Statement of Elinore F. McCance-Katz, MD, PhD, Assistant Secretary for
Mental Health and Substance Use regarding the National Registry of Evidence
Programs and Practices and SAMHSA’s new approach to implementation of
evidence-based practices (EBPs)

Thursday, January 11, 2018

SAMHSA and HHS are committed to advancing the use of science, in the form
of data and evidence-based policies, programs and practices, to improve the
lives of Americans living with substance use disorders and mental illness
and of their families.

People throughout the United States are dying every day from substance use
disorders and from serious mental illnesses. The situation regarding opioid
addiction and serious mental illness is urgent, and we must attend to the
needs of the American people. SAMHSA remains committed to promoting
effective treatment options for the people we serve, because we know people
can recover when they receive appropriate services.

SAMHSA has used the National Registry of Evidence Programs and Practices
(NREPP) since 1997. For the majority of its existence, NREPP vetted
practices and programs submitted by outside developers – resulting in a
skewed presentation of evidence-based interventions, which did not address
the spectrum of needs of those living with serious mental illness and
substance use disorders. These needs include screening, evaluation,
diagnosis, treatment, psychotherapies, psychosocial supports and recovery
services in the community.

The program as currently configured often produces few to no results, when
such common search terms as “medication-assisted treatment” or illnesses
such as ”schizophrenia” are entered. There is a complete lack of a linkage
between all of the EBPs that are necessary to provide effective care and
treatment to those living with mental and substance use disorders, as well.
If someone with limited knowledge about various mental and substance use
disorders were to go to the NREPP website, they could come away thinking
that there are virtually no EBPs for opioid use disorder and other major
mental disorders – which is completely untrue.

They would have to try to discern which of the listed practices might be
useful, but could not rely on the grading for the listed interventions;
neither would there be any way for them to know which interventions were
more effective than others.

We at SAMHSA should not be encouraging providers to use NREPP to obtain
EBPs, given the flawed nature of this system. From my limited review – I
have not looked at every listed program or practice – I see EBPs that are
entirely irrelevant to some disorders, “evidence” based on review of as few
as a single publication that might be quite old and, too often, evidence
review from someone’s dissertation.

This is a poor approach to the determination of EBPs. As I mentioned, NREPP
has mainly reviewed submissions from “developers” in the field. By
definition, these are not EBPs because they are limited to the work of a
single person or group. This is a biased, self-selected series of
interventions further hampered by a poor search-term system. Americans
living with these serious illnesses deserve better, and SAMHSA can now
provide that necessary guidance to communities.

We are now moving to EBP implementation efforts through targeted technical
assistance and training that makes use of local and national experts and
will that assist programs with actually implementing services that will be
essential to getting Americans living with these disorders the care and
treatment and recovery services that they need.

These services are designed to provide EBPs appropriate to the communities
seeking assistance, and the services will cover the spectrum of individual
and community needs including prevention interventions, treatment and
community recovery services.

We must do this now. We must not waste time continuing a program that has
had since 1997 to show its effectiveness.

But yet we know that the majority of behavioral health programs still do
not use EBPs: one indicator being the lack of medication-assisted
treatment, the accepted, life-saving standard of care for opioid use
disorder, in specialty substance use disorder programs nationwide.

SAMHSA will use its technical assistance and training resources, its expert
resources, the resources of our sister agencies at the Department of Health
and Human Services, and national stakeholders who are consulted for EBPs to
inform American communities and to get Americans living with these
disorders the resources that they deserve.

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