Where Science Meets Mental Health

April 16, 2008

The Department of Social and Health Service (DSHS) is relying more and more on evidence-based practices (EBPs), according to a survey by the Washington Institute for Mental Health Research and Training – Western Branch (WIMHRT West).

"When we look at the research on mental health, we've come an incredibly long way in the past 15 years in terms of what works," says Eric Trupin, PhD, of the Division of Public Behavioral Health and Justice Policy at University of Washington's Department of Psychiatry and Behavioral Sciences.

But that doesn't mean there weren't some surprises in the survey too.

If It Works, Can You Use It?

"We really have a good database as to effective practices," Dr. Trupin says. "The problem is that for many of these programs it's hard to migrate them out of a university-based setting into a clinical or more public setting. When you actually look out into the world of community mental health, you only see about ten percent of these evidence-based practices in a public mental health center. So we've got this big disconnect in terms of what we know works and what actually exists out there."

The reasons for this are many and complex. But two big factors are community health staffing and funding.

"Community settings don't necessarily align so well with a systematic treatment approach, which may require a very low client-to-clinician ratio. And there are multiple drivers for that. Funding is obviously one. When a clinician in a community mental health center has a very high caseload, it can be difficult."

The Evidence-Based Practice Institute

In part to address the gap between proven EBPs and the resources required to actually use them, Washington State legislation last year created the Evidence-Based Practice Institute, headed by Dr. Trupin. Its mission is to help communities make decisions about EBPs that best fit their particular needs. The Institute then helps them implement the EBPs and determine strategies to sustain them.

"Researchers at the University of Washington have provided critical guidelines for consideration as more evidence-based practices are funded in public pay systems across the country," says Richard Kellogg, director of the DSHS Mental Health Division. "This has been a very important relationship for us to foster and grow. There is a growing understanding of the importance of fidelity and adherence in the promising environment of evidenced-based service delivery. The challenge is creating public funding policy that results in measurable positive outcomes in the field as manifested in the research."

"We are very much looking to play a brokering role here between researchers and clinicians," says Dr. Trupin. "There may in fact be practices in the community now that people are using to get good outcomes. We want to help them by providing the technical assistance to evaluate and move them from great ideas to something with more rigor involved. This is the adherence and fidelity issue. You have to be able to show that people implementing a practice are doing it in a specific, measurable way to understand how it produces good outcomes."

Even more important, the Institute is dedicated to helping communities implement practices already shown to produce strong outcomes reliably. Many times this part promises to come with substantial costs in terms of training and retraining, one of the most significant challenges of the effort.

"We're going to take some of the dollars that the legislature gave us and find opportunities where we can to invest and enhance the utilization of evidence-based practices," says Dr. Trupin.

"One thing I do know, that relates to sustainability, is we have a profound problem with work force. We need to develop an improved skill set for our work force. We don't train our graduates from our professional schools in evidence-based practices. One of the things that has to happen is interdisciplinary training among social workers, psychiatrists, psychologists, attorneys, pediatricians – so people know how to talk to each other about this issue."

On the Docket

Programs the Evidence-Based Practice Institute has specially targeted for efforts to migrate research findings from the university setting to communities include:

Family Integrated Treatment: Aimed at youth with mental illness and substance abuse problems and now involved with the juvenile justice system.
Program of Assertive Community Treatment: Intended for individuals with serious and persistent mental illnesses.
Partnerships for Success: Adapted from an Ohio program and funded by a Washington State legislative proviso, this effort enables counties, regional support networks (RSNs), and tribal groups to submit proposals addressing their priority needs.
Fulfilling the Promise: Still in its early stages and funded in part by the Paul G. Allen Family Foundation, this program addresses issues of providing effective mental health services for children in foster care homes.

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