By Populations Adults

Synthesis of Research Reviews

Empirically Supported Therapies for Adults

A review of interventions found to be "efficacious" (i.e., beneficial under well-controlled study conditions) and "probably efficacious" for 10 specific problem conditions have been summarized.

The following documents outline empirically supported therapies for adults:

• Empirically Supported Individual and Group Psychological Treatments for Adult Mental Disorders
• Table of Empirically Supported Therapies for Adults

Fidelity and Fidelity Scales

Fidelity refers to the degree of implementation of an evidence-based practice. A scale that measures fidelity is called a fidelity scale. Such scales have been developed for six EBPs:

• Assertive Community Treatment (ACT)
• Supported Employment (SE)
• Illness Management and Recovery (IMR)
• Family Psychoeducation (FPE)
• Integrated Dual Disorder Treatment (IDDT)
• Medication Management According to Protocol (MedMAP)

Each scale consists of approximately 15-30 items assessing the critical ingredients of the EBP, based on the underlying principles and methods of the EBP. The scale items provide concrete indications that the practice is being implemented as intended.

One important use of fidelity scales is to monitor programs over the course of their development. Routine use of fidelity scales provides an objective, structured way to give feedback about program development. Experience also suggests that this is an excellent method to highlight program weaknesses, while helping to clarify program strengths. Fidelity scales also provide a comparative framework for evaluating statewide trends and outliers. The strategic use of repeated evaluations of programs using fidelity scales, either for an individual program or on a statewide level, is based on the general principle that whatever is attended to is more likely to be improved.

Fidelity Resources:

• Introduction to Evidence-Based Practice Fidelity Scales
• References to Literature on Fidelity Scales
  

Cost-Effectiveness

Cost is an important factor to consider when selecting an EBP. Three reports analyze the cost effectiveness of different adult programs: 

• Economic impacts of assertive community treatment: Nineteen randomized studies and 15 non-randomized studies describing Assertive Community Treatment (ACT) programs were identified. Findings suggest that the most reliable cost offset to ACT treatment costs appear to be reduced hospital visits.

• Economic impacts of supported employment for persons with severe mental illness: This review focuses on the economic impact of supported employment (SE) as a clearly defined model for helping people with severe mental illness to find and maintain competitive jobs. Findings indicate that SE programs can be cost-saving or cost-neutral to hospitals, community centers, and government agencies.

• The cost of high-fidelity supported employment programs for people with severe mental illness: This study determined the costs of evidence-based supported employment programs in real-world settings. The results noted the need for greater uniformity in caseload measurement and help specify the costs of high-fidelity supported employment programs in real-world settings.