Psychosocial Interventions for
Mental and Substance Use Disorders
A Framework for Establishing Evidence-Based Standards
Committee on Developing Evidence-Based Standards for
Psychosocial Interventions for Mental Disorders
Board on Health Sciences Policy
Mary Jane England, Adrienne Stith Butler, Monica L. Gonzalez, Editors
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.
This study was supported by Contract No. 10001728 between the National Academy of Sciences and the National Institutes of Health, Contract No. 10001759 between the National Academy of Sciences and the U.S. Department of Veterans Affairs, and Contract No. 10001803 between the National Academy of Sciences and the U.S. Department of Health and Human Services, and grants from the American Psychiatric Association, American Psychological Association, Association for Behavioral Health and Wellness, and the National Association of Social Workers. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.
International Standard Book Number-13: 978-0-309-31694-1
International Standard Book Number-10: 0-309-31694-4
Library of Congress Control Number: 2015948348
Additional copies of this report are available for sale from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2015 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
Suggested citation: IOM (Institute of Medicine). 2015. Psychosocial interventions for mental and substance use disorders: A framework for establishing evidence-based standards. Washington, DC: The National Academies Press.
“Knowing is not enough; we must apply.
Willing is not enough; we must do.”
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
Advising the Nation. Improving Health.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. C. D. Mote, Jr., is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Victor J. Dzau is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. C. D. Mote, Jr., are chair and vice chair, respectively, of the National Research Council.
COMMITTEE ON DEVELOPING EVIDENCE-BASED STANDARDS FOR PSYCHOSOCIAL INTERVENTIONS FOR MENTAL DISORDERS
MARY JANE ENGLAND (Chair), Professor of Health Policy and Management, School of Public Health, Boston University
SUSAN M. ADAMS, Professor of Nursing, Director of Psychiatric Mental Health Nurse Practicioner Program, School of Nursing, Vanderbilt University
PATRICIA A. AREÁN, Professor, Director of Targeted Treatment Development, Department of Psychiatry and Behavioral Sciences, University of Washington
JOHN S. BREKKE, Frances G. Larson Professor of Social Work Research, School of Social Work, University of Southern California
MICHELLE G. CRASKE, Professor of Psychology, Psychiatry, and Behavioral Sciences, Director of Anxiety Disorders Research Center, Department of Psychology, University of California, Los Angeles
KERMIT ANTHONY CRAWFORD, Associate Professor of Psychiatry, Boston University Medical Center; Director, Center for Multicultural Mental Health, Boston University
FRANK VERLOIN DEGRUY III, Woodward-Chisholm Professor and Chair, Department of Family Medicine, School of Medicine, University of Colorado
JONATHAN DELMAN, Assistant Research Professor of Psychiatry, Systems and Psychosocial Advances Research Center, University of Massachusetts; Senior Researcher, Technical Assistance Collaborative
CONSTANCE M. HORGAN, Professor, Heller School for Social Policy and Management and Founding Director, Institute for Behavioral Health, Brandeis University
HAIDEN A. HUSKAMP, Professor, Department of Health Care Policy, Harvard Medical School, Harvard University
HAROLD ALAN PINCUS, Professor and Vice Chair, Department of Psychiatry, Columbia University College of Physicians and Surgeons; Director of Quality and Outcomes Research, New York-Presbyterian Hospital; Co-Director, Irving Institute for Clinical and Translational Research; Senior Scientist, RAND Corporation
ENOLA K. PROCTOR, Shanti K. Khinduka Distinguished Professor, and Founding Director, Center for Mental Health Services Research, George Warren Brown School of Social Work, Washington University in St. Louis
RHONDA ROBINSON-BEALE, Senior Vice President and Chief Medical Officer, Blue Cross of Idaho
SARAH HUDSON SCHOLLE, Vice President of Research and Analysis, National Committee for Quality Assurance
JOHN T. WALKUP, Professor of Psychiatry, DeWitt Wallace Senior Scholar, Vice Chair of Psychiatry, and Director, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Weill Cornell Medical College, Cornell University
MYRNA WEISSMAN, Diane Goldman Kempner Family Professor of Epidemiology and Psychiatry, Columbia University College of Physicians and Surgeons; Chief, Division of Epidemiology, New York State Psychiatric Institute
ADRIENNE STITH BUTLER, Study Director
MONICA L. GONZALEZ, Associate Program Officer
THELMA L. COX, Administrative Assistant
LORA K. TAYLOR, Financial Associate
ANDREW M. POPE, Director, Board on Health Sciences Policy
GARY BOND, Professor of Psychiatry, Dartmouth University
RONA BRIERE, Editor
BRUCE CHORPITA, Professor of Psychology, University of California, Los Angeles
MIRIAM DAVIS, Writer
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:
Margarita Alegría, Harvard Medical School
Floyd E. Bloom, The Scripps Research Institute
Robert Drake, Dartmouth Psychiatric Research Center
Deborah Finfgeld-Connett, University of Missouri
Russell E. Glasgow, University of Colorado School of Medicine
Carol D. Goodheart, Independent Practice
George Isham, HealthPartners Institute for Education and Research
Ned H. Kalin, University of Wisconsin
Eric M. Plakun, The Austen Riggs Center
Scott L. Rauch, McLean Hospital
Richard Saitz, Boston University School of Public Health
Rusty Selix, California Council of Community Mental Health Agencies
Shelley E. Taylor, University of California, Los Angeles
John R. Weisz, Harvard University
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the report’s conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Huda Akil, University of Michigan, and Alan F. Schatzberg, Stanford University School of Medicine. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Although a wide range of evidence-based psychosocial interventions are currently in use, most consumers of mental health care find it difficult to know whether they are receiving high-quality care. Providers represent many different disciplines and types of facilities, the delivery of care is fragmented, interventions are supported by varying levels of scientific evidence, performance metrics may or may not be used to measure the quality of care delivered, and insurance coverage determinations are not standardized. In this report, the Institute of Medicine’s Committee on Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders offers a framework for use by the behavioral health field in developing efficacy standards for psychosocial interventions.
Together with the Mental Health Parity and Addiction Equity Act of 2008, the Patient Protection and Affordable Care Act of 2010 (ACA) will significantly expand access to high-quality interventions for mental health/substance use disorders. In this opportune context, the committee began its work by defining psychosocial interventions for such disorders in a way that is applicable across populations, providers, and settings. The committee recommends that psychosocial interventions be elevated to a position of equal regard with physical health care, that the measurement and improvement strategies used in mental health care likewise be equated with those used in physical health care, and that the importance of context and infrastructure for high-quality psychosocial interventions receive greater emphasis.
The committee envisions a bold path forward for the behavioral health field within the framework presented in this report for applying
and strengthening the evidence base for psychosocial interventions. In this framework, the committee recommends that psychosocial interventions be considered in terms of their elements of therapeutic change, and that these elements be subject to systematic reviews, quality measurement, and quality improvement efforts. Key to the framework are a consumer-centered approach to care and the continuous need to strengthen the evidence base. Above all, the committee strove to propose a path forward in which the roles of scientific evidence and quality improvement would be afforded the same importance in mental health care that they have in physical health care.
The committee is most grateful to the sponsors of this study for entrusting us with the opportunity to develop this timely report. As committee chair, I am also deeply appreciative of the expert work of our dedicated, hard-working, and collegial committee members and their forward-thinking approach. Study director Adrienne Stith Butler offered superb leadership, with instrumental support from Monica Gonzalez and Thelma Cox. Andrew Pope also offered exceptional guidance. It is the committee’s hope that this report will assist not only payers, purchasers, and providers in their vital efforts to bring high-quality, evidence-based psychosocial interventions into clinical practice, but also the broader consumer community, whose members should be involved in and benefit from each step of the framework offered in this report.
Mary Jane England, Chair
Committee on Developing Evidence-Based Standards
for Psychosocial Interventions for Mental Disorders
The committee and staff are indebted to a number of individuals and organizations that made important contributions to the study process and this report. The committee wishes to thank these individuals, but recognizes that attempts to identify all and acknowledge their contributions would require more space than is available in this brief section.
To begin, the committee would like to thank the sponsors of this report. Funding for this study was provided by the American Psychiatric Association, American Psychological Association, Association for Behavioral Health and Wellness, National Association of Social Workers, National Institutes of Health, the Office of the Assistant Secretary for Planning and Evaluation within the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, and the U.S. Department of Veterans Affairs.
The committee gratefully acknowledges the contributions of the many individuals who provided valuable input to its work. These individuals helped the committee understand varying perspectives on quality measurement and improvement of psychosocial interventions. In particular, the committee is grateful for the time and effort of those who provided important information and data at its open workshops; Appendix A lists these individuals and their affiliations. The committee is also grateful for the contributions of Alisa Decatur and Heather Lee.
Finally, many within the Institute of Medicine were helpful to the study staff. The committee would like to thank Laura DeStefano, Chelsea Aston Frakes, and Greta Gorman for their invaluable assistance.
This page intentionally left blank.
This page intentionally left blank.
Boxes, Figures, and Tables
American Board of Psychiatry and Neurology
Patient Protection and Affordable Care Act
Accreditation Council for Graduate Medical Education
accountable care organization
Adult Consumer Satisfaction Survey
assertive community treatment
Agency for Healthcare Research and Quality
Assistant Secretary for Planning and Evaluation
Consumer Assessment of Healthcare Providers and Systems
Children’s Health Insurance Program
Children’s Health Insurance Program Reauthorization Act
Centers for Medicare & Medicaid Services
Current Procedural Terminology
Distillation and Matching Model
U.S. Department of Defense
electronic health record
eye movement desensitization and reprocessing
Evidence-Based Practice Center
Cochrane Effective Practice and Organization of Care Group
Evidence-Based Synthesis Program
U.S. Food and Drug Administration
Grading of Recommendations, Assessment, Development and Evaluation
U.S. Department of Health and Human Services
Health Insurance Portability and Accountability Act
Health Information Technology for Economic and Clinical Health Act
health maintenance organization
Health Resources and Services Administration
Improving Access to Psychological Therapies
International Classification of Diseases
Institute of Medicine
Measures Application Partnership
mental health and substance use
Mental Health Parity and Addiction Equity Act
Mental Health Research Network
Mental Health Statistics Improvement Program
National Academy of Sciences
National Association of Social Workers
National Committee for Quality Assurance
National Health Service of the United Kingdom
National Institute on Alcohol Abuse and Alcoholism
National Institute for Health and Care Excellence of the United Kingdom
National Institute on Drug Abuse
National Institute of Mental Health
National Quality Forum
National Registry of Evidence-based Programs and Practices
National Standard Project
participatory action research
Patient-Centered Outcomes Research Institute
National Patient-Centered Clinical Research Network
Physician Consortium for Performance Improvement
population/disease, intervention or variable of interest, comparison, outcome, time
Recovery Assessment Scale
randomized controlled trial
Substance Abuse and Mental Health Services Administration
Scientific Merit Rating Scale
U.S. Department of Veterans Affairs
Veterans Health Administration
World Health Organization
Youth and Family Satisfaction Survey
This page intentionally left blank.
ACA: The Patient Protection and Affordable Care Act (ACA), known colloquially as health care reform or “Obamacare,” was designed to increase the quality and affordability of health care for all Americans. The law’s provisions focus on expanding coverage, controlling health care costs, and improving the health care delivery system (KFF, 2013). The law became effective on March 23, 2010. Several major provisions, including the individual mandate, guaranteed access to insurance for those with preexisting conditions, minimum standards for health insurance policies, federal subsidies, and the implementation of health insurance exchanges, were phased in through 2014.2
Accreditation: “A voluntary process by which a nongovernmental agency grants a time-limited recognition to an institution, organization, or business, or other entity after verifying that it has met predetermined and standardized criteria” (McHugh et al., 2014, p. 2; NOCA, 2005, p. 5).
Certification: “The voluntary process by which a nongovernmental entity grants a time-limited recognition and use of a credential to an individual after verifying that he or she has met predetermined and standardized criteria. It is the vehicle that a profession or occupation uses to differentiate among its members, using standards, sometimes developed through a consensus-
1 Definitions for terms without a citation were developed by the committee.
2 Patient Protection and Affordable Care Act (ACA), Public Law 111-148, 111th Congress, 1st session (March 23, 2010).
driven process, based on existing legal and psychometric requirements” (McHugh et al., 2014, p. 2; NOCA, 2005, p. 5).
Clinical practice guidelines: “Statements that include recommendations intended to optimize patient care that are informed by a systematic review of evidence and assessment of the benefits and harms of clinical interventions in particular circumstances” (IOM, 2011, p. 25).
Clinical trial: “A clinical trial is a prospective biomedical or behavioral research study of human subjects that is designed to answer specific questions about biomedical or behavioral interventions (vaccines, drugs, treatments, devices, or new ways of using known drugs, treatments, or devices). Clinical trials are used to determine whether new biomedical or behavioral interventions are safe, efficacious, and effective” (The Bill & Melinda Gates Foundation, 2015).
Comparative effectiveness research: “The generation and synthesis of evidence to compare the benefits and harms of alternative methods for preventing, diagnosing, treating, and monitoring a clinical condition or improving the delivery of care” (IOM, 2009, p. 41).
Competency: A skill or capability that is developed or measured by credentialing programs. Examples of competencies include psychomotor skills and complex cognitive skills; practice-based learning and improvement; communication and clinical skills; patient care and care coordination; professionalism; system-based practice; medical knowledge; and knowledge, skills, and attitudes (Holmboe, 2014; Lauzon Clabo, 2014; Needleman et al., 2014).
Consumers: People with mental illnesses and/or chemical dependency who receive services in settings where it is not customary to use the term “patient.” These settings would include, for example, outpatient and community-based mental health, residential, and psychosocial settings. The term “consumer” has been applied to people with disabilities who are organizing to be treated as consumers in health care rather than plan enrollees in an insurance company. A consumer is thus someone who strives to be treated like a buyer, with rights to information regarding insurance and treatment. Consumers have organized into peer-run networks and through research and evaluation efforts supported by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Credentialing: “Processes used to designate that an individual, programme, institution or product has met established standards set by an agent (govern-
mental or nongovernmental) recognised as qualified to carry out this task. The standards may be minimal and mandatory or above the minimum and voluntary” (International Council of Nurses, 2009, p. 1; Needleman et al., 2014, p. 1). These standards should be defined, published, psychometrically sound, legally defensible, and uniformly tested. The qualified agent should provide objective, third-party assessments (Hickey et al., 2014; McHugh et al., 2014; NOCA, 2005; U.S. Department of Labor, 2014). The purpose of credentialing is to protect the public, enable and enforce professional accountability, and support quality practice and services (Newhouse, 2014).
Delphi method/technique: A series of sequential questionnaires or “rounds,” interspersed with controlled feedback, aimed at gaining the most reliable consensus of opinion of an “expert panel” (Powell, 2003). The technique is intended to correct for a lack of conclusive data by drawing on and sharing the knowledge and experience of experts (Fink et al., 1984).
Effect size: The difference between treatment and control groups, generally expressed in standard deviation units.
Effectiveness: The benefit of an intervention under real-world conditions.
Efficacy: The benefit of an intervention under the ideal circumstances of a randomized controlled clinical trial.
Element: A therapeutic activity, technique, or strategy, categorized as either nonspecific or specific. Nonspecific elements are fundamental strategies of engagement that occur in most if not all psychosocial interventions (e.g., a trusting relationship with a therapist). Specific elements are unique to a particular theoretical orientation and approach (e.g., systematic exposure to feared objects is a specific element of cognitive-behavioral therapy for anxiety).
External validity: “The extent to which the results of a study can be generalized to other situations and to other populations” (Brewer, 2000, p. 4).
Family: “Not only people related by blood or marriage, but also close friends, partners, companions, and others whom patients would want as part of their care team” (IOM, 2015, p. 28).
Fee-for-service: “A payment system in which a health care program or plan pays providers a fee for each covered service performed for its enrollees” (CBO, 2013, p. 41).
Fidelity: The degree to which a given psychosocial intervention is implemented as intended in research studies.
Functional ability: An individual’s actual or potential capacity to perform activities and tasks that one normally expects of an adult (IOM, 1991).
Functional status: An individual’s actual performance of activities and tasks associated with current life roles (IOM, 1991).
HITECH Act: The Health Information Technology for Economic and Clinical Health (HITECH) Act was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009 and officially established the Office of the National Coordinator for Health Information Technology at the U.S. Department of Health and Human Services. The act includes incentives designed to accelerate the adoption of health information technology by the health care industry, health care providers, consumers, and patients, largely through the promotion of electronic health records and secure electronic exchange of health information.3
Internal validity: The extent to which a scientific study demonstrates a causal relation between two variables, satisfying the criteria of temporal precedence (the cause precedes the effect), covariation (cause and effect are related), and nonspuriousness (there is no plausible alternative explanation for the observed relationship) (Brewer, 2000).
Learning health care system: A health care system in which science, informatics, incentives, and culture are aligned for continuous improvement and innovation, with best practices being seamlessly embedded in the care process, patients and families being active participants in all elements of care, and new knowledge being captured as an integral by-product of the care experience (IOM, 2012).
Licensure: “The mandatory process by which a governmental agency grants time-limited permission to an individual to engage in a given occupation after verifying that he/she has met predetermined and standardized criteria and offers title protection for those who meet the criteria” (McHugh et al., 2014, p. 2; NOCA, 2005, p. 5).
3 Health Information Technology for Economic and Clinical Health (HITECH) Act, Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act of 2009 (ARRA), Public Law 111-5, 111th Congress, 1st session (February 17, 2009).
Manual: A psychotherapy treatment manual describes the theory, procedures, techniques, and strategies for a specific intervention and its indication. The procedures are detailed with scripts and case examples to define, illustrate, and operationalize the intervention. Manuals were developed to enhance internal validity and to reduce reliance on intuitive clinical judgment. They also ensure fidelity to the intended treatment and allow for rigorous replication by independent research groups. Following clinical trials, but sometimes before, manuals became books for dissemination of the psychotherapy, and many different adaptations were developed. Adaptations usually retained the core of the psychotherapy but were adapted for different age groups, cultures, formats of delivery, or disorders (Addis and Waltz, 2002; Fairburn and Cooper, 2011; Luborsky and DeRubeis, 1984).
Meaningful use: The use of certified electronic health record technology in a purposeful manner (such as electronic medication prescribing), ensuring that the technology is connected in a manner that provides for the electronic exchange of health information to improve the quality, cost, and outcomes of care (CDC, 2012; CMS, 2014).
Mechanism: How psychosocial interventions effect change, with causal links between treatment and outcomes (Kraemer, 2002).
Mediator: “In general, a given variable may be said to function as a mediator to the extent that it accounts for the relation between the predictor and the criterion. Mediators explain how external physical events take on internal psychological significance” (Baron and Kenny, 1986, p. 1176).
Meta-analysis: The process of using statistical methods to combine the results of similar studies quantitatively in an attempt to allow inferences to be drawn from the sample of studies and be applied to the population of interest (IOM, 2011).
Moderator: “In general terms, a moderator is a qualitative (e.g., sex, race, class) or quantitative (e.g., level of reward) variable that affects the direction and/or strength of the relation between an independent or predictor variable and a dependent or criterion variable” (Baron and Kenny, 1986, p. 1174).
MHPAEA: The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal law that requires group health plans and health insurance issu-
ers to provide mental health or substance use (MH/SU) disorder benefits at levels equal to those of medical/surgical benefits.4
Patient-centered care: Health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care (IOM, 2001).
Patients: People with mental illnesses and/or chemical dependency who receive clinical care or treatment in medical settings where everyone with any type of condition (physical, mental, or emotional) is called a “patient.”
Peer specialists: People with lived experience of mental illness and/or chemical dependency who act formally in roles that entail helping their peers to overcome and recover from mental illness and/or chemical dependency. They are also known as “peer mentors,” “recovery support specialists,” and “peer navigators.”
Peer support: Services delivered by individuals who share life experiences with the people they are serving. These individuals offer informational, emotional, and intentional support to their peers, which allows for personal growth, wellness promotion, and recovery (SAMHSA, 2014).
Peers: People with mental illnesses and/or chemical dependency receiving services from peer specialists.
Pharmacotherapy: Therapy using pharmaceutical drugs.
Precision medicine: “An emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment, and lifestyle for each person” (NIH, 2015).
Psychotherapy: “When a person speaks with a trained therapist in a safe and confidential environment to explore and understand feelings and behaviors and gain coping skills” (NAMI, 2015).
4 Mental Health Parity and Addiction Equity Act (MHPAEA), amending section 712 of the Employee Retirement Income Security Act of 1974, section 2705 of the Public Health Service Act, and section 9812 of the Internal Revenue Code of 1986, H.R. 6983, 110th Congress, 2nd session (September 23, 2008).
Quality of evidence: “The extent to which one can be confident that the estimate of an intervention’s effectiveness is correct” (IOM, 2011, p. 158).
Recovery: A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential. The four major dimensions that support a life in recovery are overcoming or managing one’s diseases or symptoms, having a stable and safe place to live, engaging in meaningful daily activities, and developing relationships and social networks (SAMHSA, 2010).
Registry: A data system developed for the purpose of collecting health-related information from special populations. Registries typically include all consumers with an illness, with no specified inclusion criteria, and collect data on any therapy used in any setting. Historically, registries have served as sources of information when no randomized controlled trial data are available. Registries are used to determine treatment safety and effectiveness, measure quality of care, and collect epidemiologic data.
Scientific rigor: Improves objectivity, minimizes bias, provides reproducible results, and fosters more complete reporting (IOM, 2011).
Standard: A process, action, or procedure that is deemed essential to producing scientifically valid, transparent, and reproducible results. A standard may be supported by scientific evidence, by a reasonable expectation that the standard helps achieve the anticipated level of quality, or by the broad acceptance of its practice (IOM, 2011).
Systematic review: A scientific investigation that focuses on a specific question and that uses explicit, planned scientific methods to identify, select, assess, and summarize the findings of similar but separate studies. It may or may not include a quantitative synthesis of the results from separate studies (i.e., meta-analysis) (IOM, 2011).
Systems-based approach: “An organized, deliberate approach to the identification, assessment, and management of a complex clinical problem; may include checklists, treatment algorithms, provider education, quality improvement initiatives, and changes in delivery and payment models” (Weissman and Meier, 2011, p. 2).
Vulnerable populations: “People from ethnic, cultural, and racial minorities, people with low educational attainment or low health literacy, and those in prisons or having limited access to care for geographic or financial reasons. Also included are people with serious illnesses, multiple chronic
diseases, and disabilities (physical, mental, or cognitive), as well as those without access to needed health services” (IOM, 2015, p. 28).
Addis, M. E., and J. Waltz. 2002. Implicit and untested assumptions about the role of psychotherapy treatment manuals in evidence-based mental health practice. Clinical Psychology: Science and Practice 9(4):421-424.
Baron, R. M., and D. A. Kenny. 1986. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology 51:1173-1182.
The Bill & Melinda Gates Foundation. 2015. Clinical trials. https://docs.gatesfoundation.org/documents/clinical_trials.pdf (accessed May 12, 2015).
Brewer, M. B. 2000. Research design and issues of validity. In Handbook of research methods in social and personality psychology, edited by H. T. Reis and C. M. Judd. Cambridge, MA: Cambridge University Press. Pp. 3-16.
CBO (Congressional Budget Office). 2013. Dual-eligible beneficiaries of Medicare and Medicaid: Characteristics, health care spending, and evolving policies. CBO publication no. 4374. Washington, DC: U.S. Government Printing Office.
CDC (Centers for Disease Control and Prevention). 2012. Meaningful use: Introduction. http://www.cdc.gov/ehrmeaningfuluse/introduction.html (accessed May 8, 2015).
CMS (Centers for Medicare & Medicaid Services). 2014. EHR incentive programs. http://www.cms.gov/RegulationsandGuidance/Legislation/HERIncentivePrograms/index.html?redirect=/ehrincentiveprograms (accessed November 7, 2014).
_____. 2015. The Mental Health Parity and Addiction Equity Act. https://www.cms.gov/CCIIO/Programs-and-Initiatives/Other-Insurance-Protections/mhpaea_factsheet.html (accessed June 23, 2015).
Fairburn, C. G., and Z. Cooper. 2011. Therapist competence, therapy quality, and therapist training. Behaviour Research and Therapy 49(6):373-378.
Fink, A., J. Kosecoff, M. Chassin, and R. Brook. 1984. Consensus methods: Characteristics and guidelines for use. American Journal of Public Health 74(9):979-983.
Hickey, J. V., L. Y. Unruh, R. P. Newhouse, M. Koithan, M. Johantgen, R. G. Hughes, K. B. Haller, and V. A. Lundmark. 2014. Credentialing: The need for a national research agenda. Nursing Outlook 62(2):119-127.
Holmboe, E. 2014. Competency-based medical education (CBME) and transformation. Presentation at the IOM’s Future Directions of Credentialing Research in Nursing: A Workshop, Washington, DC. http://www.iom.edu/~/media/Files/ActivityFiles/Workforce/FutureDirectionsCNRworkshop/NCRWorkshopPresentations/DRAFT-EricHolmboeFutureofNursingCredentialing.ppt (accessed December 18, 2014).
International Council of Nurses. 2009. Credentialing: Fact sheet. http://www.icn.ch/images/stories/documents/publications/fact_sheets/1a_FS-Credentialing.pdf (accessed November 7, 2014).
IOM (Institute of Medicine). 1991. Disability in America: Toward a national agenda for prevention. Washington, DC: National Academy Press.
_____. 2001. Envisioning the national health care quality report. Washington, DC: National Academy Press.
_____. 2009. Initial national priorities for comparative effectiveness research. Washington, DC: The National Academies Press.
_____. 2011. Finding what works in health care: Standards for systematic reviews. Washington, DC: The National Academies Press.
_____. 2012. Best care at lower cost: The path to continuously learning health care in America. Washington, DC: The National Academies Press.
_____. 2015. Dying in America: Improving quality and honoring individual preferences near the end of life. Washington, DC: The National Academies Press.
KFF (Kaiser Family Foundation). 2013. Summary of the Affordable Care Act. http://kff.org/health-reform/fact-sheet/summary-of-the-affordable-care-act (accessed May 19, 2015).
Kraemer, H. C. 2002. Mediators and moderators of treatment effects in randomized clinical trials. Archives of General Psychiatry 59(10):877-883.
Lauzon Clabo, L. 2014. Core competencies in nursing credentialing and certification. Presentation at the IOM’s Future Directions of Credentialing Research in Nursing: A Workshop, Washington, DC. http://www.iom.edu/~/media/Files/ActivityFiles/Workforce/FutureDirectionsCNRworkshop/NCRWorkshopPresentations/3CoreCompetenciesinNursingCredentialingandCertificationpublicversion.pptx (accessed December 30, 2014).
Luborsky, L., and R. J. DeRubeis. 1984. The use of psychotherapy treatment manuals: A small revolution in psychotherapy research style. Clinical Psychology Review 4(1):5-14.
McHugh, M. D., R. E. Hawkins, P. E. Mazmanian, P. S. Romano, H. L. Smith, and J. Spetz. 2014. Challenges and opportunities in nursing credentialing research design. Discussion Paper, Institute of Medicine, Washington, DC. http://iom.edu/~/media/Files/PerspectivesFiles/2014/Discussion-Papers/CredentientialingResearchDesign.pdf (accessed November 4, 2014).
NAMI (National Alliance on Mental Illness). 2015. Psychotherapy. https://www.nami.org/Learn-More/Treatment/Psychotherapy#sthash.kgOfTezP.dpuf (accessed May 8, 2015).
Needleman, J., R. S. Dittus, P. Pittman, J. Spetz, and R. Newhouse. 2014. Nurse credentialing research frameworks and perspectives for assessing a research agenda. Discussion Paper, Institute of Medicine, Washington, DC. http://www.iom.edu/~/media/Files/PerspectivesFiles/2014/DiscussionPapers/CredentialingResearchFrameworks.pdf (accessed November 4, 2014).
Newhouse, R. 2014. Understanding the landscape and state of science in credentialing research in nursing. Presentation at the IOM’s Future Directions of Credentialing Research in Nursing: A Workshop, Washington, DC. http://www.iom.edu/~/media/Files/ActivityFiles/Workforce/FutureDirectionsCNRworkshop/NCRWorkshopPresentations/Workshop_IOM_Newhouse.pdf (accessed December 18, 2014).
NIH (National Institutes of Health). 2015. Precision medicine initiative. http://www.nih.gov/precisionmedicine (accessed May 8, 2015).
NOCA (National Organization for Competency Assurance). 2005. The NOCA guide to understanding credentialing concepts. Washington, DC: NOCA.
Powell, C. 2003. The Delphi technique: Myths and realities. Journal of Advanced Nursing 41(4):376-382.
SAMHSA (Substance Abuse and Mental Health Services Administration). 2010. SAMHSA’s working definition of recovery: 10 guiding principles of recovery. http://content.samhsa.gov/ext/item?uri=/samhsa/content/item/10007447/10007447.pdf (accessed May 8, 2015).
______. 2014. Peer support and social inclusion. http://www.samhsa.gov/recovery/peer-support-social-inclusion (accessed May 8, 2015).
U.S. Department of Labor. 2014. Credential resource guide. http://wdr.doleta.gov/directives/attach/TEGL15-10a2.pdf (accessed November 7, 2014).
Weissman, D. E., and D. E. Meier. 2011. Identifying patients in need of a palliative care assessment in the hospital setting: A consensus report from the center to advance palliative care. Journal of Palliative Medicine 14(1):17-23.
This page intentionally left blank.