In Reply: Mr. Seitzer's letter regarding my article supports the contention that high-quality leadership is an important consideration in the provision of high-quality mental health services. Establishing a link between leadership and the attitudes of mental health service providers toward adopting innovation and change—evidence-based practices in particular—was the main point of the article. The article does not, however, contend that evidence-based practices are the only means of improving outcomes for those involved in mental health services.
There is considerable debate regarding applicability, standards for fidelity, and the need for local adaptation of evidence-based practices. The article takes no stand on the value of evidence-based practices per se. The Evidence-Based Practice Attitudes Scale (1), which was used in the study, was developed because providers' attitudes toward adopting innovation have been largely ignored in the research literature, even while the impetus to disseminate and implement evidence-based practices has gained momentum.
Mr. Seitzer's assertion that outcomes matter more than particular practices raises a complex and important issue. Services might be greatly improved if outcomes were routinely empirically assessed in usual care. Rigorous outcome measurement and use of such outcome data to inform clinical practice are relatively rare. Indeed, research suggests that clinicians' attitudes about using such measures vary greatly, with some believing that clinical knowledge and judgment are at least as accurate as empirically reliable and valid assessment, thus obviating the need for such measures (2). There is evidence that draws such an assumption into question (3). Assessments will likely be beneficial to the degree that they can be incorporated into the clinical process both to better understand initial diagnoses and problems and to track clinical progress.
Although my study did not directly address outcome assessment, it did establish a link between leadership and providers' attitudes toward adopting evidence-based practices as part of a research program on improving the context for delivery of high-quality mental health services and implementation of innovation (4). An innovation in mental health care may or may not be evidence based. What is emerging from this line of research is that leadership and organizational context are likely to play an important role in implementing innovation and promoting more positive outcomes for mental health and social service agencies and clinics (5).
1.Aarons GA: Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research 6:61-74, 20042.Garland AF, Kruse M, Aarons GA: Clinicians and outcome measurement: what's the use? Journal of Behavioral Health Services and Research 30:393-405, 20033.Dawes RM, Faust D, Meehl PE: Clinical versus actuarial judgment. Science 243:1668-1674, 19894.Aarons GA: Measuring provider attitudes toward evidence-based practice: consideration of organizational context and individual differences. Child and Adolescent Psychiatric Clinics of North America 14:255-271, 20055.Glisson C: The organizational context of children's mental health services. Clinical Child and Family Psychology Review 5:233-253, 2002