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Strategies for implementing evidence-based practices in routine mental health settings
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  1. Robert E Drake, Md PhD, Professor of Psychiatry,
  2. William C Torrey, MD, Associate Professor of Psychiatry,
  3. Gregory J McHugo, PhD, Associate Professor of Community and Family Medicine
  1. All authors at Dartmouth Medical School, New Hampshire, USA

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    The term `evidence-based medicine‘ was coined in 1990. Since then, the systematic use of scientific evidence in clinical decision-making has expanded.1 The evidence-based medicine movement inspired parallel developments in mental health. Administrators, clinicians, advocates and researchers generally agree that they are obligated to provide the most effective mental health treatments. Implementing evidence-based practices in routine treatment settings is a crucial part of this.2–5

    The key question is: how do we implement evidence-based practices? Routine mental health settings are generally deficient in evidence-based practices.2–5 To redress this, we must understand broad-scale implementation in diverse treatment systems. Working with state mental health systems and researchers throughout the United States, we have been engaged in a multi-state demonstration, the National Evidence-Based Practices Project.6–9 We used several sources to understand implementation: literature on changing healthcare practices; focus groups and interviews with stakeholders; the experience of advocacy groups, and the collective experiences of mental health researchers.9 This editorial summarises findings from these sources and describes the US National Evidence-Based Practices Project.

    Implementing evidence-based mental health programmes

    PRACTICE IMPLEMENTATION LITERATURE

    The practice implementation literature agrees on several points. First, education alone is ineffective at changing health care practices.10 Changing complex programmes requires more extensive interventions than education or training. Among the strategies involved are enhancing motivation, providing adequate resources, increasing skill development and removing environmental constraints.11 Second, change occurs over …

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