Is leadership committed?

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dhgustaf
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Joined: 02/21/2012 - 09:13
Is leadership committed?

I've seen lot's of ideas on how to make sure you get staff buy-in with whatever change or EBP you're about to implement. And the literature says that an essential component of any successful change is to have leadership committed to the change. What I haven't seen is how to gauge the level of commitment from leadership. Or how to get leadership committed. Has anyone faced that challenge or situation?

Maureen Fitzgerald
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Joined: 06/04/2014 - 10:33

About getting commitment from leadership: Here's resource from IHI:
http://www.ihi.org/resources/Pages/Publications/GettingBoardsonBoardLead...

venrrao
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Joined: 06/06/2014 - 08:29

Goodness Me!!! I have hardly spent a few minutes on this site and already have received information on things that I have been looking for long. This Network of Practice site is turning out to be "Gold Mine" initiative. Good Job Dave and others who have put this together and of course a special thanks to Maureen for sharing this resource.

dhgustaf
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Joined: 02/21/2012 - 09:13

That's great to hear! Make sure to let others know about it as well. The more the merrier!

Eldon
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Joined: 06/06/2014 - 09:07

The State of Mississippi is putting Peer Surpport into there Mental Health System.
Being Peer Surpport I see it hard for Clinical Leadership to except Lived experence.
As another tool they can put into there tool box. any advice

mjellison
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Joined: 06/06/2014 - 16:39

Hi Eldon,
I work for a new grant program that uses peer support, funded by SAMHSA. We use Critical Time Intervention(CTI) with a peer support aspect. We also have a peer navigator which is a new position created that helps with issues on the system level, sort of a liaison between peer supporters and clinical/management staff. As a lot of us know, usually, if one sits down with an alcoholic or addict, that peer connection goes a long way. In my experience it has helped to strengthen the therapeutic relationship through a window of shared experience. The National Organization of Peer Supporters has a lot of good info and trainings available. This type of treatment (peer support) has been used in the military for many years and has been very successful. In the MH/SA arena this type of treatment is just going to expand. Here in Massachusetts it is being used in the Mental Health field and we have now implemented it for co-occurring disorders.

kaiulani
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Joined: 06/08/2014 - 14:43

Thanks for the information about The National Organization of Peer Supporters. I was not familiar with it. I have completed the coursework necessary to sit for the Certified Recovery Support Services exam, but need work/volunteer hours. Perhaps this organization may have some suggestions . . . again, thanks for the reference.

mzshiem
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Joined: 06/06/2014 - 13:42

Dave, Since this is a pilot I wasn't sure if we were allowed to send the information and web link to others. Are you wanting us to invite others?

dhgustaf
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Joined: 02/21/2012 - 09:13

If you know of other folks who would benefit, absolutely. This is a pilot but we're also doing it as a soft release. So the site is live on the web, we're just not publicizing it too much. But the more folks we get using it, the better. We want to get the word out that this exists.

Brian Crowley
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Joined: 04/27/2016 - 17:02

Hi Dave, I'm brand new to this pilot. How it the pilot going. It doesn't seem like there is a lot of active participation. Can you give me some updates on where things are at with the tool. Also what is this tool? What is the back-end engine. I like it and would like to you it for other private label functions. Thanks

outreach1
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Joined: 06/06/2014 - 10:45

In my experience the line staff are usually willing to implement new ideas and promote change within their clients. I've noticed resistance to change in administration. The attitude appears to be "it worked for me, it will work for them", referring to a strong dependence on 12 step buy in. At this point that many younger clients tune out and then discharged for non-compliance because they did not attend meetings.

Kevin
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Joined: 06/06/2014 - 12:06

I agree, line staff are more willing to implement new ideas primarily because they are interested in building their process of providing care across the spectrum of assignments. Leadership is often separated from the daily tasks of providing care and somewhat hesitant to engage in new tools with which they are unfamiliar. Buy-in can only be obtained if leaders utilize the concepts in practice, or at the least as part of their interactions with staff on a daily basis. As implementation leaders we must be willing to engage in the process and advocate across process lines acting as an ambassador between staff and leadership teams. Changing the ethos of a community is difficult work.

mjellison
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Joined: 06/06/2014 - 16:39

Yes, I have run up against leadership getting on board with EBP, especially when we were trying to implement tobacco cessation throughout our facility. What really ended up helping us was the ATTOC model (Addressing Treatment Through Organizational Change). One has to realize that to provide good and competent services at least at larger facilities, there should be an acceptance and implementation of EBP at the individual, systems, and organizational levels.

Janis Dauer
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Joined: 06/07/2014 - 07:43

Did you use the ATTOC resources yourself or contract for training/TA? In my work with behavioral healthcare programs I get acquiescence from upper administration but then it's delegated to line-staff (if anyone is interested or motivated) and no monitoring is done or actual policy and protocol changes made other than what the staff is willing and able to fit in within their usual tasks. Often it is delegated to the Prevention staff, not the treatment clinicians. I'd love to pick your brain more about this!

mjellison
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Joined: 06/06/2014 - 16:39

Hi Janis,
We used some of the aspects and strategies of ATTOC from Umass, including the six core strategies. We did contract for some consultation, but we followed our parent company(Umass Memorial). We had a leadership team backed by administration that included smokers and non-smokers. Developed a policy and offered training cessation and educational groups. Tobacco champions and peer support including tobacco education coordinators.
Several months prior to the implementation of the new
tobacco policies, groups of both staff and consumers were
formed to discuss and prepare for the impending ban.
These steering groups included smokers and nonsmokers and
were drawn from different levels and programs in the agency.
While each area of Community Healthlink had its own representative
to spearhead the tobacco initiative, roles for the
implementation team were left largely indefinite to allow for
more flexibility. An agency-wide tobacco champion was chosen with
the CEO’s clear support, and the policy’s enforcement
and ongoing development were chiefly allotted to the agency’s
compliance manager, Safety Committee chair, and department
managers. Department Managers were also designated to orient
new employees on the tobacco policy. The Safety Committee
was charged with periodically updating agency leadership
on compliance and enforcement of the policy. This prior paragraph comes from a case study we had done that was published in the journal of Dual Diagnosis. (Implementing Tobacco and Education Services at a Large Community Mental Health Center: Lessons Learned).I have provided the link, for some reason I am unable to send the whole article as an attachment on this site. If you have a another e-mail address I could send it there. http://dx.doi.org/10.1080/15504263.2012.670897. It has some very good information about the process, which to this day is still very successful.

Michael

mjellison
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Joined: 06/06/2014 - 16:39

Hi Dave,
I have had that experience of the lack of commitment from leadership. However, there are other variables that can complicate the process(especially at Non-profits) such as lack of funding, time management, understaffed facilities, lack of a developed policy, etc. I think that successful results from EBP is the best validation that one can provide in an organization. For instance, Stages of Change and Motivational Interviewing are widely used, from my experience, meeting the client where they are at (readiness to change) has had success in the field of behavioral health. And at one time I'm not sure leadership was on board with those EBP's, so, I think it takes time to implement some EBP, depending on all the variables. I would like to think that most leadership would want what's best for clients, but I also know a lot time it can come down to money and numbers.

outreach1
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Joined: 06/06/2014 - 10:45

Many times we expect change in our clients but when it comes to us as clinicians we have trouble applying the techniques of Mi to ourselves. We can teach it and use it but some of us fall short when it comes to living it. Thats something I respect in peer led services. Sometimes the good clinicians just point the direction and the others take over.

mjellison
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Joined: 06/06/2014 - 16:39

Janis, Here is the case study. This is a great example of implementing change in an organization. This was used to implement a tobacco free campus and to provide evidence-based education and cessation.

Documents: 
Janis Dauer
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Joined: 06/07/2014 - 07:43

Thank you so much and for taking time to send the earlier detailed response.

Maureen Fitzgerald
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Joined: 06/04/2014 - 10:33

A news item of interest from SAMHSA re: tobacco cessation: http://www.samhsa.gov/newsroom/advisories/1406173258.aspx