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Managing and Adapting Practice

Building an Evidence-Based System from Common Elements

Scientific Rating
Since the Managing & Adapting Practice (MAP) system is designed based on numerous evidence-based practices, it cannot be rated as a single practice.

The MAP system is designed to coordinate and supplement the use of evidence-based programs for children’s mental health.  The system is not a single treatment program.  Rather, it involves several decision and practice support tools to assist in the selection, review, adaptation, or construction of promising treatments to match particular child characteristics based on the latest research findings.

The three main features of the MAP system are:

PracticeWise Evidence Based Services (PWEBS) Database
The PracticeWise Evidence Based Services Database is an online compilation and coded interpretation of child mental health clinical outcome studies and treatment programs.  The database includes over 370 randomized trials in the areas of childhood anxiety, depression, disruptive behavior, eating disorders, substance abuse, traumatic stress, ADHD, and autism.  New papers are added to the database on a regular basis as the literature continues to expand.

Five Acres uses PracticeWise to address four areas: childhood anxiety, depression, disruptive behavior and traumatic stress.

One of the many reporting functions of the database allows a therapist to enter child and setting characteristics in order to obtain a summary of all relevant studies, treatment programs, or common elements matching that particular case.  Thus, this tool allows one to identify “best-match” evidence based programming for a particular youth, and in the absence of such programs, to custom-build a treatment based on a summary of the common elements from those successful treatments that are most relevant to that child’s characteristics.

Clinical Dashboard
The Clinical Dashboard is a Microsoft Excel based tool that presents a convenient visual summary of individual client progress along with the history of clinical practices delivered.  Professionals can configure this tool to track up to five measures of client progress at a time, using any measures of their choice.

Practitioner Guide
The Practitioner Guide is a set of treatment materials that summarize 27 of the most common elements of evidence-based treatments for youth.  Each practice is summarized in a convenient one-page handout and checklist format to guide therapists in performing the main steps of the common components of evidence-based practices.  These components are used as the “building blocks” for designing promising interventions as needed.

Recommended Population:  
For the four PracticeElements utilized at Five Acres, the following populations are targeted:

Childhood Anxiety: Ages 3-19 of both genders and multiple ethnicities.

Depression: Ages 8-23 of both genders and several ethnicities common to our area.

Disruptive Behavior: Ages 0-21 of both genders and multiple ethnicities.

Traumatic Stress: Ages 2-18 of both genders and several ethnicities common to our area.

Practitioner Qualifications
With the exception of Traumatic Stress, practitioners can be either Rehab Specialists or Clinicians, as long as the Practice Elements they are using fall within their Scope of Practice.  Traumatic Stress elements are required to be delivered by a therapist with a minimum of a master’s degree.

Supervisor Qualifications
An Agency Supervisor is one who has demonstrated the core competencies necessary to deliver evidence-informed care using the MAP system and is qualified to produce Supported Users who qualify for a Therapist Promotion Review.  This supervisor has successfully completed the Supervisor Performance Review which requires:

•    performance-based evidence of knowledge, awareness of treatment targets, decisiveness, task focus, error detection and correction, performance evaluation, technical skills in planning, practice, and monitoring, and achievement of client outcomes using the MAP system

•    training or supervised experience sufficient to meet the standards of the Supervision and Consultation Curriculum (16 hours beyond the Direct Services Curriculum)

•    provision of at least 15 hours of supervision or consultation in the MAP system to at least 6 professionals

•    Maintenance of Agency Supervisor status requires successful completion of an Agency Supervisor Performance Review every 2 years.

The MAP direct services workshop is delivered in a 5-day format.

Participants in the 5-day training subsequently participate in phone consultation groups, ranging in size from 6 to 8 therapists per call.  Participants take part in up to twelve 1-hour telephone conference calls twice per month with a MAP consultant to evaluate delivery of care to their clients using the practice support tools (i.e., the PWEBS Database, Practitioner Guides and Clinical Dashboards).

In addition to the consultation calls described above, MAP practitioners meet on alternating weeks for 1 hour for group supervision.

Training for Trainers
Agency Supervisors (described above) are eligible to provide supervision and consultation to up to six intra-agency Supported Users.

A certificate is issued to individuals who complete a MAP direct services workshop with PracticeWise.  Presentation of this certificate to Los Angeles County Department of Mental Health (DMH) qualifies the practitioner as a MAP direct service provider for a period of one year from the start date of the workshop that is specified on the certificate.

Maintaining Qualification
To maintain qualification as a MAP direct service provider under DMH after expiration of the qualifying period (as indicated on Certificate of Completion), individuals must submit an Award of Status as a MAP Therapist (which is obtained from PracticeWise by successfully completing a MAP Therapist Promotion Review)
Fidelity Measures and Standards
Fidelity is measured via consultation calls and submission of the Portfolio at the completion of the consultation calls.
Outcome measures are specific to the four PracticeElements:

Anxiety – Revised Child Anxiety/Depression Scale (RCADS), caregiver and slef-report versions) pre- and post-treatment.

Depression – Patient Health Questionnaire-9 at pre- and post-treatment

Disruptive Behavior – Eyberg Child Behavior Inventory (ECBI) at pre- and post-treatment.

Trauma – Post-traumatic Stress Disorder Reaction Intake (PTSD-RI) at pre- and post-treatment.

All four elements receive the Youth Outcome Questionnaire (caregiver and self-report versions) pre- and post-treatment.