Letter

Advancing Evidence-Based Practices Through Psychiatric Consultation

To the Editor: An emerging role for a psychiatric consultant is to advance the implementation of evidence-based mental health practices. Evidence-based practices are the emerging standard on which current mental health treatments are based ( 1 ). The Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence is a statewide technical assistance center that focuses on assisting programs to implement and maintain high fidelity to the integrated dual disorders treatment model ( 2 , 3 ). The center employs a psychiatrist as a consultant; the primary consultees include treatment teams at mental health agencies, county mental health boards, and the state department of mental health. As in traditional psychiatric consultation roles, a supportive nonhierarchical relationship is fostered between consultant and consultees ( 4 ). In contrast to usual psychiatric consultation, the center's psychiatric consultant has unique roles.

Six roles of the center's psychiatric consultant include trainer-educator, consultant to teams, consultant to physicians, fidelity reviewer, linkage resource, and role model. As a trainer-educator, the psychiatric consultant educates others about general and specific aspects of the model by means of in-person and videotaped presentations and a statewide video-conference network. Consultation to teams includes programmatic and clinical consultation. Most often, the team will seek consultation on patients viewed as "difficult" or for whom the usual interventions are ineffective. Consultation to physicians may entail meeting with individual psychiatrists about model implementation, training small groups of psychiatrists, or communicating by e-mail or Web site bulletin board. As a fidelity reviewer, the psychiatric consultant takes part in the annual visit to treatment teams for the purpose of measuring fidelity to the integrated treatment model. A written report summarizes findings and makes recommendations for improving fidelity. As a linkage resource, the consultant makes beneficial connections between treatment teams and the criminal justice, vocational rehabilitation, and child welfare systems. As a role model, the consultant can provide guidance for other psychiatrists about how to establish and maintain a similar role in their own community.

The infrastructure of the Ohio Substance Abuse and Mental Illness Coordinating Center of Excellence is the major factor that ensures the success of the psychiatric consultant. The psychiatric consultant is a member of the center's staff and meets with other staff members to discuss training, administrative, and clinical issues that have an impact on integrated treatment teams. Training and consultation are jointly conceptualized and delivered by team members, including the psychiatric consultant. Another facilitating factor is that the psychiatric consultant treats patients using the integrated treatment model, which increases role credibility. Three other strategies for success include fostering a strong relationship with the team through ongoing communication, focusing on specific populations of providers, and providing stagewise interventions to treatment teams in the same way that these interventions are applied to individual patients.

To summarize, evidence-based practices in mental health are more easily accepted and implemented when an existing infrastructure supports training and consultation about these practices. A psychiatrist can play several key roles as a statewide consultant to teams, agencies, and systems throughout the implementation process.