Institute for Mental Health Research - Definitions Of Best And Promising Practices

There are varying professional opinions about what constitutes a "best," "promising," or "emerging" practice in behavioral health prevention and treatment. For purposes of this web site, we have elected to include information about programs and practices that meet one or more of the following criteria:

There have been sufficient studies and evaluations to indicate that the practice is promising and is most likely beneficial for consumers and families;
The practice or approach has become a nationally accepted best practice and has been widely used as a standard and guideline for program implementation and service delivery for a substantial period of time;
There are examples of successful and beneficial implementation of the practice or approach.

Guiding principles are recommendations on how to create effective prevention programs. When a community already has a prevention program or strategy in place, the guiding principles can be used to gauge the program's potential effectiveness. They can also be used to design an innovative program/strategy when none of the best practices are appropriate to the community's needs. Before you select a best practice or apply the guiding principles, your community must conduct an assessment (risk assessment) to identify the risk and protective factors that need to be addressed in your community. Once you have identified which risk and protective factor(s) to address through your assessment, you can use the information in this document to select best practice(s) and/or guiding principles to address your community's needs.

For the purposes of this document, "Best Practices" are those strategies and programs which are deemed research-based by scientists and researchers at the National Institute for Drug Abuse (NIDA), the National Center for Substance Abuse Prevention (CSAP), the National Center for the Advancement of Prevention (NCAP), the National Office of Juvenile Justice and Delinquency Prevention (OJJDP), and/ or the National Department of Education, (DOE). These are strategies and programs that have been shown through substantial research and evaluation to be effective at preventing and/or delaying substance abuse.

We have also included a category called "Promising Practices" in areas where there are few programs that have enough outcome data (or that have been sufficiently evaluated) to be deemed best practices. "Promising Practices" are programs and strategies that have some quantitative data showing positive outcomes in delaying substance abuse over a period of time, but do not have enough research or replication to support generalizable outcomes.

Volume I contains a brief discussion of the criteria used to identify and select best practice approaches and models relevant to Arizona. In this volume, many of the criteria for best practice selection are used to define performance standards and criteria that can be used to continuously assess the degree to which Arizona is moving towards best practice models.

Best practices in public behavioral health are recognized to be multi-dimensional. That is, best practices are defined by several different domains, including vision and values, systemic implementation, and point-of-service excellence in clinical and program delivery. The first domain reflects characteristics of any public sector human services, health care, or behavioral health care system in any jurisdiction. These characteristics include:

Customer orientation - respect for and responsiveness to the individual needs and choices of consumers and their families at all levels of the system;
Clinical excellence - implementation of evidence-based clinical treatment practices consistently throughout the public behavioral health system;
Continuity - assurance that every individual and family will have a single point within the system with the accountability and responsibility to be there when needed, and to respond to individual and family needs as they change over time;
Integration - assurance of uninterrupted movement among the components of the public behavioral health system as well as full and coordinated access to, and integration with, other important services and supports, including primary health care, housing and vocational services; and
Stewardship of public funds - clearly identified single points of public accountability for the quality, effectiveness and efficiency of the public behavioral health system, and consistent evaluations of the quality and performance of the system.

The second domain reflects the practical elements of implementing specific program model and clinical treatment best practices within the preferred public behavioral health system. These are elements without which the first set of criteria cannot effectively be met, and include:

Vision - clearly articulated and understood mission, values, and strategic direction for the public behavioral health system as a whole;
Strategy - feasible and proven approaches to structuring, organizing, financing, and operating the public behavioral health system;
Technology - the actual practice and delivery of services to priority consumers and their families;
Human Resources - the supply of trained, competent, and culturally appropriate staff necessary to deliver best practice service models; and
Culture - the expectations and beliefs by all participants in the system in the value and potential of all consumers and the value of a high quality, customer-oriented, efficient and effective public behavioral health system.

The third domain reflects the combination of empirical research, professional judgement, feasibility of implementation, and relevance to Arizona. The practical criteria are used for those many elements of the public behavioral health system that are not sufficiently evaluated to assure implementation of evidence-based best practice. They also provide a reality check on the application and prioritization of best practice models throughout Arizona. These practical criteria include:

There have been sufficient studies and evaluations to indicate that the practice is promising and is most likely beneficial for consumers and families;
The practice or approach has become a nationally accepted best practice and has been widely used as a standard and guideline for program implementation and service delivery for a substantial period of time;
There are examples of successful and beneficial implementation of the practice or approach in other jurisdictions;
The practice or approach is relevant to Arizona local conditions and resources. It addresses gaps or needs in the current service system; and/or
The implementation of the practice or approach is feasible within the current Arizona public behavioral health system.

Each of the above domains of best practice criteria has been applied to the models and approaches selected for inclusion in this report. They have also been used as guideposts for the strategic recommendations and for recommended implementation strategies. In fact, the above domains of best practice criteria represent best practice in and of themselves. If a state such as Arizona were to apply these criteria to the planning, design, implementation, management, monitoring, and evaluation of public behavioral health systems, the system would be driven towards constant improvements in quality and effectiveness as well as towards newly emerging best practice models.

Science-Based Programs Programs that have been reviewed by experts in the field according to predetermined standards of empirical research. Science-based programs are theory-based, have sound research methodology, and can prove that effects are clearly linked to the program itself and not to extraneous events. Results from science-based programs may be positive, neutral, or negative.
Effective Programs Programs that are science-based, but produce consistently positive patterns of results. Only programs positively affecting the majority of intended recipients or targets are considered effective.
Model Programs Effective programs whose developers have agreed to participate in CSAP's dissemination efforts and to provide training and technical assistance to practitioners who wish to adopt their programs. Ensuring that programs are carefully implemented maximizes the probability for repeated effectiveness.

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