We are deeply disappointed to read that the National Registry of Evidence
Based Programs and Practices will no longer be funded through SAMHSA. This
has been an invaluable resource for many years and frankly a gold standard
for many community based behavioral health providers.

Trump administration halts ‘evidence-based’ program that evaluates
behavioral health therapies

By Sharon Begley @sxbegle

January 10, 2018

The Trump administration has abruptly halted work on a highly regarded
program to help physicians, families, and others separate effective
“evidence-based” treatments for substance abuse and behavioral health
problems from worthless interventions.

The program, called the National Registry of Evidence-Based Programs and
Practices, was launched in 1997 and is run by the Substance Abuse and
Mental Health Services Administration. Its website lists 453 programs in
behavioral health — aimed at everything from addiction and parenting to HIV
prevention, teen depression, and suicide-hotline training — that have been
shown, by rigorous outcomes measures, to be effective and not quackery. The
most recent were added last September.

In an email dated Jan. 4 and sent to program developers, the contractor
hired by SAMHSA to work on the registry said, “It is with great regret that
we write to inform you that on December 28, 2017, we received notification
from SAMHSA that the NREPP contract is being terminated for the convenience
of the government. This cancellation means that we can no longer make any
updates to your program profile. … We are deeply saddened by the
government’s sudden decision to end the NREPP contract, under which we have
been able to provide and strengthen science-based information about mental
health and substance use treatment and prevention programs.”

A recipient shared the email with STAT. The contractor, Development
Services Group Inc., of Bethesda, Md., did not reply to a request for
comment. A SAMHSA spokesman did not reply to questions sent by phone and
email. The agency is part of the Department of Health and Human Services.

The website of the now-frozen
registry has not been taken down. In an online statement, SAMHSA said
future work on the registry, including vetting new applications, would be
moved in-house “to reconfigure its approach to identifying and
disseminating evidence-based practice and programs.”

Despite the inclusion of the phrase “evidence-based,” the statement did not
assuage critics’ concerns. Because SAMHSA has not explained how or when it
will pick up the registry work, “I’m pessimistic,” said psychology
professor Warren Throckmorton, of Grove City College in Pennsylvania, who
teaches a seminar that includes lessons on evidence-based programs and
practices. “Why did they stop something before they had something to put in
its place? Why stop what was working reasonably well?”

The administration said last month

that it had advised agencies such as the Centers for Disease Control and
Prevention to avoid using seven words — including “evidence-based,”
“science-based,” “fetus,” and “transgender” — in budget documents and to
instead use language that wouldn’t antagonize members of Congress.

The guidance, for example, suggested that instead of describing a policy or
decision as “evidence-based,” the CDC say that it “bases its
recommendations on science in consideration with community standards and
wishes.”

But critics alarmed by the SAMHSA decision said it suggests that what they
described as the administration’s skepticism about scientific evidence has
now been extended.

Just as mainstream medicine has been embracing an evidence-based approach
(testing assumptions that, say, arthroscopic surgery for knee osteoarthritis works)
so that patients do not receive useless care, so has behavioral health, which
includes mental health as well as things such as parent-child relationships
and social functioning. Behavioral health has lagged behind, however,
because some of the problems it addresses are partly subjective, making it
“easy to convince yourself that something is effective when it’s not,” said
Throckmorton. That’s harder to demonstrate for interventions meant to help
with parent-child interactions than, say, to treat cancer.

Throckmorton said his interest in the field grew from his realization that
“change therapy” — to alter people’s sexual orientation — has no scientific
basis.

By identifying programs whose effectiveness is supported by evidence, the
registry “has been a gold seal of approval,” said a physician at a child
health program who asked not to be identified because he did not want to
jeopardize his SAMHSA funding. And there is considerable work still to be
done in spreading evidence-based programs: Only 3 percent of children with
problems ranging from attention deficit hyperactivity disorder to
disruptive behavior to suicidality receive evidence-based services, he
said, partly because scientifically valid programs often have a high price
tag.

Making it harder for people struggling with addiction and their families to
see whether a treatment they’re being offered has been shown to work
is especially worrisome,
said the physician. “In the midst of an opioid epidemic, they’re suspending
work on a registry that tells you this,” he said.
About the Author

Sharon Begley

Senior Writer, Science and Discovery

sharon.begley@statnews.com

 

Glenn Liebman, CEO

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