The modular practice elements approach to EBP offers several major advantages to agencies serving a client population with multiple and complex needs compared with traditional approaches to implementation of evidence-based practice.
Individual tailoring. By breaking interventions into small elements, practitioners and clients are better able to choose therapeutic content that addresses individual needs and therapeutic techniques best suited to the skills and style of the worker and the nature of the relationship. Content and techniques can be more readily selected and organised according to the developmental stage of a young person and their personal goals (Barth, et al., 2012; Garland, Hawley, Brookman-Frazee, & Hurlburt, 2008; Moos, 2007; Murphy, Cooper, Hollon, & Fairburn, 2009).
Ready integration with existing practice. Rather than attempting to replace existing practice with whole new intervention models or integral programs, the modular practice elements approach provides a way of building on the strengths of existing practice through incremental enhancement (Chorpita, Becker, & Daleiden, 2007; Garland, et al., 2008).
Because they each involve only a small number of techniques and a discrete selection of content, practice elements (on their own or combined into modules) can be readily added to existing practice approaches or adjusted as the need arises (Southam-Gerow, Hourigan, & Allin, 2009).
Amenable to varied modalities. Most ESTs are designed for use in highly structured modalities, such as a series of one-on-one or group-work sessions. In contrast, many of the agencies serving youth with complex needs rely on varied modalities including outreach, day programs, acute residential and long-term residential rehabilitation.
Within these settings, opportunities for psychotherapeutic work are built into and interspersed with other activities and interaction; the shape of these opportunities is highly variable. Furthermore, each young person connects with services for variable amounts of time. This diversity of modality presents significant barriers to the implementation of structured, session-by-session manualised programs.
In contrast, the modular practice elements approach is amenable to diverse modalities. Because of their small size and interchangeability, one or several practice elements can be selected and used whenever opportunities arise. For example, elements comprising social skills training and emotion regulation skills training can be built into everyday domestic activities in a residential setting. Individualised problem-solving practice, personalised cognitive restructuring and graded exposure to challenging situations in the young person’s usual environment can be readily incorporated into outreach contact.
Cost efficiencies in training and support. Rather than training and supervising staff in multiple elaborate ESTs, training can focus on practice elements that are missing from, or underdeveloped within, the skillset of workers within particular service settings (Chorpita, Becker, & Daleiden, 2007).
Modularity also allows much more flexibility in the allocation of resources to training and support. Effective introduction of a new integral EST demands large sums upfront. In contrast, after practitioners have been introduced to the overall modular system and trained in a core set of modules, introduction of new modules is not a major undertaking (Southam-Gerow, Hourigan, & Allin, 2009). By working with smaller chunks of training material, workforce development investment can be spread out more easily, or scaled and timed more readily according to funding, readiness and need. Smaller chunks of content are also likely to be learned more easily and comprehensively because they can be readily digested and more quickly integrated into practice.
Sensitivity to context. Service units can select groups of practice elements or modules that are particularly suited to the modalities of service offered and the needs of clients in those settings (Chorpita, Daleiden, & Burns, 2004; Chorpita, Daleiden, & Weisz, 2005). As contextual factors and needs shift, practice elements can be added, subtracted or enhanced.
Evaluation and quality assurance. Usual care is poorly described and its components poorly understood (Weisz, Jensen-Doss, & Hawley, 2006). What we do know is that it is very eclectic – practitioners use a broad array of interventions (Garland, Hurlburt, & Hawley, 2006; Lyon, Charlesworth-Attie, Vander Stoep, & McCauley, 2011; McLeod & Weisz, 2010), and that it is sometimes just as effective as new evidence-based treatments (Weisz, Jensen-Doss, & Hawley, 2006). Without knowing more about what is delivered, when and how often, it is very difficult to know how far removed usual practice is from evidence-based practice.
Defining an agreed set of EBP modules essential to practice in a particular setting would provide a set of benchmarks that could be used to systematically explore the extent to which current practice is consistent with EBP. The results could then be used to identify practice elements that need to be introduced, developed or dropped. Informed revision of training and organisational support can be undertaken.
Interagency collaboration. There is little guidance in the EBP literature to help decision-makers design a collaborative practice approach or infrastructure for supporting the delivery of ESTs across multiple service settings. Factors such as professional values, philosophy and organisational culture that differ across sectors are likely to be major barriers to design of integrated practice models unless ways can be found to recognise and accommodate different contributions.
At the system level, a common language around practice elements could be used to build shared understanding of the interventions that are unique to a particular service or shared across multiple services. This will help clarify points in a client’s journey at which referral versus collaborative care are indicated.