The terms "Best Practice" and "Evidence Based" are getting increased attention in recent years.  In general they apply to standards of practice that are researched based.  "Evidence Based" is generally used to apply to practice that is based upon hard research to produce certain results.  "Best Practice" refers to evidence based practices that are demonstrated by hard research to produce the best outcomes in certain defined situations.

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When "Best Practice" is used, it is in reference to a determination by some group or organization that the practice or procedure in reference is a "best practice."   Thus, while the term implies that objective research is behind claim of best results, there remains a subjective element. Some person or group has chosen which research to apply and which practices to test against the research and which research studies to consider.  Usually the organizations determining "Best Practices" are government agencies, but not always.  The subjectivity is demonstrated by the fact that different organizations documenting best practices do not always create the same list. 

The subjectivity is not a valid reason for ignoring these research based methods.  Specialty schools and treatment programs all too frequently base their procedures on the "way we've always done it" or reinventing the wheel in situation in which research is available to inform the decisions that are most beneficial to clients. 

We strongly urge that schools and programs apply Best Practice and Evidence Based methods whenever practical.  When we say "whenever practical" we do not mean that Evidence Based methods and Best Practices should become strait jackets.  There is still room for creativity.  Remember, that which is Evidence Based was attempted by someone before there was research backing. 

More importantly, there are situations where research does not resolve the question of best methods to use.  The research in which leads to the designation "Evidence Based" or “Best Practice might not appear to apply to a specific situation in school or program.  We do want all schools and programs to be aware of Best Practices and Evidenced Based practices that are relevant to the job programs schools and programs are doing, and to apply them unless there is a clear and explainable reason to do otherwise.

We realize that some programs are working in cutting edge areas where best practices have not been established. In other cases, programs are working with innovations that appear to have potential but have not yet been adequately researched. In considering limitations of evidence based We encourage that kind of innovation, but want programs to be transparent about what is research based, what is innovation, and what is simply the specific personality or twist of the program at issue. 

An example of a program not following these designations that we believe has made that choice appropriately is Elk Mountain Academy.  There has not been good outcome research on twelve-step programs.  What there is has not isolated schools like  that pursue  Elk Mountain Academy twelve-step work in its purest form nor work with the concept of perceived risk as that program does.  We would prefer to see Elk Mountain Academy generating outcome studies on their own work and we urge them to give attention to research developments that could help them to improve, but we would challenge any person or organization that would attempt to use “Evidence Based” or “Best Practice” designations to challenge their work. 

As the public becomes more aware of the designations, "Evidence Based," and "Best Practices," we expect that the terms will be used in a misleading way, so the public should be aware of the real issues.  For example, the "Seven Challenges" substance abuse programming (which we at FamilyLight^sm highly respect) is an Evidence Based program.  However our understanding is that the studies that lead to that designation are based upon a specific population of people receiving other therapeutic intervention at the same time as they are working with the Seven Challenges.  That would suggest that the "Evidence based" designation would only apply to a population similar to the population studied, including having that particular population receiving other services as well.  While we subjectively believe that the Seven Challenges program has value that is broader than that, we do not believe the studies this program relies on to call itself “Evidence Based” demonstrate that at this time. 

Our conclusion is that schools and programs need to adhere better to “Evidence Based” practices and “Best Practices” to a much greater extent than is now the case, but we need to approach these concepts with caution.

Some references: 

Evidence based:

http://ebmh.bmj.com/

http://www.ps.psychiatryonline.org/cgi/content/abstract/52/2/179

http://ebmh.bmj.com/cgi/content/extract/6/1/6

Best Practice:

 http://www.psychservices.psychiatryonline.org/cgi/content/full/52/2/157

http://gwbweb.wustl.edu/CMHSR/best%20practices/best_practice.html

http://www.son.washington.edu/research/samhsa/

When students in programs need evaluations, we particularly appreciate the work of Psychological Solutions, of Salt Lake City, Utah, because of their attention to Best Practices and their ability to consult with schools and programs later working with the client. 

Guidelines Checklist:

·        Schools and Programs should examine Evidence Based practices and Best Practices as they develop and refine their methods and communicate a clear rationale for any methods that differ from known Evidence Based practice and Best Practices. (Current compliance, unfortunately, is not common.)

Feedback is invited. We will publish selected feedback.  Email FamilyLightResponse@yahoo.com

Disclaimer: No  program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation.  When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree.  When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source.  We have also set the bar very high, and do not expect any school or program to be in total compliance.  It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines.  Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.

Last revised 10-13-08; menu adjustments 10-07-08