Academic journal article The Journal of Rehabilitation

Evidence-Based Practices for Individuals with Severe Mental Illness

Academic journal article The Journal of Rehabilitation

Evidence-Based Practices for Individuals with Severe Mental Illness

Article excerpt

Over a short period of time, evidence-based practice (EBP) has revolutionized thinking not only in the health care field, but also in education and throughout many other human service fields (Fixsen, Naoom, Blase, Friedman, & Wallace, 2005). The fundamental reason for favoring EBPs, which are practices that have rigorous research support for their effectiveness, over practices that lack this evidence, is self-evident. All things being equal, administrators, practitioners consumers, family members, and funders all should prefer practices that have been proven to work over those that have not.

For individuals with severe psychiatric disabilities, a group of six practices have achieved broad acceptance as evidence-based (Drake, Merrens, & Lynde, 2005). While the extensive dissemination of information about these practices has proven to be a catalyst to the psychiatric rehabilitation field, many questions remain. One concerns whether these 6 practices all warrant the status of "evidence-based." A second key issue is whether other practices merit EBP status at this time. A third pressing concern is the existence of important outcome domains not covered by any EBPs. This paper seeks to clarify what is, and is not, addressed by EBPs for individuals with severe psychiatric disabilities. We are not the first to attempt to comprehensively map the evidence base for this field; many textbooks and reviewers (Bellack & Brown, 2001; Bustillo, Lauriello, Horan, & Keith, 2001; Clark & Samnaliev, 2005; Lehman et al., 2003; Lehman et al., 2004; Mueser & McGurk, 2004; Wykes, 2003; Zahniser, 2005b) have repeatedly attempted at least partial answers to this question. The current paper is a "work in progress" of a template that is a sorely needed and sought-after resource by policy-makers, researchers, family members, and consumers.

In the mental health field, the most common term used to identify the population of interest is severe mental illness, which we use synonymously with severe psychiatric disabilities. Severe mental illness (SMI) is defined by a psychiatric diagnosis found in the Diagnostic and Statistical Manual Version IV Text Revision (DSM-IV-TR) (American Psychiatric Association, 2000), disability, as defined by role impairment in one or more life domains (e.g., social relationships, independent living, employment), and duration, defined by an extended period of time receiving intensive mental health services (e.g., hospitalization or supervised group living) (Schinnar, Rothbard, Kanter, & Jung, 1990). Schizophrenia is the most common psychiatric diagnosis in this population. The range of appropriate services differs for children and adults; the focus of the current paper is on adults. For individuals with SMI (sometimes referred to as "consumers"), mental health treatment and rehabilitation services are usually considered together, because integrated services (i.e., services integrating mental health, vocational rehabilitation, housing, and substance abuse services) have been found to be far more effective than when they are provided separately (Rapp & Goscha, 2005). In this paper, the term psychiatric rehabilitation practices will be used to encompass both treatment and rehabilitation services.

A number of formal definitions with explicit criteria have been proposed for identifying EBPs (Mueser & Drake, 2005). We propose the following set of operational criteria:

The practice must be clearly defined. To meet this criterion, the practice should have a list of practice principles and a fidelity scale, which is a method for assessing if a particular program meets the criteria for a program model (Bond, Evans, Salyers, Williams, & Kim, 2000). In addition, the practice should have a practice manual providing concrete instructions for its implementation.

The practice should designate the target group for whom it is intended. The population(s) for which the EBP has been found effective should be specified. …

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