Participating in Project SUCCESS enabled our Certified Community Behavioral Health Center to pilot one of the two evidence-based practices (EBP) the project compares. Here, we share a few of the implementation facilitators, barriers, and strategies we believe most influenced the delivery of the intervention. Many of the strategies we share here are informed by the Expert Recommendations for Implementing Change (ERIC).
First, exploring consumers’ motivations was fundamental for activating potential participants to engage in the intervention. We found that participants had a diversity of unmet needs across different life domains, so the one-on-one sessions ensured that facilitators could tailor material for participants to best support their recovery goals. We found that those participants who could most benefit from the intervention often presented with substantial barriers to participation, including limited transportation options for attending group, minimal social networks with which to practice new skills, and food insecurity, which inhibited learning, recalling, and practicing skills modeled in group.
Several discrete strategies could be supportive of group engagement and cohesion. Our site was fortunate to have a Recovery Center, which is inspired by the Clubhouse Model, and allowed for participants to engage with each other outside of the intervention’s weekly group sessions. The Recovery Center also provides meals for participants and can play a part in addressing food insecurity among participants. Participants also successfully advocated for snacks during group, which helped to facilitate a more convivial atmosphere. As many participants had unplanned life or health events over the course of the group, strategies to re-engage participants were essential. Telehealth options should be considered to increase access to the group if life events disrupt participation. Emphasizing that participants are encouraged to return to group even if they missed sessions was important for our participants to hear, as many had been exited from other groups due to unplanned absences.
For supporting buy-in among staff and administrators, ongoing technical assistance, clinical supervision, and facilitated meetings were necessary. Our group facilitators were not participants’ primary clinicians, so intensive outreach and engagement of participants’ treatment teams was necessary. These primary clinicians had a crucial role in supporting participants towards their recovery goals by reinforcing skills outside of group. However, without clear endorsement from leadership, clinicians may be hesitant to invest in learning new practices. The buy-in for EBP generally may be variable across practice sites. To this end, identifying and preparing staff to champion the intervention and advocating for leadership to support the scaling up of the intervention was essential for ensuring formal commitment to delivering the intervention.
In sum, bringing an EBP to a new practice context can be facilitated by intentionally exploring the needs of the client population served, partnering with participants to motivate group adherence and increase demand, and assessing the organizational context to ensure that the agency has the resources and infrastructure to sustain the practice.
Nathaniel Dell, PhD, LCSW
Site-PI, Places for People, Inc.
Assistant Professor of Psychiatry
Washington University School of Medicine