Consultation as an Implementation Strategy for Evidence-Based Practices Across Multiple Contexts: Unpacking the Black Box

Abstract

There is great interest in the dissemination and implementation of evidence-based treatments and practices for children across schools and community mental health settings. A growing body of literature suggests that the use of one-time workshops as a training tool is ineffective in influencing therapist behavior and patient outcomes and that ongoing expert consultation and coaching is critical to actual uptake and quality implementation. Yet, we have very limited understanding of how expert consultation fits into the larger implementation support system, or the most effective consultation strategies. This commentary reviews the literature on consultation in child mental health, and proposes a set of core consultation functions,processes, and outcomes that should be further studied in the implementation of evidence-based practices for children.

A Digital Feedback System to Support Implementation of Measurement-Based Care by School-Based Mental Health Clinicians

“…During calls, clinicians and expert consultants (a) troubleshot use of the SB-MHITS technology and (b) supported clinicians in incorporating MBC practices into their routine services. Given uncertainty in the field about the dosage of consultation required to adequately support clinicians following training (Nadeem et al, 2013; Owens et al, 2014), the emphasis of the current project on maximizing consultation efficiency, evaluated the immediate (i.e., one week) effects of consultation calls on clinician behavior. Results indicated that the effects of consultation calls on MBC practices in the subsequent week were either significant or approached significance for assessment feedback and administration, respectively.…”

“…Clinicians were expected to attend three of the six calls and to make one case presentation that incorporated assessment data derived from SB-MHITS. This level was determined based on (a) a desire to limit the consultation sessions as much as possible for the sake of efficiency and (b) an understanding that key functions of consultation include problem-solving, trainee engagement, case support, and accountability among others, which may require multiple contacts to achieve successfully (Nadeem, Gleacher, & Beidas, 2013). Consultation call attendance and case presentation dates were tracked for each clinician (see below).…”

Can Learning Collaboratives Support Implementation by Rewiring Professional Networks?

“…Direct training and ongoing consultation from those with specific expertise in the targeted EST contribute to quality implementation and EST fidelity (Beidas, Edmunds, Marcus, & Kendall, 2012; Herschell, Kolko, Baumann, & Davis, 2010; Nadeem, Gleacher, & Beidas, 2013). Thus, increased advice-seeking from faculty experts may also be associated with treatment fidelity.…”

“…Collaborative learning models are strategies that can be used to implement empirically supported treatments (ESTs) within multiple organizations or multiple levels of a healthcare system (Nadeem et al 2013, Ebert et al, 2011). Based on the Institute for Healthcare Improvement’s Breakthrough Series Collaborative, the learning collaborative (LC) model was originally intended as a method for improving care quality within traditional health and medical settings by emphasizing shared learning within and across agency quality improvement teams (Institute for Healthcare Improvement, 2003; Kilo, 1998).…”

State-wide dissemination and implementation of parent–child interaction therapy (PCIT): Application of theory

“…Beidas, Edmunds, Marcus, & Kendal, 2012;Edmunds, Beidas, & Kendall, 2013.;Nadeem, Gleacher, & Beidas, 2013). These include several approaches in one protocol, and often include a treatment manual, an intensive several day workshop, expert consultation and review of clinical materials, completion of booster training sessions, and pilot cases under supervision (Hurley, Ingram, Czyz, Juliano, & Wilson, 2006;Jameson, Stadter, & Poulton, 2007).…”