Academic journal article Social Work

Evidence-Based Practice in Mental Health Care to Ethnic Minority Communities: Has Its Practice Fallen Short of Its Evidence?

Academic journal article Social Work

Evidence-Based Practice in Mental Health Care to Ethnic Minority Communities: Has Its Practice Fallen Short of Its Evidence?

Article excerpt

Evidence-based practice (EBP) in the provision of mental health care for adults is a powerful mandate in the United States, where it has dramatically influenced and transformed mental health services in many communities and contributed significantly to the advancement of knowledge in the treatment and prevention of mental health disorders. A major impetus for EBP is the need to increase the effectiveness of mental health practices with clients through the use of standardized interventions based on rigorous scientific research (Drake et al., 2001). As primary agents in the delivery of mental health services to historically underserved and marginalized ethnic communities, social workers are committed to the provision and use of treatments and services known to promote the health and well-being of diverse populations of clients. This commitment impels social workers to examine and potentially expand current ideas of what constitutes evidence rather than to assume that scientific knowledge is superior to other sources of evidence, including cultural ways of knowing (Whitbeck, 2006).

In the field of medicine, Sackett, Richardson, Rosenberg, and Haynes (1997) originally conceptualized EBP as being informed by the following types and sources of evidence: the current best evidence in making decisions about the care of the individual, clinical expertise, and the client's experiences and preferences. All three types of evidence were crucial and conjointly respected. Gambrill (2006) likewise noted that important sources of knowledge and evidence include clinicians' knowledge and experience of particular contexts and specific clients as well as qualitative findings on the beliefs, preferences, and practices concerning mental health care within diverse cultural communities. These perspectives support more inclusive approaches to EBP in the provision of mental health care. However, in practice they have been overshadowed by much narrower understandings of EBP that are based on a biomedical research model that sets a priority for evidence derived from well-designed and carefully implemented randomized controlled trials (RCTs) (Egger, Smith, & O'Rourke, 2001). In addition, meta-analyses of RCTs also contribute to the documentation and understanding of the accumulated evidence.

This narrow understanding of EBP, which is promulgated by many researchers, practitioners, state divisions of mental health, funding sources, and legislative bodies as the exemplary paradigm or gold standard for mental health practice, markedly influences the priorities of funding sources, state policies, curriculums in schools of social work and psychology, and editorial policies of scholarly journals (Tanenbaum, 2005). Despite its valuable emphasis on rigor and demonstrated outcome effectiveness, EBP falls short in several key domains, especially with regard to the inclusion of the varying perspectives and stakeholders within communities of color and the generalizability of results to diverse racial and ethnic populations. Thus, a major question persists: Has EBP, despite its prominence in mental health program planning, fallen short of its evidence with ethnic populations?

EVIDENCE-BASED PRACTICE: AN OVERVIEW

The promotion and dissemination of EBP as the standard in mental health care appears very reasonable. EBP has contributed substantially to the advancement of knowledge in the treatment and prevention of mental health disorders to certain populations. Policymakers, funding sources, and service agencies are operating in a milieu of limited resources and increasing cutbacks and demands. In this context, and often beholden to federal funding, states and mental health providers are strongly motivated to use programs and interventions that have demonstrated effectiveness. In addition, political pressures are at times exerted by the federal government or courts on states to implement mental health programs that have been shown to work in cost-effective ways. …

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