Novel models for dissemination and implementation

Alan Kazdin

Alan Kazdin

In an article pre-published online, prolific Yale child psychologist Alan Kazdin and colleague Sarah Rabbitt detail what they call five novel models for delivering mental health care that move beyond a highly trained mental health clinician sitting in an office with an individual client. This post lists the five models and discusses two for application in the social services.

Their novel models were:

task shifting: the notion that services can be provided by people with lesser skills (by the nurse, not the doctor);

unconventional (everyday) settings: the service can be delivered in the barber shop instead of the public health clinic;

best buy interventions: designation of some interventions as "best buys" because they not only work, they are cost effective, scalable and feasible.

lifestyle changes: the notion that substantial positive benefits acorss a number of domains can accrue from lifestyle changes like increased exercise or better eating.

disruptive technologies: qualitative, nonlinear leaps in the way services are delivered (these are not otherwise specified).

I'll talk about two here -- task shifting and best buy designations -- and their implications for the social services more broadly.

Task shifting may have less bang in the social services, because services are often delivered by people without special academic credentials. For example, most child welfare workers are not professional social workers or counselors. They are folks with college degrees in history or physical education. Same goes for probation officers and juvenile officers and a host of other jobs in the social services. Ours is not a world of pharmacists, it is a world of pharm techs. Plus, social service professionals are not well paid, typically making far less than teachers, cops or firemen. Thus, there are fewer payoffs for care delivered more cheaply through task shifting. Quite frankly, the social services may have already gone too cheap for their own good.

However, social service agencies may be well served to consider of one kind of task-shiftingm the integration of peer advocates. These are consumers or former consumers who can help guide new social service consumers to the complex social service world into which they have entered, help them get better services when quality is lacking, and may help destigmatize the helping process.

The idea of best buy interventions has appeal. In the juvenile justice field for example, two well regarded interventions -- Multidimensional Treatment Foster Care and Multisystemic Treatment -- are expensive, complicated, hard to mount and difficult to reimburse interventions. Worthy? I think so. But it might be hard to qualify them as "best buys." The best buy designation might spur treatment developers and policy experts to keep searching for cheaper, more effective, more scalable alternatives. It sets the bar high and that is likely a good thing.

Interventions in the helping professions have gone designation happy. Every intervention developer wants her intervention to be on all the right lists that help her intervention grow (and fatten her wallet). And not all lists are created equal, although the buyers of these services are likely unaware of that fact. It was just a matter of time that a new tier designation would appear to try to separate the especially worthy from the worthy. The value of the best buy designation may lie in who does the designation, the criteria used for the designation, and agreement among designators. But I fear the progression. The best of the best buys. Super best buys. Someone call a trademark attorney.

Thanks to Byron Powell for sending me a link to this article. He rocks implementation science.

 

 


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