | Supported Employment/Individual Placement and Support
- BAP | Benefits Advocacy and Planning
- PHS | Promoting Housing Stability
Drs. Kola, Ronis, and Boyle have chosen Ric Kruszynski, MSSA, LISW-S LICDC-CS, to provide leadership to continue the Center’s 20-plus year legacy and to usher in a new era of technical-assistance innovation. Kruszynski was the Center’s director of consulting and training for substance abuse and mental illness (SAMI) initiatives for 18 years. He is currently the acting managing director and will become the director in July 2020 when the Center ends its two-decade partnership with the Department of Psychiatry upon Dr. Kola’s retirement.
The Center for EBPs will also join the Mandel School’s Dr. Semi J. and Ruth W. Begun Center for Violence Prevention Research and Education in July 2020. The Begun Center is a natural fit, Kola explains, because it is the umbrella entity for another technical-assistance organization, called the Center for Innovative Practices (CIP), which provides consulting and training to organizations that provide mental health and/or substance abuse services to children, adolescents, and families. By adding the Center for EBPs, which focuses on adults, the Begun Center is now poised to provide organizations and communities throughout the country with technical assistance for a continuum of behavioral healthcare innovations across the lifespan.
As the new Director of the Center for EBPs, Kruszynski oversees the organization’s vision, product development, staff supervision, and budget. Kruszynski brings to his new leadership role more than 20 years of training and 35 years of experience in direct practice, clinical supervision, administration, and technical assistance in the fields of addiction services and mental-health services. With this diverse professional history, Kruszynski will ensure the Center continues to promote and support inter-system collaborations among mental health services, addiction services, vocational rehabilitation, health, housing, residential services, consumer advocacy, and criminal justice, among others.
Kruszynski is joined in his leadership role by Deborah Myers, MEd, LPCC-S, the Center’s new managing director, Myers has been a consultant and trainer at the Center since 2004. In her new role, she collaborates with Kruszynski to supervise EBP-implementation efforts in communities throughout Ohio and the nation.
With this new leadership, the Center will continue its legacy of helping behavioral healthcare organizations create the context of safe, trusting, and consistent relationships among clients of services, service providers, and family and friends—relationships that support people in their recovery journeys and make personal transformation possible.
National & International Reach
Since 1999, policymakers and leaders of state and regional behavioral healthcare authorities, service organizations, hospitals, and health clinics from 36 states and 5 countries—as well as Veterans Affairs (VA) medical centers in Ohio—have sought technical assistance from the Center for Evidence-Based Practices, which has also received requests for help from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).