The National Registry of Evidence-Based Programs and Practices (NREPP) was an initiative of SAMHSA that served an important function. It created a database of programs that met certain criteria for being evidence-based in treating mental health and substance use conditions. Last week, SAMHSA hosted a call on the future of NREPP and released a statement on how it plans to improve processes for translating evidence to practice.
Mental Health America (MHA) looks forward to working with the Assistant Secretary and the new National Mental Health and Substance Use Policy Laboratory to reimagine NREPP in a way that better accomplishes three goals:
1. Focus on outcomes and implementation. Among the challenges that communities face when choosing an evidence-based program from somewhere else and putting it into place in their community, there are several that stand out. It may not be transportable because the local resources needed to support the program are different. The replicating community may lack the political and community leadership and buy-in that were present in the first community. The evaluation itself may have been too narrowly focused, and not considered potential obstacles that could arise in taking the initiative to scale. In many cases, communities do not ultimately get the outcomes they anticipated. New initiatives should help communities identify interventions that meet their needs and fit their context, use an implementation science and continuous quality improvement frame to make sure it works in practice, and focus on collecting the outcomes that matter to individuals to ensure ongoing effectiveness.
2. Foster innovation. The policies and practices we have now are not necessarily the most effective ones possible, and we need to keep improving them to ensure that recovery is a reality for more and more people. “Evidence-based programs” have been made out to be the enemy of innovation, and the fact is that we need to promote both evidence-based replication and creative and innovative new programs. New initiatives should support “evidence-informed” or “theory-backed” approaches that focus on rapid evaluation and outcomes. If a community proposes a policy or practice that is likely to work, and then proves that it does, SAMHSA should support and celebrate this work.
3. Support bottom-up peer leadership. For decades individuals in recovery from mental health and substance use conditions have led the way in creating supports that meet the needs of people in their communities. This leadership has taken many forms, from certified peer support specialists to peer-led advocacy and policy. However, these initiatives – which have proven time and again to be effective – have suffered because they didn’t fit the models of traditional clinical interventions, didn’t get attention from university-based researchers who publish in peer-reviewed journals, and therefore couldn’t always be packaged as easy-to-replicate evidence-based program. New initiatives should recognize and foster the crucial role of peers as leaders in improving outcomes in mental health and substance use – understanding that while we typically use the term to refer to people with lived experience of, and in recovery from, mental illnesses, this also includes understanding the relevant roles that peers, young and old, in general play in the lives of others – including social networks, classmates, work associates, extended families, caregivers, and more.