CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 52EVIDENCE-BASED PRACTICESMATTHEW R. MERRENSROBERT E. DRAKEThe desire to improve outcomes by promoting evidence-based health care has recentlyled to a proliferation of practice recommendations, guidelines, and algorithms throughoutmedicine. Research indicates, however, that the distribution of information regardingeffective treatments has been largely insufficient to transform the health care system. Implementingand sustaining new approaches to health care are difficult, notwithstandingthe evidence of benefits to patients.In a parallel fashion, the mental health field has been attempting to facilitate thewidespread adoption of evidence-based practices in routine mental health care settings,so that persons with mental illnesses can benefit from interventions that have been shownto work. Yet implementing and sustaining major changes in mental health care has alsoproven to be difficult.THEORYSeveral models of organizational change have gained attention (Everett M. Rogers’s Diffusionof Innovations [2002] is a scholarly presentation, whereas Malcolm Gladwell’sThe Tipping Point [2002] is a popular best seller). Theorists agree that behavior changeswhen intention to change is combined with the necessary skills and the absence of environmentalconstraint.Theorists also agree that promotion of organizational change has at least threephases:1. Predisposing or disseminating strategies include building information, enthusiasm,and planning, often through educational events or written material.2. Enabling methods refer to processes of putting a new intervention or method ofpractice into place, and include training and supervision based on practice guidelinesand decision supports.3. Sustaining strategies are mechanisms to reinforce continuation of a new practice,and include information technology, financing, and outcomes-based contracting.541