Table 6

Dimensional Summary of Implementation Process—1st version

Site: 2 State: 2 EBP: IDDT
Phase Facilicators Strategies Barriers Approach to Barriers
Prep Although most interviewed clearly articulate a philosophy that assumes integration of SA and MH treatments and a recovery approach, at baseline there are those who are not buying in. CEO is vocal advocate for best practices for most needy clients. CEO had previously advocated for and implemented other best practices. Assignment vs. recruiting of staff to implementation effort; Local MHA is " kind of ambivalent" and unsupportive. Designated staff are expected to "select out" if they wish.
Early Implementation through 6-mos. Team MD and RN are both very eager to be doing the model, and are fluent in stage-wise thinking at this point. They represent good reinforcement of the model across teams, and support the TL accordingly.   At 6 months, several veteran CMs on both teams are reluctant to adopt the model. Local MHA is " kind of ambivalent" and unsupportive. CAT recommends applying stage-wise principles approach to staff. A majority of folks who "get it" at their meetings goes a long way toward positively influencing the entire team meeting process.
Implementation through 12-mos. Stage-wise approach to engagement/motivation with practitioner pays off as formerly reluctant staff buy in. Stage-wise approach to engagement and training of staff leads to feelings of efficacy and optimism. Local MHA is " kind of ambivalent" and unsupportive.  
Sustaining: 12-24 mos.     Local MHA is " kind of ambivalent" and unsupportive.  

Source: see Resources section for details regarding source for matrices.

Table 7

Dimensional Summary of Implementation Process—2nd version

Display #2 *** County MHC IDDT
Dimensional Summary of Implementation Process
Dimension Facilitators Strategies Barriers Approach to Barriers Net Trend Dimension Summary
Attitude Admin were consistent, vocal supporters of the IDDT EBP since its initial stages. As a rule, they conveyed an enthusiastic attitude about innovative projects at the agency, and a commitment to make necessary changes to enhance services for consumers. CAT, Admin, and PLs set the tone for an agency-wide positive attitude toward the IDDT EBP, and they provided education and support for doing so to practitioners, other staff, and consumers. During the preparation stage, advocacy for the EBP was present in most meetings.     This positive attitude was intense and present throughout the 24-month time period. 2
  CAT provided education, training, and consultation in an attempt to improve this practitioner’s attitude toward the IDDT EBP. In addition, she discussed the matter with the PLs when the practitioner’s reports and documentation showed a concerning pattern. The PLs addressed the matter through group and individual supervision by providing a consistent message to practitioners that the IDDT EBP principles would be followed. One practitioner demonstrated a negative attitude about the IDDT EBP (this person showed negativity toward consumers, in general). She complained about consumers using drugs in the supported housing units, and her documentation reflected that she did not believe in consumers' potential for recovery and the potential for the IDDT EBP to be helpful to them.   By the 1 year mark, this practitioner showed an increased understanding of the IDDT EBP, which improved her attitude toward it (as well as toward DD consumers). The strategy had an intense effect all the way through to the late sustaining phase. 2
Money   The agency did not hold back anything related to time and funding to support the IDDT EBP. Both Admin and the psychiatrist donated their time for participation in trainings and meetings, caseloads were lowered to support the EBP, and time for training/study groups was allotted for the practitioners.     This strategy was present from early preparation through late sustaining and was intense and constant. 2
    During the later months of the sustaining phase, the agency announced that they decided to stop applying for substance abuse funding from the state. Admin relayed that they were often not reimbursed for much money after filling out an enormous amount of paperwork to apply for state funds.   This barrier was constant and only mildly intense. It occurred during late sustaining phase and there did not appear to be any effects upon the IDDT EBP. 0
Responsibility   PL1 took more responsibility for sustaining the EBP than PL2, and worked with practitioners to practice and enhance skills. PL2 focused more on administrative tasks.     PL1 took more responsibility for sustaining the EBP than PL2, and worked with practitioners to practice and enhance skills. PL2 focused more on administrative tasks. 2
Leadership Skills   During the sustaining phase, PL1's leadership role changed a bit, as she was able to shift other duties to allow for more time to be spent on the IDDT EBP. PL1 carried out all the follow-up to the training, including assisting the practitioners with skill-building during group supervision. PL1 provided leadership related to clinical skills, while PL2 oversaw changes in documentation, eligibility, etc. During the latter months of the sustaining phase, PL2 expressed that he believed that too much emphasis was being placed on practicing the IDDT EBP skills, such as MI. This concerned CAT, who believed that regular practice was key to sustaining the IDDT EBP. However, PL1 did make the skill building portion of weekly team meetings optional attendance. CAT attempted to educate PL2 about the necessity of practicing skills and about making attendance mandatory. PL1 continued to provide opportunities for practitioners to practice skills. It appeared as if the leadership skills of Admin and PL2 were strong enough to counter any negative influence of PL1's dismissal of the need for practice. This occurred during the later part of the sustaining phase. 2

Source: see Resources section for details regarding source for matrices.