A promising practice is a given practice’s potential to become evidence-based. This potential is acknowledged in identifying an “emerging” or “promising” practice. The promising practices of today will, with sound theoretical rationale and thorough science, become the EBPs of tomorrow. For the purposes of this section, a promising practice is a behavioral health intervention that appears to be effective but does not yet have enough evaluation data to consistently demonstrate positive outcomes.
Most, if not all, of the current evidence-based practices (EBPs) in mental health were developed in urban areas. Implementing these EBPs with full fidelity in rural areas is typically impossible, due to limitations in personnel, vast geographic areas, and other resource shortages. Additionally, states are mandating the use of EBPs, with possible penalties for those counties or areas that do not comply. This places rural areas in a difficult position given the issues noted.
There are many challenges to providing behavioral health services in rural America. But, despite the challenges, there are programs that have a positive impact on the behavioral health of rural Americans. By sharing information about these successful programs, other providers can learn from these models of practice and incorporate these successful program designs into their own communities.
There are several approaches that can help rural mental health systems in regards to Evidence Based and Promising practices. These are: 1) developing rural-specific promising and, ultimately, evidence-based practices (EBPs); 2) applying “core components” of existing EBPs that show the most clinical effectiveness in rural; and 3) developing a continuum of care model that provides reality-based standards for rural areas.
Identifying PRomising PRactices
In collaboration with the Health Resources & Services Administration's Office of Rural Health Policy, and the Nakamoto Group, Inc., the WICHE Mental Health Program is working to identify promising practices, best practices, models that work, and evidence based practices in rural behavioral health.
This project proposes to 1) highlight promising practices throughout the U.S. and 2) provide information for the promising practices to achieve higher levels of evidence based practice to become models for other communities. This contract will support the development of an approach to equip the Office of Rural Health Policy's community based grant programs, which include the Rural Health Care Services Outreach, Network Development and Network Planning Grant Programs with the necessary tools to propose innovative mental health and substance abuse projects and seek funding as a measure to implement these projects in rural communities.
This contract provides funding for two years to examine effective programs in rural and frontier mental health. A final document will take an in-depth look at these programs in a descriptive manner and outline what would be required to move these programs/practices to broader scientific validation and system adoption. In order to ensure that the selected programs have made a real impact, site visits to the programs were conducted. A final report will provide an in-depth look at promising practices for mental health in rural and frontier areas. In addition to the final report describing the promising practices, a technical assistance guide will be developed as a resource for programs that are well established and interested in becoming evidenced based practices.
Developing Rural Promising Practices into Evidence-Based
As part of WICHE's contract with SAMHSA to produce and deliver four web casts, the MHP also submitted a Promising Practices Report that was initiated by the need to address the gap in research and practice and intended to identify emerging or promising rural practices in the areas of behavioral health promotion, prevention, and treatment across the lifespan. The report included a description of identified practices, their target population, challenges to implementation, strategies for meeting those challenges, and lessons learned.
In summary, when examining the current research on behavioral health prevention, promotion, and treatment, there is some empirical evidence concerning their effectiveness. However, an overriding theme is the lack of focus on what is effective (i.e. appropriate research and outcomes) for rural communities. This is not unlike other areas of research where rural-urban differences and similarities are not considered. An important challenge is to strengthen the evidence base for rural-specific interventions in order to inform practice and policy. As has been noted previously, rural programs and communities often face numerous resource and geographic limitations, but they also demonstrate pockets of innovation. These pockets should not be ignored but fostered to promote the sharing of model programs across rural contexts.