Implementation of Evidence-Based Practice in a Substance Abuse Treatment Recovery Program for Women and Their Families: A Case Study of the Texas Christian University Program Change Model

Introduction: The state of Kentucky is one of the centers of the opioid epidemic, and has the third highest rate of deaths from opioid use in the U.S. (CDC 2017). This study utilizes the Texas Christian University (TCU) Program Change Model (Simpson & Flynn, 2007) to examine the implementation of a system of family-centered, evidence-based practices by a women’s residential substance abuse treatment facility in Kentucky, Freedom House. The TCU Program Change Model includes the steps of: (1) Training, (2) Adoption, (3) Implementation, and (4) Practice Improvement. We will focus on Adoption and Implementation in this paper.

Methods: The implementation of a new system of evidence-based practices at Freedom House, based on a gender-specific approach to substance abuse treatment (Greenfield et al., 2007), included implementation of structured mental health and fetal alcohol syndrome disorder (FASD) screenings, and two evidence-based interventions, a trauma intervention for women, the Boston Consortium Model (BCM; Amaro, et al., 2004), and a parent-child intervention, Child-Parent Psychotherapy (CPP; Lieberman, Ippen, & van Horn, 2006). To date, 91 women have received services. Outcome measures completed at baseline and six months later include the Trauma Symptoms Inventory-2^nd edition (Briere, 2011) and the Brief Symptoms Inventory (Derogatis, 1993).

Results: Adoption. During the adoption phase, although the agency leadership was in agreement, staff raised some concerns regarding adaptability and capacity. For example, staff reported feeling incompetent to screen for FASD, and difficulty implementing CPP due to inexperience working with children and few children visiting during working hours. Staff indicated they had the capacity to implement other components, such as BCM. Implementation. As a result, during implementation, the agency nurse was tasked with conducting FASD screenings. In addition, two clinicians with experience working with children were hired. Moreover, all staff were required to work one evening shift per week. Client Outcomes. Women who completed the program evidenced changes in multiple areas, such as decreases in depressive, t = 4.97, p < .01 and traumatic intrusive symptoms, t = 3.93, p < .01. Findings regarding CPP are forthcoming.

Conclusions: In the current study, in order to implement new evidence-based services for women in recovery and their families, broad changes at the agency level, such as hiring of professionals from multiple disciplines and re-allocating responsibilities, were made. This study highlights the importance of including staff at every step of decision-making, and of an iterative process of adaptation, when implementing evidence-based practices in behavioral health.