National Registry Of Evidence-based Programs And Practices Research Articles

4.2 STUDENT THREAT ASSESSMENT AS A STANDARD SCHOOL SAFETY PRACTICE

Leading authorities in education, law enforcement, and mental health recommend a systematic threat assessment approach to evaluate youth who threaten to commit a violent act. School providers do not want to overreact to threats that are not serious, yet they must recognize and take action in response to a serious threat in order to prevent a threat from being carried out. Farah Williams, PhD, will briefly review the use of the Comprehensive School Threat Assessment Guidelines (CSTAG), an evidence-based model for schools to use in conducting threat assessments in K-12 schools. The CSTAG focuses on the identification, assessment, and management of threats with a preventative and problem-solving approach. The guidelines allow providers to resolve less serious, transient threats quickly while focusing greater attention on more serious, substantive threats. The CSTAG has been extensively examined through field tests and controlled studies that demonstrate its utility and effectiveness. It has been widely adopted by schools nationwide and was recognized as an evidence-based program by the National Registry of Evidence-based Programs and Practices (NREPP) in 2013. Research comparing general-education and special-education students receiving a threat assessment using the CSTAG evidenced no statistically significant differences in terms of disciplinary sanctions. Similarly, no statistically significant differences in disciplinary sanctions were seen for White, Black, or Hispanic students when the CSTAG was used to evaluate threats made. School threat assessment teams using the CSTAG learn how to use a decision-tree process to efficiently assess whether a youth is not just making a threat but actually poses a threat of violence. Using this prevention- and intervention-focused, systematic approach promotes efficient identification and resolution of threats with less susceptibility to reactive, fear-based responses and less vulnerability to discriminatory biases that often come to light in threat assessment, including disproportionate discipline and suspension of our minority and special-education students.

Intermediary/purveyor organizations for evidence-based interventions in the US child mental health: characteristics and implementation strategies

BackgroundMany psychosocial interventions are disseminated and supported by organizations, termed “Intermediary/Purveyor Organizations” (IPOs). Because IPOs remain largely unstudied, we lack understanding of their scale and the strategies they utilize. The role and function of organizations that link resource systems with user systems, such as IPOs, have been identified as an important but understudied issue in implementation science. The objectives of this paper are to describe features of IPOs that disseminate evidence-based interventions (EBIs) for child behavioral health and identify the strategies they use to support their implementation.MethodsThe Substance Abuse and Mental Health Services (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP) listed 119 unique IPOs for the 127 child behavioral health EBIs listed on its website. Data characterizing each organization were drawn from NREPP and GuideStar profiles. From 119 unique IPOs identified, we found contact information for 108. We sent an electronic survey to capture additional organizational information and implementation strategies the IPOs employed in spreading the EBIs; response rate was 50%. Data are presented descriptively and analyzed using ordinary least squares (OLS) regression and Latent Class Analysis (LCA).ResultsVirtually all identified EBIs had an IPO. IPOs train individuals, organizations, and communities and provide supervision for the use of EBIs. About 20% of IPOs trained at large scale, some training 500–1000+ providers annually. IPOs reported using an average of 32 distinct strategies to implement their EBIs, with most using educational, planning, and quality improvement strategies. However, there was little convergence around strategy helpfulness. The only significant predictor of number of strategies used by an IPO was the NREPP-posted implementation readiness score of the intervention. LCA revealed that IPOs either used several implementation strategies or used very few.ConclusionsFindings add significantly to knowledge about IPO structure, scale, and function. They use numerous and varying implementation strategies but report little consensus in what works. The study advances methods for measuring and characterizing real-world implementation by demonstrating the feasibility of using a common nomenclature, per a published compilation and of LCA for data reduction in characterizing profiles of implementation approaches.

Technology-Oriented Suicide Prevention Interventions for Adolescents and Adolescent Gatekeepers: A Qualitative Review

Youth suicide is increasing in the United States. To moderate youth suicide, it is important to implement effective prevention programs and target modifiable protective and risk factors through intervention. This review examined programs that are consistent with these goals, specifically, technology-oriented suicide prevention programs included in the National Registry of Evidence-Based Programs and Practices (NREPP) and Best Practices Registry (BPR). Technology-oriented programs are highly accessible among adolescents, as well as adolescent gatekeepers. Gatekeepers were defined as adults in a community who frequently interact with youth in the community, and who may be trained to identify and refer at-risk youth (e.g., teachers, coaches, counselors, parents). To understand the impact of these interventions, program efficacy (i.e., outcomes), program reach (i.e., population-level impact, level of technology integration), location of supporting program evidence (i.e., medical literature, Google Scholar, national registries, program organizational website), and quality of supporting research evidence (i.e., study design, quality of research ratings) were explored. PubMed, PsycINFO, PsycARTICLES, PASCAL, CINAHL, Scopus, Cochrane Library (n = 3,942); Google Scholar (n = 411); the NREPP (n = 127); the BPR (n = 114); and program organizational websites (n = 26) were searched. Published and unpublished studies (n = 35) were integrated. Review of technology-oriented interventions indicated that many have been found to improve secondary outcomes, suicide outcomes, and gatekeeper preparedness. Interventions also demonstrated potential for reach, as technology generally enhanced the spread of prevention content among adolescents and/or adolescent gatekeepers. However, the accessibility of evidence was often reduced through dispersion, as evidence was retained within multiple forums (i.e., medical literature, Google Scholar, national registries, program organizational websites). Finally, the quality of supporting research evidence was generally strong, although there was variability with regard to rigor in study design and inclusion of large samples. Additional research is important toward strengthening the evidence base, and additional evidence that is readily accessible may increase both reach and sustained use, to enhance overall impact.

Has the National Registry of Evidence-based Programs and Practices (NREPP) lost its way?

Has the National Registry of Evidence-based Programs and Practices (NREPP) lost its way?

Commentary: Improving the lives of individuals with serious mental illness.

A Dr. Satel’s Open Forum essay (1) illustrates, much has been said and written lately about the need to more adequately address the needs of people with serious mental illness and their families. Addressing these needs is a critical part of the overall mission of the SubstanceAbuse andMentalHealth Services Administration (SAMHSA). SAMHSA is also charged by Congress with helping to build resilience and emotional health, prevent substance abuse and mental illness and their disabling effects, implement current evidencebased practices, cultivate new practice models, and support individuals who are in recovery from mental and substance use disorders. SAMHSA has significant leadership responsibilities for substance abuse and mental health issues for children, adolescents, adults, and families. For example, SAMHSA is working with federal, state, and local partners to implement the Affordable Care Act and federal parity law, which together offer more than 60 million Americans expanded access to behavioral health treatment and services. This is the single largest expansion of mental health and substance abuse benefits in a generation. SAMHSAalsoworks to improveavailable treatments for people with schizophrenia, bipolar disorder, depression, and other serious conditions through policy making, distribution of grants, collection and dissemination of data, and clinician and public education. SAMHSA provides funds to address homelessness and criminal justice involvement, support mental health courts, create employment opportunities, provide outreach, and engage individuals with seriousmental illness whomight otherwise be in jail, on the streets, in emergency rooms, or not in treatment. Less than a third of SAMHSA’s budget is for mental health issues. The rest is appropriated to address substance use and addiction. Almost 80% of the mental health portion is targeted for persons with the most serious mental disorders. According to 2009 data, most of the funds spent in the United States for mental health services come from Medicaid (27%), private insurance (26%), state and local governments (15%), and Medicare (13%). The SAMHSA-administered mental health block grant is part of other federal spending on mental health care. Congress allocates these funds by formula to states for individuals with the most serious mental illnesses and allows states to determine the proportion to be used for adults and for children and the specific communitybased services to fund, as each state considers its Medicaid and other available funding. Congress recently implemented a 5% set-aside for individuals who are in the early stages of serious mental illnesses, including psychotic disorders. SAMHSA and the National Institute of Mental Health are providing states with guidance and assistance for this program. SAMHSA also funds grants to support family involvement in mental health care. To address treatment needs when traditional medications and psychiatric care are not effective or when they only partially help manage symptoms (2), a small portion of SAMHSA’s funding supports an annual conference about promising alternatives and adjunctive therapies. In addition, SAMHSA’s work in suicide prevention and disaster response saves thousands of lives each year, including the lives of many who do not have serious mental illness but who do have severe emotional responses that need attention to prevent devastating outcomes. Some critics have implied that SAMHSA should focus primarily on adults who meet criteria for certain diagnoses and who do not accept that they have a mental illness and do not agree to medical treatment. This group is one of themany SAMHSA is charged to address. As one commentator noted, all mental illness is serious, especially when symptoms cause concern or are not controlled (3). SAMHSA recognizes that behavioral health is essential to health and that mental and substance use disorders should be treated like any other health condition—when they are in a serious stage, when they are disabling, or when symptoms are under control. SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP) includes more than 330 model programs of all types and is just one part of SAMHSA’s commitment to disseminating evidence-based and promising practices. Any program developer—including those who create mandated treatment programs— can submit a program for review. If it is found to have sufficient research backing and is able to be replicated, it can be listed in NREPP. Through these and other initiatives, SAMHSA is changing the way mental illness is understood and treatment is provided. The recovery model advanced by SAMHSA and articulated by thePresident’sNewFreedomCommission on Mental Health in its 2003 report (4) includes helping those who are experiencing mental health conditions and their families receive Ms. Hyde is administrator of the Substance Abuse and Mental Health Services Administration, Rockville, Maryland (e-mail: pam. hyde@samhsa.hhs.gov).

The review of new evidence 5 years later: SAMHSA's National Registry of Evidence-based Programs and Practices (NREPP)

The Substance Abuse and Mental Health Services Administration (SAMHSA) decided that NREPP should offer a second review option for interventions that have already been reviewed and included in the registry for 5 years. Principals from 135 such interventions were invited to participate in a second review, and an exploratory study of the Principals’ responses to this invitation was conducted. The study used a mixed-method approach, quantitatively describing characteristics of Principals and their interventions and qualitatively summarizing feedback from phone interviews with a convenience sample of Principals participating in a second review. Of the Principals invited, 21% accepted a second review, 24% were interested but unable or not ready to submit materials, and 56% did not accept or did not respond. Mental health treatment interventions were more likely to undergo a second review, and substance abuse treatment interventions were less likely. Similar percentages of interventions undergoing a second review had received funding from the National Institutes of Health (86%) and had been evaluated in a comparative effectiveness research study (79%). Overall ratings for interventions improved in each second review completed. The interviewed Principals perceived potentially lower ratings as the only risk in participating in a second review.

A Review of School Mental Health Programs in SAMHSA’s National Registry of Evidence-Based Programs and Practices

OBJECTIVE School programs provided by the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices (NREPP) were reviewed to describe program characteristics, costs, and ratings of research and dissemination. METHODS Data were gathered from the NREPP to identify mental health programs adaptable for schools. Program costs and quality and dissemination ratings were examined as a function of program characteristics. RESULTS School mental health programs constituted 32% of the registry, with 44% providing only materials at cost and 46% providing universal mental health promotion rather than intensive supports. Readiness for dissemination was poorer for programs providing only intensive supports, and quality of research increased as total costs of program implementation increased. CONCLUSIONS Mechanisms for tracking mental health promotion and treatment can be effective in disseminating information about evidence-based school programming. Assessing program transportability is necessary for decision making to match programs with the needs of particular schools and communities.

RURAL ADOLESCENT SUBSTANCE ABUSE: PREVENTION IMPLICATIONS FROM THE EVIDENCE

Purpose: To identify appropriate adolescent substance abuse prevention programming for rural populations through the application of three concepts: effectiveness (best clinical evidence), efficiency (benefit to rural populations), and equality (access). Methods: A review of the literature guided by these concepts was conducted to identify criteria essential to the tailored development of rural adolescent substance abuse prevention programming. An advanced search of the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices (NREPP) was then conducted using criteria tailored to rural populations. Findings: Results from the literature search support the inclusion of two components directed at improving quality of outcomes through a customized approach to rural adolescent substance abuse prevention programming: inclusion of parents in prevention education efforts and use of the Internet as an appropriate method of program delivery. These components were satisfied by one program listed on SAMHSA’s NREPP: Parenting Wisely . Conclusions: While Parenting Wisely is an ideal program for rural adolescent substance abuse prevention strategy, it may not be suitable for all communities. Parallel to recommendations from the SAMHSA and Institute of Medicine, other evidence-based prevention programs need to be expanded to include a web-based delivery option. Strategies for moving forward would include the use of advanced-practice nurses at the forefront of discussion for rural professionals, researchers, educators, and policymakers. Key Words: Access to Care, Technology, Substance Abuse Prevention, Rural

PROTOCOL: Family Behavior Therapy (FBT) for young people in treatment for non‐opioid drug use

PROTOCOL: Family Behavior Therapy (FBT) for young people in treatment for non‐opioid drug use

A Review of Mental Health Interventions in SAMHSA's National Registry of Evidence-Based Programs and Practices

This study identified and examined characteristics of mental health interventions listed in a registry of evidence-based behavioral health programs and practices. Data were from the National Registry of Evidence-Based Programs and Practices (NREPP), which is sponsored by the Substance Abuse and Mental Health Services Administration. All mental health interventions posted as of May 2010 were reviewed. A total of 91 interventions were assessed. Over half (57%) focused on promoting mental health rather than on treating mental illness. The implementation materials and trainings for most interventions (52%) were proprietary. Analysis of NREPP's rated dimensions revealed that quality-of-research scores were significantly lower for interventions with exclusively proprietary materials, whereas readiness-for-dissemination scores were significantly lower for interventions with exclusively publicly available materials. NREPP represents a practical tool for organizations seeking to initiate or expand their use of evidence-based services. Periodic studies of listed interventions may help to identify programmatic gaps in NREPP.

A Squandered Opportunity?

In the past decade, the push for evidence-based programs has taken on unprecedented prominence in the fields of substance abuse and correctional treatment as a key determinant for intervention funding. The National Registry of Evidence-based Programs and Practices (NREPP), managed and funded by the Substance Abuse and Mental Health Services Administration, was established in 1997 to aid community agencies in adopting intervention models for their particular clientele. Although well intentioned, the NREPP has also created opportunities that invite conflicts of interests and promulgate programs with questionable efficacy. After an exhaustive review of the literature that purports to have provided the “empirical evidence” for the NREPP registered programs, the authors found numerous irregularities in the studies with findings often based on small sample sizes. A more troubling finding is that much of the supporting literature is produced by the program developers themselves. There is a general lack of independent verification of the claimed treatment effects. If the NREPP is to fulfill its intended function, a tighter vetting process is needed for programs to be registered so that community agencies and treatment practitioners can consult with confidence.