This article was downloaded by: [University of West Florida] On: 04 October 2014, At: 08:20 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Journal of Evidence-Based Social Work Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/webs20

Collaborative Adaptations in Social Work Intervention Research in Real-World Settings: Lessons Learned from the Field a

Amy Blank Wilson & Kathleen Farkas

a

a

Mandel School of Applied Social Sciences, Case Western Reserve University , Cleveland , Ohio , USA Published online: 09 Jan 2014.

To cite this article: Amy Blank Wilson & Kathleen Farkas (2014) Collaborative Adaptations in Social Work Intervention Research in Real-World Settings: Lessons Learned from the Field, Journal of Evidence-Based Social Work, 11:1-2, 183-192, DOI: 10.1080/15433714.2013.847267 To link to this article: http://dx.doi.org/10.1080/15433714.2013.847267

PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http://www.tandfonline.com/page/termsand-conditions

Journal of Evidence-Based Social Work, 11:183–192, 2014 Copyright © Taylor & Francis Group, LLC ISSN: 1543-3714 print/1543-3722 online DOI: 10.1080/15433714.2013.847267

Downloaded by [University of West Florida] at 08:20 04 October 2014

Collaborative Adaptations in Social Work Intervention Research in Real-World Settings: Lessons Learned from the Field Amy Blank Wilson and Kathleen Farkas Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio, USA

Social work research has identified the crucial role that service practitioners play in the implementation of evidence-based practices. This has led some researchers to suggest that intervention research needs to incorporate collaborative adaptation strategies in the design and implementation of studies focused on adapting evidence-based practices to real-world practice settings. This article describes a collaborative approach to service adaptations that was used in an intervention study that integrated evidence-based mental health and correctional services in a jail reentry program for people with serious mental illness. This description includes a discussion of the nature of the collaboration engaged in this study, the implementation strategies that were used to support this collaboration, and the lessons that the research team has learned about engaging a collaborative approach to implementing interventions in research projects being conducted in real-world social service delivery settings. Keywords: Implementation research, evidence-based practices, jails

INTRODUCTION The gap between interventions that research has identified as effective and those used in practice is a major challenge confronting a number of human service professions (Brekke, Ell, & Palinkas, 2007; Leykum, Pugh, Lanham, Harmon, & McDaniel, 2009; Mullen, Bledsoe, & Bellamy, 2008; Palinkas, Schoewald, Hoagwood, Landsverk, Chorpita, & Weisz, 2008). Several prominent national reports have noted that this research to practice gap spans upwards of 20 years in health and mental health settings (Institute of Medicine, 2000; Presidents New Freedom Commission on Mental Health, 2003). A number of approaches are being used to address the research to practice gap in mental health settings. For example, translational and implementation science are dedicated to developing the knowledgebase and research infrastructure required to support faster and more successful uptake of service innovations in daily practice (Brekke et al., 2007; Fixsen, Naoom, Blasé, Friedman, & Wallace, 2005). Another approach that is growing in popularity are evidence based practice models, which provide practitioners with a structured decision-making process that can be used to facilitate the incorporation of empirically supported interventions into every day practice (Thyer, 2006). Regardless of the approach used, researchers and practitioners need to find This study is supported by funding from the U.S. Department of Justice, Second Chances Grant. Address correspondence to Amy Blank Wilson, Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH 44106, USA. E-mail: [email protected]

183

Downloaded by [University of West Florida] at 08:20 04 October 2014

184

A. BLANK WILSON AND K. FARKAS

ways to improve the integration of knowledge development and service delivery in human service professions. Research that has examined how to optimize the uptake of new practices in mental health services has generally studied the implementation of these evidence based practices in routine treatment settings (Brunette et al., 2008; Drake, Torrey, & McHugo, 2003; Gioia & Dziadosz, 2008; Mancini et al., 2009; Mueser, Torrey, Lynde, Singer, & Drake, 2003; Torrey et al., 2001). These studies have identified a number of different issues that impact the implementation of new practices in these treatment settings. These issues include administrative concerns associated with the structure of service delivery systems, financing, regulation, and licensing; organizational issues associated with agency practices, leadership, and organizational climate; and clinical issues such as the education and training, engagement, service orientation, motivation of the service provider, and the supervision and oversight they receive related to the use of a new practices (Brunette et al., 2008; Drake et al., 2001; Mancini et al., 2009; Torrey et al., 2001). Research on implementation efforts in social service settings have identified three main approaches to implementing new services in practice settings: top-down, bottom-up, and hybrid approaches where components of the other two approaches are combined in various fashions in one implementation project (Mullen et al., 2008). In top-down implementation approaches interventions are developed, manualized, tested, and prepared for implementation without input from the agencies and service practitioners who will use them. While bottom-up approaches engage collaborative, often equalitarian methods of implementation where ground level staff are actively involved, and possibly leading, all of the above-described activities. The effectiveness of each of these implementation approaches has yet to be determined, but studies of their use have identified a growing number of implementation strategies that can be used to support the successful uptake of new practices in routine mental health treatment settings. For example, research has found that successful implementation efforts have moved past the traditional reliance on training and practice guidelines to engage a comprehensive array of strategies designed to support practitioner’s uptake of new service strategies at each stage of the implementation process (Mullen et al., 2008; Mueser et al., 2003). Research from several large scale practice demonstration projects in routine mental health treatment settings has identified a number of strategies that appear to be important elements for the comprehensive array of implementation strategies that need to be used in these settings. These strategies include deliberate and careful selection of staff (Fixsen et al., 2005; Palinkas et al., 2008), the provision of adequate programmatic resources, properly timed training, ongoing consultation and technical assistance to the staff providing the intervention (Drake et al., 2003; Palinkas et al., 2008), as well as strategies to remove environmental constraints and enhance motivation among key stakeholders (Drake et al., 2003; Torrey et al., 2001) and techniques to provide feedback, and monitor fidelity and programmatic outcomes (Drake et al., 2003; Mullen et al., 2008). Another promising direction for implementation strategies is fostering interactions that create links between researchers and service practitioners (Mullen et al., 2008; Mueser et al., 2003; Walter et al., 2005). Prior research indicates that these interactions can take a number of forms, such as regularly schedule meetings, collaboration on administrative and staffing decisions, and dissemination of findings. Research on the effectiveness of implementation strategies, while limited, has found that fostering interactions between researchers and service practitioners appears to be one of the most promising strategies currently in use (Walter et al., 2005). These interactions could be important facilitators of implementation efforts because they can be used during the different stages of implementation to carry out many of the specific strategies that have been identified as important in implementation efforts, such as increasing staff motivation and training, and providing monitoring and feedback. Most of the research on implementation efforts in routine mental health treatment settings has focused on how to facilitate the uptake of new interventions after they have been proven effective. But research designed to determine the effectiveness of interventions in real-world

Downloaded by [University of West Florida] at 08:20 04 October 2014

SOCIAL WORK INTERVENTION RESEARCH IN REAL-WORLD SETTINGS

185

settings face many of the same implementation challenges present in these other studies. Fraser, Richman, Galinsky, and Day (2009) have proposed an approach for engaging intervention research in real-world practice settings that explicitly calls for the inclusion of “collaborative adaptation” techniques in the research process. Fraser et al. (2009) argued that in studies designed to adapt an intervention to new populations or practice settings it is especially important for problem experts associated with the research project to work collaboratively with service practitioners in the agency settings where the study will be conducted to determine what modifications need to be made to an intervention’s structure and/or materials before implementing it in the new setting. Fraser et al.’s (2009) call for collaboration in intervention research is supported by a small but growing body of literature which describes how some intervention studies are trying to incorporate collaboration into the research process (Blevins, Farmer, Edlund, Sullivan, & Kirchner, 2010; Gold & Taylor, 2007; Leykum et al., 2009; Magnabosco, 2006). One area of potential collaboration that has yet to receive attention in these discussions is how strategies to increase researcher and practitioner collaborations can be used to foster adaption and support the implementation phase of intervention research in real-world settings. This stage of intervention research faces the same implementation challenges associated with the implementation efforts examined in the studies cited above. Engaging a collaborative approach to service implementation in intervention research being conducted in real-world settings represents a potentially important implementation strategy. It provides the research team with the opportunity to develop mechanisms that support sustained interactions between research staff and service practitioners across all project phases. Developing a collaborative approach to implementation efforts is especially important in intervention research that is specifically studying the steps involved in adapting an empirically supported intervention to new populations and/or service settings. Regardless of how much planning occurs during the pre-implementation phase, some portion of the service adaptations will occur during the active implementation phase. It is reasonable to expect that some necessary service adaptations are not apparent to the research project because they are being made by the services practitioner as part of service delivery, and most likely without the involvement or knowledge of research staff. The development of mechanisms that allow the researchers to work collaboratively with service practitioners on how to address barriers and issues that come up during the implementation phase of a research study creates a process for collaborative, systematic, and transparent decision-making about service adaptations in intervention studies. This collaborative decision-making mechanism, in turn, allows review and consideration of service adaptations’ potential importance and implications for service delivery and facilitates accurate, prospective assessment and documentation of the adaptation process. The following section describes a collaborative approach was engaged during the implementation phase of an intervention study, currently in process. This study is designed to examine how to integrate and adapt two service models, Integrated Dual Diagnosis Treatment (IDDT; Drake et al., 2001) and jail in-reach reentry services (Osher, Steadman, & Barr, 2003) for young adults with serious mental illness and substance abuse problems incarcerated in a jail setting. This discussion will include a presentation of the type of collaboration that was engaged in this study, the implementation strategies that were used to support the collaboration effort, and the lessons that the research team has learned to date about engaging a collaborative approach to implementing study interventions in research projects being conducted in real-world social service delivery settings.

SETTING The intervention study being described in this article is a randomized controlled trial that is part of a federally funded demonstration project designed to provide reentry services to 100 young offenders (aged 18–24) who have a diagnosis of serious mental illness and substance use disorder

Downloaded by [University of West Florida] at 08:20 04 October 2014

186

A. BLANK WILSON AND K. FARKAS

and are in jail on misdemeanor and low level felony charges. The experimental condition in this trial was developed by the authors at the request of the local county sheriff’s department responsible for this project. This experimental condition, the enhanced reentry model, is a jail in-reach service model that uses an adapted version of IDDT as the treatment platform, and the control condition, best available treatment, is a linkage and brokerage case management service that provides discharge planning while the person is incarcerated. Since the primary goal of this demonstration project is to reduce recidivism rates the research team made several modifications to the IDDT model being used as the treatment platform, because prior research has found the IDDT services alone are not effective at reducing recidivism among criminal justice populations (Chandler & Spicer, 2006; Calsyn, Yonker, Lemming, Morse, & Klinkenberg, 2005). These modifications include integrating IDDT into a jail service in-reach model, and integrating criminogenic risk assessment and treatment tools into the IDDT treatment platform. Integrating three services into one program created the need to adapt some components of each service model so that they can be used in one program. The first major adaptation associated with the enhance reentry model being used in this study was the integration of IDDT services into a larger reentry in-reach model where services begin while the client is incarcerated and continue for a year after release. The integration of these two services allowed this project to incorporate central service components from each model into the pre-release phase of the new service being examined in this study. These components include active pre-release planning services to prepare the person for release from incarceration, stage wise assessment, and interventions provided while individuals are incarcerated with the goal of increasing the person’s readiness for treatment after release. Most mental health programs, including those using traditional IDDT approaches, do not typically engage clients in active jail-based services due to a number of structural and financial barriers. The current program incorporates service adaptations that allow for active treatment and active re-entry planning within the jail setting. Another adaptation that had to accompany this service integration relates to the realities of doing service planning in jail settings, which do not offer the breadth of client choices associated with most client-centered approaches like IDDT. Therefore, the client centered approach to goal setting associated with this approach is being adapted in this project to deal with the role that the criminal justice system plays in structuring a person’s options at the point of release. The second major adaptation to this treatment platform was the incorporation of tools to assess for criminogenic risk factors, and incorporation of plans to address these risk factors in the release and treatment planning process. The third major adaptation involves the creation of a flexible pool of economic and material benefits that the treatment team can use to address service recipient’s basic needs during the first few months after release, a critical transition period in the release process. After the research design and intervention model was developed and approved by the project funders, the research team worked with staff of the county sheriff’s department to identify community treatment providers to carry out the two types of reentry services being provided in this project. The project was able to engage two well established, and highly regarded mental health treatment providers for both treatment conditions. The service practitioners working in the enhanced reentry service have extensive experience using the traditional IDDT treatment platform and working with the study’s target population, but relatively little experience providing IDDT services or structured reentry services within a jail setting. The research team recognized from the inception of the project that the adaptations that were being made to support the integration of the different service components into one service model would create a number of changes to the structure and content of services being provided in this treatment condition. These changes have the potential to create challenges to practitioner uptake of the service model during the implementation phase of the study because they required changes in how staff typically delivered services. For example, the enhanced reentry service model requires practitioners to work extensively inside the county corrections center, develop skills in jail

Downloaded by [University of West Florida] at 08:20 04 October 2014

SOCIAL WORK INTERVENTION RESEARCH IN REAL-WORLD SETTINGS

187

release planning, and incorporate new tools, targets, and practices into their clinical assessment and treatment process. In order to optimize the uptake of the enhanced reentry service, the research staff engaged a number of implementation strategies that were identified as important components of top-down approaches to implementation efforts in the introduction section. These strategies included, properly timed training in the intervention model with on-going consultation and support; careful selection of service practitioners with a background and interest in working with the intervention modalities, service setting and client population; and addressing potential environmental barriers, and ongoing monitoring of program fidelity and outcomes. However, one of the Principal Investigator’s prior research and practice experiences sensitized them both to the reality that while all of these implementation strategies are important, they might not be enough to support the implementation of such a complicated new service within the context of a complex, real-world service environment because it was highly unlikely that all of the necessary services adaptations could be identified during the planning stages of the project. This potential problem was addressed by incorporating more collaborative implementation strategies than are typically found in the top-down approaches to program implementation associated with intervention research. These collaborative strategies were incorporated specifically to address issues of service adaptation and barriers that arise over the course of all three phases of the project’s implementation efforts (pre-implementation, initial implementation, full implementation/sustainability) in ways that are structured and systematic, but also allow the project to draw on the experiences and expertise of both the service practitioners and research team when addressing them. COLLABORATIVE ADAPTATION STRATEGY The implementation strategy that we are using to carry out the collaborative process described above during the implementation phase of the project is a shared decision-making model that is illustrated in Figure 1. This figure uses a pie chart to delineate how decision making is shared on this project across the three implementation phases. The left portion of the chart labeled “researcher decisions” denotes the issues and areas of the project where the researchers maintain decision-making authority, and the right portion denotes the areas where the service practitioners holds authority. The middle section of the chart represents the areas in which the researcher and practitioners work together to make decisions about how services will be delivered. The research team has engaged a number of implementation strategies to facilitate the identification of issues that require shared decision making and mechanisms to support these decisionmaking processes. These strategies are broken out by implementation stage and listed in Table 1. As can be seen by the number and range of strategies listed in Table 1, the use of shared decision making in the implementation process requires the creation of number of different mechanisms of communication that facilitate interactions between research staff and service practitioners over the life of the project. It is possible that the inclusion of shared decision-making strategies in this project will improve implementation efforts in other areas such as staff motivation, buy in, and training in the intervention model. The main reason collaborative strategies are being used in this study is to ensure that mechanisms are in place to support systematic decision making regarding what adaptations are required to support successful implementation of intervention. LESSONS LEARNED The work on this research project is ongoing, and is currently at the completion of the initial phase of implementation efforts. However, since we are actively studying the implementation

Downloaded by [University of West Florida] at 08:20 04 October 2014

188

A. BLANK WILSON AND K. FARKAS

FIGURE 1 Shared decision making chart.

TABLE 1 Implementation Strategies Implementation Phase Pre-implementation

Initial implementation

Full implementation and sustainability

Implementation Strategies Multiple project meetings with administrative staff of agency providing the enhanced reentry service Two-day project “kick off” training for staff of the enhanced reentry model; training was organized and run by the research team; it provided project overview, rationale, and objectives Seven-day training in IDDT treatment modality; planned jointly by research staff and treatment providers Training for staff of the enhanced reentry program in risk assessment tools and rationale for their use in this project provided by research team Research and jail staff attended IDDT training with the staff of the enhanced reentry model Research staff attend enhanced reentry service’s treatment team meetings on a regular basis Research staff obtains and regularly uses project space in same area in the jail as the enhanced reentry service staff (including study PIs) Conducting “ride alongs” with the staff of the enhance reentry model Meet with staff of the enhanced reentry model to provide feedback on initial program outcomes and discuss their questions, concerns, and interpretations of the preliminary findings Meet with staff of the enhanced reentry model to discuss fidelity issues

Downloaded by [University of West Florida] at 08:20 04 October 2014

SOCIAL WORK INTERVENTION RESEARCH IN REAL-WORLD SETTINGS

189

process, a number of issues have arisen during this process that we believe relate to the use of shared decision-making methods. First, it was learned that attempts to use shared decision-making techniques within the structured, top-down approach associated with the overall development of this project requires a clear explication at the beginning of the collaboration as to what decisions would be shared, and more importantly, what ones would not. This lesson led to discussions early on in this project designed to provide clarity about the boundaries around who was responsible for which decisions. Since then, the research team has worked to re-enforce these boundaries as the intervention moved into the field. So for example, the research team tried to clearly lay out boundaries of decision making in the project kick-off training that was held during the preimplementation phase of the project where discussions were held surrounding who was responsible for what decision and why. Later, during the initial implementation phase, as the service providers assumed more and more responsibility for the ongoing operations of the program, research staff attended treatment team meetings on a regular basis, in large part to identify service issues that they are dealing with that need to be addressed in a collaborative fashion. The team and staff of the enhanced reentry service then worked together within the context of these meetings and other less formal interactions to facilitate shared decision making surrounding these issues and document their outcome. The second lesson learned in the efforts to engage in this shared decision-making process was the importance of the strong backgrounds that each principal investigator holds in both research and practice arenas. Prior experiences with the target population and the intervention modalities boosted the ability to engage in the shared decision-making process by mitigating the dynamic that arises in intervention studies where researchers assume authority over design and content while service practitioners assume authority for implementation. In this study, the research teams’ expertise in both areas allows for meaningful dialogue with the service practitioners about the issues they are experiencing in their daily practice and to work with the practitioners to identify the conceptual issues at stake in the decisions and solutions that addressed both the needs of the provider and those of the larger study. For example, the discussion that took place during the pre-implementation phase related to the target populations size included a frank discussion of how many clients case managers could serve and what case load limits would be. This discussion included considerations of the research demands for adequate sample size, but was fostered by the research staff’s understanding of the challenges that the service practitioners’ would face when dealing with a complex client group like the one being studied in this project. The mutual understanding and shared decision-making process resulted in agreement on the number of clients who would be serviced that benefited both the research design and the service delivery strategy. A second example from the implementation phase concerns project recruitment. One unexpected consequence of locating the project within the jail setting was that a variety of other workers within the jail approached staff of the enhanced reentry service with referrals. Enhanced reentry service staff were not sure how to respond to these referrals, since many of the clients appeared to fit project eligibility criteria. The research staff member attending team meetings heard about these situations and both the service practitioners and the research staff were able to talk about the referral process and methods for responding to these outside referrals without jeopardizing the research study’s design and randomization process. The collaborative process and communication structure in place facilitated clear communication and transparent discussion of a potential barrier and implementation problem. Another important aspect of the research team’s professional background that became an essential component of the shared decision-making process was the combined years of experience working in criminal justice settings. This was the one piece of expertise that was missing among the staff of the enhanced reentry service, and yet an essential component of the service adaptation. The project’s ability to engage service practitioners who have experience with the intervention platform and target population allowed the project to focus early on in the implementation process on the

Downloaded by [University of West Florida] at 08:20 04 October 2014

190

A. BLANK WILSON AND K. FARKAS

service adaptations that would be required to support the implementation of this integrated service model in a jail setting. The synergy that was created by the service practitioners’ experience with the intervention modality, but newness to the service setting, and the research team’s knowledge of the issues associated with providing treatment services in correctional settings has been important to the development and implementation the enhanced reentry service. For example, the staff of the enhanced reentry service were able to quickly identify several issues early on that could be important to implementation, such as the client population’s newness to the public mental health treatment system and how this situation could impact their eligibility for public benefits. The enhanced reentry staffs’ early identification of this potential problem allowed the research team to better allocate resources to the flexible pool of benefits. The enhanced reentry staffs’ familiarity with the use of motivational interviewing techniques also enabled them to identify, very early in the initial implementation phase, the problems that they would encounter using this approach in its pure form in a correctional setting where many outside mandates are present that cannot be ignored in treatment plans. However, one of the avenues through which the enhanced reentry staff was able to identify this conflict was through discussions they had with the research team on how they were going to incorporate assessments of criminogenic risks into their treatment planning process and what the possible outcomes were for clients if they failed to address the court mandates in their treatment planning. The final lesson learned to date about using collaborative decision-making strategies to support the implementation of the enhanced reentry service is that the success of these efforts have probably been aided by the fact that this project is being implemented during a time of scarcity. What is meant by this is that all of the service practitioners in this study, like social service practitioners generally, are facing funding cuts that involve substantial reductions in program size and staffing. It is believed that these larger fiscal realities have actually benefited our study and the collaborative decision-making strategies described here, because they seem to have contributed substantially to the availability of seasoned, well trained staff that are willing to work on a one year demonstration project. This quality and experience among the staff of the enhanced reentry service has contributed positively in a number of ways to the shared decision-making process. First, the staff have a wealth of experience and knowledge to contribute to identifying and resolving programmatic issues that have arisen during the implementation process. Second, these staff have a comfort level within group decision-making formats that have contributed positively to the overall decision-making process. But it is also believed that fielding this study in a time of scarcity is likely to have impacted the shared decision-making process on an agency level as well. This tentative conclusion is based on observations that administrators at the agency providing the enhanced reentry service were more willing than expected to sign onto a short term project, they have selected one of their most seasoned and well trained staff to lead the program, and have been willing to share power over some implementation decisions, such as case load size, that social service providers typically see as falling solely within their realm of decision-making powers. CONCLUSION The discussion of the development of collaborative adaptation techniques across two phases of program implementation is rooted in experience with an intervention study that is engaging multiple layers of service integration of established service models where service delivery spans two distinct service settings. The works of Walter et al. (2005) and Fraser et al. (2009) have been heavily drawn upon to guide the development of the collaborative adaptations that are used in the intervention research project. The intervention is moving through the initial implementation phase and it is realized that there is much ground ahead, but has been thus far successful. Over half of a narrowly defined client sample was recruited, and the rigor of a randomized controlled design

Downloaded by [University of West Florida] at 08:20 04 October 2014

SOCIAL WORK INTERVENTION RESEARCH IN REAL-WORLD SETTINGS

191

in a jail setting maintained, during initial implementation efforts that spanned a six-month time period. This success so far has been greatly facilitated by reliance on collaborative strategies that foster interaction and shared decision-making across a number of areas. Certainly the close, weekly interactions with service practitioners enabled pro-active dealings with barriers and implementation issues in a respectful, effective, and collegial manner. The shared decision-making paradigm has also ceded responsibility to agencies and service practitioners in ways that strengthen their ability to provide high quality social services and to facilitate the uptake of a complex service model in a relatively short period of time. The research team’s first-hand knowledge of service delivery issues and their investment in relationship building with project staff have focused objective attention on service adaptations that occur during the course of service delivery, not just on those initially planned or those revealed at the end of the study. In fact, the shared decision-making paradigm has worked well, in part, because all members involved the intervention-administrative staff, service staff, and research staff, have expert knowledge vital to the adaptive integration of the service models in the setting, but none have complete knowledge or skill sets to fully integrate and implement the model in the jail and community settings. Through a clearly delineated yet collaborative strategy and by using standard, routine communication mechanisms that began during pre-implementation and have continued through initial implementation, all partners can meaningfully contribute to the systematic study of the program’s implementation and its outcomes. One limitation of the discussion of lessons learned provided here is that it is from the viewpoint of the research team only. A view of administrative and practitioner behavior has been provided, but only through the research lens. Future steps in collaborative adaptation approaches should include the view from all members of the intervention group, including the views of practitioners and clients. Another limitation is that it is only at the initial implementation phase and has not begun to face some of the more challenging clinical questions. However, experiences so far have bolstered confidence in the collaborative decision-making and communication strategies, and continuing this work through the next phases of implementation and service development is eagerly anticipated. In conclusion adapting implementation efforts, in an intervention study taking place in a realworld setting, to include expanded amounts of collaboration between researchers and services practitioners requires more study. However, experiences in this project suggest that these types of collaborations offer ways to improve the relevance of social work research to real-world practice settings and by so doing offer a potentially important avenue for narrowing the gap between research and practice. REFERENCES Blevins, D., Farmer, M. S., Edlund, C., Sullivan, G., Kirchner, J. (2010). Collaborative research between clinicians and researchers: A multiple case study of implementation. Implementation Science, 5, 76–85. Brekke, J., Ell, K., & Palinkas, L. A. (2007). Translational science at the National Institute of Mental Health: Can social work take its rightful place? Research on Social Work Practice, 17, 123–133. Brunette, M. F., Asher, D., Whitley, R., Lutz, W. J., Wieder, B. L., Jones, A. M., & McHugo, G. (2008). Implementation of integrated dual disorders treatment: A qualitative analysis of facilitators and barriers. Psychiatric Services, 59(9), 989–995. Calsyn, R. J., Yonker, R. D., Lemming, M. R., Morse, G. A., & Klinkenberg, W. D. (2005). Impact of assertive community treatment and client characteristics on criminal justice outcomes in dual disorder homeless individuals. Criminal Behavior and Mental Health, 15(4), 236–248. Chandler, D. W., & Spicer, G. (2006). Integrative treatment for jail recidivists with co-occurring psychiatric and substance use disorders. Community Mental Health Journal, 42(4), 405–425. Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, : : : Richards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469–476.

Downloaded by [University of West Florida] at 08:20 04 October 2014

192

A. BLANK WILSON AND K. FARKAS

Drake, R. E., Torrey, W. C., & McHugo, G. J. (2003). Strategies for implementing evidence-based practices in routine mental health settings. Evidence Based Mental Health, 6, 6–7. Fixsen, D. L., Naoom, S. F., Blasé, K. A., Friedman, R. M., & Wallace, F. (2005). Implementation research: A synthesis of the literature. Tampa, FL: University of South Florida. Fraser, M. W., Richman, J. M., Galinsky, M. J., & Day, S. H. (2009). Intervention research: Developing social programs. USA: Oxford University Press. Gioia, D. & Dziadosz, G. (2008). Adoption of evidence-based practices in community mental health: A mixed-method study of practitioner experiences. Community Mental Health Journal, 44(5), 347–357. Gold, M., & Taylor, E. F. (2007). Moving research into practice: lessons from the US agency for healthcare research and quality’s IDSRN program. Implementation Science, 2, 9–20. Institute of Medicine. (2000). Crossing the quality chasm; A new health system for the 21st century. Washington, DC: National Academy of Science. Leykum, L. K., Pugh, J. A., Lanham, H. J., Harmon, J., & McDaniel, R. R. (2009). Implementation research design: Integrating participatory action research into randomized controlled trials. Implementation Science, 4, 69–77. Magnabosco, J. L. (2006). Innovations in mental health services implementation: A report on state-level data from the U.S. Evidence-Based Practices Project. Implementation Science, 1, 13–22. Mancini, A. D., Moser, L. L., Whitley, R., McHugo, G. J., Bond, G. R., Finnerty, M. T., & Burns, B. J. (2009). Assertive community treatment: Facilitators and barriers to implementation in routine mental health settings. Psychiatric Services, 60(2), 189–195. Mueser, K. T., Torrey, W. C., Lynde, D., Singer, P., & Drake, R. E. (2003). Implementing evidence-based practices for people with severe mental illness. Behavior Modification, 27, 387–411. Mullen, E. J., Bledsoe, S. E., & Bellamy, J. L. (2008). Implementing evidence-based social work practice. Research on Social Work Research, 18(4), 325–338. Osher, F. C., Steadman, H. J., & Barr, H. (2003). A best practice approach to community re-entry from jails for inmates with co-occurring disorders: The APIC model. Crime & Delinquency, 49(1), 79–96. Palinkas, L. A., Schoewald, S. K., Hoagwood, K., Landsverk, J., Chorpita, B. F., & Weisz, J. R. (2008). An ethnographic study of implementation of evidence-based treatments in child mental health: First steps. Psychiatric Services, 59(7), 738–746. Presidents New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Pub no SMA-03-3832. Rockville, MD: Department of Health and Human Services. Thyer, B. (2006). What is evidence-based practice. In A. Roberts & K. Yeager (Eds.), Foundations of evidence-based social work practice (pp. 35–46). New York: Oxford University Press. Torrey, W. C., Drake, R. E., Dixon, L., Burns, B. J., Flynn, L., Rush, A. J., Clark, R. E., & Klatzker, D. (2001). Implementing evidence-based practices for persons with severe mental illnesses. Psychiatric Services, 52(1), 45–50. Walter, I., Nutley, S., & Davies, H. (2005). What works to promote evidence-based practice? A cross-sector review. Evidence and Policy: A Journal of Debate, Research, and Practice, 1(3), 335–364.

Collaborative adaptations in social work intervention research in real-world settings: lessons learned from the field.

Social work research has identified the crucial role that service practitioners play in the implementation of evidence-based practices. This has led s...
461KB Sizes 1 Downloads 0 Views