Evidence-Based Practices are interventions, treatments, and programs that have proved effective in producing specific positive outcomes. These methods have been studied and are confirmed to produce positive changes in individuals.
Partners encourages our Provider Network to adopt and use Evidence-Based Practices as part of the treatment array. The use of evidence-based practices ensures that we are offering the best available treatment and services to our enrollees.
The following are evidence-based practices that Partners encourages providers to adopt and use.
To learn more about evidence-based practices, simply select from the list below:
Assertive Community Treatment Team
Assertive Community Treatment Team (ACTT) consists of professionals who use a team approach to meet the needs of those with severe and persistent mental illness. Teams are composed of, at a minimum, a licensed behavioral health clinician, psychiatrist, nurse, substance use specialist, vocational specialist and peer specialist. ACTT serves as the single point of responsibility in addressing all the needs for those whose functioning is impaired by a serious mental illness. It is intended to help those with a significant history of hospitalization, homelessness, and/or incarceration. A fundamental feature of ACTT is that the majority of services are provided outside of an office and in the consumers’ home or in another community location. ACTT teams have staff available 24 hours a day, 7 days a week, and 365 days a year.
This service/evidence-based practice is designed for adults, 18 years and older, who are diagnosed with severe and persistent mental illnesses (such as schizophrenia, schizoaffective disorder, and bipolar disorder). These illnesses are more likely to cause long-term psychiatric disability. ACTT has been found to help those who have not benefitted from traditional office-based services and has a history of frequent mental health crises and functional impairment.
ACTT is not intended for the treatment of substance use disorders, intellectual and developmental disabilities, borderline personality disorder, traumatic brain injury or autism spectrum disorder.
Dialectical Behavioral Therapy (DBT)
Dialectical Behavioral Therapy (DBT) is a structured outpatient treatment, as defined by Marsha Linehan, PhD, which combines strategies from behavioral, cognitive, and other supportive psychotherapies. DBT services encompass individual therapy, DBT skills group, therapeutic consultation with the beneficiary on the telephone, and the therapists’ internal consultation meeting(s). Through an integrated treatment team approach to services, DBT seeks to enhance the quality of the beneficiary’s life through group skills training and individual therapy with a dialectical approach of support and confrontation.
DBT is a comprehensive cognitive-behavioral treatment for difficult to treat mental health disorders. Although originally developed for chronically suicidal individuals, DBT has evolved into a treatment for multi-disordered individuals with borderline personality disorder. DBT is a recognized and highly respected Evidence-Based Practice for adults. It is considered by the American Psychological Association and the American Psychiatric Association to be a “best practice” and a “first-line” treatment option for individuals who suffer from Borderline Personality Disorder (BPD).
DBT is an appropriate treatment modality for adults who are experiencing chronic instability with episodes of serious affective dysregulation and dangerous impulsivity, which results in self-injury and high utilization of both health and mental health resources. Persons suffering from BPD react abnormally to emotions; they often refuse to cooperate in the therapeutic setting, experience intense rage and impulsively self-injure.
DBT treatment is comprised of both individual and group therapy per the DBT model. In addition, DBT trained staff are available for phone coaching if needed for crisis between sessions to gradually lessen parasuicidal behavior and crisis episodes. Staff receive specialized training on the Linehan Institute’s DBT model but are also expected to continually participate in a DBT Consultation Group. This ongoing support helps mitigate burnout with high intensity consumers and offers oversight for providers to assure adherence to the DBT model. Individual therapy usually occurs weekly and DBT Skills Group occurs one to two times weekly. The focus of the group therapy is to teach skills that are needed to enhance the consumer’s life; Individual therapy is aimed at identifying issues that the consumer confronted during the past week and developing a treatment strategy to address those issues by applying DBT skills learned. For DBT to be effective, individuals participating in DBT must agree to do homework related which includes daily “diary cards” that track more than 40 emotions, urges, behaviors, such as lying, self-injury, or self-respect. The diary cards are used to identify the individual’s skill needs and current use of skills.
Eye Movement Desensitization and Reprocessing (EMDR)
Eye Movement Desensitization and Reprocessing (EMDR) is an evidenced based form of individual psychotherapy designed to reduce trauma-related stress, anxiety, and depression symptoms. EMDR is primarily used in the treatment of Posttraumatic Stress Disorder (PTSD); however, literature shows successful treatment of other mental health problems. Treatment is provided by an EMDR-trained therapist. Therapists work with clients to identify a positive memory associated with feelings of safety or calm that can be used to reduce the psychological distress associated with traumatic memories. To achieve that response, EMDR uses repetitive motor exercises during which clients attend to the exercise while focusing on changing their thoughts and reactions to traumatic memories. The most common motor task used in EMDR is side-to-side eye movements that follow the therapist’s finger. Exercises are repeated until the client reports no emotional distress. EMDR is well researched in treating adults. Although, interventions have been developed for use with children and adolescents. The number of sessions varies with the complexity of the trauma being treated.
Family Centered Treatment
Family Centered Treatment® (FCT©) is a comprehensive evidence-based model of intensive in-home treatment for children and adolescents and their families. It is designed to prevent out-of-home placement (e.g. residential, hospital, correctional facility placement) of the youth. FCT is a model that works intensively with family members to affect each member in a positive way. FCT uses four stages: joining, restructuring, value change and generalization, to improve family functioning. Clinicians use individualized therapeutic interventions with the family and in the home to treat the youth. FCT therapists strengthen family members’ problem-solving skills, including how they communicate, handle conflict, meet the needs for closeness, and manage the tasks of daily living.
FCT is delivered by an assigned therapist, who is supervised by a trained FCT supervisor. A distinctive aspect of FCT is that it was developed because of frontline practitioners’ effective practice. FCT is one of few home-based treatment models with extensive experience with youth with severe emotional and behavioral challenges, dependency needs, and mental health diagnosis as well as histories of delinquent behavior, otherwise known as crossover youth. In addition, FCT is extremely cost-effective and stabilizes youth at risk and their families.
Family Centered Treatment is designed for children ages three through 20 with a mental health or substance use disorder whose symptoms and behaviors are unmanageable at home, school, or in other community settings. Youth at risk of out-of-home placement or may be facing involvement in the juvenile justice system may be eligible to receive this treatment. FCT incorporates “trauma-focused treatment,” which is particularly effective for behavioral and emotional problems due to maltreatment (neglect or abuse) and trauma (from domestic violence, sexual abuse or substance abuse).
High Fidelity Wraparound (HFW)
High Fidelity Wraparound (HFW) is built on system of care values. HFW is an ecological model described through ten principles: Family “voice and choice”, Team Based, Natural Supports, Collaboration, Community-based, Culturally Competent, Individualized, Strengths Based, Persistence or Unconditional Support and Outcome Based. It is an intensive, team-based, person-centered service that provides coordinated, integrated, family-driven care to meet the complex needs of youth/young adults who:
- are involved with multiple systems;
- are experiencing serious emotional or behavioral difficulties;
- have dual diagnosis (MH and/or SUD, and IDD) with complex need;
- are at risk of placement in PRTFs or other institutional settings; and/or
- are aging out of Department of Social Services (DSS) care.
It is designed to facilitate a collaborative relationship among youth with SED (serious emotional disorder), his/her family and other involved child-serving systems.
High Fidelity Wraparound (HFW) team facilitates care planning and coordination of services; provides access to family and youth peer support services; establishes a strengths-based individualized child and family team plan; and addresses youth and family needs across domains of physical and behavioral health, social determinants of health, and natural supports. The HFW Team consists of a Facilitator, Family Partner, and/or a Youth Partner. Each team must have access to a Supervisor/Coach. Each Facilitator may serve 10-12 families. The HFW Facilitator is a Qualified Professional who coordinates the development of a Child and Family Team (CFT). This includes development of a Crisis/Safety plan to address needs and goals developed by the family; convening CFT meetings; coordination and communication with the Team members; and working with family to integrate information from multiple sources into the strengths needs and culture discovery. The Coach/Supervisor is Licensed or Associate Licensed Professional who provides supervision, ongoing consultation, and crisis support. The Family Partner must have lived experience as a primary caregiver for a child who has/had mental health or substance abuse challenges. The Family Partner works one-on-one and maintains regular frequent contact with the parent(s)/caregiver(s) to provide information and support throughout the care planning process. The Youth/Young Adult Peer Partner must have lived experience with mental health or substance abuse challenges and have experience in navigating any of the child and family-serving systems to provide support, encourage leadership and camaraderie.
HFW activities are grouped into four phases:
- Engagement and Team Preparation: 2-4 weeks, initiates a strengths-based, non-judgmental engagement process.
- Plan Development: 1-2 weeks, includes a discussion of treatments and strategies that have been successful in the past and identification of individuals who play key roles in the life of the youth and family.
- Plan Implementation: 2-12 months, work with the family to build the transition assets that will prepare the family to move forward successfully after HFW ends. This includes transferring responsibility to the family and natural supports.
- Transition Phase: 1 meeting to ensure successful transition.
The expected outcomes for HFW include the following:
- Decrease frequency or intensity of crisis episodes;
- reduction in symptomatology;
- engagement in the recovery process;
- increased ability for self-advocacy and resource gathering; and
- increased use of available natural and social supports.
The purpose of Multisystemic Therapy (MST) is to keep youth in the home by delivering an intensive therapy to the family within the home. The service is delivered through a team approach to youth and their families. MST is a service, supported by evidence-based practice and designed to address the needs of children and adolescents with significant behavioral problems. The children receiving this service are transitioning from out of home placements, or are at risk of out-of-home placement, and need intensive interventions to remain stable in the home and community.
MST includes a variety of therapeutic and crisis interventions for those with mental health or substance abuse issues. MST has solid evidence of effectiveness as a treatment for problematic substance use in adolescents and is promoted by the National Institute on Drug Abuse. Services are available in-home, at school, and in other community settings. The duration of MST intervention is three to five months. MST involves families and other systems such as the school, probation officers, extended families, and community connections.
Ideally, this service is delivered by a masters-level therapist supporting a caseload of four to six families. The therapist provides most mental health services and coordinates access to other important services (e.g., medical, educational, and recreational). While the therapist is available to the family 24 hours a day, seven days a week, the direct contact hours per family varies according to clinical need.
Generally, the therapist spends more time with the family in the initial weeks of the program (daily if needed) and gradually tapers off (as infrequently as once a week) during a three to five month course of treatment. Treatment fidelity is maintained by weekly group supervision meetings involving three to four therapists along with a doctorate- or advanced masters-level clinical supervisor.
The goals and progress of each case are reviewed during group supervision to ensure the multisystemic focus of the therapists’ intervention strategies, identify barriers to success, and facilitate the attainment of treatment goals. In addition, an MST expert consultant reviews each case with the team weekly to promote treatment fidelity and favorable clinical outcomes.
MST-PSB (Multisystemic Problem Sexual Behavior) is designed for sexual offenders and delivered similarly to standard MST. It focuses on aspects of a youth’s ecology that are functionally related to the problem sexual behavior. Treatment includes:
- Reducing parent and youth denial about sexual offenses and their consequences;
- Promoting development of friendships and age-appropriate sexual experiences; and
- Modifying the individual’s social perspective-taking skills, belief systems, or attitudes that contributed to the sexual offenses.
Intervention is individualized for each family; families are provided family therapy and the youth receives individual therapy. Services are delivered over a period of five to seven months. Therapists have three to five families on their caseloads and members of the team rotate to cover. Team members are available to respond to crises 24 hours a day, seven days a week.
This service is designed for youth generally between the ages 12 through 17 who:
a. Have antisocial, aggressive or violent behaviors;
b. Are at risk of out-of-home placement due to delinquency;
c. Adjudicated youth returning from out-of-home placement;
d. Chronic or violent juvenile offenders; or
e. Youth with serious emotional disturbances or a substance use disorder and their families.
Psychosocial Rehabilitation (PSR)—Clubhouse Model
The Psychosocial Rehabilitation (PSR) service is designed to help adults with psychiatric disabilities increase their functioning so that they can be successful and satisfied in the environments of their choice, with the least amount of ongoing professional intervention. The goal is to contribute to the individual’s recovery through a therapeutic environment that includes responsibilities within the clubhouse, as well as through outside employment, education, and meaningful relationships. PSR focuses on developing skills related to one’s life in the community, and to increase the person’s ability to manage their illness and live as independently as possible.
The Psychosocial Rehabilitation- Clubhouse Model is an evidence-based practice; that is, the practice has proved to help people achieve and maintain recovery. People who participate in the Clubhouse are called “members”. Fundamental elements of participation include openness and choice in the type of work activities, choice in staff, and a lifetime right of reentry and access to Clubhouse services. Each person is welcomed, wanted, needed, and expected each day. They are considered a critical part of the PSR community.
The day-to-day operation of the Clubhouse is the responsibility of members and staff who work side by side in a rehabilitation environment. Clubhouse staff function as generalists who maintain a caseload, including managing employment placements, housing issues, and access to community supports. The service is based on the principles of recovery; including skill building in daily living (personal care, housekeeping, shopping/cooking, money management, educational/employment, use of transportation, etc.), social and interpersonal relationships, leisure activities, and educational/vocational domains. The emphasis is on improving functioning in real world environments, and allowing time for interventions to have an effect over the long term.
Services are available at least five days per week and may include weekends or evenings. Attendance is voluntary and participation can be as little or as much as consumers choose.
Psychosocial Rehabilitation (PSR) is designed for adults with psychiatric disabilities to help improve their daily functioning in the areas of education/employment, money management, accessing community resources, social skills, and/ or personal care. PSR is not available to those receiving Assertive Community Treatment Team (ACTT) services.