Shortcomings of Evidence-Based Practice in Community Health

But I contend that they did not know the ethos of the community in which they were operating. Though it’s not their fault that local people were insulted because they got the contract and attacked, the unhealthy attack back mode made a few heads roll, including mine. In the process, the strong local consumer base was denied the opportunity to run the peer support.

I believe what happened in Cook County is likely when a practice uses research to proclaim that fidelity measures are going to work anywhere. It’s a false sales pitch. It presumes there is no such thing as politics. It presumes that an academic elite is needed to train the masses of people who may well have walked a different path.

It releases all or nothing funding streams without taking into account that there are cultural factors at play, personalities, egos, cliques and competing financial incentives.

In the bee hive where I was hired, competing fidelity measures didn’t match. Local case managers and the employment IPS domain were highly critical of the peer domain in part for survival purposes. If peers could do what they could, jobs might be lost or pay cut.

Recovery didn’t seem to be promoted because of a lack of collaboration and enormous amount of political infighting. Some disenfranchised workers blamed it on clients.

Recovery cannot be replicated in a uniform manner. I’d argue that what is more important is a healthy family mental health system that is in a cultural state of learning in order to meet people where they are.

In spite of the difficulties, the pilot program did transform some lives on the ground in ways that aren’t measurable. Although the dysfunction is memorable, I also learned a lot about different EBPs.

But my intial questions stand: Did all the money for all the promises of the evidence-based practices trickle down into the lives of the people served? Would the county not have been better off going to its strong consumer base, taking the ideas from these evidence-based practices and co-constructing locally sensitive recovery? Was imposing change in top-down ways based on the notion of a superior intelligentsia cost effective?

Theorists need to first define themselves culturally and then assert themselves locally. They need to interact with their local consumer base and not gear themselves up to sell their experience on a global market.

When it comes to practice of mental health, a theorist and a therapist need to constantly define the limits of themselves. They should not focus on growth and impose their values and experience in universal terms on others. Administrators must ease up on the evidence-based demands.

Bees photo available from Shutterstock

Shortcomings of Evidence-Based Practice in Community Health

Clyde Dee

Clyde Dee is an anonymous MFT and author of "Fighting for Freedom in America: Memoir of a "Schizophrenia" and Mainstream Cultural Delusions. Clyde writes from different states at different times. His blog site can be viewed at


APA Reference
Dee, C. (2016). Shortcomings of Evidence-Based Practice in Community Health. Psych Central. Retrieved on February 25, 2020, from


Scientifically Reviewed
Last updated: 18 Jan 2016
Last reviewed: By John M. Grohol, Psy.D. on 18 Jan 2016
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