Start here for a guide to building rural community health programs to address any type of health issue. Learn how to identify community needs, find evidence-based models, plan and implement your program, evaluate results, and much more. Learn about approaches rural communities can use to improve access to care for people with disabilities.
A DIFFERENT PERSPECTIVE ON RECOVERY
Find models and program examples for delivering high-quality care across different rural healthcare settings. Find resources and best practices to develop diabetes prevention and management programs in rural areas. Find resources and strategies to help create or expand a rural health network or coalition.
Learn about strategies and models for rural health promotion and disease prevention in the community, clinic, and workplace. Discover resources and models to develop rural mental health programs, with a primary focus on adult mental health. Find out how rural communities, schools, and healthcare providers can develop programs to help address obesity. Discover rural oral health approaches that focus on workforce, access, outreach, schools, and more. Find emerging practices and resources for building successful relationships with philanthropies.
Learn about models and resources for developing substance use disorder prevention and treatment programs in rural communities. Learn how rural communities can integrate health and human services to increase care coordination, improve health outcomes, and reduce healthcare costs.
Last week, my colleague George Braunstein pointed out that the framework and approaches for delivering a continuum of behavioral health services had some real legs as population health management tools see Bend The Cost Curve? Most physical health care delivery systems have outpatient clinic services and acute inpatient care—with little in between to support consumers in the community. Intensive community-based supports, more typical in behavioral health, offer great promise in supporting other chronic conditions.
That article brought a response that takes the argument a step further. Not only is the behavioral health service continuum framework a good model for population health management, but some of the behavioral health evidence-based practices EBP could be and should be adopted for managing the care for consumers with chronic diseases. He pointed out that using behavioral health EBP for broader population health management created new opportunities—not just with the more robust non-facility based continuum, but also by routinely addressing social determinants, and engaging and leveraging consumers and caregivers.
Frequently measure outcomes such as pain ratings, opioid use, and nonpharmacologic interventions. Flexible selflearning modules and pocket reference cards can help staff gain confidence with the new practice. Electronic health record prompts, other types of remind — ers, and reports to leadership reinforce the new practice.
In addition, patient education and support help ensure success. This stage demands ongoing effort and resources to ensure the practice becomes hardwired and replaces the old practice. This may take weeks, months, and even years. In the case study, staff work to maintain their commitment to offering patients nonpharmacologic pain strategies. Booster training may be needed for existing staff and a structured process created for onboarding new staff.
Implementation strategies: Several implementation strategies can help maintain the practice change. Monitor data trends, report data to senior leaders, and encourage leadership rounds to ask about nonpharmacologic interventions. Project team members and unit leaders should continue to celebrate and recognize success and support champions with incentives and rewards. Other strategies include rolling out the practice to other units, recognizing that drift back to the old practice can occur at any time, changing the reminder mechanisms, continuing to review literature and new evidence at regular intervals, setting new goals and objectives as needed, updating action plans, reporting to quality improvement teams, presenting project details and data through informal and formal presentations, and including project reports in annual reports.
If the practice is truly hardwired, no additional efforts are needed to sustain the change, and the implementation process can be terminated. This stage may not be reached for a long time and may not be appropriate for many practice changes. Implementation strategies: Specific implementation strategies at this stage begin with determining if terminating the team efforts is appropriate.
In the case study, if termination can occur, team members will want to identify what indicators suggest that the nonpharmacologic interventions are consistently used and which focused implementation strategies are no longer needed. Leadership will be responsible for ongoing monitoring of data trends and adherence to the practice change. If evidence of practice drift back is identified, the implementation project may need to be resumed or a new project created.
Thank and celebrate all staff members, as a group and individually, and consider thank-you gifts for project team members.
- The MAP Framework;
- Tools for Implementing an Evidence-Based Approach in Public Health Practice?
- Constraints on Language: Aging, Grammar, and Memory.
- The evidence-based practice methods, models, and tools for mental health professionals | ZODML.
- EVIDENCE-BASED Practice | Social Work Policy Institute.
- Evidence-Based Practices Resource Center;
Termination interviews or focus groups can help the organization learn which implementation strategies were most effective. Maintenance stage managing and preventing drift This stage demands ongoing effort and resources to ensure the practice becomes hardwired and replaces the old practice. Other strategies include rolling out the practice to other units, recognizing that drift back to the old practice can occur at any time, changing the reminder mech a ni — sms, continuing to review literature and new evidence at regular intervals, setting new goals and objectives as needed, updating action plans, reporting to quality improvement teams, presenting project details and data through informal and formal presentations, and including project reports in annual reports.
EBP uptake strategies A by-product of developing implementation models is identifying strategies for a successful EBP initiative.
- Evidence-Based Treatment (EBT).
- Smart Choices: A Practical Guide to Making Better Decisions.
- Halophilic Microorganisms and their Environments.
- Through the Window: Seventeen Essays and a Short Story.
These strategies generally fall into seven categories: leadership, coaching, communication, reinforcement, recognition, measurement, and reporting. The following references were selected to highlight key implementation strategies that nurses can use in their EBP initiatives.
Keep in mind that a toolbox of strategies will improve success.
The Evidence-Based Practice: Methods, Models, and Tools for Mental Health Professionals
A different strategy may be needed at each phase of the initiative, for use with barriers and facilitators, and in specific settings. These strategies can be used with each of the models described above. Grol and Grimshaw: Over 15 years ago, Grol and Grimshaw summarized 54 reviews about how to successfully change practice. They focused on three areas: attributes of the practice, including its complexity and difference from usual practice; barriers and facilitators within the practice change setting and people involved; and the effectiveness of the most frequently used strategies for promoting change.
Grol and Grimshaw found that education strategies, audit and feedback, and reminders and computers are important for successful change. They also recommended interactive small group meetings, mass media campaigns, and combined strategies. The authors concluded that change generally requires comprehensive approaches at different levels and for different interventions, and that a one-size-fits-all approach is unlikely to be successful. Grimshaw and colleagues: Grimshaw and colleagues suggested that successfully translating research into practice requires asking five key questions:.
The authors stressed that a critical first step is assessing organizational barriers and facilitators specific to the proposed practice change. This assessment can guide implementation strategy selection. They also reviewed the latest evidence on various implementation strategies and highlighted the most effective: Holding educational meetings and providing learning materials, leveraging the influence of local opinion leaders, auditing clinician documentation and providing specific feedback, and building computerized reminders.
EBP Resource Center | SAMHSA - Substance Abuse and Mental Health Services Administration
In addition, they noted patient strategies— such as patient decision aids, interactive health communication apps, and communication before consultations to introduce recommended health behavior— that can help facilitate health behavior change. For each of 63 implementation strategies, the authors provide a definition, benefits, procedure, case example, and support references. Powell and colleagues: Similar to the work led by the UIHC nursing team, Powell and colleagues used an expert panel to compile a list of 73 implementation strategies for example, accessing funding, audit and feedback, centralizing technical assistance, developing an implementation glossary, distributing education materials, facilitating, and using advisory boards and data experts for the mental health sector.
The panel was selected based on expertise in implementation science and clinical practice, and members participated in three rounds of a survey using a Delphi process research design. The first two rounds involved a web-based survey; the third round used a web-based live polling and consensus process. Although these strategies are specific to mental health, they cross disciplines, specialties, and settings. Li and colleagues: A systematic review by Li and colleagues focused on organizational contextual features that influence EBP implementation across healthcare settings.
They reviewed and rated the quality of 36 studies published between January and June Using a standardized rating tool, they scored five studies as high quality, 22 as moderately high quality, and eight as moderate quality. Factors identified as important to implementation included organizational culture, networks and communication, leadership, resources financial, staffing and workload, time, and education and training , evaluation, monitoring and feedback, and champions. The authors noted that leadership influences all other factors and should be a priority in implementation initiatives and that combined factors are more influential than a single factor, pointing to the importance of a multistrategy toolkit.
These combined resources provide nurses with multiple strategies to consider when embarking on EBP changes. Tucker and colleagues from the Ohio State University developed a scale that includes a list of implementation strategies clinicians can rate their confidence in using.
Many implementation models promote EBP, and a toolbox of strategies is your surest path to success. Iowa model of evidence-based practice: Revisions and validation. Worldviews Evid Based Nurs. Cullen L, Adams SL. Planning for implementation of evidence-based practice. J Nurs Adm. A guiding framework and approach for implementation research in substance use disorders treatment. Psychol Addict Behav. Am J Public Health. Knowledge translation of research findings. Implement Sci. Grol R, Grimshaw J.
Organizational contextual features that influence the implementation of evidence-based practices across healthcare settings: A systematic integrative review. Syst Rev. The first U. Nilsen P. Making sense of implementation theories, models and frameworks. Krieger Publishing: Malabar, FL; Rycroft-Malone J. J Nurs Care Qual. Evidence-based practice models for organizational change: Overview and practical applications.