Hi, my name is Joanna Prout and I am a psychologist and program evaluator in the Division of Child and Adolescent Psychiatry at the University of Maryland School of Medicine. I help teams integrate behavioral health supports into school and community settings, including through work at the National Center for School Mental Health (www.schoolmentalhealth.org) and the National Center for Safe Supportive Schools (www.ncs3.org).
As a social worker and psychologist for children and families I saw first-hand that best-practice services can be difficult to use and poorly aligned with client needs and experiences. This challenge and the desire to ensure that behavioral health services were user-friendly and effective led me to shift from direct practice to program evaluation and continues to shape my work.
- The dominant model in behavioral health is not designed to allow rapid change to interventions based on user feedback.Healthcare is notoriously slow to change, with estimates that it takes an average of 17 years for new findings to be incorporated into routine practice! Further, in behavioral health, once an evidence-based practice (EBP) is established, the focus is on maintaining treatment fidelity rather than adapting to the needs of clients.
- This expert-driven model has both strengths (science!) and limits. It can be paternalistic — clients must do what we advise, even if it does not fit with their preferences or experiences. EBPs are based on work done in controlled settings, often with people from dominant cultures, and may not make sense or work for everyone!
- Behavioral healthcare should support and facilitate the healing practices that have been developed and used in communities for generations in addition to offering EBPs.
- Program evaluators, who act as intermediaries between the people who design and disseminate interventions and the people who participate in them, may be ideally positioned to bring client perspectives and feedback to the table.
- Before asking clients to spend time and energy providing feedback about their experiences, we should ensure that this information will be used in a meaningful way. Ideally, we should compensate clients for sharing their lived experience and expertise.
Here are some recent viewpoints to consider and articles to learn from related to bringing client voice and input into the development and use of behavioral health interventions.
- In this article, Katti Gray (@KattiGray) discusses how the healthcare system can fail to meet the needs of people of color and rural communities and describes leaders drawing from and expanding the use of community-developed practices that facilitate healing.
- In an article for American Psychologist, Aaron Lyon (@Aaron_Lyon) discusses the use of human-centered design to improve the development and implementation of EBPs.
- This “best of” AEA blog outlines the benefits of including people using services in efforts to make meaning of data and this article describes the process of including people with lived experience in data analyses
I would love to hear your thoughts and experiences! Get in touch on twitter via @joieprout.
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