Engineering Youth Service System Infrastructure: Hawaii's Continued Efforts at Large-Scale Implementation Through Knowledge Management Strategies

Abstract

Hawaii's Child and Adolescent Mental Health Division provides a unique illustration of a youth public mental health system with a long and successful history of large-scale quality improvement initiatives. Many advances are linked to flexibly organizing and applying knowledge gained from the scientific literature and move beyond installing a limited number of brand-named treatment approaches that might be directly relevant only to a small handful of system youth. This article takes a knowledge-to-action perspective and outlines five knowledge management strategies currently under way in Hawaii. Each strategy represents one component of a larger coordinated effort at engineering a service system focused on delivering both brand-named treatment approaches and complimentary strategies informed by the evidence base. The five knowledge management examples are (a) a set of modular-based professional training activities for currently practicing therapists, (b) an outreach initiative for supporting youth evidence-based practices training at Hawaii's mental health-related professional programs, (c) an effort to increase consumer knowledge of and demand for youth evidence-based practices, (d) a practice and progress agency performance feedback system, and (e) a sampling of system-level research studies focused on understanding treatment as usual. We end by outlining a small set of lessons learned and a longer term vision for embedding these efforts into the system's infrastructure.

Clinician Use of Standardized Assessments Following a Common Elements Psychotherapy Training and Consultation Program

“…A number of public mental health contexts are now implementing centralized web-based data entry MFS that require clinicians to enter data on treatment content and to complete outcome assessments. The Hawaii mental health delivery system has the only state-wide system that requires routine completion of a SA measure (Higa-McMillan, Powell, Daleiden, & Mueller, 2011; Nakamura et al, 2013). A large-scale Los Angeles County EBP initiative is also requiring SA (Southam-Gerow et al, in press).…”

Aligning Leadership Across Systems and Organizations to Develop a Strategic Climate for Evidence-Based Practice Implementation

“…Of course, collecting data using such measures makes even more impact when it is shared through feedback processes throughout the organization. Research suggests that such feedback processes are a critical component to successful EBP implementation across a variety of settings (19; 57; 60; 61; 77; 108). By not only collecting such information but also sharing it with employees, organizational leaders make it clear that they are serious in their attempts to improve the EBP implementation and utilization process.…”

Toward the Implementation of Evidence-Based Interventions for Youth With Autism Spectrum Disorders in Schools and Community Agencies

“…The potential promise of modular and unified approaches is demonstrated by the fact that they have been used in several statewide initiatives to bring evidence-based practices to community settings (e.g., Nakamura et al, 2014). Furthermore, these approaches simultaneously overcome two significant challenges found in the ASD field: (a) the difficulty of mastering multiple EBIs, and (b) the ambiguity about when and for how long to deliver specific EBIs.…”