National and regional trends in health care and economics are driving an increased focus on evidence-based practices (EBPs) in the US health care system. Numerous factors have heightened interest in EBPs, including the rapid expansion of scientific knowledge regarding the causes and treatments of medical, mental, and substance use disorders, the growing voice of consumer and advocacy sectors, the managed care reform movement, and concerns about the growing costs of health care. The Office of Behavioral Health (OBH) expects and supports a client and community-driven behavioral health system guided by evidence-based and promising practices and demonstrated by positive, measurable outcomes. To this end, The Office has adopted these principles:
All 17 Community Mental Health Centers (CMHCs) are required, by contract, to provide at least one Evidence Based Practice (EBP). In reality, the centers provide more. For Fiscal Year 2012, data collected by OBH showed that centers provided services in the following EBPs:
Assertive Community Treatment (ACT)
Integrated Treatment for Co-occurring Mental Health/Substance Abuse
Illness Management and Recovery
Functional Family Therapy
The Office of Behavioral Health works closely with substance abuse treatment providers and researchers to incorporate the use of EBPs and curricula into treatment programming. There are three primary evidence-based practices that are used in the treatment of addictive behaviors and substance use disorders; motivational interviewing, cognitive behavioral therapy, and contingency management.
Motivational interviewing is a client-centered style of interviewing designed to collaboratively engage the client in the process of preparing for behavior change. Motivational Interviewing is counselor-directed in that the counselor is skilled at managing ambivalence, eliciting change talk and honoring the client’s autonomy about taking the next step toward a commonly agreed upon goal. First developed by Bill Miller and Stephen Rollnick, the motivational interviewing approach is currently being implemented in the treatment of chronic health care, behavioral health and criminal justice behaviors. Over 200 studies to date have demonstrated the effectiveness of the model at positively increasing client engagement, retention, compliance and treatment outcomes. The Center for Substance Abuse Treatment (CSAT) has identified MI as a best practice within the addiction treatment field.
Cognitive-behavioral therapy (CBT) is a treatment approach that has gained widespread application in the treatment of addictions and mental disorders. CBT has been extensively researched and has solid empirical support as an evidence-based treatment for addictions. CBT is structured, goal-oriented, and focused on the immediate problems faced by individuals entering treatment who are struggling to control their substance use. It is a flexible, individualized approach that can be adapted to a wide range of clients and treatment settings as well and individual and group therapy formats.
Contingency management (CM) is a strategy used in addiction treatment to encourage positive behavior change, such as abstinence, in patients by providing reinforcing consequences when patients meet treatment goals and by withholding those consequences or providing punitive measures when patients engage in the undesired behavior. CM interventions are based on the view that addictive behaviors are influenced by neurobiological and environmental factors.
An extensive body of research supports contingency management efficacy in treating various behavioral disorders, including substance use disorders.
The OBH substance abuse community prevention program promotes evidence based programs, practices, and approaches and requires contracted providers to comply with SAMHSA’s National Outcome Measures (NOMs) by collecting and reporting the appropriate programmatic data. The strategies adopted by OBH’s prevention program align with SAMHSA’s Strategic Prevention Framework model.