Getting Started
with Evidence-Based
Practices

Family
Psychoeducation

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
Center for Mental Health Services
www.samhsa.gov

Family
Psychoeducation

Getting Started
with Evidence-Based
Practices

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

Acknowledgments

This document was prepared for the Substance Abuse and Mental Health Services Administration
(SAMHSA) by the New Hampshire-Dartmouth Psychiatric Research Center under contract number
280-00-8049 and Westat under contract number 270-03-6005, with SAMHSA, U.S. Department
of Health and Human Services (HHS). Neal Brown, M.P.A., and Crystal Blyler, Ph.D., served as
the Government Project Officers.

Disclaimer

The views, opinions, and content of this publication are those of the authors and contributors and
do not necessarily reflect the views, opinions, or policies of the Center for Mental Health Services
(CMHS), SAMHSA, or HHS.

Public Domain Notice

All material appearing in this document is in the public domain and may be reproduced or
copied without permission from SAMHSA. Citation of the source is appreciated. However,
this publication may not be reproduced or distributed for a fee without the specific, written
authorization from the Office of Communications, SAMHSA, HHS.

Electronic Access and Copies of Publication

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call SAMHSA?s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727) (English
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Recommended Citation

Substance Abuse and Mental Health Services Administration. Family Psychoeducation: Getting
Started with Evidence-Based Practicess. HHS Pub. No. SMA-09-4422, Rockville, MD: Center for
Mental Health Services, Substance Abuse and Mental Health Services Administration,
U.S. Department of Health and Human Services, 2009.

Originating Office

Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
1 Choke Cherry Road
Rockville, MD 20857

HHS Publication No. SMA-09-4422
Printed 2009

Getting Started with
Evidence-Based Practices

Getting Started with EBPs gives you an overview of the activities
that are generally involved in implementing EBPs and tells you
how to make EBPs culturally competent. This booklet is particularly
relevant to the following:

n Mental health authorities; and

n Agency staff who develop and manage EBP programs.

Family
Psychoeducation

For references, see the booklet The Evidence.

This KIT is part of a series of Evidence-Based Practices KITs created
by the Center for Mental Health Services, Substance Abuse and
Mental Health Services Administration, U.S. Department of Health
and Human Services.

This booklet is part of the Family Psychoeducation KIT that includes
a DVD, CD-ROM, and seven booklets:

How to Use the Evidence-Based Practices KITs

Getting Started with Evidence-Based Practices

Building Your Program

Training Frontline Staff

Evaluating Your Program

The Evidence

Using Multimedia to Introduce Your EBP

Family
Psychoeducation

What?s in Getting Started with
Evidence-Based Practices

Consensus Building: Build Support for Change . . . . . . . . 3

Integrate the EBP into Policies and Procedures . . . . . . . . 5

Assess Training Needs . . . . . . . . . . . . . . . . . . . . . . . . . 7

Monitor and Evaluate Regularly . . . . . . . . . . . . . . . . . . 9

Maximize Effectiveness by Making Services
Culturally Competent . . . . . . . . . . . . . . . . . . . . . . . . . 11

Getting Started with EBPs 3

Getting Started
with Evidence-Based Practices

Consensus Building:
Build Support for Change

Within a system, change affects
stakeholders differently. Consequently,
when making changes in the mental
health system, mental health agencies
should expect varied reactions from
staff, community members, consumers,
and families. Since misunderstandings
can stymie your efforts to implement
evidence-based practices (EBPs),
it is important to build consensus
to implement EBPs in the community.

Practitioner training alone is not
effective. The experience of mental
health authorities and agencies that have
successfully implemented EBPs reinforces
that fact. Instead, practitioner training

must be complemented by a broad range
of implementation activities, including the
following:

n Building support for the EBP;

n Integrating the EBP into agency
policies and procedures;

n Training staff agency-wide on basic EBP
principles; and

n Allowing for ongoing monitoring and
evaluation of the program.

This overview introduces the general
range of activities involved in successfully
implementing EBPs. For guidelines and
suggestions for EBP-specific activities, see
the remaining sections of each KIT.

4 Getting Started with EBPs

How to build support for your EBP

Consensus-building activities are designed to build
support for implementing EBPs. Here are some
ways to develop them:

Step 1 Identify key stakeholders or people who
will be affected by the EBP. Stakeholders
may include agency personnel at all
levels, mental health authority staff, and
consumer and family representatives.
Depending on the EBP, you may also
wish to build relationships with other
community organizations, such as the
Department of Vocational Rehabilitation,
homeless shelters, food banks, police,
hospitals, peer-support programs, and
consumer and family groups.

Step 2 Invite one potential EBP champion from
each stakeholder group to participate in
an EBP advisory committee. According
to agencies that have successfully
implemented EBPs, identifying ongoing
champions and forming an advisory
committee are critical activities. While at
first you may feel that creating an advisory
committee slows the process, any amount
of time used to build stakeholder support is
worth the effort.

EBPs have little hope for success if the
community doesn?t recognize that they are
needed, affordable, worth the effort, and
congruent with community values and the
agency?s practice philosophy. Mental health
authorities and agency administrators must
convey to key stakeholders a clear vision
and a commitment to implementing the
EBP. By forming an advisory committee
of potential champions from each
stakeholder group, you will be able to

broadly disseminate information in the
community. After training committee
members in the basic principles of the EBP,
ask them to hold informational meetings
or to regularly disseminate information to
their stakeholder groups.

Step 3 Ask for advice. Developing the advisory
committee and educating its members
in the EBP early in the planning process
will allow you to ask committee members
for their advice during all phases of the
implementation process. Community
members may help assess how ready
the community and the agency are to
implement the EBP and its activities.
Once the EBP is in place, committee
members can keep EBP staff informed of
relevant community trends that may have
an impact on providing the EBP services.

EBP advisory committees are crucial
for sustaining the EBP over time. When
EBP staff turn over, or other well-trained
staff leave and must be replaced, or when
funding streams or program requirements
change, community and political alliances
are essential. A well-established committee
can champion the EBP through changes.

Step 4 Build an action plan. Once key
stakeholders basically understand the EBP,
have your advisory committee develop an
action plan for implementation. Action
plans outline activities and strategies
involved in developing the EBP program,
including the following:

n Integrating the EBP principles into
mental health authority and agency
policies and procedures;

n Outlining initial and ongoing training
plans for internal and external
stakeholders; and

Getting Started with EBPs 5

n Designing procedures to regularly
monitor and evaluate the EBP.

Base the activities in your action plan on
the needs of the population you serve, your
community, and your organization.

Step 5 Involve the advisory committee in an
ongoing evaluation of the EBP. Committee
members can help you decide which
outcomes you should target. They can
help you integrate continuous quality
improvements.

Integrate the EBP into Policies
and Procedures

Examine policies and procedures

Mental health authorities and agencies that have
successfully implemented EBPs highlight the
importance of integrating the EBP into policies and
procedures. For example, you will immediately face
decisions about staffing the EBP program. Mental
health authorities can support the implementation

To start implementing your EBP

n Pinpoint key stakeholder groups that will be
affected by implementing the EBP.

n Identify potential champions from each group
and invite them to participate in an EBP
advisory committee.

n Ask the committee to advise you during
the process.

n Build an action plan.

n Outline responsibilities for committee members,
such as:

o Participating in EBP basic training;

o Providing basic information about the EBP to
their stakeholder groups;

o Advising you during all phases of the
implementation process; and

o Participating in an ongoing evaluation
of the EBP.

6 Getting Started with EBPs

process by integrating staffing criteria into
regulations. Agency administrators should select
an EBP program leader and practitioners based
on mental health authority regulations and
qualifications that the EBP requires. New EBP
position descriptions should be integrated into
the agency?s human resource policies. EBP-
specific suggestions in Building Your Program
will help mental health authorities and agency
staff determine the appropriate mix and number
of staff, define staff roles, and develop a
supervision structure.

Agency administrators and mental health
authorities should also review administrative
policies and procedures to ensure that they are
compatible with EBP principles. For example,
you may need to modify admission and discharge
assessment, treatment planning, and service-
delivery procedures. Make sure policies and
procedures include information about how to
identify consumers who are most likely to benefit
from the EBP and how to integrate inclusion
and exclusion criteria into referral mechanisms.
Integrating EBP principles into policies and
procedures will build the foundation of the
EBP program and will ensure that the program
is sustainable. Examine policies and procedures
early in the process. While most changes will occur
in the planning stages, regularly monitoring and
evaluating the program (see discussion below)
will allow you to periodically assess the need for
more changes.

Identify funding issues

Identifying and addressing financial barriers is
critical since specific costs are associated with
starting new EBP programs and sustaining them.
Identify short- and long-term funding mechanisms
for EBP services, including federal, state, local
government, and private foundation funds. You can
work with your EBP advisory committee to project
start up costs by identifying the following:

n Time for meeting with stakeholders that is not
reimbursed;

n Time for staff while in training;

n Staff time for strategic planning;

n Travel to visit other model EBP programs; and

n Costs for needed technology (cell phones and
computers) or other one-time expenses accrued
during the initial implementation effort.

You should also identify funding mechanisms for
ongoing EBP services and to support continuous
quality improvement efforts, such as ongoing
training, supervision, technical assistance, fidelity,
and outcomes monitoring. In addition, you may
need to revise rules for reimbursement that are
driven by service definitions and criteria; this may
require interagency meetings on the federal, state,
and local levels.

Getting Started with EBPs 7

Get these valuable resources to help implement your EBP

Numerous materials are available through the U.S. Department of Health and Human Services
(http://www.hhs.gov) about using Medicaid and Medicare to fund necessary services. If you are
implementing EBPs, one useful resource is Using Medicaid to Support Working Age Adults with Serious
Mental Illnesses in the Community: A Handbook, published by the Assistant Secretary of Planning and
Evaluation, January 2005.

http://aspe.hhs.gov/daltcp/reports/handbook.pdf

This handbook gives you an excellent introduction to the Medicaid program, including essential features,
eligibility, and coverage of mental health services, community services, and waivers. It also provides helpful
information for states seeking Medicaid funding to implement the following:

n Family Psychoeducation;

n Assertive Community Treatment;

n Illness Management and Recovery;

n Integrated Treatment for Co-Occurring Disorders;

n Medication Management;

n Supported Employment;

n Supportive Housing;

n Consumer-Directed Services; and

n Peer Support.

Assess Training Needs

One of the next steps in implementing your
EBP is to develop a training plan. You may gauge
the amount of training needed by assessing the
readiness of your community. If a community
doesn?t know about the EBP and doesn?t recognize
the existing need, you may have to conduct a wide
range of educational activities. If a community
already understands the EBP and knows how it may
address problems that community members want
to solve, you may need fewer educational activities.

You can help train key stakeholder groups if
you first train members of your EBP advisory
committee and then ask them to disseminate
information about the purpose and benefits
of the EBP.

In addition to assessing training needs in the
community, agency administrators should gauge
how well staff across the agency understand the
EBP. Agency administrators who have successfully
implemented EBPs highlight the importance of
providing basic training on the EBP to all levels
of staff throughout the agency. Educating and
engaging staff will ensure support for the EBP.
In the long run, if they are well trained, EBP
staff will have an easier time obtaining referrals,
collaborating with staff from other service
programs, and facilitating a continuum of care.

Ongoing in-service training is an efficient way to
provide background information, the EBP practice
philosophy and values, and the basic rationale
for EBP service components in a comfortable
environment. Consider including members of
your advisory committee in decisions about the
frequency and content of basic EBP training.

8 Getting Started with EBPs

Offer more intensive training to program
leaders and practitioners

While staff at all levels in the agency should
receive basic EBP training, the program leader and
practitioners will require more intensive training.
To help practitioners integrate EBP principles
into their daily practice, offer comprehensive
skills training to those who provide EBP services.
Each KIT contains a variety of EBP-specific
training tools to help you provide both basic and
intensive training.

Although most skills that practitioners need may
be introduced through these training tools, research
and experience show that the most effective way to
teach EBP skills is through on-the-job consultation.
Consultants may provide comprehensive training
and case consultation to EBP practitioners.

Consultants may also help mental health authorities
and agency administrators to do the following:

n Provide basic information to key stakeholders;

n Assess the community?s readiness for change;

n Assist in integrating EBP principles into policies
and procedures; and

n Design ongoing training plans.

In many mental health agencies, turnover of
staff is high. This means that the EBP will not
be sustained unless ongoing training is offered to
all employees.

Many agencies have also found it useful for
program leaders and practitioners to become
familiar with the structure and processes of the
practice by visiting agencies that have successfully
implemented the EBP.

Early in the process, mental health authorities
and agency administrators must decide how to
accomplish the following:

n Identify internal and external stakeholders who
will receive basic training;

n Determine how often basic training will be
offered;

n Identify who will provide the training;

n Identify EBP staff and advisory group members
who will receive comprehensive skills training;

n Determine the training format for ongoing
training to EBP staff; and

n Determine whether EBP staff may visit a model
EBP program.

EBP-specific suggestions in Building Your Program
will help mental health authorities and agency staff
develop an EBP training plan.

Getting Started with EBPs 9

Monitor and Evaluate Regularly

Key stakeholders who implement EBPs may find
themselves asking two questions:

n Has the EBP been implemented as planned?

n Has the EBP resulted in the expected
outcomes?

Asking these two questions and using the answers
to improve your program is a critical component
for ensuring the success of your EBP.

n To answer the first question, collect process
measures (by using the EBP Fidelity Scale and
General Organizational Index). Process measures
capture how services are provided.

n To answer the second question, collect outcome
measures. Outcome measures capture the results
or achievements of your program.

As you prepare to implement an EBP, we strongly
recommend that you develop a quality assurance
system using both process and outcome measures
to monitor and improve the program?s quality from
the startup phase and continuing through the life
of the program. Evaluating Your Program in the
KIT contains an EBP-specific Fidelity Scale, the
General Organizational Index, and sample outcome
measures. These measures may be integrated
into existing quality assurance programs or help
agencies develop new ones.

Why you should collect process measures

Process measures, such as the EBP Fidelity Scale
and General Organizational Index, help you assess
whether the core elements of the EBP were put
into place in your agency. Research tells us that
the higher an agency scores on a fidelity scale, the
greater the likelihood that the agency will achieve
favorable outcomes (Becker et al., 2001; Bond &
Salyers, 2004). For this reason, it is important to
monitor both fidelity and outcomes.

Process measures give agency staff an objective,
structured way to determine if you are delivering
services in the way that research has shown will
result in desired outcomes. Collecting process
measures is an excellent method to diagnose
program weaknesses, while helping to clarify
program strengths. Process measures also give
mental health authorities a comparative framework
to evaluate the quality of EBPs across the state.
They allow mental health authorities to identify
statewide trends and exceptions to those trends.

Why you should collect outcome measures

While process measures capture how services
are provided, outcome measures capture the
program?s results. Every service intervention has
both immediate and long-term consumer goals.
In addition, consumers have goals for themselves,
which they hope to attain by receiving mental
health services. These goals translate into outcomes
and the outcomes translate into specific measures.

10 Getting Started with EBPs

Some outcomes directly result from an
intervention, such as getting a job by participating
in a supported employment program. Others are
indirect, such as improving consumers? quality of
life as a result of having a job. Some outcomes are
concrete and observable, such as the number of
days worked in a month. Others are subjective,
such as being satisfied with EBP services.

Therefore, you should collect outcome
measures, such as homelessness, hospitalization,
incarceration, and recovery, that show the effect
that services have had on consumers, in addition
to the EBP fidelity measures. Monitoring fidelity
and outcomes on an ongoing basis is a good
way to ensure that your EBP is effect