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Design of the Seclusion and Restraint Study and The National Registry of Evidence-Based Programs and Practices

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Title: A Brief History of Evidence-based Practice and a Vision for the Future Author: HSRI Last modified by: Meighan Created Date: 2/2/2005 7:51:04 PM – PowerPoint PPT presentation

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Title: Design of the Seclusion and Restraint Study and The National Registry of Evidence-Based Programs and Practices


1
Design of the Seclusion and Restraint Study and
The National Registry of Evidence-Based Programs
and Practices
  • H. Stephen Leff, Ph.D.
  • Human Services Research Institute
  • Harvard Medical School Department of Psychiatry
    at the Cambridge Health Alliance
  • Coordinating Center to Reduce and Eliminate the
    Use of Seclusion and Restraint

2
LEARNING GOALS
  1. To Review Seclusion and Restraint Study Design To
    Date
  2. To Increase Understanding of the Origins and
    Design of The National Registry of Evidence-based
    Programs and Practices (NREPP)
  3. To Increase Understanding of the Benefits of and
    Concerns about NREPP
  4. To Increase Our Understanding of NREPP
    Requirements

3
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Two key points.
  • First COLLABORATION
  • Second Evaluation of INTERVENTIONS not sites

4
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Four objectives of evaluation
  • Insure implementation
  • Measure effects of best practice components
  • Develop and test fidelity measures
  • Support application to NREPP


5
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Insuring implementation
  • Process components (How closely did
    implementation match the plan? etc.)
  • Outcomes components (What was the effect of
    infrastructure development on service capacity
    and other system outcomes? etc.)
  • To be captured by fidelity assessment
  • To assess need for TA


6
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Four objectives of evaluation
  • Insure implementation
  • Measure effects of best practice components
  • Develop and test fidelity measures
  • Support applications to NREPP


7
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Measure effects of best practice components
  • Multiple interventions with extensive overlap
  • Lack of standard definitions
  • Relatively undeveloped evidence base


8
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Four objectives of evaluation
  • Insure implementation
  • Measure effects of best practice components
  • Develop and test fidelity measures
  • Support application to NREPP


9
Alternatives to Restraint/Seclusion Evaluation
Overview
Developing and Testing a Fidelity
Scale Fidelity refers to the degree to which a
particular program follows a program model
Fidelity measures are tools to assess the
adequacy of implementation of program models.
(Bond et al., 2000)

10
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Developing and Testing a Fidelity Scale
  • Effectiveness and fidelity
  • Defining the intervention
  • Identifying critical ingredients
  • Facilitating dissemination
  • Gary Bond consultation


11
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Four objectives of evaluation
  • Insure implementation
  • Measure effects of best practice components
  • Develop and test fidelity measures
  • Support application to NREPP


12
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Support application to NREPP
  • NTAC model
  • Other models Support from The Evaluation Center
    _at_ HSRI
  • Importance of comparison sites


13
National Registry of Effective Programs and
Practices (NREPP)
  • A voluntary rating and classification system for
  • substance abuse and mental health prevention
  • and treatment interventions
  • Vision - NREPP becomes a leading national
  • resource for contemporary and reliable
  • information on the scientific basis and
  • practicality of substance abuse and mental
  • health prevention and treatment interventions

14
NREPP Policy Relevance
  • Influence SAMHSA discretionary and block grant
    investments
  • Serve as a resource for states and communities
    seeking to implement evidence-based MH and SA
    prevention and treatment services
  • Provide an important tool for both public and
    private purchasers in selection of effective
    services

15
NREPP is necessary but not sufficient to promote
use of EBPs
  • Prioritize Center-driven technical assistance
    for implementation of evidence-based services
    two key areas
  • Implementation of NREPP programs
  • Science-to-service support to organizations and
    practitioners
  • Development of evidence base for new programs
  • Service to science support to program developers

16
National Registry of Effective Programs and
Practices (NREPP)
  • New web site Fall 2005
  • www.nationalregistry.samhsa.gov
  • Goals - comprehensive and transparent
  • Posting of evaluative scores and criteria
    summaries from scientist reviewers
  • Posting of utility scores and criteria summaries
    from stakeholder reviewers
  • Outcomes searchable database
  • Self-assessment for candidate programs and links
    to educational materials on review criteria

17
National Registry of Effective Programs and
Practices (NREPP)
  • Brief history
  • 1998 began in Center for Substance Abuse
    Prevention
  • 1998-2003 reviewed and rated over 1,100
    substance abuse prevention programs,
  • information on over 150 Model, Effective, and
    Promising Programs on web site (www.modelprograms.
    samhsa.gov)
  • 2004 initial expansion of system to include
    substance abuse treatment, and mental health
    promotion and treatment programs

18
The Need for NREPPTreatments are based on
idiosyncratic and ill-informed judgments
A health care delivery system characterized by
idiosyncratic and often ill-informed judgments
must be restructured according to evidence-based
medical practice, regular assessment of the
quality of care and accountability. The
alternative is a system that makes life and death
treatment decisions base on conflicting anecdotes
and calculated appeals to emotion.
Millenson, ML. Demanding Medical Excellence
Doctors and Accountability in the Information
Age. pg.6 University of Chicago Press, Chicago,
1997
19
The Need for NREPPConsumers are confused and
concerned
Evidence based practices is a new metaphor to
me. I thought evidence was the source of mental
health practices. Are you saying it was not? May
still not be? On what are practices then based?
At no time have I ever heard that people in the
mental health profession based their acts upon
anything other than evidence. Was that a lie? Is
this new metaphor also a lie? And how would I
tell the difference? (Personal Communication,
Harold A. Maio, MA)
20
Medication Medical Device Development System
Behavioral Health Intervention Development System
Basic Science NIH
Basic Science NIMH, NIAAA, NIDA
Intervention Development, Testing, Dissemination
Post Dissemination Monitoring Pharmaceutical
Biotechnology Companies
Intervention Development, Testing, Dissemination
Post Dissemination Monitoring SAMHSA, NIMH,
NIDA, NIAAA To a lesser degree, states,
counties, local programs, foundation and other
funders
Evaluation of Evidence FDA
Evaluation of Evidence SAMHSA, NREPP, to a
lesser degree NIMH
Consumers, Providers, Purchasers
Consumers, Providers, Purchasers
21
Proposed NREPP Intervention Categories Defined by
The Ladder of Evidence in Intervention Science
The Evidence Ladder
Intervention Science Activity
6. Reliable Intervention
5. Disseminable
4. Effective
3. Conditionally Effective
2. Emerging
1. Program of Interest
22
NREPP Rating Criteria Evaluative Criteria
  1. Adjustment of Outcome Measures for Alpha
    Inflation
  2. A Priori Identification of Outcome Measures
  3. Reliability of Measures
  4. Validity of Measures
  5. Intervention Fidelity
  6. Comparison Fidelity
  7. Comparison Condition
  8. Assurances to Participants
  9. Participant Awareness of Condition
  1. Standardized Data Collection
  2. Data Collector Bias
  3. Selection/Assignment Bias
  4. Subject Attrition
  5. Missing Data
  6. Analysis Meets Data Assumptions
  7. A Priori Identification of Analytic Methods
  8. Analysis Consistent with Theory
  9. Anomalous Findings
  10. Replications of Findings

23
Examples of Psychosocial Interventions with
Complex Arrangements and Soft Boundaries that
Have Been Shown To Have Substantial Evidence
24
Alternatives to Restraint/Seclusion Evaluation
Overview
  • Human Services Research Institute
  • 2336 Massachusetts Ave.
  • Cambridge, MA 02140
  • www.hsri.org
  • The Evaluation Center _at_ HSRI
  • www.tecathsri.org

.  
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