edited by Chris E. Stout and Randy A. Hayes; Somerset, New Jersey, John Wiley and Sons, Inc., 2005, 384 pages, $60
Dr. Sederer is executive deputy commissioner, Mental Hygiene Services, New York City Department of Health and Mental Hygiene.
The trouble with evidence-based practices—stated in this text as "the use of treatment methodologies for which there is scientifically collected evidence that treatment works"—is that they don't cover enough ground, have typically excluded consumer and family preferences and input, and can crowd out promising but as yet unproven practices. Also, knowing what works does not equate to doing what works.
I recall reading an opinion piece in the British Medical Journal on evidence-based practices (EBPs) that examined MEDLINE and other databases to see whether any randomized controlled trials had been performed to determine whether parachutes were effective in preventing death and major trauma (1). Clearly, no such trials exist, although the effectiveness of parachutes is commonly known. The authors of the opinion piece went on to say that strict adherents of EBPs should organize and participate in a randomized, placebo-controlled, cross-over trial of the parachute. They might then come to reconsider their previously held conviction that EBPs should be the sole standard for clinical practice.
But when EBPs exist, and when we employ them, what good they can do. It is not sufficient, the editors of this book assert, to intend to do well and yet fail to do what has been proven to work. They demonstrate that good clinical practice is the fortunate marriage of ethical intent and fidelity to proven practices. And this text serves the cause of good clinical practice with a consistent and clear voice through standardized chapter design and capable editors' hands.
The book begins with nine chapters on specific EBPs, including assertive community treatment, supported employment, child and adolescent treatments, treatments for clients with mental illness and chemical abuse, and psychosocial rehabilitation. Six of these nine chapters constitute the Substance Abuse and Mental Health Services Administration's "tool-kit" for EBPs. An exceptional chapter on recovery from severe mental illness offers the reader decades of research and wisdom from William Anthony and the Center for Psychiatric Rehabilitation. The text concludes with several chapters by one of the editors, Dr. Hayes, that provide practical information on how to assess programmatic readiness for EBPs and how to implement them in a practice, agency, or facility.
Dr. Hayes, one of the editors, himself has not merely talked the talk, he has walked it. His community-based organization has won the distinguished Codman Award from the Joint Commission on Accreditation of Healthcare Organizations and the American Psychiatric Association's Bronze Psychiatric Services Award. His coeditor, Dr. Stout, has notable experience in academic, management, and government work. Together they have produced a text not only worth buying but worth reading.
Still, even if we learn, we also must do. The world of clinical practice often falls short of using the evidence we have. This shortfall is not because of bad clinicians; it is typically because our systems of information technology have yet to encode guidelines and best practices into electronic clinical records and make them standard operating practices. When that happens, consumers, families, and clinicians alike will realize the aims of what the editors offer as their standard, the Hippocratic Oath: to help or at least to do no harm.
Smith GC, Pell JP: Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials. British Medical Journal 327:1459-1461, 2003