Evidence-Based Practices or Practice-Based Evidence: What Is the Future?

Although multiple evidence-based practices are available for the treatment of behavioral disorders, these interventions are not consistently delivered in routine care in the United States. This research to practice gap has created a large quality chasm that may be even larger for people with serious mental illnesses and those with substance use disorders. The process through which behavioral evidence-based practices are integrated into routine care is influenced by the same factors affecting the diffusion of other innovations, that is, characteristics of patients, providers, and the innovation, and system-level factors. Barriers related to each of these factors impede successful EBP implementation through their effects on fidelity and other implementation outcomes, and as a result, intervention effects are substantially smaller than those predicted from the original clinical studies. Key among these barriers are an innovation-related factor, that is, a process of evidence generation and research translation that has traditionally neglected the needs and realities of potential implementers and end-users, and several system-level factors, including financing policy, regulations, and the basic design of the behavioral healthcare system. These barriers are described in detail and strategies to address them and to develop new models growing out of effective practice are discussed.