Almost everywhere I go these days, I hear people talking about “evidence-based practices” or “EBPs.” Frequently, the label is used in conversations to lend credibility to a comment about a particular clinical or program intervention; EBPs do open the doors to payment for services. Rarely does anyone mention why the particular practice is an EBP or what evidence undergirds it. Assertions about EBPs have become so common that they are somewhat like the mandatory “How are you?” when greeting a friend or colleague.
Ignored almost always in these conversations are the systems, organizations and communities in which the EBP is being deployed. Just a few moments of reflection will help assure you that these latter contexts do have a very potent influence upon whether an EBP actually will work and how well it will work. Hence, they simply cannot be ignored.
In reality, much of our current angst in behavioral health is about systems, organizations and communities. For example, how can we deploy a crisis response behavioral care system in a county? How can we integrate primary and behavioral healthcare in a medical home or an accountable care organization? How can we address the social determinants of health in a community? And many more examples also come to mind.
Fortunately, work has been done to provide a framework to help us address these issues. Murali D. Nair and Erick G. Guerrero have written an important text on Evidence Based Macro Practice in Social Work (Wheaton, IL: Gregory Publishing, Second Edition, 2020). As the authors cogently note, evidence-based macro practices (EBMPs) “respond to the high demand for public accountability and organizational performance in health and human service delivery.”
EBPs are designed to address practice at the micro level; EBMPs, by contrast, address macro practice at the system, organization and community level. The two meet where an EBP is being implemented in one or more of these contexts. Clearly, EBMPs can and should be deployed to enhance the effectiveness of EBPs.
The authors note that EBMPs should be designed and implemented with careful consideration of client self-determination and empowerment. This insight is exceptionally important for us. Most of our thinking about self-direction and self-determination is focused only upon the individual consumer and the role that person plays in their own intervention, whether that be clinical, housing, job or social supports. Rarely, if ever, do we examine self-direction, self-determination and empowerment from a system, organization or community perspective.
Later, the authors also elaborate the operational features of EBMPs at the system, organizational and community levels. Each of these chapters contains a wealth of practical information and tools that we can take into the field. Topics range from client pathways, organizational collaboration, synthesizing operational problems and organizational leadership, to community problem analysis, community intervention strategies, community development and client advocacy.
At this juncture in the evolution of behavioral healthcare, we are undertaking many complex design changes simultaneously: care integration across primary care, behavioral health and social services; movement upstream from disease response to disease prevention and health promotion; community interventions to reduce trauma; and much, much more. All of these changes will require careful deployment of EBMPs.
Our hats are off to Murali Nair and Erick Guerrero for leading the way on implementation and deployment of EBMPs. They are essential for addressing many of today’s behavioral healthcare challenges.