Examining evidence-based practice, I want to use professional experience to look at how putting-the-cart-first treatment translates into wasted public dollars and second class services.
I take myself out of the State Hospital, and insert myself 13 years later in the ranks of the mental health workers. Not only are we perhaps wrongly trained in the universality of counseling theories (as part 1 of this article suggests) but we are also the rank and file that gets hired into local systems that use fidelity measures to promote proven recovery practices.
Much like with economics, it appears to be widely presumed among administrators that recovery services can only transform via academic trickle down guided by research.
I contend that this reductionist view is self-serving to the power structure not taking into consideration the nuances of local culture and recovery itself.
I have seen evidence-based practices in community mental health perpetuate myths, stigma, unstable relationships and limit healing.
They may be used to fuel programs that are chasing money and more concerned about silos and statistics than the community.
From the Rank and File
I, like others in the rank and file, have a difficult time when a person with a highly reputable background comes in from out of town and says, “this is the best way to do it.”
I look at their culture and wonder what they know about the systemic history of their subjects. I wonder how much money they are going to take and waste. I could do this and that alone could easily prevent a researched recovery principle from materializing.
Evidence-based practices, as I’ve seen them play out, presume that there is no such thing as class, race and gender biases or local distinctions that are going to get in the way of implementation.
They need to.
A Social Experiment: Three Competing EBPs
Four years ago, I left my job in a community I love and to which I’ve since returned to join an effort to jumpstart recovery via importing three evidence-based practices.
In 2008, Cook County imported the Housing First best practice; the IPS employment model; and the best practice of Peer Support by a leading out-of-state company.
Clients were given all three practices at the same time and expected to transform into work and end their dependence on Social Security.
Teams were set up with representatives of all three of these best practices. They were led by case managers from seven local case management teams.
I came on board during the second year of operation as the back-up administrator of peer support. I completed a comprehensive and experiential peer-employment training with a new team of workers and my first task was to attend all the team meetings and represent the peer workers.
Sure enough, I would find many of our peer workers, just out of the system and battling external and internal stigma, being bullied into silence at meetings.
After I made the rounds, on a day when the top administrator and our boss were present, a worker who appeared most effectiv, and on-the-ground respected, came into my office before meetings commenced. He shook my hand and told me I was walking into a bee hive. As soon as he was gone, I discovered that the top administrator had a file on this worker. He was a racial minority and he was on track to be fired alongside another minority worker, who was axed that day.
This man was trying to provide for his family on wages that barely cut it according to the local standard of living. The things he had done, in my mind, demonstrated his economic need.
Memories were triggered of my own sense of financial hopelessness. Indeed, the more I took inventory, I became alarmed about what I considered to be racial and class in-sensitivities: workers who had harder inner-city backgrounds seemed to be more heavily scrutinized.
I felt that the best thing to do was to send an email expressing my concerns to the boss.
Bullying at the Table
Meanwhile, as I was feeling bullied and insulted at the tables, I got feedback from my own company that I didn’t know how to present as a professional. However, the feedback from the program evaluation came back that I was well received in the eyes of the local workers.
Time passed and the worker who warned me about the bee hive was fired. Likewise, a minority director who I had forged a relationship with was replaced. I continued to observe the other male minorities to be not treated well from my perspective. The new director formed a close relationship with my domain boss, who, though rarely around, seemed to be offended by my email.