Evidence-Based Practice And Research

• Federal and state agencies should use the definition of Evidence-Based Practice adopted in the Institute of Medicine Report, Crossing the Quality Chasm (2001): "Evidence-Based Practice is the integration of best research evidence with clinical expertise and patient values." This definition balances 3 essential components of state of the art practice: the best science-based evidence; the skills and judgment of health professionals; and the unique needs, concerns and preferences of the person receiving services.
  
  
• National Institute of Mental Health needs to identify mechanisms to:
  • Rapidly identify promising practices for adults with severe mental illness and children with serious emotional disorders.
  • Prioritize these promising practices for research awards
  • Develop service research strategies for use with complex, real world populations (for instance adults with co-occurring mental illness and substance abuse disorders, receiving multiple medications) and ensure 15% of the agency's research portfolio supports this area of services research.
  • Disseminate information on evidence-based practices to other federal and state agencies that develop policy and funding for services, as well as to the mental health community.
    
    
• The Substance Abuse and Mental Health Services Administration needs to receive authorization and funding to continue multi-site demonstration investigations that target high priority services areas.
  
  
• The Agency for Healthcare Research and Quality is the government agency mandated to research the delivery of healthcare services, but historically little attention has been given to mental health services. It needs to substantially increase its attention to services research for adults with severe mental illness and children with serious emotional disorders.
  
  
• The National Institute of Disability and Rehabilitation Research needs to aggressively pursue services research for adults with severe mental illness. In the recent past, much of the agency's research portfolio has concentrated on services common to all people with disabilities. Unfortunately, much of this research is not useful for adults with severe mental illness.
  
  
• The Center for Medicaid and Medicare Services needs to develop mechanisms to:
  • Incorporate these services into Medicare and Medicaid in a timely fashion. New mental health services have not been incorporated into Medicare since 1992, and the reimbursement mechanism is not in place for a decade of promising practices.
  • Regularly update state Medicaid agencies on new evidence based practices for potential inclusion in state Medicaid plans.