OHIO SAMI CCOE

September 16, 2008

BOARD'S-EYE VIEW

An executive’s perspective about EBP implementation

—by Matthew K. Weiland and Paul M. Kubek

Listen to Ken Gill's advice about implementing IDDT (3m 5s).

Mentor, OH--Times are especially good for NEIGHBORING’s Chief Operating Officer Ken Gill, MSSA (’82), LISW-S, LICDC, and his Integrated Dual Disorder Treatment (IDDT) team. They are being recognized for raising the standard of exceptional care with the third annual Lynn Goff Spirit of Integrated Treatment Award. They have successfully implemented two additional evidence-based practices, Supported Employment and Wellness Management and Recovery. And their continuing outreach efforts in the community have helped mental health consumers in Lake County on their journeys toward recovery in various innovative and measurable ways (see “Agency Profile: Community Partnership” story | click here |).

Things, however, weren’t always running this smoothly.

When NEIGHBORING began implementing its IDDT services earlier this decade, it faced challenges on many fronts, from staffing and financing to staff buy-in and community partnerships. In light of this, Gill and his implementation team decided to take the cautious approach. They gradually adopted the core components of IDDT and chose not to unveil their efforts formally until every piece was in place. At the time, it seemed like a prudent approach.

WHAT I WOULD HAVE DONE DIFFERENTLY

Looking back, however, Gill says he would have solicited support and input sooner from the Lake County Alcohol Drug Addiction and Mental Health Services (ADAMHS) Board. He also would have involved all community stakeholders in the implementation process, educating them along the way about IDDT, its methods, and its expected outcomes.

“We really didn’t bring our board into the process soon enough,” says Gill. “There was a perception at the board level that there was no Integrated Dual Disorder Treatment being done in the Lake County system, even though we were in the process of doing it. That happened because we didn’t communicate with them effectively about what we were doing and how we were doing it.”

It was a lesson well-learned by Gill and the NEIGHBORING team. When the agency had the opportunity to implement the evidence-based Supported Employment and the Wellness Management and Recovery models, they contacted the board as one of the first steps in the process, encouraging board members to attend meetings, respond to ideas, and provide input.

“We’ve done a pretty good job of promoting evidence-based practices in the county,” says Gill. “And the board has become a strong advocate of the work that we’re doing.”

PEOPLE WITH THE LONG-VIEW OF RECOVERY

Building an IDDT service team is a critical function, Gill explains, and many agencies like his start in a similar way: they ask staff members to take on additional responsibilities, which is not always a smooth process. Staff members may not have the time, energy, or interest to buy-into the implementation process wholeheartedly.

“We had therapists, case managers, employment specialists, nurses, and such—all of whom had dual disorder clients in their case loads,” Gill says. “But we didn’t have folks who had been hired to work specifically with the dual disorder population. This work takes special people with a special disposition.”

Gill has learned to look for people who are open-minded, eager to attend training, willing to work collaboratively with team members, and committed to the long-view of recovery. He explains that people with severe mental illness who also struggle with addiction frequently do not respond to traditional short-term intensive and confrontational treatments.

“When I started my career in addiction treatment, we had models that were 14-day programs and 28-day programs, and we expected miracles to happen,” says Gill. “And some miracles did happen. But that’s a very different approach than IDDT, which recognizes the complexities of these disorders. Folks do improve and make progress in their recovery, but that often happens incrementally over time. We’re talking about several years in many cases, and you have to have patience and perseverance to stay with people through a lot of ups-and-downs. So that’s what I’m looking for, people who can ride the waves a little bit because it’s not always a smooth course.”

Matthew K. Weiland, MA, is senior writer, producer, and new-media specialist, and Paul M. Kubek, MA, is director of communications at the Center for Evidence-Based Practices at Case Western Reserve University.