Why Does the ‘Evidence’ in Evidence-Based Practice Matter?

Mental health providers at Children’s Advocacy Centers (CACs) work with highly vulnerable children and youth: those who have experienced and/or witnessed abuse, neglect, homicide, domestic violence, and other interpersonal traumatic events. Many children are remarkably resilient, and some require treatment for their psychological and physical injuries. CACs face significant hurdles to helping these children. There aren’t enough mental health professionals to work with abused and neglected children, and there aren’t enough resources to serve all the children and youth who need help. And there is another, less obvious challenge to getting child victims the help they need: the fact that too often, therapy is a “black box”—the service provided reflects the orientation of the practitioner rather than what the evidence shows works best for the child client.

We now know what works to strengthen children’s mental health and to help children recover from traumatic events. Multiple databases review and list treatments that have shown evidence for their effectiveness in reducing children’s symptoms and improving their social, emotional, and behavioral functioning. These treatments have been proven effective with children of all ages, and diverse races, ethnicities, and traumatic experiences. One example is the California Evidence-based Clearinghouse for Child Welfare.

But incorporating evidence-based practices (EBPs) into regular treatment is a challenge; many providers still have not been trained in EBPs or do not use them with fidelity. One first step is to empower and educate children, their families, and CAC staff to demand high-quality, evidence-based practice from the therapists they see and refer to. Here in Minnesota, we worked with the National Alliance for Mental Illness to develop a pamphlet and workshops to explain evidence-based practice for child trauma to youth and family consumers.  (Minnesota state law requires mental health professionals to be certified or licensed in EBPs they claim to deliver. Certification demands achievement of core skills in the EBP.)

Why go to these lengths? The payoff is great—in both human and financial terms. Research overwhelmingly shows that evidence-based practices implemented properly by therapists show significantly better outcomes for children and youth than “treatment as usual.” These practices or therapies also cost less. One example is trauma-focused cognitive behavioral therapy, or TF-CBT. Over the past nine years, we have worked with more than 700 providers in over 70 children’s mental health agencies across Minnesota to learn and implement TF-CBT along with evidence-based assessment and progress evaluations. Kids are getting better, therapists are feeling competent about their work, and are delivering on promises to heal our most vulnerable children and youth.

A therapist at a Twin Cities mental health agency shared the following from a letter that her 16-year-old client had written to her at the end of treatment. This teenager had a history of exposure to abuse and violence over several years, foster care placement and subsequent adoption; she had received multiple diagnoses and been on several different medications prior to participating in TF-CBT.  She wrote, “…this (therapy) helped me with an issue that has been haunting me since it happened eight years ago.  It is no longer scaring me.  No therapists have been able to help me with that before.”After completing treatment, her behavioral difficulties subsided, her mood improved, and her symptoms of depression and anxiety were significantly reduced.

The evidence in EBPs is crucial and can make the difference between a successful and a failed treatment. Let’s encourage mental health professionals to match their practice with their intentions to help children recover and get back on track socially, emotionally, and behaviorally, so that they can get on with the business of growing up.

Abi Gewirtz is Lindahl Leadership Professor in the Department of Family Social Science and the Institute of Child Development at the University of Minnesota, and the Director of the University’s Institute for Translational Research in Children’s Mental Health. Her research focuses on the development, evaluation, and implementation of evidence-based practices for highly stressed and traumatized children.