Realized: The Promise of Evidence-Based Practice in Behavioral Health

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“A systemic approach to analyze published research as the basis of clinical decision making.” That’s how evidence-based medicine was first defined more than two decades ago. And it makes sense doesn’t it? The best treatment philosophies are born of experience – and if we can draw from our collective experience we give ourselves the best chance of improving outcomes.

Evidence-based treatment (EBT) in medicine has been embraced for years, but in the behavioral setting we have struggled to implement it for reasons big and small.

An individualistic mentality by a therapist, while a strength in many ways, can limit his or her ability to utilize collectively developed insights. A lack of consensus on what truly works best has also slowed the adoption of EBT models.

But adoption of evidence-based practices is beginning to increase; in part because modern care records and tools such as Enlighten Analytics have made the shift too compelling to deny, in part because health and human services providers no longer have the option of maintaining the status quo … accountable care requires that we collect data and measure our effectiveness as a community of providers.

Evidence-based theory could just as easily be called data-based theory. And, oh, the promise that data holds if used properly. The examples abound. Analysis within care records (EHRs) of persons with schizophrenia or alcohol dependence are easily produced today, whereas years ago we had to rely on paper and stick-figured charts. We can look at profiles of people and what has or has not been successful. That is a reality today! And therein lies the beginning of evidenced-based or data-based theory!

But the analysis is just the beginning.

Once we’ve developed what’s worked or reviewed another provider’s successful research, we can move on to the application phase of treatment protocols. These may vary by geography, socio-economics, race and gender. But our selection of populations within the care record can be easily performed via queries that yield people fitting a particular demographic, diagnosis or profile. That’s the opposite of cookie-cutter care. That’s meeting people where they are. Such people will benefit from the EBT … many currently are reaping the benefits.

Furthermore, evidence-based protocols offer clinicians a detailed roadmap to success. Clinicians can utilize tools that were part of the research; such as PHQ-9 for depressive disorders, Addiction Severity Index (ASI), DLA-20, etc. The care record (EHR) allows them to orchestrate the assessment tools and utilize discrete algorithms or definitions to properly apply the same techniques as defined in the Evidence-based theory. Periodic administration of these instruments, as called for by the EBT, yield data for comparison and adherence to the evidence previously collected.  Keep in mind, adherence to the same clinical protocols, interventions and goals are required if you are truly basing treatment on associated evidence.

A major opportunity is before us in the health and human services community. I strongly suggest in fact, implore clinicians to continue to develop data-based interventions and seek to measure them against proven research or treatment models. Our services need to withstand examination and provide accountability. Accountable care will continue to move us aggressively to payment strategies for services that require evidence based approaches and will require them to be measurable.