You've been there: You just finished participating in a great training on a new clinical intervention, and you're enthusiastic and committed to trying it with your clients. Although there wasn't much time for skill-building, you have lots of notes and handouts. You're raring to go.
Then you get back to the agency, to the routine, to the caseload and the paperwork, to the supervisor and co-workers who didn't take the training, to the clients who aren't prepared for you to do something new or different. Your notes now seem incomplete and you scratch your head trying to recall details from the training. All that enthusiasm and new knowledge begin to fade. Adopting new practices in the context of everyday practice is often difficult and frustrating. Given all the challenges associated with implementing something new, most of us fall back to the familiar and the necessary.
In 2003, the Addiction Technology Transfer Center of New England was one of 14 ATTCs nationwide to begin working with the National Institute on Drug Abuse to assist in disseminating research emanating from NIDA's Clinical Trials Network (for more information, go to http://www.nida.nih.gov/CTN/index.htm). Following NIDA's instructions to “prepare the field” for upcoming dissemination and adoption efforts, the ATTC-NE staff reflected on the number of times that we as clinicians had experiences like those noted above. We determined to focus our efforts on looking at the process of adopting evidence-based treatment practices, rather than on teaching the EBPs themselves. This process is actually technology transfer—moving the science from the laboratory to the field.
We began our preparation by holding regional and national discussions with key stakeholders, and conducted an extensive review of the research literature in order to identify barriers to the effective adoption of new practices. In contrast, we also researched characteristics of organizations that had successfully completed change initiatives. Eventually a model for adopting new practices emerged. As a vehicle for agencies to experience this comprehensive technology transfer model, we developed the Science to Service Laboratory in association with the New England School of Best Practices.
Stephen J. Gumbley, MA, LCDP
Daniel D. Squires, PhD, MPH
In order to become skillful in adopting EBPs, agencies must practice implementing a real intervention. Based on recommendations from state and clinical leaders across the New England region, contingency management was selected as an evidence-based practice to model the Science to Service Laboratory. Contingency management, a treatment approach that uses incentives such as prize vouchers to promote positive behavior change in substance abuse clients (see cover story in September/October 2006 issue) is easy to teach and learn, integrates well into a variety of treatment models, and has generated interest among treatment providers. Nancy Petry, PhD, of the University of Connecticut Health Center, a widely published researcher in contingency management, trained the technology transfer specialists and agency staff.
The comprehensive technology transfer model has several key components. The first is getting organizational commitment for the process. Two concepts related to adopting new treatment practices have long impeded successful implementation. One is the belief that making organizational changes “just happens,” that it doesn't require much thought or preparation. Indeed, many practitioners believe that if an intervention is good enough, it will “sell itself.” Another barrier is the widely held belief that implementation is the counselor's responsibility, since the counselor is the one delivering the intervention. Little thought is given to the context and culture into which the new intervention must fit.
The reality is that successful implementation of a new practice depends greatly upon organizational change that requires significant agency involvement. Given the complexity of successfully implementing new treatment practices, the responsibility for spearheading adoption efforts belongs as much with the agency as it does with the individual practitioner, if not more so.
We address these barriers by requiring a number of up-front commitments from the agency:
An initial pledge to ensure the availability of the fiscal and human resources necessary to complete the adoption process;
The identification of internal agency “champions for change” and other interested personnel for participation on the implementation team; and
Assurances that the organization will develop and maintain the use of a work plan as outlined in The Change Book,1 a “blueprint for technology transfer” developed by the ATTCs.
Support for the adoption process begins with an “exposure meeting” for agency executives, to give them an overview of the key elements of the Science to Service Laboratory model, and of the essential components of the intervention (contingency management) that will be used to model that process.