Contents:
They also raise the interesting possibility that telehealth may help improve access to these specialist teams. Hence, there is a need to increase the ease and incentive for correctly identifying effective treatment options. An additional search via the National Guideline Clearinghouse http: With this proliferation in the sources of information, some diffusion of focus and confusion seems inevitable. In England, the NICE guidelines fulfill this role and have been the impetus for important government-level initiatives that will be discussed below.
While progress toward establishing EBPTs for most mental disorders has been excellent, much work remains. The effect sizes can be small to moderate, gains may not persist, and there are a small proportion of patients who derive little or no benefit. Hence, there is an ongoing need for innovation to develop new treatments and to continue to improve existing treatments.
This is a domain in which our field has been active and successful, as illustrated by the examples below. Clark and Salkovskis proposed four steps for developing an effective treatment for mental disorders. The first is to fully grasp the phenomenology of the disorder via clinical practice.
The aim of clinical practice is to carefully listen to patients and watch for phenomena that are not consistent with existing theory and to then carefully consider whether such phenomena reflect processes that have not yet been recognized. These clinical observations are then used to inform a theory of the maintenance of the disorder and are subjected to experimental investigation.
If the research confirms the importance of the new process, its place in the theory of the maintenance of the disorder is confirmed. The validated theory can then be used as a map to guide the development of a specific targeted treatment in which the maintaining processes are reversed. Our view is that there has been some excellent Stage 2 work in our field.
Moving through Stages 3 through 5 more rapidly is important because there is currently a 15—20 year lag between treatment discovery and incorporating new treatments into routine practice Sorensen, et al. To give one example of the utility of these two models for generating a novel, effective and efficient treatment, consider the example of posttraumatic stress disorder. It is highly unlikely that any one therapist will be able to master them all. One relatively new approach—the transdiagnostic approach—holds potential for contributing to solving this problem.
The transdiagnostic approach involves targeting treatment at a transdiagnostic process, defined as a common process that occurs across more than one mental disorder e. The advantages of a transdiagnostic approach are threefold. First, if a transdiagnostic process contributes to the maintenance of symptoms across multiple disorders, then one potentially powerful approach would be to focus treatment on that process rather than on the large number of discrete disorders currently listed in the DSM. Second, comorbidity is the norm.
Treating transdiagnostic processes, or processes common across the comorbidities, provides one path forward to improve outcomes. Third, as already mentioned, a transdiagostic approach may reduce the current heavy burden on clinicians, who must learn multiple disorder-focused protocols, often with common theoretical underpinnings and interventions Harvey, et al. There has been progress in developing transdiagnostic treatments that target transdiagnostic processes across the anxiety disorders and depression in adults Craske et al.
In an evaluation of MATCH, a total of 84 community clinicians were randomly assigned to 1 of 3 conditions for the treatment of clinically referred youth aged 7 to 13 years old. The three conditions were: MATCH produced significantly steeper trajectories of improvement relative to both usual care and to standard manualized disorder-focused treatment. Notably, outcomes from the disorder-focused manualized treatments did not differ significantly from the outcomes of usual care Weisz, et al.
This study was conducted across outpatient settings i. A similarly impressive example is the demonstration that CALM, a modularized CBT treatment for the anxiety disorders, which is delivered via a computer and assisted by an Anxiety Clinical Specialist. CALM was superior to usual care across adult patients and 17 primary care clinics Craske, et al. The Anxiety Clinical Specialists for this study were: The advantage to CALM was sustained for 18 months for individuals with generalized anxiety disorder and social anxiety disorder, and for 12 months for individuals with panic disorder.
These studies also demonstrate the potential utility of transdiagnostic and modular treatments. This acute problem is likely to hold for many other countries. More transportable treatments including ehealth - interactive computer programs and apps — are also being developed Andersson, ; Teachman, Screening and treatment for depression, smoking reduction and drug and alcohol problems are being prioritized and the services are provided by psychologists and social workers.
The barriers to accessing and implementing EBPTs within organizations are relatively understudied. Lack of administrative support and staff time are other key organizational barriers Willenbring et al. These data are very useful for informing potential organizational restructuring to promote increased access to, and utilization of, EBPTs. For example, Weisz, Kuppens, Eckshatin, Ugeto, Hawley and Jensen-Doss conducted a meta-analysis of 52 studies conducted in clinical settings in which the effect size difference between EBPTs and usual care was 0.
Centers for Disease Control and Prevention. REP outlines four phases that guide the process of ensuring dissemination of treatments into real-world organizational settings. This is also the phase for packaging the intervention and identifying implementation barriers. Phase 2 is the Pre-Implementation Phase during which delivery is customized and logistics are planned.
Phase 3 is the Implementation Phase during which training, weekly supervision, building partnerships with the local organizations and process evaluation take place. The focus of Phase 4 is Maintenance and Evolution. The goals are to ensure sustainability of delivering the intervention within the local organization and then packaging the intervention to be ready for national dissemination Kilbourne, et al.
Second, Weisz et al. This strategy is in contrast to the usual method in which the treatment is developed within a university or research setting and later tested for applicability to real world settings. Similarly, the dynamic sustainability framework emphasizes understanding the changing context of healthcare involving continued learning and problem solving. The goal is to ensure ongoing adaptations of interventions to fit the context and to aim for ongoing improvement as opposed to diminishing outcomes over time Chambers, et al. This model is particularly relevant in contexts that are in the midst of rapid change, such as the health system in the USA, as will be discussed in the Government-Level section below.
To illustrate the critical role of government-level factors, we focus on two countries—the USA and England. These countries have been selected because 1 they have both have undergone relevant and significant, albeit very different, changes in the provision of mental healthcare services over the past decade, 2 data has been collected on trends in delivering EBPTs in both countries and 3 they represent two very different approaches to health care. In , national health care spending was 5. In , the Surprisingly, this level of funding does not seem to have translated into better outcomes.
Also, until recently, 45 million Americans did not have health insurance. The percentage of uninsured had been rising because the costs associated with buying insurance had been steadily rising. Hence, when people become unemployed or underemployed they may lose their health coverage and they may be unable to afford to buy their own insurance. Individuals with a mental disorder have been significantly overrepresented among the uninsured. Clearly, there was a great need for change, particularly for individuals with a mental disorder. Two relatively new laws hold promise for improving the situation.
While the Parity laws are an important advance, there is concern about their effectiveness. One-third of employers reported no difference in coverage for mental and physical health problems. However, for the remaining two thirds, the differential benefits appear to be increasing. Also, from to the limits on coverage for mental health treatment rose. Moreover, Barry et al. Hence, two challenges ahead include 1 realizing the potential of the parity laws, particularly for the provision of EBPTs and 2 determining parity in the context of EBPTs because they are not easily comparable to treatment for any physical illness Sundarararman, The goal of the ACA, which became law in , is to improve access to affordable health insurance and to create coverage that is more affordable for those who are already covered.
The law includes requirements: Medicaid is a government program that provides health services to individuals who are very low income. Medicare is a government program that provides heath services to individuals who are older than 65 years of age.
This change was driven by a decrease in the average number of psychotherapy visits. Unfortunately, this vision has not been fully realized in practice, and elements of PBS still need to be subjected to rigorous scientific inquiry. Barriers to treatment seeking in primary insomnia in the United Kingdom: Specifically, Wang et al. Functional and structural approaches to behavioral assessment of problem behavior. These countries have been selected because 1 they have both have undergone relevant and significant, albeit very different, changes in the provision of mental healthcare services over the past decade, 2 data has been collected on trends in delivering EBPTs in both countries and 3 they represent two very different approaches to health care.
It is estimated that 3. There will be 1. To state this a different way, from — ACA funding is expected to contribute to the caseloads of mental health professionals increasing them in the order of 19 million to between 34 million assuming mandatory funding levels and 44 million assuming appropriation of authorized funding levels Leighton et al. With this increase in the utilization of mental health services, the need to provide the optimal treatments is particularly critical Garfield, et al. Also, there is a great need to rapidly mount a workforce who are skilled in the delivery of EBPTs Goldman, ; Thomas, et al.
There are also important state-based government-level efforts. For example, in California, the Mental Health Services Act was passed in as a result of a ballot initiative known as Proposition The ballot achieved broad support and has provided much needed funds for a broad range of important mental health initiatives such as improving access to services, the development of prevention programs, providing supported housing, and integrating mental health with other services Feldman, Discussion as to whether the same path may yield the same positive outcome in other states is being considered Bambauer, A comprehensive and encouraging effort is in progress within the Veterans Health Administration VA , which operates the largest integrated health care system in the USA.
Although more progress still needs to be made, these efforts at the government level show promise for the increased provision of services and more widespread dissemination of EBPTs in the USA. More specifically, the cost would be recovered within two to five years. Based on this analysis, between and the government invested million pounds sterling per year above existing spending to establish the Improving Access to Psychological Therapies IAPT program.
Key to convincing the government to increase spending in this domain were the NICE recommendations that EBPTs should be frontline treatments for anxiety and depression, along with the data that these treatments were not available to the public. The preliminary data from two specific demonstration sites, involving almost 5, treated patients indicates marked improvement in clinical outcome and employment status and these gains were maintained at 10 month follow-up Clark, A broader analysis of the first year of operation for 32 IAPT services, involving 19, patients who received at least 2 sessions of treatment, indicated that The — data from IAPT is also looking very promising.
It is notable that these data verify the assumptions on which the IAPT program was based—IAPT is reducing unemployment and improving outcomes for people with a mental disorder. Many other lessons have been learned from this important program. First, recovery was higher where there were more highly trained and experienced therapists and where patients received more sessions, and at least an average of eight sessions per person were delivered Gyani, et al. There are many differences between the USA and English systems. Treatment providers are typically employed within the NHS. Hence, it is likely to be easier to institute uniform training standards within the NHS relative to in the USA where there are many treatment providers operating independently.
In the latter, ensuring nationally agreed upon standards of care is much more difficult. In particular, a first step would be to establish a tradition of country-wide cost-effectiveness analyses focused on the costs and savings of providing EBPTs. Careful consideration would need to be given to the outcomes that policy makers and the public in the USA care about, such as demonstrations of loss of productivity or reduced potential for violence. FDA is an acronym for the U. Food and Drug Administration and is the authority that reviews new treatments for mental disorders—typically drug treatments—and judges whether or not they should be available to the public.
The number of people affected by one or more mental disorders is large and growing, the majority of people with a mental disorder are not getting treated and, even among those who do get treated, the majority are not receiving a minimally adequate treatment, far or less an EBPT. We highlighted that the amount and quality of evidence for EBPTs as effective sole interventions for a wide range of mental disorders is a puzzling contrast to data indicating that the availability of these treatments has steeply declined. Barriers and possible solutions are summarized in Table 1.
In the assessment of the authors, the principle domains during the period ahead include 1 helping patients identify good providers of EBPTs, 2 training many more providers to be able to deliver EBPTs and 3 convincing governments to devote more resources to EBPTs. We are grateful to Dr. Henry Hieslmair for helpful discussions that shaped the content of this paper. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript.
The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. National Center for Biotechnology Information , U. Author manuscript; available in PMC May 1.
Harvey and Nicole B. Author information Copyright and License information Disclaimer. Department of Psychology, University of California, Berkeley. The publisher's final edited version of this article is available at Behav Res Ther. See other articles in PMC that cite the published article. Abstract The prevalence of mental disorders is high and appears to be growing, yet the majority of individuals who meet diagnostic criteria for a mental disorder are not able to access an adequate treatment. Open in a separate window. We offer five pathways to begin to address these patient-level barriers.
Develop and test conceptual models One valuable approach to address patient-level factors would be to devise and test conceptual models of the various barriers faced by patients. Barrier-specific research With so many important patient-level barriers there is also a great need for research programs focused on specific barriers, and there have already been several promising efforts in this domain.
Improve diagnosis There have been a range of approaches to reducing the time elapsed from the onset of a mental disorder to receiving an accurate diagnosis. Therapist-Level Therapist beliefs and preferences Research on therapist-level barriers is critically important given the challenge of mounting a workforce skilled in the delivery of EBPTs and who deliver EBPTs with fidelity Goldman, ; Shafran, et al. Specialists and generalists Comer and Barlow raise concerns about the move toward training generalist practitioners to provide EBPTs. Continuing to innovate While progress toward establishing EBPTs for most mental disorders has been excellent, much work remains.
Government-Level To illustrate the critical role of government-level factors, we focus on two countries—the USA and England. USA In , national health care spending was 5. Patient Protection and Affordable Care Act ACA The goal of the ACA, which became law in , is to improve access to affordable health insurance and to create coverage that is more affordable for those who are already covered.
State-based initiatives There are also important state-based government-level efforts. Summary and Conclusion The number of people affected by one or more mental disorders is large and growing, the majority of people with a mental disorder are not getting treated and, even among those who do get treated, the majority are not receiving a minimally adequate treatment, far or less an EBPT. Mental health provider attitudes toward adoption of evidence-based practice: The organizational social context of mental health services and clinician attitudes toward evidence-based practice: Barriers to dissemination of evidence based practices: Diagnostic and statistical manual of mental disorders.
American Psychiatric Association; Using the Internet to provide cognitive behaviour therapy. Behaviour Research and Therapy. State Mental Health Policy: Toward a unified treatment for emotional disorders. Design of mental health benefits: Methods to improve diagnostic accuracy in a community mental health setting. American Journal of Psychiatry. Understanding practitioners characteristics and perspectives prior to the dissemination of an evidence-based intervention. Examination of therapist-level barriers to their use.
The ognitive and affective structure of paranoid delusions: A transdiagnostic investigation of patients with schizophrenia spectrum disorders and depression. Archives of General Psychiatry.
An open trial investigation of a transdiagnostic group treatment for children with anxiety and depressive symptoms. Experiences of mental illness stigma, prejudice and discrimination: Trends in service use and treatment for mental disorders in adults throughout Great Britain. The British Journal of Psychiatry. Service use for mental health problems: Australian and New Zealand Journal of Psychiatry. The dynamic sustainability framework: Empirically supported psychological interventions: Annual Review of Psychology. Training and education in clinical psychology in the context of the Patient Protection and Affordable Care Act.
Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: International Review of Psychiatry. Improving access to psychological therapy: Initial evaluation of two UK demonstration sites. The occasional case against broad dissemination and implementation: Retaining a role for specialty care in the delivery of psychological treatments.
National trends in the antipsychotic treatment of psychiatric outpatients with anxiety disorders. National trends in child and adolescent psychotropic polypharmacy in office-based practice, — The treatment of common mental disorders across age groups: Journal of affective disorders. Disorder-specific impact of coordinated anxiety learning and management treatment for anxiety disorders in primary care. The effect of outcome monitoring feedback to clinicians and patients in short and long-term psychotherapy: A randomized controlled trial.
Journal of the American Medical Association. A decade of direct-to-consumer advertising of prescription drugs. New England Journal of Medicine. The changing face of US mental health care. Post-traumatic stress disorder in the context of terrorism and ther civil conflict in Northern Ireland: Effectiveness of national implementation of prolonged exposure therapy in Veterans Affairs care.
Perfectionism as a transdiagnostic process: A cognitive model of posttraumatic stress disorder. A randomized controlled trial of cognitive therapy, a self-help booklet, and repeated assessments as early interventions for posttraumatic stress disorder. The nature of intrusive memories after trauma: The warning signal hypothesis. Transdiagnostic treatment of bipolar disorder and comorbid anxiety with the unified protocol: A clinical replication series. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders: Cognitive behaviour therapy for eating disorders: Unified protocol for transdiagnostic treatment of emotional disorders: Anxiety and oppositional defiant disorder: The impact of national health care reform on adults with severe mental disorders.
The evidence-based practice of psychotherapy: Facing the challenges that lie ahead. Why does choice enhance treatment effectiveness? Using placebo treatments to demonstrate the role of personal control. Journal of Personality and Social Psychology. Community-based cognitive therapy in the treatment of post-traumatic stress disorder following the Omagh bomb. Who gets the most out of cognitive behavioral therapy for anxiety disorders?
The role of treatment dose and patient engagement. Journal of Consulting and Clinical Psychology. Is there a shortage of psychiatrists? Sociodemographic and psychopathologic predictors of first incidence of DSM-IV substance use, ood and anxiety disorders: Mental Health Services Research. Filling the implementation gap: Early Intervention in Psychiatry. Insomnia, psychiatric disorders, and the transdiagnostic perspective. Current Directions in Psychological Science. A transdiagnostic approach to treating sleep disturbance in psychiatric disorders. Sleep disturbance as transdiagnostic: A Transdiagnostic Approach to Research and Treatment.
Oxford University Press; Cognitive Behavioural Processes across Psychological Disorders. International comparisons, underlying factors, and federal programs. Congressional Research Service; The US infant mortality rate. The mark of shame: Stigma of mental illness and an agenda for change. Hinshaw SP, Stier A. Stigma as related to mental disorders. Annual Review of Clinical Psychology. Introduction to research-based practices in special education. In Research-based practices in special education pp. Evidence-based practices in learning and behavioral disabilities: The search for effective instruction.
Parent participation in assessment and IEP development. Constructing Effective Instructional Toolkits: Evidence-based practices Volume 26 pp. In Research-Based Practices in Education pp. The Search for Effective Instruction. Evidence-based practices in special education. In Handbook of leadership in special education pp. Evidence-based practices in education.
In APA educational psychology handbook Vol. Classroom behavior, context, and interventions: The search for solutions to complex problems. Evidence-Based Practices in Special Education. The future of special education research. In Research in special education: In The handbook of special education pp. The Future of Special Education Research. Designs, Methods, and Applications 2nd ed. In The Handbook of Special Education pp.
Co-Teaching and Students with Disabilities: A Critical Analysis of the Empirical Literature. Journal Articles Collins, L. Navigating common challenges and pitfalls in the first years of special education: A replication by any other name…: A systematic review of replicative intervention studies. Remedial and Special Education , 37 , — Meta-analysis of behavioral self-management techniques used by students with disabilities in inclusive settings. Null hypothesis significance testing and p values.
Learning Disabilities Research and Practice. Sampling and special education research: Examining whether and how study results apply to you. Learning Disabilities Research and Practice , 32 , 78— Evidence-based practices in special education [special issue]. Intervention in School and Clinic , 44 2.
Research designs and special education research: Different designs address different questions. Learning Disabilities Research and Practice , 31 , — Leveraging evidence-based practices through partnerships based on practice-based evidence. A Contemporary Journal , 14 2 , — Classifying evidence-based practice through partnerships based on practice-based evidence. Terminology and evidence based practice for students with EBD: Exploring some devilish details. Beyond Behavior , Education and Training in Autism and Developmental Disabilities , 48 1 , 18— Using the 6S Pyramid to identify research-based instructional practices for students with learning disabilities.
Learning Disabilities Research and Practice , 30 2 , 91— Teaching Exceptional Children , 47 , 85— Republication of "Evidence-based practices in special education: Intervention in School and Clinic , 50 , — Journal of Special Education , 47 2 , 71— Education and Training in Autism and Developmental Disabilities , 48 , 18— Unraveling evidence-based practices in special education. General education teachers' goals and expectations for their included students with mild and severe disabilities.
Journal of Special Education , 47 , 71— Evidence-based practices and implementation science in special education. Exceptional Children , 79 , — Evidence-based practices and implementation science in special education [special issue]. Exceptional Children , 79 2 , 20— Exceptional Children , 79 2 , 1—8.
Moving research into practice: Can we make dissemination stick? Exceptional Children , 79 2 , — Journal of Special Education. If the shoe fits: Finding and adapting evidence-based practices. Early identification for special education: Implications for research and development in the Pacific Rim. Journal of International Special Needs Education , 15 2 , 75— An analysis of the different patterns of 1: International Journal of Inclusive Education , 16 12 , — Facilitating parental involvement in evidence-based special education. Teaching Exceptional Children , 44 3 , 22— Evidence-based practices and parents of children with disabilities: Teacher-student interactions in inclusive classrooms.
Journal of International Special Needs Education , , 27 4. Facilitating the effective implementation of evidence-based practices through teacher—parent collaboration. Teaching Exceptional Children , 45 1 , 64— Universal Design for Instruction in Postsecondary Education: Journal of Postsecondary Education and Disability , 24, Issue 1 , 5— Journal of Postsecondary Education and Disability , 24 1 , 5— Evidence-based practices, Research-based practices, and best and recommended practices: Some thoughts on terminology.
Intervention in School and Clinic , 46 2 , 67— Remedial and Special Education , 31 , 67— Savage Controversies , 4 1 , 2—4.
Editorial Reviews. Review. US and Australian contributors offer detailed instructions and Buy Evidence-Based Practices: 26 (Advances in Learning & Behavioral Disabilities): Read Kindle Store Reviews - www.farmersmarketmusic.com Evidence-based Practices (Advances in Learning and Behavioral Evidence- Based Practices: 26 and millions of other books are available for Amazon Kindle. . Several chapters are devoted to EBPs for students with learning disabilities.
Using teacher narratives in the dissemination of research-based practices. Investigating the validity of ratings and comparing student groups. Supporting evidence-based practice with practice-based evidence [special issue]. Intervention in School and Clinic , 46 2 , 1— Intervention in School and Clinic , 46 2 , 1—8. Determining evidence-based practices in special education.
Exceptional Children , 75 , — Evidence-based practices for reading, math, writing, and behavior [special issue]. Exceptional Children, 75 3 , 1— Exceptional Children , 75 3 , 1—8. Nonexperimental quantitative research and its role in guiding instruction.