The American Psychological Association has identified “best research evidence” as a major component of evidence-based practice (APA Presidential Task Force on Evidence-Based Practice, 2006). To help disseminate such research evidence, the Society of Clinical Psychology (Division 12, American Psychological Association) has launched a website on research-supported psychological treatments. The site can be found via PsychologicalTreatments.org, or through the following direct link: http://www.div12.org/PsychologicalTreatments/index.html.
The purpose of this website is to provide information about effective psychotherapeutic treatments for psychological disorders. The website is meant for a wide audience, including the general public, practitioners, researchers, and students. The website provides basic descriptions for a variety of psychological disorders and treatments. In addition, for each treatment, the website summarizes the level of current research support, and lists key references, clinical resources, and training opportunities. Thus, beyond identifying treatments with research support, the website is meant to help practitioners find opportunities to learn and improve their delivery of research-supported treatments, and to educate members of the public regarding the diversity of treatment options available to them. Importantly, the online format ensures that content can be continually revised based on new research findings, as well as input from psychologists regarding treatments or studies that have not yet been incorporated into the website.
Defining and quantifying research support for any given psychological treatment is quite challenging, and there are many reasonable approaches. The website relies on the criteria outlined by Chambless et al. (1998). These criteria require treatments to be efficacious in randomized controlled trials (RCTs) or their logical equivalents. As in all health care, psychologists are dedicated to verifying the effects of their treatments on the targeted health problems. While many types of studies can help evaluate the benefits and safety of treatments, only RCTs and their logical equivalents (e.g., controlled case-studies with on-off-on-off or multiple baseline designs) allow strong causal inferences.
Research support for a given treatment is labeled “strong” if criteria are met for what Chambless et al. (1998) termed “well-established” treatments. To meet this standard, well-designed studies conducted by independent investigators must converge to support a treatment’s efficacy. Research support is labeled “modest” if criteria are met for what Chambless et al. (1998) termed “probably efficacious treatments.” To meet this standard, one well-designed study or two or more adequately designed studies must support a treatment’s efficacy. In addition, it is possible for the “strong” and “modest” thresholds to be met through a series of carefully controlled case study designs (see Chambless et al., 1998 for a full description).
Of course, The Society recognizes that there is considerable and healthy debate about the definition of research support and which treatment approaches can be considered to have support. The website therefore includes links to many of these discussions, including but not limited to Beutler (1998), Goldfried and Wolfe (1998), Norcross (1999), and Persons and Silberschatz (1998). The website also acknowledges that many factors beyond method of treatment contribute to therapy outcomes, including the client, the therapist, and the therapeutic relationship. Nevertheless, I hope and believe that the website provides a valuable service in presenting a vast amount of relevant and useful information on research-supported psychological treatments in an accessible, user-friendly format.
Much of the credit for the website goes to Dr. Marsha Linehan, who in 2007, as President of The Society, asked the Committee on Science and Practice to develop the website. As Chair of the Committee on Science and Practice I was asked to take the lead in developing the website, and was fortunate to receive assistance from a large number of exceptionally smart and accomplished psychologists (a list of current and past contributors can be found here: http://www.div12.org/PsychologicalTreatments/contributors.html). The website has also benefited from the support and input of subsequent Society Presidents, particularly Dr. John Norcross. In addition, work by the Committee on Science and Practice in the 1990s, led by Dr. Dianne Chambless, laid a critical foundation for the website (see http://www.div12.org/content/empiricallysupported-treatments).
In 2008, the Division 12 board voted to indefinitely fund, maintain, and update the website. Today I serve as the website editor, and I and a team of section authors work to continually revise the website based on new studies and user feedback. I welcome your input, and hope you will find the website informative.
APA Presidential Task Force on Evidence-Based Practice. (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285.
Beutler, L.E. (1998). Identifying empirically supported treatments: What if we didn't? Journal of Consulting and Clinical Psychology, 66, 113-120.
Chambless, D.L., Baker, M.J., Baucom, D.H. et al. (1998). Update on empirically validated therapies, II. The Clinical Psychologist, 51(1), 3-16.
Goldfried, M.R. & Wolfe, B.E. (1998). Toward a more clinically valid approach to therapy research. Journal of Consulting and Clinical Psychology, 66, 143-150.
Norcross, J.D. (1999). Collegially validated limitations of empirically validated treatments. Clinical Psychology: Science and Practice, 6, 472-476.
Persons, J.B. & Silberschatz, G. (1998). Are results of randomized controlled trials useful to psychotherapists? Journal of Consulting and Clinical Psychology, 66, 126-135.
SAMHSA’s National Registry of Evidence-Based Programs and Practices
By Kevin D. Hennessy, Ph.D. and Sharon Green-Hennessy, Ph.D.
For psychologists and other mental health professionals interested in assessing the evidence for a range of well-known psychological interventions, the National Registry of Evidence-based Programs and Practices (or NREPP) may be a practical and welcome resource.
Launched by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) in 2007, NREPP is a searchable online registry of mental health and substance abuse interventions that have been evaluated and rated by independent experts/reviewers. The purpose of NREPP is to assist clinicians, program administrators, and the public in identifying and evaluating approaches to preventing and treating mental and/or substance use disorders that have been scientifically tested and that can be readily disseminated in real world clinical and community settings. NREPP is one way that SAMHSA works to improve access to information on evidence-based interventions and thereby reduce the research to practice gap.
The NREPP site (www.nrepp.samhsa.gov) currently contains summaries for over 160 interventions. Each of these summaries includes: general information about the intervention (e.g., target population, setting, implementation history, costs); a description of the research outcomes reviewed; ratings of both the quality of research for key intervention outcomes and the readiness of the intervention for broader dissemination; a list of studies and materials reviewed; and contact information for both the intervention developer and dissemination staff.
SAMHSA is committed to the steady and continuous growth of NREPP as a decision-support vehicle to assist individuals and agencies in determining which evidence-based interventions best meet their needs, resources, and organizational cultures. Between two and four new interventions are added to the NREPP website each month – a pace that should continue for the foreseeable future.
NREPP Selection and Review Process
Unlike other evidence-based registries, NREPP is a voluntary system where developers choose to submit their intervention in response to an annual call from SAMHSA. Because the number of annual submissions to NREPP usually exceeds allocated federal resources for the operation of the registry, the agency prioritizes for review those interventions best meeting the following requirements: 1) presence of statistically significant behavioral outcomes in mental health or substance use among individuals, communities or populations; 2) evidence that these outcomes have been demonstrated in at least one study using an experimental or quasi-experimental design; 3) publication of study results in a peer-reviewed journal or comprehensive evaluation report; and 4) development of implementation materials, training, and support resources that are ready to use by the public. In addition, SAMHSA seeks to select those interventions likely to address existing service gaps and/or improve the lives of individuals and families with – or at risk for developing – mental illness or substance abuse.
If their intervention is selected, developers’ inputs are solicited at various points during the review process so that reviewers have all the information needed to conduct a thorough and objective evaluation of each intervention. At the end of the review process, developers need to consent in writing to the posting of their intervention summary before it will appear on the NREPP website. To date, 99% of the developers whose interventions were reviewed by NREPP have consented to this posting.
NREPP’s Utility to Psychologists and Other Clinicians
The “About NREPP” section of the website provides several recommendations regarding the use of NREPP. Notably, SAMHSA cautions against using the registry as an exclusive or exhaustive list of interventions, and discourages policymakers and funders from limiting service providers to selecting interventions only from NREPP. Moreover, inclusion in NREPP does not imply SAMHSA endorsement or approval of the included intervention, but is rather an objective assessment of the strength of an intervention’s evidence and its potential for successful dissemination. NREPP can – and does - serve psychologists and other clinicians as a useful tool to promote informed decision-making in the identification, selection, and implementation of evidence-based services. Since 2007, the NREPP website has attracted more than 500,000 unique visitors – an average of more than 13,000 per month. And while the website will never contain all mental health and substance abuse interventions of interest, it is a unique resource, and a logical place to start a search for an evidence-based program or practice to meet one’s needs and requirements. Considered together, the more than 160 interventions currently posted on NREPP have been implemented successfully in more than 229,000 sites, in all 50 states and more than 70 different countries, and with more than 107,000,000 clients.
NREPP represents a useful tool not only to practicing psychologists, but also to the programs that train such practitioners. The American Psychological Association’s recently revised training competencies identify the ability to apply evidence-based knowledge as an essential skill for independent practice. At a time when the profession’s knowledge base is rapidly evolving, doctoral programs need not only to provide their students with training in currently supported treatments, but also the skills and tools to evaluate the evidentiary base of interventions in the future. With its dual focus on both the internal validity and the generalizability of various mental health and substance abuse prevention and treatment interventions, NREPP represents one such tool. Facility with NREPP during training will increase the likelihood of its use when students graduate and become busy practitioners.
SAMHSA continues to look for ways to further enhance NREPP as a tool to improve the quality of mental health and substance use services in this country. In addition to new intervention summaries, future plans include establishing links to evidence-based assessments of mental health and substance use screening instruments, as well as highlighting the research base for various relationship factors (e.g., alliance, empathy, congruence) that contribute to psychotherapy success.
It appears that the passage of health reform will increasingly challenge providers to demonstrate the effectiveness of the services they deliver. In this context, the information on NREPP could prove beneficial to psychologists in their efforts to address these new health care realities.
Dr. Hennessy is a practicing clinical psychologist and senior advisor at the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services. His duties include oversight of NREPP.
Dr. Green-Hennessy is a practicing clinical psychologist and an Associate Professor of Psychology at Loyola University Maryland. She has been a member of the National Register since 2001.
A Note on This Section:
Evidence-based practice (EBP) is, arguably, the most consequential development in mental health during the past decade. The international movement in EBP in health care depends on practitioners – not only academics and researchers – routinely accessing and applying the best available research. The challenge is for practitioners to locate, in a few comprehensive, practice-friendly online sites, balanced compilations of that best available research. In this issue, the National Register features two such sites: The APA Division of Clinical Psychology's Research-Supported Treatments and SAMHSA's National Registry of Evidence-Based Programs and Practices. Both compendiums have evolved over the years to address psychologists' emerging needs and practices. We are fortunate to have the coordinators of the respective sites summarize their current value and future benefits.
Accessing the research is the first and critical step in EBP, but only the first. That best available research must then be integrated with clinical expertise in the context of patient characteristics, culture, and preferences. Those latter steps are frequently and selectively neglected by external agencies and health care insurers, but all seasoned psychologists realize that treatment works best when the research, the clinician, and the patient are united.
John C. Norcross, PhD, Vice-Chair, National Register Board of Directors