Pushing the frontier in Evidence Based Practice

Named after Katharine (Kitty) Felton, the founder of Family Service Agency of San Francisco, who directed what was then called Associated Charities from 1900 to 1940. The Felton Institute opened in November 2006 by offering a series of core competency courses on Evidence Based Practice, Team Implemented Treatment, and Strength Based Case Management. These courses were the first of many steps in accomplishing the Felton Institute’s mission to have all clinical front line staff sufficient in at least one Evidence Based Treatment (EBT) and one Evidence Based Case management approach in the first four to six years of operation.

In accomplishing the Felton Institute's mission, fundamental agency-wide changes need to be made. To ensure an adequate environment is established for the adoption of EBT, the Felton Institute works across divisions on

• Re-structuring clinical services
• Establishing service guidelines
• Training programs for management and staff
• Creating baseline outcome measures
• Establishing an infrastructure for research in Partnership with the University of California San Francisco.

 
Sample of Classes:
To implement Evidence Based Practice, Felton Institute offers courses that address core practices with a variety of agency-valued expertise. The courses included:

• Strength Based Case Management by Pat Miles
  
• Life and Work in San Francisco: A Celebration of Cultural Diversity (panel of FSA employees)
• PioNEERS: New Frontiers in Mental Health Services (panel of FSA Peers)
• Directive Supervision for Supervisors by Pat Miles
• Recovery Model: From Vision to Practice  by Dr. Mark Ragins
• Cognitive Behavior Therapy by Dr. Pat Areán
• Cognitive Impairment by Dr. Scott Mackin
• Suicide Prevention by Dr. James Hawkins
• Prevention and Early Intervention to Psychosis Series by Dr. Rachel Lowey, Dr. Demion Rose and Linda May, MFT
• Motivational Interviewing by Greg Merill, MFT

Felton Institute also offers smaller courses within the agency:

• Introduction to Computer
• Budgeting for Managers
• Word for Beginners
• Excel for Beginners

CIRCE (Electronic Charting System)
The Felton Institute has been instrumental in designing, implementing and training all mental health providers in adopting a web-based medical records computer application. We named the application CIRCE, which stands for Consumer Integrated Record & Charting Environment. CIRCE was disseminated in June 2006 to all of FSA’s mental health programs.

Our web-based computer program is a built-out application of Salesforce.com.  Salesforce.com donated FSA 275 free licenses, and a ‘start up grant’ of $10,000 in order to assist FSA’s development and implementation of the application. At this time we are in our second phase of rollout of this electronic charting application, and currently designing our third phase. The third phase will incorporate strength-based assessment and diagnostic criteria which guide our clinicians in planning treatment interventions that utilize the strengths our clients bring with them to FSA, as well as accurately assess diagnostic criteria.   

FSA Way (Practice Manual)
The Felton Institute has also been leading the Agency-at-large in a process to manualize the FSA Way. The FSA Way is a set of core values that represent the principles of social justice that speak to what FSA leadership believes every person seeking services at FSA deserves. The FSA Way includes the following values:

1. Welcoming:When an individual encounters FSA, whether they are seeking services or are an employee or an associate in the community, they will be welcomed and made to feel safe.  Those seeking services will be linked to a service provider who will help them describe their needs and the services they might require.  FSA will then either provide service ourselves or ensure that they receive other services that are most appropriate to their need.
2. Strength based:  All services, interactions, treatment interventions, and practice models must build on the assets, skills, capabilities, cultural values, preferences, and interests of oursalves and the people we interact with and serve, their families and the communities in which we live. Our practices will emphasize partnership both within the agency as well as between any outside individual and staff, which also includes a careful understanding of people’s experience, needs, and goals.
3. Culturally Relevant:  All services, interactions, service interventions, and practice models must reflect the unique cultural attributes of the people we work with and serve, their families, and the communities we live in.  Culture, in this context, reflects the broadest definition possible.
4. Team Implemented:  All services, interactions, service interventions, and practice models will be implemented using a team approach.  At a minimum, all agency interactions reflect a collaborative process between one another and the people we serve - including staff, community partners, treatment specialists, contracted service providers, clinicians, volunteers, and peer’s (people with first person experience) - on the basis of equality and shared purpose. 
5. Recovery Oriented: All services, interactions, service interventions and practice models must use a recovery-oriented approach. At its minimum, a recovery-oriented approach reflects a person-centered strength-based model of problem solving and means we value a client driven collaboration between staff and the people we serve. The potential of recovery-oriented services further acts to integrate the people we work with and the people we serve into the community to improve everyone’s quality of life.
6. Family Oriented: All services, interactions, service interventions and practice models will be proactive in including and embracing the family as a whole unit in all services provided through FSA. At its minimum, for those individuals who are isolated from their blood relations for whatever reason, a family can be a friend, an important contact, or anyone defined as family by the person being served. We strive to listen to family members’ input, experience, cultural values and desires, and when possible do what we can to include the family unit in the services we provide.
7. Advancing the Field:The people we work together with and the people we serve have a right to the most effective work practices and service approaches available.  FSA will continually work to train our staff in the most effective methods of service and treatment.  Individual work practices and treatment approaches will be guided by continuous feedback from outcome assessments.  We choose to adopt practices when the outcomes are consistent with our overall mission and vision. FSA participates in research that helps to advance an excellent work environment and to provide excellent services in the community.