Best Practice - Use of Best Practices in Health and Human Services

Use of Best Practices in Health and Human Services

In recent years, public agencies and NGOs have been exploring and adopting best practices when delivering health and human services. In these settings, the use of the terms "promising practices", "best practices", and "evidence-based practices" is common and often confusing as there is not a general consensus on what constitutes promising practices or best practices. In this context, the use of the terms "best practices" and "evidence-based practices" are often used interchangeably. Evidence-based practices are methods or techniques that have documented outcomes and ability to replicate as key factors.

Despite these challenges, literature suggests that there is some common use of and criteria for identifying best practices. For example, a general working definition used by the U.S. Department of Health and Human Services (HHS) in referring to a promising practice is defined as one with at least preliminary evidence of effectiveness in small-scale interventions or for which there is potential for generating data that will be useful for making decisions about taking the intervention to scale and generalizing the results to diverse populations and settings. (Reference: U.S. Department of Health and Human Services, Administration for Children and Families Program Announcement, 2003).

Since evidence of effectiveness, potential for taking the intervention to scale and generalizing the results to other populations and settings are key factors for best practices, the manner in which a method or intervention becomes a best practice can take some time and effort. The table below demonstrates the process for a promising practice to achieve the status of research validated best practice. (Reference: U.S. Department of Health and Human Services, Administration for Children and Families Program Announcement. Federal Register, Vol. 68, No. 131, July 2003)

The National Registry of Evidence-Based Programs and Practices (NREPP) (External Link: http://nrepp.samhsa.gov) is a searchable online registry of interventions supporting substance abuse prevention and mental health treatment that have been reviewed and rated by independent reviewers. NREPP accepts submissions for interventions that meet minimum requirements to be considered for review. Minimum requirements include (1) demonstration of one or more positive outcomes among individuals, communities, or populations; (2) evidence of these outcomes has been demonstrated in at least one study using an experimental or quasi-experimental design; (3) the results of these studies have been published in a peer-reviewed journal or other professional publication, or documented in a comprehensive evaluation report; and (4) implementation materials, training and support resources, and quality assurance procedures have been developed and are ready for use by the public. NREPP is not an exhaustive list of interventions and inclusion in the registry does not constitute an endorsement. (Reference: National Registry of Evidence-Based Programs and Practices. Federal Register/Vol. 76, No. 180/Friday, September 16, 2011/Notices)

There is existing controversy about the lack of culturally appropriate evidence-based best practices and the need to utilize a research-based approach to validate interventions. Some communities have deployed practices over a long period of time that has produced positive outcomes as well as a general community consensus to be successful. The California Reducing Disparities Project (CRDP) is working to identify such practices. (External Link: http://www.dmh.ca.gov/Multicultural_Services/CRDP.asp) CRDP intends to improve access, quality of care, and increase positive outcomes for racial, ethnic and cultural communities. These communities have been identified as (1) African American, (2) Asian/Pacific Islanders, (3) Latinos, (4) Lesbian, Gay, Bi-sexual, Transgender, Questioning, and (5) Native Americans. Strategic Planning Workgroups composed of mental health providers and community members as well as consumers and family members are given the task of identifying new approaches toward reducing disparities. The five Strategic Planning Workgroups work to identify new service delivery approaches defined by multicultural communities for multicultural communities using community-defined evidence to improve outcomes and reduce disparities. Community- defined evidence is defined as “a set of practices that communities have used and determined to yield positive results as determined by community consensus over time and which may or may not have been measured empirically but have reached a level of acceptance by the community.” (Reference: National Latina/o Psychological Association, Fall/Winter 2008, National Network to Eliminate Disparities in Behavioral Health, SAMHSA, and CMHS, Larke Nahme Huang, Ph.D)