This is question 4 of a series of Q & As about how PCOMS proactively addresses many ongoing struggles of providing mental health and substance abuse services in the public sector. Although Mary Haynes takes the lead, folks from the four largest CMHCs in their respective states provide their insights and experiences. This ongoing conversation can be found at https://heartandsoulofchange.com/content/community/ and click on “Public Behavioral Health.”

1. PO Box 6157, Jensen Beach., FL 34957; 772.204.2511; 561.239.3640; barrylduncan@comcast.net
Dr. Barry L. Duncan, Director_______________________________________________________________________
Training and Implementation of the Partners for Change Outcome Management System
Public Behavioral Health and PCOMS: Questions and Answers
4. Implementation is a long haul. How can I keep enthusiasm for PCOMS alive during and after
implementation?
It is very likely that your agency will take 5–10 years to fully incorporate PCOMS into the existing
agency culture. You will begin to see significant changes well prior to that, of course, but it is
important to acknowledge that a profound cultural shift must take place within your agency for full
implementation to occur, and that takes time. You probably won’t even recognize all of the many
changes that will need to take place at the outset – the awareness of how deeply PCOMS
implementation will affect your organization at every level will escape notice until you get into it.
Checking out the Readiness Checklist and watching the webinar “Four Secrets of Implementation” are
good places to start. But, if your agency is like Mary Susan Haynes’ Community Health and
Counseling Services, many staff who have been with you for a long time will have become experts at
patiently waiting out change projects until they lose steam and the status quo is restored, so you can
expect prolonged passive protest from some.
It’s easy for agencies to lose the intensity of focus during such a long change period, particularly in the
face of new challenges that crop up with frequency in PBH’s such as funding cuts, limitations to
services, or additional regulations and authorization processes from state or managed care entities. If
you don’t want the long implementation period to sap energy and enthusiasm for PCOMS at your
agency, here are some ideas for keeping enthusiasm up:
 Make sure that you have developed a training and implementation program that can actually get
the job done. Because the values and principles of PCOMS are so attractive to mental health
professionals, it is easy to think that the implementation process is a simple matter. In fact,
competent PCOMS practice is very nuanced, and requires a great deal of skill. Your initial
training program should be thorough enough that the sophisticated concepts can be adequately
taught and the implementation should ensure that adequate program monitoring is in place. If
it isn’t, staff will lose interest quickly because they won’t feel confident and competent.
 The PCOMS implementation leader can offer periodic “booster” trainings to managers and
supervisors, as well as to direct service teams, which focus on specific topics or skills within
PCOMS practice.
 If time does not permit visits by the implementation leader to each team, supervisors can be
provided with prepared materials that allow them to teach units on specific topics with little or
no advance preparation. These units should fit easily within the time allotted for team meetings
so that direct service time is not impacted. On Becoming a Better Therapist provides a useful
structure of these materials.
 A short newsletter can be sent out periodically to staff that highlights aspects of PCOMS
practice. This keeps the implementation process fresh even when it is ongoing.

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 Client success stories are very compelling in keeping PCOMS practice actively in the minds of
staff. Supervisors should ask staff to share success stories in team meetings.
 These success stories should also be shared with support staff, managers, the clinical director
and the agency executive director. Everyone at all levels needs to know how PCOMS practice
is positively impacting clients.
 It can be helpful for implementation leaders to be in contact with their peers in other PBH’s
that have implemented PCOMS. Getting input on how to handle challenges, as well as sharing
successes, can provide project leaders with some of the energy needed to keep the
implementation going strong. If you don’t know which other agencies are implementing, check
out the Therapist Directory list on the Community page of the Heart and Soul of Change
Project. It lists individual therapists who use CDOI practice, and also the PBH’s.
 Project leaders at the Heart and Soul of Change Project can serve as consultants to agencies in
need of outside input. Contact information for these leaders is available on the Community
page of the Project.
 And finally, be persistent. As long as you keep at it, even with some sidetracking to take care
of other projects that momentarily have to take precedence, the day will come when PCOMS
becomes the way clinical work is done at your agency.
 If your organization is governed by a board of directors, make sure that they understand and
support PCOMS and then keep them (or at least a subcommittee) informed of the progress and
challenges involved in implementation. Ongoing board support for the values behind and the
practice of PCOMS is essential when decisions about the future direction of the organization or
tough funding allocation decisions have to be made.
 Continue to develop new leadership within the organization. Even when a large number of
staff are early adopters and champions, inevitably these people will be lost to the organization
through attrition. Identifying key staff who can be groomed as leaders for the years ahead is
essential to long-haul success.
Written by Mary Susan Haynes, with input from David Hanna, Jodi Daly, & Bob Bohanske.