What is Evidence-Based Treatment?May 14, 2004
Research Summary
Earlier this week, Join Together Online reported that Oregon now mandates that evidence-based treatment practices must be used by programs funded by the state. According to the article, though, the bill vaguely defines evidence-based practices and does not offer guidance about how to implement them. Luckily, people in other states and communities are asking the same questions.
Last year, the Iowa single state agency director asked the Iowa Practice Improvement Collaborative (PIC) to develop implementation guidelines for community-based providers, with the same goal as Oregon: to make use of evidence-based practice tied to future funding. The guidelines are publicly available through the JTO Resource Directory.
Evidence-based practices are specific clinical guidelines that help bridge the gaps between what researchers find to be effective treatment and what is implemented at the practice level. Their use is growing in all areas of health care in an effort to reduce errors and improve health.
According to the Iowa PIC, evidence-based practices often focus on treatment approaches, such as motivational enhancement, and include copious data from the research behind the practice. Project MATCH, a multisite clinical trial of alcohol treatment, has eight monographs that are evidence-based treatment for alcohol use disorders. In contrast, the National Institute on Drug Abuse's Principles of Effective Drug Treatment are clinical guidelines; they offer a lot of freedom in the practice's implementation.
The guidelines developed by the Iowa PIC suggest developing criteria to evaluate evidence-based practices, such as "At least one randomized clinical trial has shown this practice to be effective" and "The practice either targets behaviors or shows good effect on behaviors that are generally accepted outcomes." The criteria should be specific to the treatment organization's population, their primary substances of abuse, and even the geographic location.
The next step is to develop a process to implement the practice. Like any organization change, applying an evidence-based practice will be difficult, so the guidelines also offer some recommendations to make the process smoother.
If Oregon and Iowa are bellwethers, then many more states -- and private payers -- may require the use of evidence-based practices in substance use treatment. This manual will help treatment organizations take the first step; however, further discussion and guidance will be critical to help them transition smoothly.
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