Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: The decision to implement an evidence based practice (EBP) in a community mental health center is multifaceted and complex. Integrated Dual Disorders Treatment (IDDT) is an EBP that combines traditionally separate systems of care (namely mental health and substance abuse). To deliver the service effectively requires a paradigm shift for clinicians trained and/or experienced in one of the two disciplines. While there is extensive literature on the components of the practice (e.g. integration of mental health and substance abuse treatment, creation of a multidisciplinary team, use of stage-appropriate interventions and motivational techniques), there is little theoretical and no empirical literature on selecting the appropriate staff for the practice. Experimental research on staff selection has focused largely at the practitioner level, examining the characteristics, credentials, skills, behaviors, etc., predictive of good service delivery. Some procedures have been described and some data have been collected around practitioner selection, although in general, the functional components of effective staff as well as of effective staff selection have little empirical support. A few descriptions of staff selection specifically for EBP implementation exist, however no data on the selection process or criteria for selection have been reported. This poster presents findings related to staff selection issues in the implementation of IDDT. Methods: Ohio was one of eight states that participated in the National Implementing Evidence Based Practices Project, funded in part by SAMHSA and coordinated by the Dartmouth Psychiatric Research Institute. A goal of that project was to illuminate the EBP implementation process and thereby identify facilitators and barriers to successful program establishment and maintenance in community treatment centers. Four agencies in Ohio were selected to install IDDT teams in their facilities. Qualitative data were collected via semi-structured interviews and participant observation of implementation activities. Data were coded and analyzed using the qualitative analysis software, Atlas.ti. Results: Data collected over the project period confirm the salience of practitioner selection as a critical element in IDDT implementation and provide empirical support for previously identified and newly emerging functional components of the selection process. Two thematic categories emerged from the analysis – practitioner characteristics and selection methods. The degree to which practitioners were motivated, enthusiastic, open to change, and otherwise receptive to the practice changes asked of them had a notable influence on the uptake of the training. Although experience and skills were important for implementation success, a willingness to take on IDDT was primary. Expert supervision and training appeared to compensate for deficits in experience and skill level. Negative staff attitudes often resulted in costly turnover and retraining. In addition, staff who volunteered or were willingly recruits for the implementation showed superior mastery of core IDDT skills, such as motivational interviewing techniques, over staff assigned to the project. Implications: These results take an important step toward clarifying and operationalizing elements of staff selection, a core components of effective IDDT implementation. Policy-makers and administrators will benefit from the development and testing of evidence based methods of identifying and hiring the appropriate clinicians to deliver the practice.