Evidence-Based Practices

Evidence-based practice (EBP) is the integration of clinical expertise, patient values, and the best research evidence into the decision making process for patient care. Clinical expertise refers to the clinician’s cumulated experience, education and clinical skills. The patient brings to the encounter his or her own personal and unique concerns, expectations, and values. The best evidence is usually found in clinically relevant research that has been conducted using sound methodology. (Sackett D, 2002)

FrontLine Service provides the following evidence-based practices:

Housing First (HF) is an evidence based intervention that effectively ends homelessness for persons with psychiatric disabilities by providing immediate access to independent, permanent scatter-site housing combined with community support services (Tsemberis et al. 2004).

Critical Time Intervention (CTI).  Is an empirically supported, time-limited case management model designed to prevent homelessness in people with mental illness following discharge from hospitals, shelters, prisons and other institutions.  Traditionally, clients leave an emergency shelter, and trusted staff, to essentially start over in a housing program.  Now, CTI workers meet and build rapport with the client in the shelter.  An important aspect of CTI is that services are delivered by workers who have established relationships with patients before they transition to housing.  Workers then assist in the transition to permanent housing, introducing the client to staff and providing independent living skills.  These intensive services and continued support help clients adapt to their new home, accept their new community and learn to access additional support.  After the transition has been successfully navigated, CTI services are tapered and transitioned to traditional community providers.  The typical time-frame is nine months and has three distinct phases.  Our experience shows us that when someone is provided flexible comprehensive services that follow them into housing, people who have remained entrenched in homelessness for years can successfully transition into permanent housing and recovery.

Motivational Interviewing (MI) is an evidence-based treatment that addresses ambivalence to change.  Ambivalence is a natural state of uncertainty that each of us experiences throughout most change processes. Ambivalence occurs because of conflicting feelings about the process and outcomes of change.  MI is a conversational approach designed to help people discover their own interest in considering and/or making a change in their life (e.g., managing symptoms of physical or mental illness, reducing and eliminating the use of alcohol, tobacco, and other drugs), express in their own words their desire for change, examine their ambivalence about the change, plan for and begin the process of change, enhance their confidence in taking action and noticing that even small, incremental changes are important, strengthen their commitment to change.  http://www.centerforebp.case.edu/library/media/practices/mi

Supported Employment helps people with severe mental illness identify, acquire, and maintain competitive employment (“real jobs”) in their local communities. LINK http://www.centerforebp.case.edu/library/media/practices/se  These are jobs that pay at least minimum wage for which anyone in the community may apply.  SE is different from traditional vocational rehabilitation (voc rehab). SE emphasizes consumer choice and utilizes rapid job-search and placement services as well as time-unlimited and individualized follow-along services.  SE does not delay competitive employment by requiring consumers to utilize sheltered workshops, pre-employment training, and volunteer experiences.

Integrated Dual Disorder Treatment (IDDT) (LINK http://www.centerforebp.case.edu/practices/sami/iddt)  improves quality of life for people with co-occurring severe mental illness and substance use disorders by combining mental-health and substance-abuse services. It helps people address both disorders at the same time—in the same service organization by the same team of treatment providers.  IDDT emphasizes that individuals achieve big changes like sobriety, symptom management, and an increase in independent living via a series of small, overlapping, incremental changes that occur over time. Therefore, IDDT takes a stages-of-change approach to treatment, which is individualized to address the unique circumstances of each person’s life.

Trauma-Focused Cognitive-Behavioral Therapy TF-CBT is a unique form of cognitive-behavioral therapy that has been specially adapted for children who have experienced trauma. The Kauffman Best Practices Report has recognized TF-CBT as an evidence-based treatment for sexually abused children. Now, it is also considered a best practice for treating children who have experienced other trauma, including other types of child abuse or witnessing domestic violence. After a trauma, children may experience symptoms of posttraumatic stress disorder (PTSD) or other emotional or behavioral symptoms, such as depression, anxiety, or disruptive behaviors. Some symptoms of child traumatic stress include repeated upsetting memories of the incident, flashbacks, avoiding people or places that are reminders of the event, being easily startled, having nightmares, and difficulty sleeping. But research indicates that within 12 to 16 sessions of TF-CBT, most children will show significant improvement (Cohen, Deblinger, Mannarino, & Steer, 2004; Deblinger, Mannarino, Cohen, Runyon, & Steer, 2011).  Many clinicians claim that TF-CBT has been the most effective treatment they’ve utilized in working with young trauma patients. “TF-CBT has the most research support of any treatment for children and families exposed to traumatic life events,” says Anthony Mannarino, PhD, a professor and vice chair of the department of psychiatry at Allegheny General Hospital in Pittsburgh who co-developed TF-CBT with Esther Deblinger, PhD, and Judith Cohen, MD.

Applied Suicide Intervention Skills Training (ASIST) is an internationally recognized Evidence-Based Practice designed to teach professionals and non-professionals alike how to recognize suicide risk and what to say and do to keep the person safe until the next level of help can become involved (see: www.livingworks.net).