SAMHSA cites system flaws in moving to alter identification of evidence-based practices

Calling the federal government's two-decade-old registry of evidence-based behavioral health programs “a biased, self-selected series of interventions,” the government's assistant secretary for mental health and substance use last week explained the rationale for a shift in the program for identifying research-based practices.

The Department of Health and Human Services (HHS) has terminated the contract for operating the National Registry of Evidence-Based Programs and Practices (NREPP), which was established in 1997. The National Mental Health and Substance Use Policy Laboratory (Policy Lab), created within HHS's Substance Abuse and Mental Health Services Administration (SAMHSA) under the 21st Century Cures Act, will now assume the role of evaluating and identifying practices and programs supported by research.

Some professionals have said that NREPP has been an essential and impartial resource for seeking out evidence-based approaches, while others countered that some programs appearing on the registry had received virtually no vetting. Elinore McCance-Katz, MD, PhD, who heads SAMHSA as assistant secretary for mental health and substance use, said in a Jan. 11 statement that NREPP mainly evaluated programs submitted by outside developers, thus presenting a skewed view of the research base and leaving some areas of service virtually ignored.

“We at SAMHSA should not be encouraging providers to use NREPP to obtain EBPs, given the flawed nature of this system,” McCance-Katz said. “From my limited review—I have not looked at every listed program or practice—I see EBPs that are entirely irrelevant to some disorders, 'evidence' based on review of as few as a single publication that might be quite old and, too often, evidence review from someone's dissertation.”

Little detail has been released about how the system for identifying evidence-based approaches will differ under the Policy Lab's direction. Some field professionals who were quoted in a Washington Post article last week fear that a new system will move away from some of the focus areas under NREPP, including prevention services.