The terms Evidence Based Practice (EBP) and Evidence Informed Practice (EIP) crept into the medical vernacular only in the last ten years and these terms are now becoming more familiar to mental health professionals and educators. Why so and what do the terms actually mean? To answer, I’ll use a medical example and then take a look at the implications for school based mental health.
If you took your young child to the family doctor some years ago because of an earache, chances are following a peek into the ear revealing some redness, your doctor prescribed an antibiotic. Not so long ago a systematic review of the use of antibiotics for otitis media was published. It was found that most cases of otitis media will get better in a few days, regardless of whether antibiotics are used and antibiotics do not significantly speed up the process. This information was not available recently until many studies were systematically analyzed. These studies came not from just one expert source but from many researchers from around the world, using controlled trials where a patient was randomly assigned to treatment or no-treatment (placebo). Some of the results were conflicting but taking them all into consideration, some general conclusions were drawn. This type of evidence base from multiple sources is generally considered to be the most valid and reliable, much more so than anecdotal reports or single experiments with only one type of patient. Today, physicians are expected to be familiar with up-to-date research findings and use this knowledge in their clinical practice. Furthermore many “usual” practices, have been found to be clinically ineffective and in some cases, harmful.
In school based mental health, we are no less desirous of doing what works and avoiding doing things that are harmful. If we don’t pay heed to the evidence base, our intuitions might lead us astray. A good example is with respect to how we package the “don’t do drugs” message in schools. Having an assembly to “warn” students about the danger of drug use doesn’t work but some approaches do work. The Rand Corporation researched the Project ALERT program in 50 states in the U.S. with thousands of students and found that it is effective in curbing substance abuse. There are a number of databases of evidence-based practices, the best known is probably that of the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).
There is a subtle difference between an EBP and an EIP. An EBP is an intervention which, from research, is known to work with the problem and population to which it is addressed; whereas an EIP is the inclusion of sound evidence into approaches that take into account both professional judgment and experience. In school based mental health, it is necessary to ensure that any approaches are a good fit for the school context, are acceptable to educators and are workable in a classroom setting. In our work we are talking about three different approaches. The first is a manualized approach (following a specific program exactly); the second is a modularized approach (distilling the “active ingredients” into replicable actions, e.g. ensuring that graduated exposure is a component when dealing with anxiety) and the third is an embedded approach (i.e.: weaving the intervention naturally into the daily routines and everyday occurrences). An example of an embedded approach is to coach teachers to use collaborative problem solving as opposed to resorting a disciplinary measure for a challenging student.
There is a subtle difference between an EBP and an EIP. An EBP is an intervention which, from research, is known to work with the problem and population to which it is addressed; whereas an EIP is the inclusion of sound evidence into approaches that take into account both professional judgment and experience.
This is all still in its infancy. There are attempts to categorize interventions as: “Proven”, “Probably Effective”, “Ineffective” and “Probably harmful”. There are only a few in the top category. Furthermore, there is more to it than just knowing what works. Along with the rise of EBPs and EIPs is the growth of “implementation science”, which is the “how to” of putting scientific knowledge into practice. There is still a huge gap here.
To return to medicine, not all practices introduced today are clearly evidence-based. Just this month, a policy has just been introduced in Canada to shift the responsibility for prescribing medical marijuana to physicians from governmental control. Apparently, the effectiveness of medical marijuana in controlling pain in chronic illnesses relies solely on anecdotal accounts rather than any randomized trials or systematic reviews. The news reports indicate that doctors don’t have any guidelines about how much to prescribe and what kind of patients it is likely to work for. This seems to be a case where politics has trumped science. Go figure!
This blog post is part of CEA’s focus on student mental health, which is also connected to Education Canada Magazine’s student mental health theme issue and a Facts on Education fact sheet on what the research says about effective approaches to improving students’ mental well-being. Please contact firstname.lastname@example.org if you would like to contribute a blog post to this series.