Friday, September 10, 2021

Putting New Practices into Place: What Gets in Our Way?

By David S. Prescott, LICSW

A woman who attended a workshop I gave in the mid-2000s contacted me this summer looking for more information. I was astonished not so much by the number of years that I had passed, but by the circumstances. The training was part of efforts to implement motivational interviewing (MI) in the institution where I worked. After leaving my position, one of the staff apparently asked that they be allowed to revert to their erstwhile and less-motivational approaches now that I was gone. Following my departure, another administrator’s campaign to have all staff focus on becoming kinder towards the clients was also reportedly controversial. Several years later, approaches focusing on strengths and motivation had become the norm in this and most other institutions of its kind.

As much as I would love to say that I was ahead of my time and ahead of the curve, I wasn’t. By this time, MI had been the subject of hundreds of randomized controlled trials and several meta-analyses. The truth is that implementing any best practice takes time and teamwork. As just one example, Dean Fixsen and his colleagues have emphasized that implementing any human-service practice can take years. More recently, in a study of Feedback-Informed Treatment (FIT) by Heidi Brattland and her colleagues in Norway found that implementation efforts took two years to bear fruit.

From the author’s perspective, several things are important to keep in mind. First, we often hold onto the myth of the guru. In this myth, there is a guru whose training one must have in order to be considered an expert (sometimes referred to as “one and done” training). While having an expert come in to train is always a good idea, programs and practitioners often seem to neglect the importance of having ongoing consultation to ensure that what was taught is actually being implemented and practiced. As a part of this, it’s easy to overlook the importance of building up the internal “champions” who will carry the implementation efforts forward within each agency after the guru goes home. As an ATSA member once quipped, “An expert is an out-of-towner with slides.”

Why is this so important? In the author’s opinion, it’s not just about the mechanics of implementing best practices, but about the mentality. When implementing any model, method, or approach, agencies have an opportunity to build up the professionals in their employ. This attention to local ownership of models and methods can help build professional longevity and reduce turnover as well as improving services, and yet it is easy to miss. Even more important is to keep in mind that putting new practices into place simply takes time and work. For this reason, it’s vital to build in some self-compassion along the way. Implementing new approaches often not only upsets the apple cart of historical treatment methods employed but can cause personal and interpersonal challenges as well. For example, the person who has always been in a position of implicit power within an agency may find their influence diminished with agency-wide attempts to master new approaches.

In recent discussions with colleagues, three less obvious barriers to implementation have also become apparent. They are worth mentioning so that those seeking to innovate might be better prepared for pushback:

The first is the belief that “We already do this.” Many people who receive introductory information about new approaches form premature judgments about it. In particular, they may take note of the elements that seem most familiar (for example, that many skills in MI, FIT, or the good lives model [GLM] can be found elsewhere) and arrive at the conclusion that they are already proficient at implementing the method. Sadly, it is sometimes difficult for people to dissuade themselves of this notion. It can come in the form of, “I’ve already gotten training on this kind of thing.” By this time, extra work can be required for the person to learn what is new, different, or unfamiliar about the approach.

The next is the belief that “This is easy.” It is indeed easy to read a paper or even a book and assume one can quickly develop expertise in a given method, model, or approach. In order to prevent this, training is most effective with the trainer reminds trainees to suspend their beliefs or disbeliefs until they understand the entire model and how its components interrelate. Further, the most effective way to learn a new approach is with guidance, supervision, and coaching. Receiving feedback on one’s practice is one of the most effective ways to improve one’s performance.

Finally, there is the response that, “We’ve seen these new models come and go.” This can also take the form of, “We tried that and it didn’t work.” Again, this is where the truth became inconvenient: it takes time and effort to implement new practices. Very often, the best antidote is for the person who is learning the new approach to either experience it for themselves (for example, to engage in a motivational dialog with a skilled practitioner) or to apply it within their own life (for example, understanding how the GLM might apply to their own behaviors).

Fixsen’s work reminds us that for every approach one tries to implement it’s important to let go of two other approaches that are no longer serving the program or practitioner. Ultimately, however, we can all be at our best when we let go of everything else and simply seek to become the most effective practitioner we can be; one skill at a time and one client at a time.

Note: The author is grateful to many colleagues who contributed ideas to this blog post, including Gwenda Willis, Christine Friestad, and Ingeborg Sandbukt Jenssen.




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