Developing Evidence-Based Standards for Psychosocial Interventions for Mental Disorders
The Affordable Care Act calls for health care delivery system reforms and innovations that rely heavily on putting more health services under budgeted systems. These include accountable care organizations, health homes, bundled payment systems, coordinated care entities, and other forms of managed care. In these systems, accountability will increasingly take the form of linking performance and quality measures to economic rewards. The behavioral health field should further its progress in the development of measures to allow one to track whether the content of psychosocial treatment is consistent with evidence-based treatment.
The process by which psychosocial therapies are currently validated, and coverage determinations are made, is highly variable. There are a wide range of disciplines and levels of training that claim to provide effective psychosocial treatments. Variation exists in the levels of scientific evidence as well as types of studies and outcome measures that are used to determine what constitutes an effective treatment, the necessary dose and duration of a treatment, and coverage for a treatment. Further, there are no standards in place to ensure that treatment fidelity is based, for example, on providers’ training or performance metrics for providers. As a result, it is difficult for consumers and payers to understand what they are buying. This uncertainty creates skepticism among purchases regarding the value of the average psychosocial service. Developing evidence-based standards will help ensure quality care for patients.
An IOM committee will develop a framework from which to establish efficacy standards for psychosocial interventions used to treat individuals with mental disorders (inclusive of addictive disorders). The committee will explore strategies that different stakeholders might take to help establish these standards for psychosocial treatments.
The work of this committee will focus on three major areas:
- determining evidence-based standards for modalities,
- quality and outcome performance measures for individual treatments, and
- provider training and certification.
The committee will define the scope of the problem/issues in each of the three areas and identify a range of solutions/recommendations, producing a path forward for widely-accepted measures for psychosocial therapies that are informed by the latest science on effectiveness.
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