Mark Sanders, LCSW, CADC
State Program Manager, Illinois
Great Lakes ATTC, MHTTC, and PTTC
An African proverb says, “Teeth are just bones!”
It’s often said it can take up to 17 years for a practice to move from research to clinical practice, and many innovations never reach wide dissemination and implementation. Thirty years ago, SAMSHA funded the Addiction Technology Transfer Center Network (ATTC) to help the behavioral health workforce implement evidence-based practices for substance use prevention, treatment, and recovery more efficiently.
Many organizations attempting to implement evidence-based practices use a top-down approach. Upper management announces a new evidence-based approach to working with clients, then brings experts in to train the staff in the new approach. The staff smiles politely as the expert introduces them to the new approach. Teeth are just bones: we are smiling but will resist this approach because we do not have a voice in the change.
Lesson One: Get staff input from the start!
I have learned that there is often less resistance to change if leadership consults with the staff before mandating an approach without staff input.
The conversation could go like this:
“Increasingly programs are being asked by funding sources to shift towards evidence-based practices. The leadership team has identified three evidence-based practices. Based upon what you know about our clients, staff strengths, and talents, please give us your input as to which approach would be best. Feel free to share other approaches that you think would be effective for our program.”
Lesson Two: Create a transitional space to address the emotional aspect of change and the grief that follows.
Shifting to a new clinical approach can negatively impact staff confidence in their effectiveness. Some agencies report that their best counselors resign when required to shift to a new clinical practice. One of the things that makes the best counselors the best is that they have mastered their current approaches. The new approach can affect their feelings of competence, too. These counselors leave the organization rather than deal with feelings of incompetence and accompanying emotions. Some staff become angry when the new evidence-based practice is introduced. Anger is one of the stages of grief, and some may respond to their grief in anger and refuse to adopt the new approach. Other staff may yearn for and miss the old approach.
One approach to address the emotional aspect of loss is to create a Transitional Space. Similar to a support group, in the transitional space leadership invites the staff to engage in a discussion led by questions such as this:
As we begin to shift to the new evidence-based practice,
Lesson Three: Pilot projects can be more effective than a complete programmatic overhaul.
Jim Collins, author of the book Good to Great, explains how his research revealed companies that are most successful with systems transformation begin with small pilot projects that cause less disruption to the system. The NIATx approach, widely used to guide process improvement efforts in our field, embodies this concept in Principle 5: Use Rapid-cycle Testing.
Here’s an example:
The staff was livid when an agency program director wanted to add medication-assisted treatment to their array of services. Recognizing the staff's anger and resistance, the agency's leadership decided to try the program as a pilot with a small percentage of the clients. Staff resistance to the approach decreased when they saw the excellent program attendance among clients taking medication, progress in treatment, and reduced criminal justice involvement.
Conclusion
When handled with care, it is possible for organizations to successfully implement evidence-based practices. A feedback loop and excellent training on the new approach, like that offered by the ATTC Network, can also help organizations adopt new practices.
Happy 30th Anniversary to the ATTC Network!
Reference
Collins, J. Good To Great. (2001). Harper Collins. New York, NY.
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