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Consultancy

The development of effective methods, such as CRA/FT, and to disseminate these evidence-based treatments into practice is of obvious importance. The overall effectiveness of health care depends upon transferring best practices into routine standards of care. Once established, clinician practice behavior is notoriously difficult to modify. One can blame clinicians for being stubbornly intransigent, a perspective similar to that of blaming clients for being insufficiently motivated to change, and no more likely to lead to the desired results. Alternatively, one can ask what shortcomings there may be in our standard practice (in training) and what approaches would be more likely to yield the desired behavior change.

Implementing evidence-based practice is a complex process that can take several years to create an atmosphere of sustainability. It has been shown that the involvement of organizations predict the adoption of evidence based innovations. Research shows that dissemination efforts fall short if they focus exclusively on the clinicians’ behavior and do not take organizational (agency) factors into consideration, however these factors are often intertwined. For instance, research yielded the protective role of clinical supervision in substance abuse treatment counselors’ turnover and occupational well-being. First of all, it plagues the quality of care that patients receive by disrupting the working alliance. Secondly, turnover is costly to behavioral health care organizations, requiring recruitment, hiring, and training of new counselors. So these empirical findings suggest that both organizations and therapists may benefit from efforts to improve the extent and quality of clinical supervision.

Everett Rogers was before his death a CASAA faculty colleague. He developed the influential Diffusion of Innovations theory, which is also applicable in the field of substance abuse treatments. This leading theory globally implicates:

(a) The diffusion of innovation is a dynamic social process that “flows” through interpersonal networks;
(b) the adoption and implementation of innovations is strongly influenced by “opinion leaders” within these networks
(c) end users participate actively in adopting and implementing innovation; and
(d) end users frequently modify or “reinvent” innovations to better suit their local needs and capabilities. It must be noted that the innovation should be implemented with close correspondence to the validated model or else lose the integrity and consequently suffer the consequences of dilution, which might in turn reduce the treatment outcome.