July 2008

Grant Results

SUMMARY

In 1998, investigators from the New Hampshire-Dartmouth Psychiatric Research Center, in collaboration with many federal and state mental health organizations, advocacy groups, mental health providers and consumers, launched the Evidence-Based Practices project to help consumers with serious mental illness and their families access effective services.

Key Results

  • The consensus panel identified six areas of intervention in which the research evidence strongly supports the effectiveness of one or more approaches:
    • Medication Management Approaches in Psychiatry
    • Illness Management and Recovery
    • Assertive Community Treatment
    • Family Psychoeducation
    • Supported Employment
    • Integrated Dual Disorders Treatment
  • Project personnel completed a series of articles focusing on evidence-based practices for the care of persons with severe mental illness.
  • Development teams created "toolkits" that can be used to promote evidence-based care for people with severe mental illness.
  • Project personnel developed guidelines for dissemination and implementation of evidence-based practices in each of the six areas.

Funding
From November 1998 through September 2003, the Robert Wood Johnson Foundation (RWJF) provided partial support for this project with three grants totaling $362,934.

  • The first grant (ID# 035746) supported a consensus panel of experts, who identified six evidence-based interventions for schizophrenia and other severe mental illnesses.
  • The second grant (ID# 036805) supported teams of researchers and stakeholders who designed six implementation "toolkits" to help consumers, families, clinicians and mental health program administrators understand and use the evidence-based practices.
  • The third grant (ID# 044030) helped three states (Ohio, Kansas and Indiana) test the process of implementing one of the toolkits, on treating patients dually diagnosed with mental illness and substance abuse. This project is part of an eight-state evaluation of toolkit implementation in routine mental health settings, which will conclude in 2006.

The federal Substance Abuse and Mental Health Services Administration (SAMHSA), Johnson & Johnson, the West Family Foundation and the John D. and Catherine T. MacArthur Foundation have contributed over $6 million to the Evidence-Based Practices project. (See Appendix 1 for a list of funders.)

 See Grant Detail & Contact Information
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THE PROBLEM

According to the United States Department of Health and Human Services and other sources, a core set of research-validated, or evidence-based, practices could, if widely adopted, improve the lives of many people with serious mental illness. However, as the 1999 Surgeon General's report concluded, routine mental health programs fail to provide the great majority of their clients with access to these evidence-based practices. In addition, when practitioners apply the evidence-based practices, they may not achieve expected outcomes if they fail to adhere to specific programmatic standards, referred to as fidelity of implementation. Guidelines and toolkits are needed to help practitioners maintain fidelity of implementation.

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RWJF STRATEGY

This project relates to RWJF's strategic objective, current at the time the grants were issued, of improving chronic illness care through the use of evidence-based disease management protocols or algorithms. RWJF supported this work through its support of the Texas Medication Algorithm Project (TMAP) (see Grant Results on ID# 039931), the findings of which have been integrated into the development of the toolkits and training materials in Phase I of this project. TMAP was the first attempt to evaluate clinical and economic outcomes associated with algorithm-based care for seriously mentally ill patients treated in a public mental health system.

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THE PROJECT

These grants from RWJF supported the Evidence-Based Practices project, an effort by investigators from the New Hampshire-Dartmouth Psychiatric Research Center, in collaboration with many federal and state mental health organizations, advocacy groups, mental health providers and consumers, to help people with serious mental illness and their families access effective services. The national project, launched in 1998, had three major goals:

  1. To help more consumers and families access services that are effective.
  2. To help providers of mental health services develop the skills necessary to deliver effective services.
  3. To help administrators set up mechanisms to support and maintain these services.

Under the first grant (ID# 035746), project personnel recruited a consensus panel of experts to identify the most effective treatments and interventions for schizophrenia and other severe mental illness, based on evidence in the research literature. The panel included researchers who study the delivery of mental health services, mental health patients, family advocates and state mental health directors. The panel included researchers who participated in the Patient Outcomes Research Team (PORT) study, which documented the current state of care received by patients with schizophrenia.

Under the second grant (ID# 036805), project personnel worked to: (1) produce educational and training materials as part of "toolkits" and use them to train health care providers on treatments, interventions and protocols based on the latest scientific evidence; and (2) develop guidelines and procedures for implementing these evidence-based practices in routine mental health practice settings.

Project personnel recruited development teams to create resource kits to implement evidence-based care in each of six areas in which the research evidence strongly supports the effectiveness of one or more approaches. Each development team consisted of an expert panel of prominent researchers and a consensus panel representing key stakeholders. (See Appendix 2 for members of expert panels.)

Under the third grant (ID# 044030), RWJF provided partial support for a three-year study of the process of implementing the toolkits in eight states: New Hampshire, Vermont, Maryland, Ohio, Kansas, New York, Indiana and Oregon. (The project personnel designed a separate implementation track for the medication toolkit, which is largely supported by Johnson & Johnson). The four objectives of the evaluation, which will conclude in 2006, are to:

  • Test the implementation materials in a range of routine mental health settings in order to revise them prior to national dissemination.
  • Assess the practice fidelity (adherence to specific programmatic standards) in the 55 program sites that are using the toolkits to implement evidence-based practices.
  • Study the implementation barriers and strategies as explanations for the variance in implementation success.
  • Study improvements in client outcomes in relation to implementation efforts and improvement in practice fidelity.

Project personnel used RWJF funds to support the first 18 months of evaluation activities (04/01/2002 to 09/30/2003) in the three states (Ohio, Kansas and Indiana) that chose to implement the Integrated Dual Disorders Treatment toolkit for adults with severe mental illness and co-occurring substance use disorders. They are testing the toolkits in 13 community mental health sites.

Other support for the project came from the federal Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration (SAMHSA), the West Family Foundation, the John D. and Catherine T. MacArthur Foundation and Johnson & Johnson. (See Appendix 1 for a list of supporters.)

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RESULTS

(ID# 035476)

  • The consensus panel identified six areas of intervention in which the research evidence strongly supports the effectiveness of one or more approaches:
    • Medication Management Approaches in Psychiatry. Following appropriate medication guidelines can reduce symptoms and hospitalizations for patients with severe mental illness. Antipsychotic medications, for example, should be prescribed within a specific dosage range, but are often prescribed outside this range, where they are less effective and cause greater side effects.
    • Illness Management and Recovery. There are several effective approaches to helping patients with severe mental illness learn to manage their own symptoms and illnesses, ranging from social skills training interventions to cognitive therapies.
    • Assertive Community Treatment. Case management that includes specific features of assertive community treatment, such as having case management teams that visit their clients in the community rather than meeting them in the clinic, are able to reduce rates of treatment dropout.
    • Family Psychoeducation. Families that receive education and support feel less burdened and are more effective at helping their relatives with severe mental illness to manage their illness and avoid re-hospitalization.
    • Supported Employment. Vocational rehabilitation based on direct placement in competitive employment with ongoing supports (supported employment) is more effective than traditional vocational services.
    • Integrated Dual Disorders Treatment. Substance abuse treatment that is integrated with mental health treatment and tailored for individuals with severe mental illness is more effective than traditional separate substance abuse and mental health services.
  • Project personnel completed a series of articles focusing on evidence-based practices for the care of persons with severe mental illness. The articles included two overviews of evidence-based mental health care, one article on each of the six evidence-based practices identified in this project and additional articles on public policy, consumer perspectives and other aspects of the project. The articles later appeared in the journal Psychiatric Services in 2001. (See the Bibliography.)

(ID# 036805)

  • Development teams created "toolkits" that can be used to promote evidence-based care for people with severe mental illness. The toolkits include introductory and training videotapes, workbooks, implementation guidelines and techniques to measure patient outcomes. (For a complete description of the toolkit contents, see Appendix 3). "Beta versions" (drafts suitable for pilot testing) of the toolkits have been completed in five of the six areas.
  • Project personnel developed guidelines for dissemination and implementation of evidence-based practices in each of the six areas.

Findings

(ID# 044030)
In a February 2004 report to RWJF, project personnel described preliminary findings from the three-state evaluation of the implementation of the Integrated Dual Diagnosis Treatment toolkit.

  • Each of the three states (Ohio, Kansas and Indiana) developed a collaborative process and, in some cases, formal structures to fund the implementation of integrated dual disorder treatment and established the local resources, workforce and capacity to support those activities in community mental health settings. Each state initiated a systematic review of policies and procedures, especially those related to financing, to ensure appropriate funding levels for integrated dual diagnosis treatment services.
  • Each state created its first statewide consensus building process and identified top-priority system commitments to facilitate implementation of integrated dual disorder treatment. Each state required the active involvement of a broad group of stakeholders, including consumers and family members, in the local implementation process.
  • Each state provided an array of educational activities and forums to raise awareness about the presence of co-occurring disorders and the availability of evidence-based treatments. Many of these activities targeted specific stakeholders, such as front-line practitioners and psychiatrists.
  • While dual disorders treatment services offered by the 13 community mental health centers varied greatly from site to site, the implementation process yielded preliminary information about how to introduce evidence-based practices at the local level. The majority of sites participated in a multi-stakeholder implementation team that included consumers and family members.
    • One state developed a structured process for using results from the practice fidelity and general organization assessment to guide implementation. Other states are working on adapting this method for improving quality.
    • Many sites are providing, for the first time, dual disorders treatment groups in their service array.
    • Some sites are working with consumers to establish community-based peer support groups for people with dual disorders.
    • Some sites are training mental health staff in substance abuse counseling strategies for the first time. One site had 35 staff apply to become certified alcohol and drug abuse counselors.
    • Some sites have initiated a quality improvement process for their dual diagnosis treatment services, including regular collection and assessment of outcome data, tracking reduction in the use of emergency or other crisis services and tracking improvements in housing stability.

Communications

Project personnel have completed numerous publications on evidence-based mental health care, including three books published in 2003 and one in press, several book chapters and a series of articles published in the journal Psychiatric Services in 2001.

They also made presentations on the project at numerous international, national, state and local conferences. Project personnel will prepare and publish articles on the toolkit implementation process after the eight-state demonstration ends in 2006. Information about the national Evidence-Based Practices project and the six toolkits is available at the Substance Abuse and Mental Health Services Administration Web site. See the Bibliography for more information and a partial list of publications related to the project.

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LESSONS LEARNED

  1. In a project such as this one, a range of stakeholders should be involved from the beginning. Although it is less time-consuming to focus mainly on practitioners, involving all the stakeholders, including consumers, family members and state mental health authorities, leads to a better product. (Project Team Members/McHugo, Torrey)
  2. Sometimes it is not possible to reach consensus when bringing together groups of stakeholders with different interests. In those cases, it is important to have people who can manage the politics of the situation, synthesize a range of opinions and make decisions. (Project Team Members/McHugo, Gorman)
  3. The priorities of researchers, policy-makers and the public sometimes are at odds over the question of when to disseminate promising program models. Early indications of the toolkits' benefits for the seriously mentally ill fed a demand for a national dissemination. SAMHSA responded by funding additional states to implement the evidence-based practices. The Dartmouth researchers feel that national dissemination should wait until their eight-state evaluation, data analysis and subsequent revision of the toolkits is complete in 2006. (Project Director/Drake)
  4. Leadership at all levels plays a crucial role in the effective implementation of evidence-based practices. According to project director Robert Drake, because of the toolkit field test, "we now have thousands of experiments across the country, which have proven that in mental health, training by itself is not enough to create change." (Project Director/Drake)

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AFTER THE GRANT

During the two-year implementation and evaluation period, the project team observed the procedures of the participating mental health centers and rated their fidelity to the evidence-based practice model. In "Fidelity outcomes in the national implementing evidence-based practices project," (McHugo GM, Drake RE, Whitley R, Bond GR, Campbell K, Rapp CA et al) published in Psychiatric Services (58[10]: 1279–1284, 2007) researchers reported that:

  • Some 55 percent of the sites showed high-fidelity implementation at the end of two years.
  • The critical time period for implementation was approximately 12 months, after which few gains or losses in fidelity occurred.

As of June 2008, SAMHSA was supporting a national dissemination of the six evidence-based practice models by issuing requests for proposals and awarding $2.2 million in grants for further training and evaluation.

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GRANT DETAILS & CONTACT INFORMATION

Project

Evidence-Based Care for Persons with Serious Mental Illness

Grantee

University of New Hampshire (Durham,  NH)

  • Planning for a Program to Promote Evidence-Based Care for Persons with a Serious Mental Illness
    Amount: $ 15,937
    Dates: November 1998 to March 1999
    ID#:  035746

Grantee

Dartmouth Medical School (Hanover,  NH)

  • Promoting Evidence-Based Clinical and Supportive Services for Persons with Serious Mental Illness
    Amount: $ 147,525
    Dates: May 2000 to December 2001
    ID#:  036805

  • Evaluating the Implementation of Evidence-Based Practices for People with Severe Mental Illness
    Amount: $ 199,472
    Dates: April 2002 to September 2003
    ID#:  044030

Contact

Robert E. Drake
(603) 448-0126
robert.e.drake@dartmouth.edu

Web Site

http://www.dartmouth.edu/~psychrc

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Sources of Funding for the National Evidence-Based Practices Project

  • Substance Abuse and Mental Health Services Administration (September 2002–September 2005), $2,104,417
  • Johnson & Johnson (January 2001–December 2004), $2,600,506
  • West Family Foundation (July 2001–July 2004), $1,500,000
  • Charles D. and Catherine T. MacArthur Foundation, unknown

The eight states participating in Phase II provided substantial funding for services, training and evaluation activities.


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Expert Members of Evidence-Based Practices Toolkit Development Teams

Assertive Community Treatment Toolkit Development Team
Steve Baron
President
Baltimore Mental Health Systems, Inc.
Baltimore, Md.

Barbara Burns
Services Effectiveness Research Program
Duke University Medical Center
Durham, N.C.

Vicki Cottrell
Executive Director
National Alliance for the Mentally Ill Utah
Salt Lake City, Utah

Elizabeth Edgar
Director
National Program of Assertive Community Treatment PACT Center
Arlington, Va.

Marilyn Martin
Maryland Health Partners
Columbia, Md.

Melody Olson
Texas Department of Mental Health and Mental Retardation
Austin, Texas

Joe Phillipps
Consumer
Brodhead, Wis.

Marilyn Martin
Maryland Health Partners
Columbia, Md.

Dual Diagnosis Toolkit Development Team
Robert Drake
Director
New Hampshire-Dartmouth Psychiatric Research Center
Lebanon, N.H.

Lenore Kola
Associate Professor and Dean, School of Graduate Studies
Mandel School of Applied Social Sciences
Case Western Reserve University
Cleveland, Ohio

Kim Mueser
Professor
Departments of Psychiatry and Community and Family Medicine
Dartmouth Medical School
Hanover, N.H.

Fred Osher
Director
Center for Behavioral Health, Justice and Public Policy
Baltimore, Md.

Family Psychoeducation Toolkit Development Team
Lisa Dixon
Associate Director for Research
Mental Illness Research Education Clinical Center
Baltimore, Md.

Harriett Lefley
Professor
Department of Psychiatry and Behavioral Sciences
University of Miami School of Medicine
Miami, Fla.

Bill McFarlane
Principal Investigator
Maine Medical Center, Department of Psychiatry
Portland, Maine

Diane Sondheimer
Acting Branch Chief
Child, Adolescent and Family Branch
Center for Mental Health Services
Washington, D.C.

Illness Self-Management Toolkit Development Team
Co-Chairs:
Susan Gingerich
Research Associate
Medical College of Pennsylvania
Philadelphia, Pa.

Kim Mueser
Professor
Departments of Psychiatry and Community and Family Medicine
Dartmouth Medical School
Hanover N.H.

Medication Toolkit Development Team
Lynn Crismon
Professor
University of Texas College of Pharmacy
Austin, Texas

Susan Essock
Professor
Mount Sinai School of Medicine
New York, N.Y.

Steve Marder
Chief
Psychopharmacology Unit
University of California at Los Angeles
Los Angeles, Calif.

Tom Mellman
Professor
Dartmouth Medical School
Hanover, N.H.

Alexander Miller
Professor of Psychiatry
University of Texas Health Science Center at San Antonio
San Antonio, Texas

Ellen Weissman
Professor
Mount Sinai School of Medicine
New York, N.Y.

Supported Employment Toolkit Development Team
Deborah Becker
Research Assistant Professor of Community and Family Medicine and of Psychiatry
Dartmouth Medical School
Hanover, N.H.

Morris Bell
Associate Professor of Psychiatry
Yale University
New Haven, Conn.

Chrystal Blyler
Project Officer
Substance Abuse and Mental Health Services Administration
Rockville, Md.

Gary Bond
Professor
Indiana University-Purdue University of Indianapolis
Indianapolis, Ind.

Ernest Quimby
Associate Professor
Howard University
Washington, D.C.

Charlie Rapp
Professor
University of Kansas
Lawrence, Kan.

Will Torrey
New Hampshire-Dartmouth Psychiatric Research Center
Lebanon, N.H.


Appendix 3

Description of Toolkit Components

Introduction to the Implementing Evidence-Based Practices Project
This letter from the major sponsors of the program is a brief, general introduction to the Implementing Evidence-Based Practices Project.

Toolkit User's Manual
This document describes the toolkit materials and how to use them in conjunction with training and consultative services, outlining a general implementation plan.

Introductory Videotape
This short videotape functions as an introduction for all stakeholders to the evidence-based practice.

Information for Stakeholders (five separate documents)
The documents describe the evidence-based practice and highlight features of the practice most pertinent to the particular stakeholder being addressed.

A Statement on Cultural Competency
This document addresses the need for practitioners and policy-makers to integrate the design and delivery of the evidence-based practices within a culturally responsive context.

Practice Demonstration (Training) Videotapes
These videotapes model clinical skills critical for the implementation of the practice.

Workbook
The workbook is designed as a primer for practitioners designed for use in training or supervisory settings.

Implementation Tips for Mental Health Program Leaders
This document provides practical guidance for agency program leaders on how to implement the evidence-based practice in a community mental health setting.

Implementation Tips for Public Mental Health Authorities
This document provides practical guidance for public mental health authorities on how to implement the evidence-based practice within their mental health system.

Outcomes Measures
Simple outcome measures are identified that can be used to track and evaluate consumer gains and program success.

Fidelity Scales
The fidelity scales enable mental health program leaders to evaluate their program in comparison to the recommended model.

Articles and References
Copies of pertinent review articles about evidence-based practices are included in the toolkit.

Additional Resource Materials for Implementation
Additional materials to supplement the toolkit materials include two PowerPoint presentations developed by the West Institute. One is designed to supplement an introductory talk about the particular practice, adaptable for use with any audience, and the other is designed to serve as the curriculum for a two- to three-day initial training session for practitioners and clinical supervisors.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books

Drake RE (guest ed.). Psychiatric Clinics of North America: Evidence-Based Practices in Mental Health Care (4th edition, vol. 26). Philadelphia: W.B. Saunders Co., 2003.

Drake RE and Goldman HH (eds.). Evidence-Based Practices in Mental Health Care. Washington: American Psychiatric Press, 2003.

Drake RE, Merrens M and Lynde D (eds.). Evidence-Based Mental Health: A Textbook. New York: John Wiley, 2005.

Mueser KT, Noordsy DL, Drake RE and Fox M. Integrated Treatment for Dual Disorders: A Guide to Effective Practice. New York: Guilford Press, 2003.

Book Chapters

Alverson H, Alverson M and Drake RE. "Social Patterns of Substance Use Among People With Dual Diagnoses" In The Research Process in the Human Services, Alexander LB and Solomon P (eds.). Belmont, Calif.: Thomson Brooks/Cole, 2005.

Becker DR. "Implementing Supported Employment as an Evidence-Based Practice." In Connections — State Partnership Initiative, Becker DR and Barcus M (eds.). Fairfax, Va.: Virginia Commonwealth University, 2001.

Drake RE. "Dual Diagnosis Disease Management." In Best Practices in the Behavioral Management of Chronic Disease: Neuropsychiatric Disorders (Vol. I), Trafton J and Gordon W (eds.). Hanover, N.H.: Institute for Brain Potential/Institute for Disease Management, 2003.

Drake RE. "Principles of Evidence-Based Mental Health Treatment." In Evidence-Based Mental Health: A Textbook, Drake RE, Merrens M and Lynde D (eds.). New York: John Wiley, 2005.

Drake RE and Goldman HH. "Introduction to Evidence-Based Practice for Persons With Severe Mental Illness." In Evidence-Based Practices in Mental Health Care, Drake RE and Goldman HH (eds.). Washington: American Psychiatric Press, 2003.

Drake RE, Merrens M and Lynde D. "Epilogue: The Future of Evidence-Based Practices in Mental Health Care." In Evidence-Based Mental Health: A Textbook, Drake RE, Merrens M and Lynde D (eds.). New York: John Wiley, 2005.

Kavanagh D, Mueser KT and Baker A. "Management of Comorbidity." In Comorbid Mental Disorders and Substance Use Disorders: Epidemiology, Prevention and Treatment, Teeson M and Proudfoot H (eds.). Sydney, Australia: National Drug and Alcohol Research Centre, University of New South Wales, 2004.

Mueser KT and Drake RE. "How Does a Practice Become Evidence-Based?" In Evidence-Based Mental Health: A Textbook, Drake RE, Merrens M and Lynde D (eds.). New York: John Wiley, 2005.

Mueser KT and Kavanagh D. "Treating Comorbidity of Alcohol Problems and Psychiatric Disorders." In The Essential Handbook of Treatment and Prevention of Alcohol Problems, Heather N and Stockwell TR (eds.). Chichester, England: John Wiley & Sons, 2004.

Alverson H, Alverson M and Drake R. "Social Patterns of Substance Use Among People With Dual Diagnoses: Commentary on the Research Process." In The Research Process in the Social Services: Myths and Realities, Alexander LB and Solomon P (eds.). Belmont, Calif.: Thomson Brooks/Cole. In press.

Articles

Alverson H, Alverson M and Drake RE. "Social Patterns of Substance Use Among People With Dual Diagnoses." Mental Health Services Research, 3(1): 3–14, 2001.

Bartels SJ, Dums AR, Oxman TE, Schneider LS, Arean PA, Alexopoulos GS and Jeste DV. "Evidence-Based Practices in Geriatric Mental Health Care." Psychiatric Services, 53(11): 1419–1431, 2002.

Bartels SJ, Haley WE and Dums AR. "Implementing Evidence-Based Practices in Geriatric Mental Health." Generations, 26(1): 90–98, 2002.

Becker DR, Drake RE and Naughton W. "Supported Employment for People With Co-Occurring Disorders." Psychiatric Rehabilitation Journal, 28(4): 332–338, 2005.

Bond GR, Becker DR, Drake RE, Rapp CA, Meisler N, Lehman AF and Bell M. "Implementing Supported Employment as an Evidence-Based Practice." Psychiatric Services, 52(3): 313–233, 2001.

Brunette MF, Mueser KT and Drake RE. "A Review of Research on Residential Programs for People With Severe Mental Illness and Co-Occurring Substance Use Disorders." Drug and Alcohol Review, 23(4): 471–481, 2004.

Brunette MF, Richardson F, White L, Bemis G and Eelkema RE. "Integrated Family Treatment for Parents With Severe Psychiatric Disabilities." Psychiatric Rehabilitation Journal, 28: 177–180, 2004.

Caton CLM, Drake RE, Hasin D, Dominguez B, Shrout PE, Samet S and Schanzer B. "Differences Between Early-Phase Primary Psychotic Disorders With Concurrent Substance Use and Substance-Induced Psychoses." Archives of General Psychiatry, 62(2): 137–145, 2005.

Crocker AG, Mueser KT, Drake RE, Clark RE, McHugo GJ, Ackerson TH and Alterman AI. "Antisocial Personality, Psychopathy and Violence in Persons With Dual Disorders: A Longitudinal Analysis." Criminal Justice and Behavior, 32(4): 452–476, 2005.

Dixon L, McFarlane W, Lefley H, Lucksted A, Cohen C, Falloon I, Mueser KT, Miklowitz D, Solomon P and Sondheimer D. "Evidence-Based Practices for Services to Family Members of People With Psychiatric Disabilities." Psychiatric Services, 52(7): 903–910, 2001.

Drake RE. "Book Review of Integrated Treatment for Mood and Substance Use Disorders." Psychiatric Services, 55: 595, 2004.

Drake RE. "Dual Diagnosis." Psychiatry, 3: 60–63, 2004.

Drake RE, Essock S, Shaner A, Carey KB, Minkoff K, Kola L, Lynde D, Osher FC, Clark RE and Rickards L. "Implementing Dual Diagnosis Services for Clients With Severe Mental Illness." Psychiatric Services, 52(4): 469–476, 2001.

Drake RE and Goldman HH. "The Future of Evidence-Based Practices in Mental Health Care." Psychiatric Clinics of North America, 26(4): 1011–1016, 2003.

Drake RE, Goldman HH, Leff HS, Lehman AF, Dixon L, Mueser KT and Torrey WC. "Implementing Evidence-Based Practices in Routine Mental Health Service Settings." Psychiatric Services, 52(2): 179–182, 2001.

Drake RE, Goldman HH, Leff HS, Lehman AF, Dixon L, Mueser KT and Torrey WC. "Implementing Evidence-Based Practices in Routine Mental Health Service Settings." Compendium Series: Psychosis & Schizophrenia, 2: 18–19, 2002.

Drake RE, Morse GA, Brunette M and Torrey WC. "Evolving U.S. Service Model for Patients With Severe Mental Illness and Co-Occurring Substance Use Disorder." Acta Neuropsychiatrica, 16: 36–40, 2004.

Drake RE, Mueser KT, Brunette M and McHugo GJ. "A Review of Treatments for People With Severe Mental Illness and Co-Occurring Substance Use Disorder." Psychiatric Rehabilitation Journal, 27: 360–374, 2004.

Drake RE, Mueser KT, Torrey WC, Miller AL, Lehman AF, Bond GR, Goldman HH and Leff HS. "Evidence-Based Treatment of Schizophrenia." Current Psychiatry Reports, 2(5): 393–397, 2000.

Drake RE, Rosenberg SD, Teague GB, Bartels BJ and Torrey WC. "Fundamental Principles of Evidence-Based Medicine Applied to Mental Health Care." Psychiatric Clinics of North America, 26(4): 811–820, 2003.

Drake RE, Torrey WC and McHugo GJ. "Strategies for Implementing Evidence-Based Practices in Routine Mental Health Settings." Evidence-Based Mental Health, 182: 248–254, 2003.

Drake RE, Xie H, McHugo GJ and Shumway M. "Three-Year Outcomes of Long-Term Patients With Co-Occurring Bipolar and Substance Use Disorders." Biological Psychiatry, 56(10): 749–756, 2004.

Essock SM, Goldman H, Bond GR, Dixon L, Dunakin LK, Ganju V, Gorman PG, Ralph RO, Rapp CA, Teague GB and Drake RE. "Evidence-Based Practices: Setting the Context and Responding to Concerns." Psychiatric Clinics of North America, 26(4): 919–938, 2003.

Fiander M, Burns T, McHugo GJ and Drake RE. "Assertive Community Treatment Across the Atlantic: Comparison of Model Fidelity in the UK and USA." British Journal of Psychiatry, 182: 248–254, 2003.

Goldman HH, Ganju V, Drake RE, Gorman P, Hogan M, Hyde P and Morgan O. "Policy Implications for Implementing Evidence-Based Practices." Psychiatric Services, 52(12): 1591–1597, 2001.

McGovern MP and Carroll KM. "Evidence-Based Practices For Substance Use Disorders." Psychiatric Clinics of North America, 26(4): 991–1010, 2003.

McGovern MP, Fox TS, Xie H and Drake RE. "A Survey Of Clinical Practices and Readiness to Adopt Evidence-Based Practices: Dissemination Research in an Addiction Treatment System." Journal of Substance Abuse Treatment, 26: 305–312, 2004.

McHugo GJ and Drake RE. "Finding and Evaluating the Evidence: A Critical Step In Evidence-Based Medicine." Psychiatric Clinics of North America, 26(4): 821–831, 2003.

Mellman TA, Miller AL, Weissman EM, Crismon ML, Essock SM and Marder SR. "Evidence-Based Pharmacologic Treatment for People With Severe Mental Illness." Psychiatric Services, 52(5): 619–625, 2001.

Mueser KT. "Clinical Interventions for Severe Mental Illness and Co-Occurring Substance Use Disorder." Acta Neuropsychiatrica, 16: 26–35, 2004.

Mueser KT, Bond GR and Drake RE. "Community-Based Treatment of Schizophrenia and Other Severe Mental Disorders: Treatment Outcomes?" Medscape Mental Health (online journal), 6, 2001.

Mueser KT, Corrigan PW, Hilton D, Tanzman B, Schaub A, Gingerich S, Copeland ME, Essock SM, Tarrier N, Morey B, Vogel-Scibilia S and Herz MI. "Illness Management and Recovery for Severe Mental Illness: A Review of the Research." Psychiatric Services, 53(10): 1272–1284, 2002.

Mueser KT, Drake RE, Sigmon S and Brunette MF. "Psychosocial Interventions for Adults With Severe Mental Illnesses and Co-Occurring Substance Use Disorders: A Review of Specific Interventions." Journal of Dual Disorders, 1(2): 57–82, 2005.

Mueser KT, Torrey WC, Lynde D, Singer P and Drake RE. "Implementing Evidence-Based Practices for People With Severe Mental Illness." Behavior Modification, 27(3): 387–411, 2003.

O'Brien CP, Charney DS, Lewis L et al. "Priority Actions to Improve the Care of Persons With Co-Occurring Substance Abuse and Other Mental Disorders: A Call to Action." Biological Psychiatry, (56)10: 703–713, 2004.

Phillips SD, Burns BJ, Edgar ER, Mueser KT, Linkins KW, Rosenheck RA, Gorman P, Drake RE and McDonel Herr EC. "Moving Assertive Community Treatment into Standard Practice." Psychiatric Services, 52(6): 771–779, 2001.

Torrey WC and Drake RE. "Implementing Evidence-Based Treatment for Persons With Schizophrenia." International Psychiatry Today, 10(3): 1–6, 2001.

Torrey WC, Drake RE, Dixon L, Burns BJ, Rush AJ, Clark RE and Klatzker D. "Implementing Evidence-Based Practices for Persons With Severe Mental Illnesses." Psychiatric Services, 52(1): 45–50, 2001.

Torrey WC, Drake RE, Cohen M, Fox LB, Lynde D, Gorman P and Wyzik P. "The Challenge of Implementing and Sustaining Integrated Dual Disorders Treatment Programs." Community Mental Health Journal, 38(6): 507–521, 2002.

Torrey WC, Finnerty M, Evans A and Wyzik PF. "Strategies for Leading the Implementation of Evidence-Based Practices." Psychiatric Clinics of North America, 26(4): 883–897, 2003.

Tracy B. "Taking Issue: Evidence-Based Practices or Value-Based Services?" Psychiatric Services, 54(11): 1437, 2003.

Xie H, McHugo GJ, Helmstetter B and Drake RE. Three-Year Recovery Outcomes for Long-Term Patients With Co-Occurring Schizophrenic and Substance Use Disorders. Schizophrenia Research, 75(2–3): 337–348, 2005.

World Wide Web Sites

www.dartmouth.edu/~psychrc. The Web site of the Dartmouth-Hitchcock Psychiatric Research Center. It provides information on the Evidence-Based Practices project and project staff.

www.mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits. This Web site also provides access to the toolkits for the six evidence-based practices, as well as information on the Evidence-Based Practices project. It is linked to the Web site of the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration.

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Report prepared by: Jayme Hannay
Reviewed by: Janet Heroux
Reviewed by: Marian Bass
Program Officer: Rosemary Gibson
Program Officer: Constance M. Pechura

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