Science by Any Other Name

February 05, 2008

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EBPs. Let's get right to the point. It stands for Evidence-Based Practices. What it means is "best we know how." Not "sure hope that works" – and definitely not "that's the way we've always done it."

The acronym may seem to be suddenly on everyone's lips, but the reality behind it is well-grounded and widely accepted.

"EBPs are no more of a fad than science," says Dennis McBride, Survey Director of the Washington Institute for Mental Health Research and Training – Western Branch (WIMHRT West). In 2007, McBride conducted a survey of providers on their use of EBPs. The results were published in the report Mental Health Evidence Based Practices (EBPs) in Washington State and presented in a PowerPoint presentation at the Transformation Work Group (TWG) meeting on January 4, 2008.

"In social, behavioral, and health programs, there has always been an interest to better understand and apply interventions," McBride says. "Questions commonly asked are what works, for whom, under what circumstances? To answer these questions programs have increasingly turned to sound scientific research principles."

What makes a practice an EBP?

It's not easy. Like anything with a solid scientific grounding, the process can be painstaking and arduous.

"What makes something evidence-based in the research literature is that a very specific clinical protocol was followed with a defined, specific population, whatever it might be," says Ron Jemelka of the Mental Health Transformation Project. "Based on that protocol, administered to a defined population, outcomes must be demonstrated scientifically and through empirical research to accrue consistently. When a given practice has been demonstrated to consistently produce good outcomes, across a number of well-designed studies, it starts being talked about as an evidence-based practice. A small number of studies, vaguely described, and with small samples, may lead to a particular treatment being considered 'promising' or 'emerging ', but doesn't elevate it to 'evidence-based' status."

In short, for a practice to become considered an EBP, it has to produce favorable outcomes, it has to produce them repeatedly, and it has to do so no matter who uses it.

Examples of EBPs

There is still much room for disagreement about the effectiveness of an EBP even after it has been generally accepted. Verification ultimately needs to take many variables into account. It's also critically important that an EBP is administered properly (this consideration is known as fidelity). Most importantly, an EBP has to actually improve outcomes.

Here are examples of some of the most commonly accepted and widely used EBPs now:

Cognitive Behavior Therapy (CBT):: A form of psychotherapy whose treatment involves weekly sessions between therapist and patient along with a collaborative agreement on goals. The patient tracks the goals each week, learning and practicing new skills and ways of thinking
Motivational Interviewing:: A counseling style that elicits behavior change by helping patients recognize, explore, and resolve ambivalence.
Parent-Child Interaction Therapy:: A treatment strategy aimed at young children that emphasizes improving the quality of the parent-child relationship and changing parent-child interaction patterns. Parents are taught specific skills to establish a nurturing and secure relationship with their child.
Dialectical Behavior Therapy (DBT):: A form of CBT intended for individuals exhibiting self-injurious behaviors, such as self-cutting, suicidal thoughts, and suicide attempts. Standard DBT involves weekly individual therapy, weekly skills training, phone coaching as needed, and a weekly therapist consultation team.
Assertive Community Treatment (ACT):: Normally used with clients with severe and persistent mental illness, this treatment typically involves a team approach, providing client services with a highly integrated approach. Key aspects include low caseloads, 24-hour service availability, and providing services in a range of settings.

Mental health EBPs at work in Washington State

McBride identified a number of useful points from the survey that apply to the Washington State Department of Social and Health Services (DSHS):

Most DSHS agencies (88%) provide intake, assessment, and referral services
Mental Health Division (MHD): CBT was the most widely used EBP for MHD agencies (73%). The next most commonly used were Medication Management and Motivational Interviewing (both 47%) and DBT (44%)
Division of Alcohol and Substance Abuse (DASA): Motivational Interviewing is the most commonly used EBP among DASA agencies (64%). This is followed by CBT (53%) and then DBT (31%)
Children's Administration (CA): Parent-Child Interaction Therapy is the most widely used EBP among CA agencies (72%). This is followed by Multidimensional Treatment Foster Care (21%)
Juvenile Rehabilitation Administration (JRA): DBT is the most often used EBP among JRA agencies (59%), followed by Functional Family Therapy (35%) and Aggression Replacement Therapy (29%)

McBride says results from this survey will also be used as a baseline moving forward, but points out that surveys may not be the best tool for monitoring use of EBPs.

"More sustainable mechanisms need to be in place," he says. "For example, in-house monitoring tied to annual reporting. Programs need to be given financial support and training for this purpose."

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