BH TIG Week: Program Evaluation in Behavioral Health: Limitations of Expert-driven Models and New Directions by Joanna Prout

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.

Lessons Learned:

  • 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.

Rad Resources:

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.
  • 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.

The American Evaluation Association is celebrating Behavioral Health (BH) TIG Week with our colleagues in Behavioral Health Topical Interest Group. The contributions all this week to aea365 come from our BH TIG members. Do you have questions, concerns, kudos, or content to extend this aea365 contribution? Please add them in the comments section for this post on the aea365 webpage so that we may enrich our community of practice. Would you like to submit an aea365 Tip? Please send a note of interest to aea365@eval.org. aea365 is sponsored by the American Evaluation Association and provides a Tip-a-Day by and for evaluators. The views and opinions expressed on the AEA365 blog are solely those of the original authors and other contributors. These views and opinions do not necessarily represent those of the American Evaluation Association, and/or any/all contributors to this site.

1 thought on “BH TIG Week: Program Evaluation in Behavioral Health: Limitations of Expert-driven Models and New Directions by Joanna Prout”

  1. Hi Joanne, thank you so much for your engaging and informative article.  Reading through it, I found myself so deeply connecting with what you had to say.  Growing up, I had a sibling who worked with a behavioural team on a weekly basis due to her psychological needs. I saw how exhausted my parents became, trying out various services to see what would best suite their child.  It became a rollercoaster of emotion and strategy as they jumped from one approach to another.  My parents would try one approach for a while, told to keep at it even if it wasn’t yielding positive results.  They were told that certain approaches were of the latest research, thus to stick with them.     

     I am shocked to hear how long it takes health care services to change routine practice based on findings. With all this being said, I think it is amazing how much you gained from an evaluation and the guidance/insight that you provide based on the results.  I’m currently enrolled in a program inquiry and evaluation course and seeing how the results can really impact and make change is wonderful. I think you provide practical lessons that are not far fetched in the realm of evaluation and research.  I especially agree with your lesson on ensuring that client information will be used in meaningful ways before using their time to gather feedback.  Thank you for all of the work that you do, and sharing the results. It is great to see people making a change within the world of child psychology!    

    -Tori

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