The proponents of evidence-based practice would argue that only rigorous scientific research, with randomly assigned samples, and which have been replicated are the only research that can definitively be reproduced in a variety of settings, adhering of course to fidelity to the original model. However, when the adoption of mental health evidence-based practices occur in usual care setting, there is often a need to adapt the original model to make considerations for recovery-orientated individuals and cultural nuances that may have been missed or overlooked in the original research design, especially if the new target population is culturally diverse from the original sample (Glisson, 2002; Garvin, 1993). It is safe to say, that a certain degree of adaptation is warranted with any evidence-based practice. The Surgeon General's 1999 landmark report on mental (DHHS, 1999) clearly articulated that often the mental health services and clinical interventions being used in usual care settings are generally not based on evidence of effectiveness or efficacy, but rather on individualized modes of service delivery primarily dependent on the provider or organization providing the service. In short, there is a huge gap between science and practice.
Consumer and Family Members
Mental health consumers and family members have only recently played a role in research designs, implementation, and evaluation. The work of Courtney Harding, William Anthony, and Jean Campbell, among others, discusses how individual consumers view themselves and how researchers conceptualize individuals with psychiatric disabilities.
Conducting research with consumers as researchers necessitates a dedication of time, resources, and training. However, providing parents with data and results in a language they can understand, obtaining their input on evaluation activities, recruiting and training them to collect data, and paying them fairly for their efforts is a good approach to improve outcomes.
Consumers and family members were part of CMD-7 from the inception of the proposal to the California Endowment on through our data collection and analysis phases. We created research teams composed of five individuals (a consumer, a family member, a former county mental director, a current county ethnic services manager, and a current county quality improvement manager) and provided training to them.
More than half of our research team members were from culturally diverse communities and nearly all of the consumers we interviewed were also from diverse communities. Key research informed our work so that even with the barriers associated with stigma and self-disclosing, some consumers who had participated in research studies as "researchers" as opposed to "subjects" viewed their disclosure and participation as extremely beneficial, life-changing, and necessary. Participatory research reflects the best contributions when the research methods are highly structured, regularly reinforced, and conducted in a respectful, inclusive, and equitable environment.
Although both of these studies support the integration of consumers and family member's feedback into the research design, this is only part of the ideal.
Science to Service
Evidence-based practice is a concept receiving significant attention in public and private health and behavioral health systems of care throughout the nation. Evidence-based practices are intended to improve the achievement of client outcomes.
Similarly, culturally competent practices are intended to improve achievement of client outcomes; however, these practices are also designed to improve access to needed mental health treatment amongst underserved groups.
Service to Science
Practice-based practice research is a relatively new approach to the mental health study of Epidemiology.
In the National Institute of Health's National Advisory Mental Health Council's Clinical Treatment and Services Research Workgroup's report, Bridging Science and Service, it was stated, "Inclusion of practice research into the NIMH portfolio is relatively recent, and the Workgroup believes that a significant expansion in this area is warranted."