Legacy Behavioral Health Approved Evidence Based Practices
|Purpose (Evidence Base)
|Acceptance and Commitment Therapy is a contextually focused form of cognitive behavioral psychotherapy that uses mindfulness and behavioral activation to increase a client’s psychological flexibility—his/her ability to engage in values-based, positive behaviors while experiencing difficult thoughts, emotions, or sensations. (CEBC 2017)
|Assertive Community Treatment (ACT) is an evidence-based practice that improves outcomes for people with severe mental illness who are most at-risk of psychiatric crisis and hospitalization and involvement in the criminal justice system. ACT is one of the oldest and most widely researched evidence-based practices in behavioral healthcare for people with severe mental illness.
ACT is a multidisciplinary team approach with assertive outreach in the community. The consistent, caring, person-centered relationships have a positive effect upon outcomes and quality of life. Research shows that ACT reduces hospitalization, increases housing stability, and improves quality of life for people with the most severe symptoms of mental illness. ACT may also reduce staff burnout and increase job satisfaction, cost effectiveness, and client satisfaction.
|Assertive Community Treatment was found most effective in terms of cutting hospital use and promoting community reintegration among service recipients with SMI who had frequent psychiatric hospitalizations (Bond & Drake, 2015). Another study found assertive community treatment was instrumental in increasing service recipients’ ability to navigate a fragmented mental health system (Drukker et al., 2014).
Certified Community Behavioral Health Clinics Demonstration Program Report to Congress, 2017, SAMHSA
|Counseling on Access to Lethal Means – CALM
|CALM is used to counsel individuals at risk for suicide and those who support them on mean restriction to lethal means, such as firearms and medication. This can determine whether a person at risk for suicide lives or dies. Research has demonstrated CALM is effective in increasing the clinician’s comfort, knowledge, and frequency of talking about means restriction.
|CALM is modified for Child and Adolescent individuals by using with the parent or caretaker of the child or adolescent.
Therapy – individual
|Cognitive behavioral therapy teaches individuals in treatment how to recognize and stop negative patterns of thinking and behavior (SAMHSA, August 2016). Cognitive Behavioral would be appropriate for use with Veterans with PTSD and adults with SED/SMI/SUD to gain a sense of control, self-confidence, and predictability, and reduce escape and avoidance behaviors with its focus on self-reliance. Maladaptive behavior patterns are learned, and that problematic behaviors can be corrected through a range of self-monitoring skills and avoiding high-risk situations. This training will allow participants to build resiliency.
|Culturally adapted interventions to address the concerns of ethno-racial minorities incorporating cultural values of individual.
|The Cognitive-Behavioral Interventions for Substance Use (CBI-SU) curriculum is designed for individuals that are moderate to high need in the area of substance abuse and well suited for criminal justice populations. The curriculum can be delivered as a stand-alone substance abuse intervention, or incorporated into a larger program, particularly those designed for clients in the corrections system. As the name of the curriculum suggests, this intervention relies on a cognitive-behavioral approach to teach participants strategies for avoiding substance abuse. The program places heavy emphasis on skill building activities to assist with cognitive, social, emotional, and coping skill development. Such cognitive- behavioral strategies have routinely demonstrated high treatment effects, including when used with a correctional population. The University of Cincinnati (UC) serves as the sole owner and proprietor of the copyright in the CBI-SA manual and training program.
|DBT is a cognitive behavioral treatment developed to aid individuals with chronic emotion regulation issues. Appropriate for use with individuals with substance use to learn to envision, articulate, pursue and sustain goals independent of out-of-control behavioral by use of skills of mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness. Effective for individuals with suicidal ideation and risk. Individual psychotherapy and group skills-training classes help people learn and practice new skills and develop a life that they experience as worth living.
|SAMSHA’s NREPP 2018 rated DBT is the highest rated evidence-based practice. This can be modified for use with children and adolescents and their families through curriculum identifying dialectical dilemmas with validation and behavioral change.
|Eye Movement Desensitization and Reprocessing (EMDR) therapy is an extensively researched, effective psychotherapy method proven to help people recover from trauma and other distressing life experiences, including PTSD, anxiety, depression, and panic disorders. The American Psychiatric Association, the American Psychological Association, the International Society for Traumatic Stress Studies, National Alliance on Mental Illness, the Substance Abuse and Mental Health Services Administration, the U.K. National Institute for Health and Care Excellence, the U.S. Dept. of Veterans Affairs/Dept. of Defense, The Cochrane Database of Systematic Reviews, and the World Health Organization among many other national and international organizations recognize EMDR therapy as an effective treatment.
|Recognized by VA as EBP effective tor veterans with PTSD/Trauma. NIH research recognizes EMDR as effective for individuals with trauma for adults and children. Will use without modification.
|DBT is a cognitive behavioral treatment developed to aid individuals with chronic emotion regulation issues. Both individual psychotherapy and group skills-training classes are provided in order to help people learn and practice new skills and develop a life that they experience as worth living. DBT skills include topics of mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness.
|Living In Balance
|Evidence-based program that draws from cognitive, behavioral, and experiential treatment approaches with a strong emphasis on relapse prevention. The program uses didactic education and instruction, written exercises, group process interaction through role-plays and discussion, relaxation and visualization exercises and group-oriented recreational therapy exercises. Includes Core Curriculum, Recovery management Curriculum and Co-occurring Disorders Curriculum. Developed by Danya International and tested as part of a NIDA-funded project. Living in Balance is a clinically validated, evidence-based program that has been proven to retain clients longer in treatment and reduce alcohol and other drug use.
|MRT—Moral Reconation Therapy®, an NREPP program, is the premiere cognitive-behavioral treatment program for substance abuse and offender populations. Developed in 1985 by Dr. Gregory Little and Dr. Kenneth Robinson, over 200 published outcome studies have documented that MRT-treated offenders show significantly lower recidivism for periods as long as 20 years after treatment.
|Motivational Interviewing (MI) is appropriately used with adults with SUD and adults in rural communities for benefit of health promotion, medical treatment adherence and other mental health issues as a goal-directed, client-centered counseling style for eliciting behavioral change by assisting clients to explore and resolve ambivalence. Ambivalent attitudes or lack of resolve is the primary obstacle to behavioral change, so that the examination and resolution of ambivalence becomes its key goal. MI has been applied to a wide range of problem behaviors related to alcohol and substance use as well as health promotion, medical treatment adherence, and mental health issues.
|Can be modified for underserved populations by using Ecological Validity Model (EVM) a cultural adaptation framework that considers several cultural dimensions for use of interventions. Motivational interviewing positively contributes to the treatment of alcohol, tobacco, and cannabis use; depression, anxiety, and mood disorders; and numerous physical health issues, including medication adherence. Studies show motivational interviewing to be effective for a range of ages, from adolescent to elderly patients (Riper et al., 2014; Satre et al., 2016; Dean, Britt, Bell, Stanley, & Collings, 2016; Lundah et al., 2013; Moral et al., 2015).
|Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a “whole-patient” approach to the treatment of substance use disorders. Medications used in MAT are approved by the Food and Drug Administration (FDA) and MAT programs are clinically driven and tailored to meet each patient’s needs. MAT has proved to be clinically effective and to significantly reduce the need for inpatient detoxification services for these individuals. MAT provides a more comprehensive, individually tailored program of medication and behavioral therapy that address the needs of most patients. Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery. MAT is also used to prevent or reduce opioid overdose.
|Projects for Assistance in Transition from Homelessness (PATH)
|PATH is a SAMHSA funded service for people with serious mental illness (SMI) experiencing homelessness. It involves: Outreach, Screening and diagnostic treatment, Habilitation and rehabilitation, community mental health, substance use disorders treatment, referrals for housing, primary health care, job training, and educational services.
|Because they are designed and delivered by peers who have been successful in the recovery process, they embody a powerful message of hope, as well as a wealth of experiential knowledge. SAMHSA, 2009.
|Guided by the (Dr. Aaron T. Beck) cognitive model, Recovery-Oriented Cognitive Therapy (CT-R) is an evidence-based practice that provides concrete, actionable steps to promote recovery, resiliency, and empowerment. CT-R has shown to have an impact on individual’s ability to access motivation, energy, and positive beliefs about themselves, others, and the future. (Paul M. Grant, PhD, 2020).
|Must be trained in this model
|Structured follow-up and monitoring is a procedure in which individuals who have recently experienced a suicide crisis and/or recently returned home from a hospitalization are followed and monitored. The follow-up is usually by telephone; other methods, such as a home visit may be used as well. The follow-up call is usually brief and follows the same structured format each time. The call is conducted in a friendly, matter of fact, professional manner. Permission for follow-up is obtained during the crisis visit/call as is permission to leave a voice mail if the suicidal individual is not reached.
|Empirically derived rather than theoretically based both in construct and practice, the SFBT approach is a goal-directed collaborative approach to psychotherapeutic change primarily conducted through direct clinical observation of clients’ responses to a series of carefully constructed questions.
|Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) would be an appropriate EBP for children and TF-adolescents impacted by trauma as well as the LBGTQAI+ population diagnosed PTSD to resolve a broad array of emotional and behavioral difficulties associated with single, multiple, and complex trauma experiences.
|Can be modified for those in the LBGTQAI + population utilizing Life Events Checklist for DSM-5 (screener for lifetime exposure to various Criterion A traumas). Screening and assessment activating and exploring the context of memory networks linked to shame, fear, and associated cognitions due to discrimination and trauma associated with identity.
(C&A and Adult)
|The Seven Challenges® program, specifically for young people with drug problems, is designed to motivate a decision and commitment to change and to support success in implementing the desired changes. The program simultaneously aims to help young people address their drug problems as well as their co-occurring life skill deficits, situational problems, and psychological problems.
|QPR (Question, Persuade, and Refer) Gatekeeper Training for Suicide Prevention is a two-hour educational program designed to teach lay and professional “gatekeepers” the warning signs of a suicide crisis and how to respond, addressing the local need for a safety net of trained gatekeepers.
|SPRC designated this intervention as a “program with evidence of effectiveness” based on its inclusion in SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP).
|Mental Health First
|Mental Health First Aid and Youth Mental Health First Aid are appropriately utilized in rural communities with limited access to health care and in cultures where there is stigma surrounding mental health as it provides public education programs to improve participants’ knowledge and modify their attitudes and perceptions about mental health and related issues, supporting identification of mental health crises and appropriate responses and actions, protecting youth and adults
|SAMSHA’s NREPP 2018 rated Mental Health First Aid and Youth Mental Health First Aid as highest rated evidence-based practices. No modifications are proposed.
|Employment First is a national systems-change framework centered on the premise that all individuals, including those individuals with the most significant disabilities, are capable of full participation in Competitive Integrated Employment (CIE) and community life. Under this approach, publicly financed systems are urged to align policies, regulatory guidance, and reimbursement structures to commit to CIE as the priority option with respect to the use of publicly financed day and employment services for youth and adults with significant disabilities.
|Supported Employment/Individual Placement and Support (SE/IPS) is an evidence-based practice that helps people with mental illness and other disabilities identify and acquire part-time or full-time jobs of their choice in the community with rapid job-search and placement services. It emphasizes that work is not the result of treatment and recovery but integral to both.