EBP Exchange - UMB School of Social Work

One of the challenges of keeping practice evidence-informed is the high cost of journal subscriptions, especially in agencies which do not have many resources for such purchases.  Building on work done at the University of Michigan, the University of Maryland School of Social Work has identified some resources that can be used by field instructors from publically available open access settings.  Fortunately a growing number of journals are open access and all articles published with the support of NIH will soon be available–after a 12-month delay–via pubmed central (PMC), http://www.pubmedcentral.nih.gov/. Some journals already deposit their materials in PMC

There is certainly reason for concern that evidence supported interventions (ESIs) may not be effective across culttural or race/ethnic groups, given the history of developing these interventions on fairly narrow populations, sometimes in the far reaches of the country and away from more diverse major metropolitan areas.  Many of those concerns were expressed at a conference held last summer at the University of Minnesota in 2007 (see, ttp://ssw.cehd.umn.edu/img/assets/27477/SummaryOfProceedings.pdf).

A recent meta-analysis that has come (Huey and Polo, 200 helps to clarify the robust nature of mental health interventions for youth and to show that there seems to be little difference in benefit received for Caucasian and minority youth. Basically, youth ethnicity (African American, Latino, mixed=other minority), problem type, clinical severity, diagnostic status, and culture-responsive treatment status did not moderate treatment outcome. Most studies had low statisticalpower and poor representation of less acculturated youth. The authors note that these findings are not definitive becasue relatively few studies have been done in this area and validated outcome measures are mostly lacking. Although this does not mean that we should be satisifed with what we have developed or with what we know, it does indicate that there is no particular evidence that the avialable “well-established treatments” (including CBT, MST, Brief Strategic Family Therapy (BSFT) and TF-CBT) will not be effective with minority youth. There is also no overall evidence from the meta-analysis that cultural adaptations have succeeded in boosting the effectiveness of standard interventions.

Another reasonably recent paper indicates that CBT and medications are effective with minority low-income adult women (Miranda, et al., 2006).  This does not, again, mean that we should be satisifed as Wells et al. (2007)  show that relatively simple quality improvements to standard treatments can be very cost effective, across the board. The interventions are described in the paper which indicates that they are also posted at www.rand..  So, there is certainly much to be done to develop a mental health care system that is effective for minority populations–and there is certainly evidence that the funding for mental health care is not sufficient to reduce mental health care disparities (Cook, McGuire, & Miranda, 2007), but there are some promising findings to work from.org/health/projects/pic/order.htmlCook, B. L., McGuire, T., & Miranda, J. (2007). Measuring trends in mental health care disparities, 2000-2004. Psychiatric Services, 58(12), 1533-1540.

Huey, S. J., & Polo, A. J. (2008). Evidence-based psychosocial treatments for ethnic minority youth. Journal of Clinical Child and Adolescent Psychology, 37(1), 262-301.

Miranda, J., Green, B. L., Krupnick, J. L., Chung, J., Siddique, J., Belin, T., et al. (2006). One-year outcomes of a randomized clinical trial treating depression in low-income minority women. Journal of Consulting and Clinical Psychology, 74(1), 99-111.

Wells, K. B., Schoenbaum, M., Duan, N., Miranda, J., Tang, L. Q., & Sherbourne, C. (2007). Cost-effectiveness of quality improvement programs for patients with subthreshold depression or depressive disorder. Psychiatric Services, 58(10), 1269-1278

GAINS Center Juvenile Cross Training Curriculum

The juvenile cross-training curriculum is designed to address major gaps in service provision for youth with treatment needs involved with the juvenile justice system. It focuses on increasing collaboration among professionals in the fields of mental health, substance abuse, and juvenile justice when working with youth with co-occurring disorders in the juvenile justice system. This online version of the juvenile cross-training curriculum supplies participating professionals with information to better understand the needs of juveniles with co-occurring disorders and to provide more effective treatment and management. While the format retains most of the didactic elements of the original cross-training, participants may engage in modular exercises as they progress through each component. The main topic areas include:

• An overview of the juvenile justice and treatment systems
• Screening and assessment tools
• Effective treatment approaches
• Strategies for improving communication among systems

A very useful paper from  Daniel Squires  and colleagues in the esteemed Journal of Substance Abuse Treatment (JSAT) builds on work in 54 communiity SAT agencies over a 4 year period, using a strategy called Science to Service Laboratory (SSL).  The authors found that first, adopter agencies voiced a clear preference for a menu of evidence supported interventions (ESIs). As a result they began to incorporate additional evidence ESIs, including cognitive–behavior therapy, MI, and Twelve-step Facilitation, in addition to CM. To support these expanded practice offerings, the second focal area developed was a more comprehensive supervision and follow-up support component that trains supervisors and links practitioners with clinical feedback resources following didactic training. (THe authors note that all of these efforts are being designed consistent with the three-tiered approach advanced by Miller et al’s 1006 paper in JCCP that studies efforts to teach motivational interviewing.) The authors also note the deleterious effects of worker turnover on the implementation of ESIs at the agency level–yet another reason for investing in workforce development efforts.  The citation for the article and the Miller citation are below. Squires, D. D., Gumbley, S. J., & Storti, S. A. (2008). Training substance abuse treatment organizations to adopt evidence-based practices: The Addiction Technology Transfer Center of New England Science to Service Laboratory. Journal of Substance Abuse Treatment, 34(3), 293-301.