DMHAS: Lessons Learned Initiative

Lessons Learned Initiative
The mission of the Lessons Learned Initiative is to systematically identify knowledge gained from DMHAS’ state-operated, state funded, and federally funded prevention and treatment programs in order to improve the quality and cultural competence of publicly supported behavioral health services in Connecticut.

In this process we will incorporate lessons from the many exemplary and innovative programs that exist within the DMHAS system.  Key lessons learned from this dynamic process, based on a practical and inclusive definition of evidence, will inform the Department’s planning in ways that promote developing and sustaining a recovery-oriented system of care. 

 Levels/Types of Evidence Defined

Purpose: DMHAS, like other state behavioral health agencies, is working to implement Evidence-based Practices (EBPs) wherever possible.  However, scientific research is often incomplete and inadequate in many important areas of clinical practice.  Additionally, it takes an astounding average of 17 years for new knowledge generated by randomized controlled trails to be incorporated into clinical practice.[1]  This unacceptably long science-to-service waiting period has forced behavioral health policymakers to consider using other forms of “evidence” to guide programmatic and resource allocation decisions.   

DMHAS is using the following four categories to evaluate levels/types of evidence used to support clinical interventions, program design and systems policy changes.      

Evidence Based

  • Interventions, which have a body of, controlled studies and where at least one meta-analysis shows strong support for the practice.
  • Results have a high level of confidence, due to randomized control factor

Example: A series of randomized controlled trials comparing supported employment (also referred to as “IPS, Individual Placement and Support”) with a variety of traditional, “step-wise” vocational programs has clearly established supported employment as a highly effective intervention. This intervention results in significant gains in competitive employment rates, earned income levels, and employment tenure among individuals with severe behavioral health disorders. 

Evidence Supported

  • Interventions that have demonstrated effectiveness through quasi-experimental studies (e.g., “Time Series” studies or detailed program evaluations that include data on the impact of the programs or interventions).
  • Data from administrative databases or quality improvement programs that shed light on the impact of the program or intervention.

Example:  As one component of a quality improvement program in a local mental health authority, an in-service training program for providers and consumers/people in recovery was offered regarding the use of strategies to improve the collaborative, person-centered nature of treatment planning. Pre-post data collected prior to and after the training intervention indicated significant improvements in consumer satisfaction and consumers’ level of participation in treatment planning. 

Evidence Informed

  • Evidence of the effectiveness of an intervention is inferred based on a limited amount of supporting data.
  • Based on data derived from the replication of an EBP that has been modified or adapted to meet the needs of a specific population.
  • This data is fed back into the system. New interventions are developed, traditional interventions are modified, and ineffective interventions are eliminated.
  • Provides a template/framework for other systems to modify their programs and interventions.

Example: MET has been shown to be a highly effective approach for engaging people into treatment. While no studies have examined the use of MET specifically with African American men, based on the overall effectiveness of MET, it is reasonable to extrapolate and pilot this approach within this population. Data from the pilot will determine if extrapolation was an appropriate decision and identify potential MET modifications necessary for the specific population of African American men.  

Evidence Suggested

  • Consensus driven, or based on agreement among experts.
  • Based on values or a philosophical framework derived from experience, but may not yet have a strong basis of support in research meeting standards for scientific rigor.
  • Provides a context for understanding the process by which outcomes occur.
  • Based on qualitative data, e.g., ethnographic observations.

Example: Experience has shown us the importance of Culturally Competent and Recovery-Oriented Care, yet scientific evidence lags behind the expert and values-based and anecdotal consensus regarding the effectiveness of these approaches.

[1] From a 2001 report published by the Institute of Medicine (IOM), an arm of the National Academy of Sciences, entitled – Crossing the Quality Chasm: A New Health System for the 21st Century

Related Website Links:

Addiction Treatment Forum

Addiction Treatment Forum article: Evidence-based Addiction Medicine

Centers for the Application of Prevention Technologies  

Substance Abuse Mental Health Services Administration 

National Guidelines Clearinghouse

Content Last Modified on 1/28/2011 3:32:16 PM