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NeATTC/POWER Evidence-based Practice Project The Northeast Addiction Technology Transfer Center (ATTC) in Pittsburgh provides training and technical assistance to providers in Pennsylvania and New York. It is one of 14 regional ATTCs in a national network whose role is to help providers to use evidence-based practices. In April 2009 the Northeast ATTC began to work collaboratively with the Pennsylvania Organization for Women in Early Recovery (POWER) to adopt an evidence-based practice (EBP) of its choosing and the story, which spans 18 months, exemplifies the fruitful results of an organizational partnership with the Northeast ATTC. When a Medicaid oversight organization in western Pennsylvania expressed interest in exposing their drug and alcohol addiction service providers to EBPs – specifically, motivational interviewing and motivational incentives – Holly Hagle, MA, Northeast ATTC training officer, and Eric Hulsey, DrPH, MA, Northeast ATTC director of program evaluation and performance, partnered with them on a small initiative to accomplish this objective. Five providers responded affirmatively to the invitation and Ms. Hagle and Dr. Hulsey subsequently held kickoff workshops and worked individually with providers. Because research has shown that innovations in care delivery that have buy-in from staff members at all levels of an organization are more likely to be sustained, the kickoff workshops include both the professionals who would be using the new practice with clients and professionals in administrative roles who provide resource and leadership support. The workshop content included an overview of EBPs in general and motivational interviewing and motivational incentives in particular, and tools for planning to use an EBP.
As a next step, POWER chose which practice to adopt and a team to spearhead those efforts, developed an action plan and a start date, and identified a clear and measureable objective that they wanted to achieve. POWER decided to adopt motivational incentives in order to increase client retention, which led to an additional set of decisions:
Research finds that motivational incentives are most effective when clients have a say in what items are important to them; it works in part because it reframes the culture of treatment to reinforce positive behaviors instead of punish negative actions. Once the details of putting the plan into action were worked out, POWER began using motivational incentives. Because they had particularly enthusiastic staff members and supportive leadership, they quickly moved on from a general approach to apply motivational incentives to achieve a specific objective in their service delivery: retaining consumers after their initial assessment. As employees’ experience with motivational incentives increased and the organization retained clients for longer and longer, they began to apply it with more nuance, helping some clients shift from external motivators to internal motivators. While staff initiative and flexibility are important characteristics, the ATTC Network emphasizes the importance of continuing to execute new practices as they were designed. This ensures that those innovations remain effective and sustainable. POWER was particularly forward-looking: when they realized that motivational incentives were helping them to retain clients, they grew concerned that they wouldn’t have the resources to continue using the innovation. A presentation to their board of directors illustrating the success of the technique helped them to secure even more resources— and full support from the board to move ahead! During initial meetings with providers, Ms. Hagle and Dr. Hulsey addressed the fact that adopting EBPs can sometimes cost money upfront. However, said Ms. Hagle, “We stress that sometimes these innovations can be good for clients as well as the bottom line: EPBs can certainly increase the quality of care provided and can sometimes increase billable hours.” While it’s too soon to form conclusions about outcomes for the agency described here, the Northeast ATTC will assist them with data analysis, comparing retention rates, quality of care, and revenues in matched samples from before and after the initiation of motivational interviewing. From start to finish, the collaboration between the Northeast ATTC and POWER will last 18 months. While this work could have been accomplished in a shorter timeframe, Ms. Hagle and Mr. Hulsey moved at the pace that POWER chose and “met them where they were.” “Even highly motivated organizations face challenges on the road to change,” said Dr. Hulsey. The staff members must do the hard work of introspection and designing new administrative systems and processes. Administrative staff must commit staff time and other resources to these initiatives. Payers may or may not appreciate the extra effort it requires to adopt an EBP. There are often fears about the dissolution of familiar roles and comfortable routines. But resolve is bolstered when we remember that we all entered this field to help others to improve the quality of their lives. “Because providers accept the challenges and bravely adopt practices and programs that research has shown to be effective, they can look forward to improving client outcomes and helping them to maintain long-term recovery,” said Dr. Hulsey Resources: http://www.attcnetwork.org/explore/priorityareas/techtrans/index.asp |
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