Integrating the Integrating the Recovery Paradigm into Recovery Paradigm into

the Evidence-Based the Evidence-Based Practice MovementPractice Movement

The National Association of Mental The National Association of Mental Health Health

Planning and Advisory Councils Planning and Advisory Councils

EBP’s and Recovery: EBP’s and Recovery: Friends or Foes?Friends or Foes?

Are the values of recovery and Are the values of recovery and current evidence-based practices current evidence-based practices fundamentally antagonistic?fundamentally antagonistic?

What are evidence-based practices?What are evidence-based practices? What is all the fuss?What is all the fuss? What is recovery?What is recovery? Can we really infuse recovery-based Can we really infuse recovery-based

principles into current EBPs?principles into current EBPs?

EBP’s 101: EBP’s 101: A Quick Overview…A Quick Overview…

Evidence-Based Evidence-Based PracticesPractices

– Why should this be important to Why should this be important to Planning Councils?Planning Councils?

Surgeon General’s Report: Gap between Surgeon General’s Report: Gap between knowledge of effective mental health knowledge of effective mental health services and practiceservices and practice

President’s New Freedom Commission – President’s New Freedom Commission – Integral part of TransformationIntegral part of Transformation

The future is now!The future is now! EBPs are here to stay EBPs are here to stay and PACs need to be educated on the and PACs need to be educated on the process, benefits and controversyprocess, benefits and controversy

National Outcomes MeasuresNational Outcomes Measures

The importance of EBPs…The importance of EBPs…

Client:Client:– EBPs, when used and implemented appropriately, EBPs, when used and implemented appropriately,

improve outcomeimprove outcome– Every individual has the right to the most Every individual has the right to the most

effective practiceseffective practices

Mental Health SystemMental Health System– EBPs inculcate an outcomes-oriented, quality EBPs inculcate an outcomes-oriented, quality

improvement frameworkimprovement framework– EBPs help identify and address administrative EBPs help identify and address administrative

barriersbarriers

General PublicGeneral Public– Best use of available dollarsBest use of available dollars– Credibility of interventionsCredibility of interventions

Sounds like a good idea, Sounds like a good idea, right?right?

OneOne mechanism to achieve quality and mechanism to achieve quality and accountabilityaccountability

The Big Plus: Effectiveness is proven The Big Plus: Effectiveness is proven and inherent in evidence-based and inherent in evidence-based practicespractices

The Big Gap: Surgeon General’s Report The Big Gap: Surgeon General’s Report finding of the gap between knowledge finding of the gap between knowledge and practiceand practice

The Big Opportunity: Opportunities for The Big Opportunity: Opportunities for system reform embedded in system reform embedded in implementation of evidence-based implementation of evidence-based practicespractices

Wait! We must answer Wait! We must answer a few questions first.a few questions first.

What IS an Evidence-Based Practice?What IS an Evidence-Based Practice?Some DefinitionsSome Definitions

An evidence-based practice is considered to An evidence-based practice is considered to be any practice that has been established as be any practice that has been established as effective through scientific research according effective through scientific research according to a set of explicit criteria to a set of explicit criteria (Drake et al, 2001)(Drake et al, 2001)..

Evidence-based treatment is the use of Evidence-based treatment is the use of treatments for which there is sufficiently treatments for which there is sufficiently persuasive evidence to support their persuasive evidence to support their effectiveness in attaining desired outcomes effectiveness in attaining desired outcomes (Rosen and Proctor, 2002)(Rosen and Proctor, 2002)..

Evidence-based practice is the integration of Evidence-based practice is the integration of best research evidence with clinical expertise best research evidence with clinical expertise and patient values and patient values (Institute of Medicine, (Institute of Medicine, 2001)2001)..

Levels of Levels of Research/EvidenceResearch/Evidence

Level I -- Randomized Controlled TrialsLevel I -- Randomized Controlled Trials

Level II – 1 Well designed trials without Level II – 1 Well designed trials without randomizationrandomization

2 Cohort or case control, preferably 2 Cohort or case control, preferably multi-sitemulti-site

3 Multiple time series – with or without3 Multiple time series – with or withoutinterventionintervention

Level III -- Opinions of respected authorities, based Level III -- Opinions of respected authorities, based on clinical experience; descriptive studies; case on clinical experience; descriptive studies; case reportsreports

From Yannacci, Jacqueline, Evidence-Based Practices: Definitions, Models and Issues, presentation at the NAMHPAC winter meeting, January 2005.

What is evidence?What is evidence?

SAMHSA’s National Registry of Evidence-Based SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP)Programs and Practices (NREPP)

Utilize 16 rating criteria (e.g. reliabilty, Utilize 16 rating criteria (e.g. reliabilty, validity, comparison group)validity, comparison group)

Criteria rated 1-4, average of 16 criteria scoresCriteria rated 1-4, average of 16 criteria scores Five possible categoriesFive possible categories

– 4 = Effective Program or Practice4 = Effective Program or Practice– 3 = Conditionally Effective Program or Practice3 = Conditionally Effective Program or Practice– 2 = Emerging Program or Practice2 = Emerging Program or Practice– 1 = Program or Practice of Interest1 = Program or Practice of Interest– 0 = Insufficient Current Support0 = Insufficient Current Support

Who establishes Who establishes EBPs?EBPs?

SAMHSA – NREPPSAMHSA – NREPP NIMHNIMH Cochrane CollaborationCochrane Collaboration Center for Mental Health Quality and Center for Mental Health Quality and

AccountabilityAccountability

To name a few…To name a few…

Wading through the Wading through the jargon…jargon… Best Practices:Best Practices: Typically have a strong Typically have a strong

research backing and have been research backing and have been replicated in a variety of settings (also replicated in a variety of settings (also called “Exemplary Practices”)called “Exemplary Practices”)

Promising Practices:Promising Practices: Practices for which Practices for which there is considerable evidence or expert there is considerable evidence or expert consensus but are not yet supported by consensus but are not yet supported by “rigorous” scientific evidence.“rigorous” scientific evidence.

Emerging Practices:Emerging Practices: Often used Often used interchangeably with promising practicesinterchangeably with promising practices

EBPs: So what is the EBPs: So what is the controversy?controversy?

– Legislating Evidence-Based PracticesLegislating Evidence-Based Practices– Using EBPs as a cost containment Using EBPs as a cost containment

strategystrategy– Using EBPs in exclusion of other Using EBPs in exclusion of other

treatmentstreatments– What is evidence? Defining What is evidence? Defining

“beneficial outcomes” – who decides?“beneficial outcomes” – who decides?– Recovery ParadigmRecovery Paradigm

CULTURAL CULTURAL COMPETENCYCOMPETENCY Cultural competence is about adopting mental Cultural competence is about adopting mental

health care to the needs of consumers from health care to the needs of consumers from diverse culturesdiverse cultures– Culture influences numerous aspects of care (help Culture influences numerous aspects of care (help

seeking behavior, preferred settings, language, seeking behavior, preferred settings, language, coping)coping)

May need to tailor EBPs themselves or the May need to tailor EBPs themselves or the context in which they are offeredcontext in which they are offered

SAMHSA Toolkits provide a number of SAMHSA Toolkits provide a number of recommendations for making EBPs culturally recommendations for making EBPs culturally competentcompetent– Must collect and analyze data to examine disparities Must collect and analyze data to examine disparities

in servicein service– Conduct regular organizational self-assessment of Conduct regular organizational self-assessment of

cultural competencecultural competence

Now that we understand Now that we understand EBPs and the potential EBPs and the potential pitfalls…pitfalls…

How do we implement them in our state?

Evidence-based Practices Evidence-based Practices ProjectProject

EBP Implementation EBP Implementation Resource Kits Resource Kits (“toolkits”) (Dartmouth-(“toolkits”) (Dartmouth-led consortium)led consortium)

National Demonstration National Demonstration Project (IN, KS, MD, NH, Project (IN, KS, MD, NH, NY, OH, OR, VT)NY, OH, OR, VT)

Evidence-Based Practices for Evidence-Based Practices for Adults with Serious Mental Adults with Serious Mental Illness Toolkit ProjectIllness Toolkit Project

Six evidence-based services in Six evidence-based services in projectproject– MedicationsMedications– Illness self-managementIllness self-management– Assertive community treatmentAssertive community treatment– Family psychoeducationFamily psychoeducation– Supported employmentSupported employment– Integrated substance abuse/mental illness Integrated substance abuse/mental illness

servicesservices

Different Toolkits forDifferent Toolkits for Different Audiences Different Audiences

For For eacheach evidence-based evidence-based practice, there are toolkits for practice, there are toolkits for different audiencesdifferent audiences

– State Mental Health AuthorityState Mental Health Authority– Provider organizationProvider organization– Clinician/providerClinician/provider– ConsumerConsumer– Family memberFamily member

Child & Adolescent Child & Adolescent Evidence-Based Evidence-Based

PracticesPractices

Multi-systemic Therapy (MST)Multi-systemic Therapy (MST) Therapeutic Foster CareTherapeutic Foster Care Positive Behavioral Interventions Positive Behavioral Interventions

and Supports (PBIS)and Supports (PBIS)

rapidly

www.nri-inc.org/CMHQA/CMHQA.cfm

A word on FIDELITY…A word on FIDELITY…

What is fidelity?What is fidelity?– Adherence to program standards and principlesAdherence to program standards and principles

Why is fidelity important?Why is fidelity important?– The more similar the implemented practice is to the The more similar the implemented practice is to the

model, the better outcomes obtainedmodel, the better outcomes obtained– Diagnose program weakness/Clarify strengthsDiagnose program weakness/Clarify strengths

How do we monitor fidelity?How do we monitor fidelity?– SAMHSA ToolkitsSAMHSA Toolkits– Fidelity scales must adequately sample all the critical Fidelity scales must adequately sample all the critical

ingredients ingredients – Must be sensitive enough to detect change as the program Must be sensitive enough to detect change as the program

developsdevelops

SAMHSA Fidelity Scales:SAMHSA Fidelity Scales:http://ebp.networkofcare.net/uploads/http://ebp.networkofcare.net/uploads/

fidelityscales_6513943.htmfidelityscales_6513943.htm

Fidelity in Rural, Fidelity in Rural, Ethnically Diverse and Ethnically Diverse and Non-traditional Non-traditional settings…settings… Each Evidence-Based Practice Each Evidence-Based Practice

developed in certain location/populationdeveloped in certain location/population Goodness of fit problemGoodness of fit problem

– In rural, ethnically diverse, non-traditional In rural, ethnically diverse, non-traditional settings may not be possible to have full settings may not be possible to have full fidelity to the modelfidelity to the model

– However, the more we modify and deviate However, the more we modify and deviate from the original model, need increased from the original model, need increased attention to measuring fidelity and attention to measuring fidelity and outcomes. outcomes.

– Why? Need to measure the effects of Why? Need to measure the effects of changes in practice in communities with changes in practice in communities with differing cultures and values.differing cultures and values.

Review of ACT Teams Using Review of ACT Teams Using Dartmouth Fidelity Scale (2004) - Dartmouth Fidelity Scale (2004) - AlabamaAlabama

Along with consumers, families, and Mental Health Along with consumers, families, and Mental Health Association representatives, met with providers to Association representatives, met with providers to discuss their assessments and to review datadiscuss their assessments and to review data

Reviews were conducted in July and AugustReviews were conducted in July and August There are three domains assessed:There are three domains assessed:

Human Resources: structure and compositionHuman Resources: structure and composition

Organizational BoundariesOrganizational Boundaries

Nature of ServicesNature of Services

From Carlson, Greg, The Role of Planning Councils in Advocating and Implementing Evidence Based Practices. Presentation at the NAMHPAC winter meeting, January 2005.

Implementation of ACT Implementation of ACT with High and Low with High and Low FidelityFidelity

-$20,000

-$15,000

-$10,000

-$5,000

$0

$5,000

$10,000

$15,000

$20,000

Changes in Costs (2-year mean)

High FidelityLow Fidelity

Source: Rosenheck, et al. 1995

Implementation of ACT Implementation of ACT with High and Low with High and Low FidelityFidelity

-100

-80

-60

-40

-20

0

20

40

Changes in Inpatient Days (2-yearmean)

High FidelityLow Fidelity

Source: Rosenheck, et al. 1995

Infusing the Infusing the Recovery ParadigmRecovery Paradigm

Recovery Model: It’s Recovery Model: It’s all about the all about the outcomes…outcomes…

Recovery should be the “common, Recovery should be the “common, recognized outcome of mental health recognized outcome of mental health services” – President’s New Freedom services” – President’s New Freedom CommissionCommission

Draft Consensus Statement: “A Draft Consensus Statement: “A journey of healing & transformation for journey of healing & transformation for a person with a mental health a person with a mental health disability to be able to live a disability to be able to live a meaningful life in communities of his meaningful life in communities of his or her choice while striving to achieve or her choice while striving to achieve full human potential or ‘personhood’.”full human potential or ‘personhood’.”

New York State Office of New York State Office of Mental Health: A more Mental Health: A more productive stance …productive stance …

“… “… a movement toward infusing our a movement toward infusing our (consumers’) definition of quality (consumers’) definition of quality into evidence-based practices or any into evidence-based practices or any other initiative within the mental other initiative within the mental health service delivery system.”health service delivery system.”

Infusing recovery-based principles into mental health services: A white paper Infusing recovery-based principles into mental health services: A white paper by people who are New York state consumers, survivors, patients and ex-by people who are New York state consumers, survivors, patients and ex-patients. September, 2004. New York State Office of Mental Health.patients. September, 2004. New York State Office of Mental Health.

Integrating Ten Rules for Integrating Ten Rules for Quality Mental Health Quality Mental Health

ServicesServices1.1. Informed ChoiceInformed Choice2.2. Recovery FocusRecovery Focus3.3. Person CenteredPerson Centered4.4. Do No HarmDo No Harm5.5. Free Access To RecordsFree Access To Records6.6. A System Based on TrustA System Based on Trust7.7. A Focus On Cultural ValuesA Focus On Cultural Values8.8. Knowledge-BasedKnowledge-Based9.9. Partnership Between Consumer & ProviderPartnership Between Consumer & Provider10.10. Access to Services Regardless Of Ability To Access to Services Regardless Of Ability To

PayPay

Another model of Another model of integration:integration:

A time and place for everything:A time and place for everything:– More controversialMore controversial– For persons who are so seriously impaired For persons who are so seriously impaired

they are unable to discern best interests, a they are unable to discern best interests, a paternalistic, externally reasoned treatment paternalistic, externally reasoned treatment approach is appropriate (traditional EBPs)approach is appropriate (traditional EBPs)

– As person benefits from externally initiated As person benefits from externally initiated interventions, control should shift to person interventions, control should shift to person who is recovering – given greater choice who is recovering – given greater choice about evidence-based interventions and about evidence-based interventions and other available services (more recovery other available services (more recovery oriented)oriented)

– Advanced Directives means of finding a Advanced Directives means of finding a middle ground to this stancemiddle ground to this stance

Factors Affecting State-Factors Affecting State-Wide Recovery-Oriented Wide Recovery-Oriented

EBP ImplementationEBP Implementation Workforce Development & TrainingWorkforce Development & Training Financial Resources & Medicaid Financial Resources & Medicaid

ReimbursementReimbursement Consensus Building among all Consensus Building among all

stakeholdersstakeholders

Policies/proceduresPolicies/procedures

Integration with Integration with performance/quality improvementperformance/quality improvement

Latest News on the EBP Latest News on the EBP Front:Front:

Federal Action AgendaFederal Action Agenda Expand NREPP to include best Expand NREPP to include best

evidence-based interventionsevidence-based interventions Develop procedure through which Develop procedure through which

consensus can be developed across consensus can be developed across key mental health groups, consumer key mental health groups, consumer and family members regarding and family members regarding implementation of EBPsimplementation of EBPs

Develop new toolkits: children’s Develop new toolkits: children’s services, older adults, supportive services, older adults, supportive housing, trauma and violence, models housing, trauma and violence, models in primary care, consumer-operated in primary care, consumer-operated services and supported educationservices and supported education

Some Tangible Examples for Some Tangible Examples for PAC Action:PAC Action:

Host a planning meeting and invite stakeholders and national experts Host a planning meeting and invite stakeholders and national experts with expertise on different evidence-based services to address the with expertise on different evidence-based services to address the group. group.

Ask state mental health planning staff to discuss any plans the state is Ask state mental health planning staff to discuss any plans the state is working on for implementing evidence-based programs and different working on for implementing evidence-based programs and different efforts to measure quality and outcomes of these programs.efforts to measure quality and outcomes of these programs.

Establish a sub-committee or task force to focus on the issue of Establish a sub-committee or task force to focus on the issue of evidence-based mental health services and further explore the needs evidence-based mental health services and further explore the needs of consumers and families in the state and how new programs can of consumers and families in the state and how new programs can meet those needs.meet those needs.

Participate in consensus buildingParticipate in consensus building by initiating statewide by initiating statewide training/education familiarizing key stakeholders with the evidence-training/education familiarizing key stakeholders with the evidence-based practice(s) the state would like to implement based practice(s) the state would like to implement

Block Grant:Block Grant:– Review allocation of the Block Grant funds in the state and Review allocation of the Block Grant funds in the state and

determine the extent to which funds are being used to support determine the extent to which funds are being used to support implementation and delivery of EBPs. If dollars are not being used implementation and delivery of EBPs. If dollars are not being used to support EBPs, councils can issue recommendations encouraging to support EBPs, councils can issue recommendations encouraging at least a portion of funds be used to support recovery-oriented at least a portion of funds be used to support recovery-oriented initiatives, consumer-operated services and/or implementation of initiatives, consumer-operated services and/or implementation of EBPs.EBPs.

Some Tangible Examples for Some Tangible Examples for PAC Action:PAC Action:

Advocate for:Advocate for:– consumer and family member involvement at all stages of consumer and family member involvement at all stages of

the planning process in development and implementation of the planning process in development and implementation of EBPs.EBPs.

– research on promising practices research on promising practices – policy changes in the way services are funded in order that policy changes in the way services are funded in order that

flexible funding streams will be available to support flexible funding streams will be available to support evidence-based initiativesevidence-based initiatives

Work with your local university department of psychology, Work with your local university department of psychology, psychiatry and social work to identify evidence-based practices, psychiatry and social work to identify evidence-based practices, gather and interpret information about specific programs of gather and interpret information about specific programs of interest, and evaluate the effectiveness of exemplary State interest, and evaluate the effectiveness of exemplary State programs that have not previously been scientifically tested. programs that have not previously been scientifically tested.

Monitoring:Monitoring:– Fidelity AssessmentFidelity Assessment– Quality assurance assessment feedback loopQuality assurance assessment feedback loop– Sit on taskforce committees created to develop standards Sit on taskforce committees created to develop standards

for EBPsfor EBPs

Placing Consumers in the Placing Consumers in the Driver’s Seat on the EBP Driver’s Seat on the EBP

Highway…Highway…

Consumer Recommendations for Consumer Recommendations for Developing and Implementing Developing and Implementing

EBPsEBPs Consumer participation in the EBP movement Consumer participation in the EBP movement

is critical to its success.is critical to its success. The EBP movement and mental health The EBP movement and mental health

researchers should seek the participation of researchers should seek the participation of people with mental illness in all levels of EBP people with mental illness in all levels of EBP development.development.

The EBP movement must reexamine and The EBP movement must reexamine and reallocate their research resources that reallocate their research resources that encompass the entire breadth of program encompass the entire breadth of program and outcomes.and outcomes.

EBPs must be linked to all aspects of living EBPs must be linked to all aspects of living with a mental illness.with a mental illness.

What Works? What Doesn’t? Consumer perspectives and needs related to evidence-based practices. Center for Mental Health Quality and Accountability. February, 2005

Promising/Emerging Promising/Emerging PracticesPractices

Consumer-Operated ServicesConsumer-Operated Services Programs that are administratively controlled Programs that are administratively controlled

and operated by consumers and emphasize self-and operated by consumers and emphasize self-help and their operational approachhelp and their operational approach

Multi-site study of 1827 participants who were Multi-site study of 1827 participants who were randomly assigned to either traditional MH randomly assigned to either traditional MH services or traditional MH services and peer run services or traditional MH services and peer run servicesservices

From: The Consumer-Operated Service Program Multisite Research Initiative: From: The Consumer-Operated Service Program Multisite Research Initiative: Overview and Preliminary Findings. Presentation made by Jean Campbell Overview and Preliminary Findings. Presentation made by Jean Campbell at the Alternatives Conferenceat the Alternatives Conference

COSP Study ResultsCOSP Study Results

““Participants randomly assigned to consumer-Participants randomly assigned to consumer-operated services programs of the drop-in type in operated services programs of the drop-in type in addition to their traditional MH services showed addition to their traditional MH services showed greater improvement in well-being over the course greater improvement in well-being over the course of the study than participants randomly assigned of the study than participants randomly assigned to only traditional mental health services at those to only traditional mental health services at those sites”sites”

From: The Consumer-Operated Service Program Multisite Research Initiative: From: The Consumer-Operated Service Program Multisite Research Initiative: Overview and Preliminary Findings. Presentation made by Jean Campbell at Overview and Preliminary Findings. Presentation made by Jean Campbell at the Alternatives Conferencethe Alternatives Conference

Fully Integrating Fully Integrating Consumers into the EBP Consumers into the EBP MovementMovement Recognizing consumers as Recognizing consumers as

alliesallies– Develop strategies to move peer support Develop strategies to move peer support

from a promising practice to an EBP from a promising practice to an EBP – Obtain pilot funding to show that existing Obtain pilot funding to show that existing

consumer run, peer support programs are consumer run, peer support programs are an EBP/Promising practicean EBP/Promising practice

– Expand “SAMSHA Evidence-Based Expand “SAMSHA Evidence-Based Implementation Resource Kit Steering Implementation Resource Kit Steering Committee” to include consumer Committee” to include consumer researchers and community providers researchers and community providers

Information From: Evidence-Based Practices: Challenges and Opportunities. Presented at NMHA 2005 Annual Conference by Sara Thompson.

Integration Integration Continued…Continued…

Some tangible examples of steps to Some tangible examples of steps to integration of recovery from the consumers’ integration of recovery from the consumers’ perspectives into EBPs:perspectives into EBPs:– Disseminate Jean Campbell’s findings on COSPs – Disseminate Jean Campbell’s findings on COSPs –

fund data analysis and evaluationfund data analysis and evaluation– Increase mental health block grant spending to Increase mental health block grant spending to

funding promising or emerging practices set funding promising or emerging practices set aside for COSPaside for COSP

– Develop a “Consumer Information Packet” on Develop a “Consumer Information Packet” on “the possibility of recovery” which would be “the possibility of recovery” which would be included in treatment planning materials for included in treatment planning materials for providers.providers.

Integration Integration Continued…Continued… Consumers Can Address Consumers Can Address

Workforce Shortages:Workforce Shortages:

– e.g. Use State Infrastructure Grants to e.g. Use State Infrastructure Grants to develop a “recovery mentor program” so a develop a “recovery mentor program” so a consumer knows what to expect when s/he consumer knows what to expect when s/he goes to the ER or hospitalgoes to the ER or hospital

– Educate health care professionals, Educate health care professionals, academic health centers and related academic health centers and related institutions on consumer run EBPsinstitutions on consumer run EBPs

Integration Integration Continued…Continued… Making Research More Consumer-Friendly:Making Research More Consumer-Friendly:

– Train consumers to research promising practices to Train consumers to research promising practices to determine what is effective and to develop determine what is effective and to develop implementation strategies (e.g. a Consumer implementation strategies (e.g. a Consumer Research Institute)Research Institute)

– CONTAC and National Empowerment Center to CONTAC and National Empowerment Center to convened meeting for consumers on research and convened meeting for consumers on research and evaluation in August, 2005 (info on CONTAC website: evaluation in August, 2005 (info on CONTAC website: www.contac.orgwww.contac.org))

– Encourage NIMH to disseminate all research to Encourage NIMH to disseminate all research to consumers in layperson language. This could be consumers in layperson language. This could be accomplished by making it a requirement of NIMH accomplished by making it a requirement of NIMH grantees.grantees.

Integration Integration Continued…Continued… Expanding and Accelerating Research Expanding and Accelerating Research

Partnerships with Consumers to Support EBPPartnerships with Consumers to Support EBP

– Advocate for NIMH/SAMHSA inclusion of Advocate for NIMH/SAMHSA inclusion of consumers in the development of RFA processconsumers in the development of RFA process

– Ensure that there are specific requirements that Ensure that there are specific requirements that consumers are consistently part of the team in consumers are consistently part of the team in design, delivery, implementation and evaluation design, delivery, implementation and evaluation of SAMHSA grantees in the development of EBPsof SAMHSA grantees in the development of EBPs

– Develop a systematic process for putting Develop a systematic process for putting consumers in touch with established NIMH consumers in touch with established NIMH researchersresearchers

EBPs: Under the EBPs: Under the Umbrella Umbrella of of RecoveryRecovery

RECOVERYRECOVERY

EBPs