Our consultation services include the following:
- Service-systems consultation
- Program consultation (organizational change)
- Clinical consultation (supervision and direct practice)
We prefer and encourage these processes to occur simultaneously. Our experiences have informed us that systems change, organizational change, and clinical (or practice) change are interconnected and that each is necessary to support and promote the other.
Stages of Implementation and Sustainability
|Stage||Stage 1||Stage 2||Stage 3||Stage 4||Stage 5|
|Stages of change||Pre-Contemplation||Contemplation||Preparation||Action||Maintenance|
|Stages of implementation||Unaware or uninterested||Consensus building||Motivating||Implementing||Sustaining|
We have adopted a practical five-stage process of consultation for systems change and organizational change, which is based upon published research and the practice experiences of our staff of consultants, trainers, and evaluators.
Each stage contains practical action steps that will help organizations fulfill incremental goals during the implementation process. The 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. It is important for these stages of implementation (and the steps contained in each) to be a part of an organization's continuous quality-improvement process.
We understand that every service system and organization implements evidence-based practices and other innovations at a different pace and with a different investment of human and financial resources. A reasonable timeline is important for successful implementation no matter what the setting or the level of resources.
Importance of Culture
Understanding the complexities of organizational culture in healthcare and behavioral healthcare is important because when researchers discover new knowledge that can improve practices, clinical outcomes, and costs of services, the knowledge must penetrate—and be absorbed by—at least three layers of culture before it can inspire and create change. These include the following:
- Culture of the system in which policymakers in state and county government create and enforce the rules that govern the activities of service organizations and the funding or payment of services
- Culture of the organization, which holds together relationships among community stakeholders, administrators, managers, clinical supervisors, and team leaders of programs that make treatment available
- Culture of direct practice, which inevitably influences the relationships between those who provide help and those who receive the services
As a university-based facilitator of change, the Center for Evidence-Based Practices at Case Western Reserve understands the world of research and the world of policy and practice. Our consultants, trainers, and evaluators know that each system and organization has a unique leadership style and decision process and have worked closely with many to translate and transfer knowledge into daily practice. Some examples of unique cultural settings include the following:
- Mental health services
- Addiction services
- Primary healthcare
- Private hospitals
- Public hospitals
- Jails, prisons, other correctional facilities
- Housing services
- Residential services
- Employment services
Professional peer-networks are forms of dissemination for the implementation of evidence-based practices, best practices, and other service innovations and strategies. The networks help new and experienced program managers and team leaders share lessons learned, avoid common pitfalls, overcome barriers, and capitalize on strategies that work. Our center provides and encourages opportunities for professional peer-support within and across service systems and professional disciplines.
Using the Right Tools
Our multidisciplinary staff has many years of experience as direct service providers, team leaders, program managers, and administrators. Consultants and trainers are skilled at assessing readiness to change and skilled with adjusting to fluctuations in motivation to change. There are numerous tools and processes that we use to assist in the entire change process. These include:
- Organizational needs assessment
- Fidelity scales
- Fidelity assessments
- Action plans that are developed in collaboration with the organizations
- Technology-transfer manuals that prime and remind people about core concepts of the practices they are learning
- On-site training and consulting with administrators, program managers, team leaders, and direct-service providers, as well as steering committees comprised of community stakeholders
Our stage-wise implementation process is detailed in this booklet, “Implementing IDDT: A step-by-step guide to stages of organizational change”, which is organized into five sections/stages, with each providing 8–12 practical action steps.
The "stages of change" are based upon the following:
- James O. Prochaska, John C. Norcross, Carlo O. DiClemente (1994). Changing for Good: A Revolutionary Six-Stage Program for Overcoming Bad Habits and Moving Your Life Positively Forward. New York: Harper Collins.
- Janice M. Prochaska, James O. Prochaska and Deborah A. Levesque (2001). A Transtheoretical Approach to Changing Organizations. Administration and Policy in Mental Health and Mental Health Services Research, v28, n4, March, p247-261.
The "stages of implementation" are based upon the following:
- Pamela S. Hyde, Kathryn Falls, John A. Morris, Sonja K. Schoenwald (2003). Turning Knowledge into Practice: A Manual for Behavioral Health Administrations and Practitioners about Understanding and Implementing Evidence-Based Practices. Boston: Technical Assistance Collaborative (TAC).
- Dean L. Fixsen, Sandra F. Naoom, Karen A. Blase, Robert M. Friedman, and Frances Wallace (2005). Implementation Research: A Synthesis of the Literature. Tampa: University of South Florida, Louis de la Parte Florida Mental Health Institute, The National Implementation Research Network (FMHI Publication #231).
Frameworks for organizational change are based upon the following:
- Addiction Technology Transfer Centers (ATTC) Network (2000). The Change Book: A Blueprint for Technology Transfer. Kansas City, Missouri: Addiction Technology Transfer Centers (ATTC), University of Missouri.
- Ruud T. Frambach and Niels Schillewaert (2002). Organizational innovation adoption: A multi-level framework of determinants and opportunities for future research. Journal of Business Research, 55 (2002), p163-176.