1. Identifying and Implementing Evidence-Based Mental Health and Substance Abuse Services
September 16, 2005
Kevin D. Hennessy, Ph.D.
Science to Service Coordinator
Substance Abuse & Mental Health Services Administration
U.S. Department of Health & Human Services

2. Vision Mission “A Life in the Community For Everyone”
“Building Resilience & Facilitating Recovery”

4. How do we translate research into practice?
A Cross-Cutting Principle: Science to Services/Evidence-Based Practices
How do we translate research into practice?
How do we connect services to science?

5. An old and well-defined problem
Few research innovations are implemented successfully in typical health care settings
Many widely used interventions have little if any research support
Most in treatment don’t receive evidence-based interventions
Many reports exist documenting the problem and recommending actions
Bridging the Gap Between Research and Practice: Forging Partnerships with Community-Based Drug and Alcohol Treatment (Institute of Medicine Report) – 1998
Mental Health: A Report of the Surgeon General – 2000
Achieving the Promise: Transforming Mental Health Care in America (The President’s New Freedom Mental Health Commission) – 2003
Knowledge to practice gap remains at years

6. It takes 17 years to turn 14 per cent of original research
18%
variable
Negative results
Dickersin, 1987
Submission
46%
0.5 year
Kumar, 1992
Koren, 1989
Acceptance
Negative results
0.6 year
Kumar, 1992
Publication
17:14
Expert
opinion
35%
0.3 year
Poyer, 1982
Balas, 1995
Lack of numbers
Bibliographic databases
50%
years
Antman, 1992
Poynard, 1985
Reviews, guidelines, textbook
9.3 years
Inconsistent
indexing
Implementation
It takes 17 years to turn 14 per cent of original research
to the benefit of patient care

7. SAMHSA Activities for Reducing the Knowledge – Practice Gap
Identify evidence-based practices (NREPP)
Develop guides, manuals and other materials
Evidence-Based Practice Implementation Resource Kits
Disseminate materials and provide trainings through regional centers
Centers for the Application of Prevention Technology (CAPTs)
Addiction Technology Transfer Centers (ATTCs)
Center for Mental Health Services Technical Assistance Centers
Create interagency and private-public partnerships

8. National Registry of Evidence-based Programs and Practices (NREPP)
Purpose: A voluntary rating and classification system for mental health and substance abuse prevention and treatment interventions.
Goal: NREPP will become a leading national resource for science-based information on substance abuse and mental health prevention and treatment interventions.

9. NREPP Timeline
1998…Started with a focus on substance abuse prevention as the National Registry of Effective Prevention Programs
…reviewed and rated over 1,100 substance abuse prevention programs
information on over 150 Model, Effective, and Promising Programs on web site (
2004…initial expansion of system to include substance abuse treatment, mental health promotion, and mental health treatment programs

10. NREPP Current Status
Formal public comment process by SAMHSA this summer
Notice in August 26th Federal Register
Available through SAMHSA web site – access through “Quick Picks” on SAMHSA’s home page (
Written comments due no later than October 25th
U.S. Mail – SAMHSA, c/o NREPP Notice, 1 Choke Cherry Road, Rockville, MD 20877
Electronic Mail –
Posting of recently completed reviews (using older NREPP system) by Fall 2005
No new reviews until 2006
New NREPP Website will be launched in 2006:

11. NREPP: Comprehensive & Transparent
Scientists independently evaluate and classify outcomes for programs/practices based on statistical significance, replications and 16 evidence quality criteria
Program impact and practical significance will be reported through effect sizes
For status programs, additional information on implementation, training, quality tools, staffing, costs, etc. will be provided

12. NREPP: Comprehensive and Transparent
Review results will be posted on the new NREPP website
By 2006 Web site will feature:
Outcomes searchable database
Links to educational materials on review criteria
Self-assessment tool for candidate programs
Links to technical assistance centers and supports

13. NREPP: Draft Rating Criteria
Two Types of Criteria
Evidence Rating Criteria
“Utility Descriptors”

14. NREPP: Evidence Rating Criteria
16 evidence rating criteria applied to each program outcome (0 to 4 scale).
Include:
Theory-driven selection of measures & analytic methods
Reliability
Validity
Intervention and comparison fidelity
Assurances to participants
Standardized Data Collection
Selection bias
Attrition and missing data
Analysis meets data assumptions

15. NREPP: “Utility Descriptors”
Look beyond scientific evidence and ensure that programs are able to be implemented.
Assessments also made of the following:
Implementation
Quality Monitoring
Unintended or Adverse Events
Population Coverage
Cultural Relevance
Staffing
Cost

16. NREPP: Questions to the Public
From the August 26th Federal Register Notice (FRN)
Is proposed system objective, transparent, efficient, and scientifically defensible?
How might SAMHSA engage stakeholders in determining priority review areas?
How best to use statistical significance and measures of effect size in NREPP?
Beneficial to use multiple categories of effectiveness?
Approach to assessing and presenting cultural relevance?

17. NREPP: Questions to the Public
From the August 26th Federal Register Notice (FRN) - continued
Approach to re-reviewing existing NREPP programs?
Types of technical assistance needed to promote adoption of NREPP interventions?
How best to involve consumers, families, and other non-scientists in NREPP?
What, if any, guidance on use of NREPP interventions within block grants?
How best to promote other sources – e.g., clinical judgement, consumer values, etc – in decisions regarding selection, delivery and financing of services?
Panel to annually review NREPP operational and technical suggestions?

18. NREPP’s Reach
Influences SAMHSA discretionary and block grant investments
Serves as a resource for states and communities seeking to implement evidence-based Mental Health & Substance Abuse prevention and treatment services
Provides an important tool for both public and private purchasers in selection of effective services

19. Publications and Materials on Best Practices in Mental Health and Substance Abuse Prevention & Treatment
What type of Products?
Training Manuals
Evidence-based Implementation Resource Kits (CMHS)
Interactive Web-based Technical Support (Prevention Platform)
Treatment Improvement Protocols (TIPs)
Quick Reference Cards & Pocket-size Guides
Fact Sheets, Brochures, Reports, and Periodicals

20. Publications and Materials on Best Practices in Mental Health and Substance Abuse Prevention & Treatment
Who Uses the Products?
Program Administrators & Staff
Clinicians
Policymakers
Consumers
Where to Find the Products:
For SA Treatment go to
For SA Prevention go to
For Mental Health go to

21. Evidence-Based Practice Implementation Resource Kits
Focus on six practices
Assertive community treatment
Family psychoeducation
Supported employment
Integrated dual disorders treatment
Illness management and recovery skills
Standardized pharmacological treatment
Two Phases
I – Development (Fall 2000 – Summer 2002)
II – Pilot-Testing (Summer 2002 – Summer 2005)
More information is available through SAMHSA’s web site ( under “Mental Health System Transformation”

22. Evidence-Based Practice Implementation Resource Kits
Kits have targeted and distinct components for:
Consumers
Family and Other Supports
Practitioners and Clinical Supervisors
Mental Health Program Leaders
Public Mental Health Authorities/Administrators
Kits include:
Research summaries
Information sheets for all stakeholders
Tip sheets for program leaders and administrators
Program manuals/workbooks for practitioners
Introductory and training/demonstration videos
Fidelity assessment tools and cultural competence statements
Outcome measures

23. Materials, Trainings & Technical Assistance for Prevention
After evaluating and identifying evidence-based programs and practices through NREPP and producing materials and publications like Too smart to Start and the TIPs, the 3rd step is to disseminate the information.
For Prevention, SAMHSA uses our Centers for the Application of Prevention Technology.
The CAPTs are technical assistance providers that are organized in regions across the country.
They assist States and community-based organizations in the application of evidence-based substance abuse prevention programs, practices, and policies.
The CAPT system is a practical tool to increase the impact of the knowledge and experience that defines what works best in prevention programming.
Centers for the Application of Prevention Technology
Purpose: Assist States and Communities in the application
of evidence-based substance abuse prevention programs,
practices, and policies
Goal: To increase the impact of prevention

24. Materials, Trainings & Technical Assistance for Treatment
The ATTCs are similar to the CAPTs but they focus on Treatment rather than prevention.
The ATTCs bring together science, education and services to treat individuals and families affected by alcohol and other drug addictions.
They get the latest knowledge, skills and experiences of treatment providers out into the field to enhance clinical practice.
The ATTC Network operates as 14 individual Regional Centers and a National Office. At the regional level, individual Centers focus primarily on meeting the unique needs in their areas while also supporting national initiatives.
I want to briefly mention the Pacific Southwest ATTC which encompasses the States of California, Arizona and New Mexico. This ATTC has had tremendous success. I mention it because the Conference organizer for this conference heads the Pacific Southwest ATTC – Rick Rawson. I’m sure Rick would be happy to discuss this ATTC at a later time with anyone who would like more details.
SAMHSA’s Addiction Technology Transfer Centers
Purpose: To transmit the latest knowledge, skills and attitudes of professional addiction treatment practice
Goal: To enhance clinical practice

25. Center for Mental Health Services Research, Training and TA Centers
Currently 55 Centers provide a range of services – many are free but charges may apply for some:
Technical assistance
Information and referrals
On-site consultation
Training
Library services
Publications
Other resources
More information is available through SAMHSA’s web site:

26. Promoting Interagency Partnerships
Collaborations with National Institutes of Health to jointly fund state planning grants facilitating implementation of evidence-based practices
RFA-MH – State Implementation of Evidence-Based Practices: Bridging Science and Service (with NIMH)
RFA-MH – State Implementation of Evidence-Based Practices II: Bridging Science and Service (with NIMH)
RFA-DA – Enhancing State Capacity to Foster Adoption of Science-Based Practices (with NIDA)

27. Creating Public – Private Partnerships
Partnership between:
SAMHSA’s Center for Substance Abuse Treatment (CSAT)
Robert Wood Johnson Foundation (RWJF)
Goals of improving organizational processes to facilitate client access and retention in addictions treatment. Initial successes include:
Reduced Waiting Times by 31% (n=24)
Reduced No-Shows by 22% (n=13)
Increased Admissions by 25% (n=19)
Increased Treatment Continuation Rates by 33% (n=8)
More info available through web site –

28. Advancing Science to Service Efforts and Reducing the Knowledge – Practice Gap
Focus on elements of health care redesign detailed in Crossing the Quality Chasm (Institute of Medicine, 2001)
Apply evidence to health care delivery
Align payment policies with quality improvement
Prepare the workforce
Use information technology

29. In Conclusion “The future is here.
It’s just not widely distributed yet.”