Category: Dissemination / Implementation

Symposium

Enhancing the Use of Evidence in Clinical Decision Making in School-Based Mental Health

Saturday, November 18
3:30 PM - 5:00 PM
Location: Sapphire Ballroom A, Level 4, Sapphire Level

Keywords: Implementation | Evidence-Based Practice | Supervision
Presentation Type: Symposium

Service organizations often fail to make optimal use of evidence, resulting in inefficiencies in mental health care and reduced quality of life for children and families. We examined whether a Coordinated Knowledge System (CKS) that organizes and coordinates relevant evidence, the individuals who use that evidence, and the workflow and decisions in which those individuals operate would produce greater use of evidence relative to a traditional evidence resource.


We evaluated the effect of a CKS on use of evidence in the context of engaging students in CBT and other mental health services in the Los Angeles Unified School District, who sought our assistance due to high attrition. Four supervisors and their supervisees (n=16), were randomly assigned to either the CKS or the Traditional Resource (TR) condition. Individuals in the CKS condition received training in use of 4 tools as part of a coordinated action sequence: (1) a screener to detect low engagement, (2) a worksheet to structure collaborative supervisor-supervisee reflection about engagement, (3) written guides that outlined steps for different engagement procedures, and (4) a measurement feedback tool. Individuals assigned to the TR condition received training in a traditional evidence resource (practice guidelines for engagement). Supervisors and supervisees used their materials with two cases that demonstrated risk for low engagement. One supervision session was recorded for each case. A coding system was applied to each session.


During supervision, the CKS group spent more turns discussing the engagement problem and making plans to improve engagement. Discussion was more thorough in the CKS group; and CKS participants reported that the materials were easy to use, provided structure to supervision sessions, generated new ideas, and supported clinical decision making. Findings suggest that tools that structure problem detection and planning have the potential to enhance the use of evidence in decision-making and may be feasible and scalable within existing workflows.  This system has the potential to improve engagement in school based mental health and improve outcomes for a greater number of students. 

Bruce F. Chorpita

Professor
UCLA

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