The Evidence-Based Practice: Methods, Models, and Tools for Mental Health Professionals / Edition 1

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This groundbreaking book features contributions from the top researchers in this burgeoning field and covers everything from what evidence-based practice (EBP) is and its relevance to behavioral health to specific models for applying and implementing EBP and chapters on how to build best practices protocols and evaluate the effectiveness of EBP in your organization. EBP is one of the fastest-growing phenomena in mental health practice today, and savvy clinicians, group practices, and community mental health centers will be armed with the tools they need to effectively utilize EBP and improve their bottom line after reading this book.

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What People Are Saying

From the Publisher
What a great book! Stout and Hayes have brought together awonderful cast of experienced clinicians andclinician-administrators who understand both the need for, and theprovision of, solid care for people with mental disorders. Everymental health professional needs books like Evidence-Based Practicein Behavioral Health if he or she is to treat patients within thecurrent standard of care. [This] is a critical book for trainees,front-line mental health and substance abuse clinicians, programadministrators, and - especially - clinicians still bound to aquestionable past of "but this is the way we've always done it."[C]linicians and clinical administrators who follow the principlesin Evidence-Based Practice in Behavioral Health will be doing afavor for both their patients and themselves.
—William H. Reid, M.D., M.P.H., Clinical Professor ofPsychiatry, University of Texas Health Science Center
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Product Details

  • ISBN-13: 9780471467472
  • Publisher: Wiley
  • Publication date: 11/28/2004
  • Edition description: New Edition
  • Edition number: 1
  • Pages: 384
  • Product dimensions: 7.17 (w) x 10.28 (h) x 1.30 (d)

Meet the Author

CHRIS E. STOUT, PhD, is a licensed psychologist and clinicalprofessor at the University of Illinois College of Medicine,Department of Psychiatry. He is the first Chief of PsychologicalServices for the Department of Human Services/Division of MentalHealth of Illinois, and holds an academic appointment at theNorthwestern University Feinberg Medical School. He has written,edited, or coauthored twenty-nine books and is the editor ofWiley's new Getting Started series.

RANDY A. HAYES, PhD, is the director of quality assurance forSinnissippi Centers, Inc., Dixon, Illinois. With experience in bothchild welfare and behavioral health, he has thirty years'experience in human services and holds multiple certifications inaddition to being a licensed clinical professional counselor.

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Read an Excerpt

The Evidence-Based Practice

Methods, Models, and Tools for Mental Health Professionals

John Wiley & Sons

ISBN: 0-471-46747-2

Chapter One

Introduction to Evidence-Based Practices

Randy A. Hayes

Simply stated, evidence-based treatment is the use of treatment methodologies for which there is scientifically collected evidence that the treatment works. Much of this book discusses treatments for which there is an overwhelming set of evidence for their effectiveness. But before learning about these evidence-based treatments, before discovering the necessary prerequisites for establishing these treatments within a clinic, agency, or practice, we review the history of evidence-based treatment and discuss the reasons why evidence-based practice has come to the forefront at this time.


Evidence-based treatment had its earliest contemporary beginnings in the collection of evidence regarding the causes of disease-epidemiology. But in a larger sense, evidence-based therapy began at the start of Western medical care with Hippocrates. The Hippocratic Oath has beneficence at its core-to help or at least do no harm. Perhaps the originator of this oath was considering overt acts of harm, indicating a point that would not be argued even to this day. The healthcare provider shall not knowingly provide a service whose purpose is ultimately harmful rather than helpful. On the one hand, this oath is exceptionally simple. Healthcare providers of any ofthe myriad of iterations of the past or current healthcare related professions did not, would not, do not provide services or treatments that they believe would ultimately be harmful to their patients, a few notable exceptions aside. However, as often is the case, simplicity can be deceptive and lead the professional down a twisted road: How does the healthcare professional know that the services they provide are ultimately helpful or hurtful?

For centuries, the decision as to the helpfulness or harmfulness of any treatment was dependent primarily on the practitioner's ethical intent, as well as his or her judgment of the effectiveness of the treatment. However, is ethical intent (that is, the clear intent toward beneficence) and individual observation as to effectiveness sufficient for the judgment of harm or helpfulness of treatment? Sufficient or not, for centuries, ethical intent and individual observation were the only tools available to the healthcare practitioner.

As medical instruction became organized and eventually institutionalized, beneficence in terms of treatment could be considered as following the practices learned as part of the medical education. However, much of the history of such medical education preceded the development of modern scientific understandings and methodologies, including not only bacteriology and epidemiology (and thus the understanding of disease causation) but also the modern methods of collecting evidence in support of scientific theories. Thus, the practices taught in these early times, although beneficent in intent, may not have been beneficent in actual practice. Before the development of these scientific practices, there was no available methodology to determine the beneficence of actual practice. Patients simply got better or they got worse and died. The methodology, including the theoretical thought sets, necessary for the determination of practice beneficence (as compared to intent beneficence), did not exist.

It was not until scientific understanding, methods, and practices came together that practice beneficence had its beginnings. There is no better illustration of this point than the life and work of Florence Nightingale (1820-1910). Nightingale used the collection, analysis, and graphical display of healthcare data from the Crimean War to change the face of healthcare in the United Kingdom.

Nightingale used data (that is to say, evidence) to prove that conditions at the time in military hospitals were not beneficent, but in fact harmful to the lives of the soldiers being treated (Small, 1998). Inventing new forms of graphical representation of statistical analysis, Nightingale showed a statistically significant number of preventable deaths. Much of her data analysis showed the deleterious effects of uncleanliness in terms of healthcare survival. Many of the improvements she instituted based on this evidence had to do with improved cleanliness. Further, Nightingale used this evidence to successfully campaign for improved conditions in military hospitals and in general hospitals. It is interesting to note that illness from lack of cleanliness, now called nosocomial infections, is still cited, some 150 years following Nightingale's irrefutable proof of the potentially devastating effects of uncleanliness in healthcare, as a significant negative contributor to public health. See Martinez, Ruthazer, Hansjosten, Barefoot, and Snydman (2003) for one example of this continuing concern.

The collection of data regarding the cause, spread, and eventual containment of infectious disease developed slowly into the science of epidemiology during the nineteenth and twentieth centuries. Wade Hampton Front, MD, became the first American professor of epidemiology in 1921 at the Johns Hopkins School of Hygiene and Public Health (Stolley & Lasky, 1995). Joseph Goldberger moved the science solely from the realm of infectious diseases into the study of noninfectious diseases with his concentration on the effects of diet on public health (Stolley & Lasky, 1995) during the same time period. The investigation of the causes of lung cancer was included in the data collection efforts of the epidemiologists also during the early and mid-twentieth century leading eventually to the link with cigarette smoking. Epidemiology as a science held the collection and analysis of disease-related data in terms of the causes and containment of disease as its standard. However, it did not include treatment effectiveness, as such, as a focus.

The collection of medical and health-related data in terms of treatment effectiveness came to the fore, albeit briefly, with the systems of Ernst A. Codman, MD, during the turn of the past century as the science of epidemiology was developing. A graduate of Harvard Medical School in 1895, Codman had a keen interest in all of the aspects of the effectiveness of medical treatment (Brauer, 2001). Codman, an avid collector of data of all kinds, believed that the outcomes of surgery should be openly documented, monitored, and reported. Developing an elaborate system of recording the results of his own surgeries using a card system, he encouraged other physicians to do the same. Calling his system the "End Results System" (Brauer, 2001). Codman was strongly influenced by engineering concepts and was a friend of efficiency expert Frank Gilbreth. In 1911, Codman opened his own 20-bed hospital in Boston to fully apply his system of tracking the outcomes of the care he provided. Continuing the use of the index card system, each patient was categorized in terms of presenting symptoms, diagnoses (initial and discharge), complications while in the hospital, and status one year following hospitalization. Further, Codman developed a system for identifying medical errors and adverse outcomes, which he not only published, but gave to patients before their treatment (Brauer, 2001). Codman encouraged other physicians and hospitals to follow the same course.

Codman's "End Results System" processes were way ahead of his time. Perhaps because of Codman's fierce advocacy of his system, he angered many of his fellow physicians and eventually left the local medical society. His hospital closed due to lack of referrals from his colleagues. Codman then practiced medicine in Nova Scotia and in the army. Eventually returning to Boston and reuniting with Massachusetts General Hospital, he studied the Registry of Bone Sarcoma-a registry that he had initiated. Codman recognized that his "End Result" concepts would not come to fruition in his lifetime. He died in 1940 (Brauer, 2001) although the ideas did not die with him.

Some 32 years following the death of Codman, the cause of evidence-based treatment was taken up by an epidemiologist in the United Kingdom. In 1972, the Nuffield Provincial Hospitals Trust (NPHT) published the landmark work of A. L. Cochrane, MD. The NPHT had invited Cochrane, a well-known and highly respected epidemiologist, to evaluate the United Kingdom's National Health Service. Titling his work Effectiveness and Efficiency: Random Reflections on Health Services, Cochrane called for the use of evidence-based treatment practices.

Cochrane's evaluation of healthcare services, by his own admission, was crude due to the lack of properly collected evidence. Nevertheless, Cochrane used the techniques available to an epidemiologist, for example, demographics and mortality rates, and so on. He analyzed healthcare services/treatments as compared to healthcare costs and found a huge gap-increased national funding for healthcare services had not led to increased positive outcomes for patients (Cochrane, 1972/1999).

Based on these findings, Cochrane made a series of recommendations regarding the improvement of outcomes by improving treatment. These recommendations focused on the use of applied medical research in the form of random controlled trials to determine those treatments that produced improved health. It is interesting and informative to note that Cochrane discusses both in his introduction and through his evaluation the differences between pure research and applied research. He further devotes one entire chapter to the use of evidence, and another on exploring and defining the meaning of both effectiveness and efficiency as they relate to healthcare services.

The need for these discussions, begun three decades ago, continues to this day both in the field of medical services and behavioral healthcare services. In doing training for the Joint Commission Resources, both on implementing evidence-based practices in behavioral healthcare and in the use of data in this field, the problems noted by Cochrane 30 years ago, as well as Codman 80 years ago, continue to be evident in healthcare and behavioral healthcare. Few clinicians, either in medicine or behavioral healthcare, have had sufficient and meaningful training in research design or data analysis to negate the need for elementary discussion and training so that the healthcare professional who is not a professional researcher, can appreciate, understand, and properly apply the findings of research to their practice or agency. This book, in part, exists to help overcome this continuing need.

Cochrane discussed a third metric-equity-that may be coming more into play this first decade of the new millennium. Equity means effective and efficient healthcare services for all who need them. Cochrane was discussing the disparity of services that were available through the National Health Service in the United Kingdom. This had been a concern discussed a century earlier by Nightingale (Small, 1998). During Nightingale's time, public hospitals were solely for the poor and indigent. People with means were seen and treated in their homes. By Cochrane's time, although not as evident as during Nightingale's time, a disparity of treatment continued, not only between social classes, noted Cochrane, but also between geographic areas.

Although far beyond the scope of this book to discuss in length, equity of services for all people in all places may be becoming an area of concern within the United States. With the severe state budgetary crises following the tragedy of September 11, 2001, many publicly supported behavioral healthcare agencies have seen significant reductions in funding. These reductions have forced agencies to limit both the numbers of and types of consumers who receive healthcare and behavioral healthcare services.

These budgetary restrictions have also limited the staff devoted to evidence collection and analysis in service of evidence-based practice development. At a recent workshop conducted by the author on data analysis, one participant disclosed that his agency was forced to eliminate its research and analysis staff in order to provide basic behavioral health services.

Because of budgetary restrictions and limitations, the use of proven treatments, that is, evidence-based treatments, is absolutely critical, and yet agencies and practices who were in the forefront of the field in terms of having staff to do this needed work, are having to reduce or eliminate staff who are capable of doing this needed work. At some point, directors and boards of agencies will need to ask the same or similar questions Codman and Cochrane were asking many years ago. Can agencies or practices save money by providing treatment that may not be producing any effect? Is it efficient to provide treatment that has not been proven to be effective? Is it efficient in tight budgetary times to either not hire, or to reduce the professional staff who are able to provide the research necessary to "prove" what treatments actually produce statistically significant results? We hope to help you answer these questions, or minimally, understand better the importance of these questions.

Some 40 years following the death of Codman, and within a decade of Cochrane's work, McMaster University in Hamilton, Ontario Canada, took up the cause by producing a series of articles that helped the healthcare professional begin to address these questions.

The Department of Epidemiology and Biostatistics published a series of five articles in the Canadian Medical Association Journal in 1981 [(124) 5-9] from March through May entitled "How to read clinical journals." The series of articles had following subtitles: I. Why to read them and how to start reading them critically; II. To learn about a diagnostic test; III. To learn the clinical course and prognosis of a disease; IV. To determine etiology or causation; and V. To distinguish useful from useless or even harmful therapy (1981a, 1981b, 1981c, 1981d, 1981e). This series is credited (Baker & Kleijnen cited in Rowland & Goss, 2000) as being the actual starting point of the type of evidence-based therapy that this book addresses.

From McMaster University, the advance of evidence-based treatment was pursued vigorously in the United Kingdom as part of a redesign of the National Health Service in 1991 (Baker & Kleijnen as cited in Rowland & Goss, 2000). Not only has the British National Health Service adopted evidence-based practices for medical care, the institution has adopted, as of 2001, a set of evidence-based practices for behavioral health (Department of Health, 2001). These guidelines list the evidence for various treatment methodologies for the following diagnoses: depressive disorders, panic disorder and/or agoraphobia, social phobia, generalized anxiety disorder, posttraumatic stress disorder, obsessive compulsive disorder, eating disorder, somatic complaints, personality disorders, and deliberate self-harm.


Excerpted from The Evidence-Based Practice Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Foreword by Mary Cesare-Murphy, PhD, JCAHO.


Authors’ Bios.

1. Introduction to Evidence-Based Practices (Randy A.Hayes).

2. Evidence-Based Practices in Supported Employment (Lisa A.Razzano and Judith A. Cook).

3. Assertive Community Treatment (Susan J. Boust, Melody C.Kuhns, and Lynette Studer).

4. Evidence-Based Family Services for Adults with Severe MentalIllness (Thomas C. Jewell, William R. McFarlane, Lisa Dixon, andDavid J. Miklowitz).

5. Evidence-Based Psychopharmacotherapy: Medication Guidelinesand Algorithms (Sy Atezaz Saeed).

6. Psychosocial Rehabilitation (James H. Zahniser).

7. Evidence-Based Practices for People with Serious MentalIllness and Substance Abuse Disorders (Patrick W. Corrigan, StanleyG. McCracken, and Cathy McNeilly).

8. Evidence-Based Treatments for Children and Adolescents (JohnS. Lyons and Purva H. Rawal).

9. Recovery from Severe Mental Illnesses and Evidence-BasedPractice Research (E. Sally Rogers, Marianne Farkas, and William A.Anthony).

10. Evidence-Based Psychosocial Practices: Past, Present, andFuture (Timothy J. Bruce and William C. Sanderson).

11. Controversies and Caveats (Chris E. Stout).

12. Evaluating Readiness to Implement Evidence-Based Practice(Randy A. Hayes).

13. How to Start with Your Agency, Practice, or Facility (RandyA. Hayes).

14. Build Your Own Best Practice Protocols (Randy A. Hayes).

Appendix: Resources and Sample Treatment Plans.

Author Index.

Subject Index.

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