Just Released – Children’s Mental Health Ontario Evidence Based Practices Consultation Paper

Executive Summary

Over the past twenty years, progress in the identification of effective treatment interventions has raised service standards in the child, youth, and family mental health sector. The emerging benchmark is the delivery of evidence-based, empirically supported (see glossary) service delivery models that result in positive clinical outcomes for participants. As a leader in the field, Children’s Mental Health Ontario (CMHO) plans to take a proactive role in this transformation through its Accreditation Program and the development of the CMHO Evidence-Based Practice Technical Assistance Centre. This consultation paper is intended to frame this vision and to engage our stakeholders in the process of moving forward together toward its realization.Introduction

Children’s Mental Health Ontario (CMHO) is committed to promoting, supporting, and strengthening a sustainable system of mental health services for children, youth, and their families. A core feature of this system is the delivery of evidence-based services that produce the positive outcomes they were designed to achieve. Our objective is that children, youth, and families receiving services from CMHO-affiliated organizations achieve an improved quality of life. And, for that reason, our ultimate goal is that all services delivered
by children’s mental health providers become evidence-based, empirically supported, and result in positive clinical outcomes for participants.

While this sector has always focussed on service excellence, CMHO recognizes that formal supports and resources are needed to ensure continuous learning and reflective practice. We recognise that delivering effective front-line clinical services is itself an outcome of a productive service system. Therefore, CMHO is proactively supporting policy makers, funders, boards of directors, managers, and front-line mental health practitioners to bridge the gap from “science to service” in the implementation of evidence-based practice.

CMHO is embarking on this change process because advances in clinical research over the past twenty years have demonstrated that some types of treatment work, while others can be harmful or ineffective. To date, a number of evidence-based practices (EBP) have been shown to be both effective and replicable.

While there are up-front costs to implementation, EBPs are cost effective. They provide a good return on investment by maximizing the delivery of positive clinical outcomes. Cost/benefit analyses and identifying the cost of lost opportunity (e.g., economic productivity, social well-being) are regularly used to gauge the efficiency of EBPs relative to the status quo (treatment-asusual) (Aos, Lieb, Mayfield, Miller, & Pennucci, 2004; Browne, Byrne, Roberts, Gafni, & Whittaker, 2001; Browne, Roberts, et al., 2001; Browne, Roulston, et al., 2000; Schweinhart et al., 2005).

Over the past ten years, a number of accredited CMHO agencies have successfully replicated EBPs in their organizations. However, the move toward EBP implementation
has not been consistent across the service system. CMHO appreciates the importance of building on successes in the field. In addition, it is important to build capacity to evaluate promising practices and build knowledge regarding what works.

CMHO recognizes that the identification and delivery of EBP is an emerging science, and that EBPs must be considered within the ecological context in which services are delivered.

As Figure 1 illustrates, socio-historic, economic, and political contexts influence client circumstances. In addition, it should be noted that culture, gender, race, and class cut across all aspects of evidence-based policy and practice—and thus the diagram. For instance, an EBP developed to address youth gang violence in Philadelphia may need to be adapted to address the needs and gang issues facing refugee youth and their families in Toronto. Or, parenting education strategies may require modification to respect the cultural needs of Aboriginal communities and the residual intergenerational trauma from the residential schools experience.

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