T

he Trump administration has abruptly halted work on a highly regarded program to help physicians, families, state and local government agencies, and others separate effective “evidence-based” treatments for substance abuse and behavioral health problems from worthless interventions.

The program, called the National Registry of Evidence-Based Programs and Practices, was launched in 1997 and is run by the Substance Abuse and Mental Health Services Administration. Its website lists 453 programs in behavioral health — aimed at everything from addiction and parenting to HIV prevention, teen depression, and suicide-hotline training — that have been shown, by rigorous outcomes measures, to be effective and not quackery. The most recent were added last September.

In an email dated Jan. 4 and sent to program developers, the contractor hired by SAMHSA to work on the registry said, “It is with great regret that we write to inform you that on December 28, 2017, we received notification from SAMHSA that the NREPP contract is being terminated for the convenience of the government. This cancellation means that we can no longer make any updates to your program profile. … We are deeply saddened by the government’s sudden decision to end the NREPP contract, under which we have been able to provide and strengthen science-based information about mental health and substance use treatment and prevention programs.”

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A recipient shared the email with STAT.

Dr. Elinor McCance-Katz, assistant secretary for mental health and substance use, argues that NREPP needs to be improved so that it is more rigorous, calling the current registry “flawed.” In reviewing some of the listed programs, she told reporters on Jan. 11, “I see [evidence-based programs and practices] that are entirely irrelevant to some disorders, ‘evidence’ based on review of as few as a single publication that might be quite old and, too often, evidence review from someone’s dissertation.” While NREPP is frozen, she said, SAMHSA will work on helping programs deliver to people “living with these disorders the care and treatment and recovery services that they need.”

The website of the now-frozen registry has not been taken down. In an online statement, SAMHSA said future work on the registry, including vetting new applications, would be moved in-house “to reconfigure its approach to identifying and disseminating evidence-based practice and programs.”

Despite the inclusion of the phrase “evidence-based,” the statement did not assuage critics’ concerns: The decision to freeze the registry comes as the Trump administration has advised agencies such as the Centers for Disease Control and Prevention to avoid using seven words — including “evidence-based,” “science-based,” “fetus,” and “transgender” — in budget documents and to instead use language that won’t antagonize members of Congress.

The guidance, for example, suggested that instead of describing a policy or decision as “evidence-based,” the CDC say that it “bases its recommendations on science in consideration with community standards and wishes.”

The coincidence of the “banned words” policy and the decision to freeze the behavioral health registry “should give us pause,” said Rosalyn Bertram of the University of Missouri, Kansas City, an expert on evidence-based practices in the social sciences.

Because SAMHSA has not explained how or when it will pick up the registry work, “I’m pessimistic,” said psychology professor Warren Throckmorton, of Grove City College in Pennsylvania, who teaches a seminar that includes lessons on evidence-based programs and practices. “Why did they stop something before they had something to put in its place? Why stop what was working reasonably well?”

The registry has long been “the first stop” for communities trying to figure out which programs to adopt to, say, battle teen alcohol use, said Suzanne Kerns of Denver University and executive director of the Center for Effective Interventions. “If you’re a community official in the middle of Kansas, you might not have access to all the scientific literature, or the time or resources to read and critique it. That’s the gift that NREPP offers.”

Some states have laws requiring that public programs for, say, children and family services use only evidence-based interventions vetted by NREPP. Because NREPP stopped vetting and listing new programs three months ago (90 were reportedly in the pipeline), “there are potentially effective programs that communities need to know about but that are sitting dead in the water,” Bertram said.

She and other researchers alarmed by the SAMHSA decision said it suggests that what they described as the administration’s skepticism about scientific evidence has now been extended.

Just as mainstream medicine has been embracing an evidence-based approach (testing assumptions that, say, arthroscopic surgery for knee osteoarthritis works) so that patients do not receive useless care, so has behavioral health, which includes mental health as well as things such as parent-child relationships and social functioning. Behavioral health has lagged behind, however, because some of the problems it addresses are partly subjective, making it “easy to convince yourself that something is effective when it’s not,” said Throckmorton. That’s harder to demonstrate for interventions meant to help with parent-child interactions than, say, to treat cancer.

Throckmorton said his interest in the field grew from his realization that “change therapy” — to alter people’s sexual orientation — has no scientific basis.

By identifying programs whose effectiveness is supported by evidence, the registry “has been a gold seal of approval,” said a physician at a child health program who asked not to be identified because he did not want to jeopardize his SAMHSA funding. And there is considerable work still to be done in spreading evidence-based programs: Only 3 percent of children with problems ranging from attention deficit hyperactivity disorder to disruptive behavior to suicidality receive evidence-based services, he said, partly because scientifically valid programs often have a high price tag.

Making it harder for people struggling with addiction and their families to see whether a treatment they’re being offered has been shown to work is especially worrisome, said the physician. “In the midst of an opioid epidemic, they’re suspending work on a registry that tells you this,” he said.

This story was updated on Jan. 17 with comments from SAMHSA.

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  • Quite funny…” The guidance, for example, suggested that instead of describing a policy or decision as “evidence-based,” the CDC says that it
    “bases its recommendations on science in consideration with community standards and wishes.”,,,,,,what…….Lol…. what it means….” community standards and wishes”………..like we wish, as a community…….therefore, it will be useful……Lol….

  • THIS IS WHAT I MEAN WHEN I SPEAK OF A POLITICAL”SOFT GENOCIDE” (targeting sub-populations, slowly worked into law ) EMERGING FROM CURRENT GOV ADMIN POLICIES. I had a 30+ year career in behavioral health and the NREEP was invaluable in assisting states to determine, based on results, where to best allocate limited dollars for community-based programs to effectively, actually, HELP PEOPLE.

  • The ‘Evidence Based” movement is a potential threat to government. Can you imagine the consequences of governing based on evidence rather than onpopulism?

  • Listen, I am not a Trump voter, but there is nothing evidence based about treatments for mental health that still roll on the yet unproven theory, despite 2 decades of studies trying desperately to prove it, that mental illness is due to a chemical imbalance. If your treatments are based on an unprovable theory, they are not evidence based in the slightest. Furthermore, the whole field is a scientific sham. Every mental illness has been voted into existence by a panel based on opinions, no science involved. Stop lying, pretending anything about this is legitimate and just Trump attacking science.

  • Although not a huge fan of Trump,,I am very very happy they are no-longer funding ,”price tag on human life,” research,,JMO,,it has been my experience as a patient,,the Evidence Based medicine dam near killed me,,and right now,,E.B.M…is forcing me into a life time of forced physical pain..How,,u ask,,,well,,for 15 freaken years,,,no test,,no image test,no ultra sound,,no mri,,,showed a single thing wrong w/my upper gastic region,E.B.M. stated ,”nothing wrong,”send her to a shrink,or no pain medicine for me,,,Well 1.5years ago,,after 15 year of idiots who could not think outside their own Evidence Base Medicine box, finally I passed out,,still don’t know why,,but,,someone did a blood test for the 1st time in 15 years,,a lipase test,,1497,,,,Hey E.B.M idiots,,,what does that mean??!!!Ct w/contrats that night,,,labeled ,”normal,” by u E.B..M,,,,,however lipase just kept rizen,,,Sooo a surgeoun goes in,,now remember,,all testing except blood,,label normal by u E,B,M,,,idiots 48 hours earlier,,Surgeon tells me after surgery,,,”Gallbladder completely calcified,looked like a dame gravel pit,all internal organs visable w/the human eye,,”badly beaten up,,,and some sorta bacteria covering all my organs,,,gee,,,,maybe why ultra sounds,,x-rays,,contrast had no effect on seeing all this,,,unless u believe a organ can calcify over night and fill w/stones..Well,,,,after 15 years of idiots,,,E.B./M,,,,dam near killed me,,,I have asked again for a surgeon to go back in,,for a lot of the physical pain is still there,,,what does this idiot do,,,he re-runs the same tests that showed ,”normal,” 48 hours before his surgery,,,claims everything ,”normal,” again,,Sooo I see E/B/M…..really does take away any common sense the human body can teach you all!!!!Me ,,, still stuck in a lot of physical pain,,,being denied access to my medicines and denied access to effective test a,laparoscope,,that I KNOW WILL SHOW THE PROBLEMS.. surgeons excuse ,”I am tooo much of a risk,” to your E,B,M…maryw,,,

    • I could only get through about half of this rant. If you want to be taken seriously, write coherently. You may have great points, but nobody can understand you.

    • To Karissa,,,no ranting,,just factual truth of the harm E.B M will cause,,,as far as my writing perhaps your not capable of logically truthful thought?or not adhereing to a cookie cutter way of writing,,4 me,,I write as I see it. E.B.M does not work,,,,Or u are incapable of connecting the dots of someones who does nor agree w/u?,I understand my writing perfectly,,,but for you I will SPELLL IT OUT,,,
      EVIDENCE BASE MEDICINE IS NOTHING MORE THEN A COST CUTTING MEASURE FOR INSURANCE COMPANIES BY DENYING PATIENT ACCESS TO NEEDED TREATMENT,,,THUS CUTTING THEE INSURANCE COMPANIES COST…EVIDENCE BASE MEDICINE DAM NEAR KILLED ME,,,BECAUSE DOCTORS TOO MUCH RELY ON MEDICAL IMAGES/TESTING FOR ALL THEIR ANSWERS,,,,,IF A X-RAY SHOWS NOTHING,,THEN MANY DOCTORS TAKE THAT EVIDENCE of a X-RAY SHOWING ”NORMAL”,,THUS EVERYTHING IS NORMAL IN THAT PATIENTS BODY,,,BUT THE PATIENT IS STILL IN AGONIZING PHYSICAL PAIN,,,,DOCTORS USE EVIDENCE BASE MEDICINE SOLELY,TO COVER THEIR ASS ON PAPER,IT LOOKS GOOD ON PAPER,X-RAY PROVED EVERYTHING NORMAL,,AND FORGET COMMON SENSE…MY CASE PROVES EVIDENCE BASE MEDICINE IS A CROCK OF SH-T,,,,,EVERY MEDICAL IMAGE TEST DONE ON ME,48 HOURS BEFORE SURGERY BASICALLY SHOWED ,;NORMAL,,,,,NOT UNTIL A BLOOD TEST WAS DONE,,IE LIPASE 1500,,,DID A DOCTOR RELUCTANTLY GO IN TO FIND OUT WHY,,,SO AGAIN,,,UNLESS U BELIEVE A ORGAN CAN CALCIFY IN 48 HOURS,,FILL COMPLETELY W/STONES,,IE,,LOOKED LIKE A DAM GRAVEL PIT,,PANCREATITS,, OVER NITE,, IF U BELIEVE THAT CAN ALL HAPPEN OVER NITE,,PLEASE DON’T GO INTO THE FEILD OF MEDICINE,,,,,,FACT IS,,EVIDENCE BASE MEDICINE,,WILL KILL MORE PEOPLE THEN IT WILL EVER SAVE,,,,,,UNDERSTAND THAT,,??MARYW

    • The problem with your post is the grammar and all those commas. Responding with another long post with all the same issues of discombobulated thoughts and so many commas doesn’t change anything. And worse this time YOU’RE YELLING..Just stop.

    • To R Lee, Sorry if your incapable of seeing truth,logic,,,,As far as yelling,,anyone that knows me,,knows my vision sucks,but u keep on using tactics to avoid the truth,,the true message,Hospitals,Hospital CEO’s,Doctors,Nurses,and Professional medical staff use E.B.M,to disregard truth,to cover there ass’s,,ie,,,x-ray normal,,thus nothing wrong here,,Ive witness 100 times..They use E.B.M,,,to simple cya,,To justify no further testing,,cost cutting,,,,soo good riddance to E.B,M,,,,IS WAS JUST A TOOL,,,FOR THE CORRUPT TO USE,,,TO JUSTIFY HARMING THE TRUELY MEDICALLY ILL,,,,IT TOOK AWAY HUMANITY, HUMANE TREATMENT,,,,AND R.LEE,,,,,I’LL NEVER ,”STOP,” TELLING THE TRUTH,,,ON HOW CORRUPTED,INHUMANE,,,THE MEDICAL FEILD HAS BECOME,,,THE CRUELITY SOME IN THE FEILD OF MEDICINE HAS ALLOWED IS SICKENING,,,TORTUREING MEDICALLY ILL TO DEATH,,,SHAME IS WHAT E.B.M BROUGHT TO THE FIELD OF MEDICINE,,FOR IT ALLOWED CRUEL,INHUMANE TREATMENT OF THE MEDICALLY ILL,,tough,,,if don’t like the truth to be told!!,,maryw

    • omg STOP ‘YELLING’ TAKE YOUR KEYBOARD OFF CAPS. Then try actually reading what the hell me and the other poster wrote to you. We’re telling you to say your point in complete cohesive sentences and stop using so many fekking commas. Nobody understands what you’re saying cos you’re yelling and not writing coherently. Have someone you know read this so they can explain it to you really slowly.

      If you respond with the same yelling, a million commas, and ranting, I’m done, dude. smh

  • I hate to see the National Registry of Evidence-Based Programs and Practices go. In evaluating practices, it considering their plausibility, which is a key feature lacking in other such programs.

    And Trump also stopped the much needed project to improve forensic testing methods which have been for decades woefully lacking a sound basis in science.

    There will be casualties…

  • Why are the GOP Congressional leaders so hesitant to start investigating whether the 25th Amendment should be applied to 45??
    Is it because they are on the take as well from the corporate lobbyists & plutocrat dark money (virtually bribes)?? Or that they are as mentally & ethically unfit to serve just as he is???

    • Just because you don’t agree with someone, doesn’t mean they are crazy. There is no basis for the 25th with Trump. I work in the behavioral health field. I know the rules on evaluation. There’s no basis, here.

      Further? Most of what has been thwarted in this decision SHOULD have been. There is a lot of social theory out there that is accepted as “evidence based” that is, in reality, unreplicated and is conjecture at best. It’s pretty clear to me that you know nothing about the field and probably shouldn’t comment on a public thread until you do.

  • I hope our elected senators and representative read your article and take action. We should stop ranting and raving about Trump but rather focus on the terrible harm his administration is doing in the world and in our country. He and his crew are so regressive in their thinking. They are pulling the rug out from everyone except the plutocrats. Would be good for you at STAT to focus on the many things his administration is doing to diminish health care here at home with their rollback of research funds.etc.

    • Waaaa, Trump took away our broken toys. Case in point and why I agree with Mary and understand her posting. Diagnosing thyroid problems via bloodwork is not evidence enough and can cause undetected problems to become bigger. A simple thermometer under the arm in the morning registers abnormality. One does this simple test every morning beforecgetting out of bed. Track every day before a doctor’s visit. Present the evidence.

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