Variations in Definitions of Evidence-Based Interventions for Behavioral Health in Eight Selected U.S. States

Abstract

Background U.S. state legislatures fill a vital role in supporting the use of evidence-based interventions (EBIs) through statutes and regulations (mandates). Objective The study determined the terms used by selected states to describe EBIs and how those terms are defined in mandates. Research Methods The mandates of eight purposely selected states were accessed and coded using the Westlaw Legal Research Database. Results Considerable variation was found in the terms used by states to describe EBIs. Although “evidence-based” was the most frequently utilized term (60% of mandates), an additional 29 alternative terms appeared with varying frequencies. Most terms were simply mentioned, with no further definition or elaboration. When terms were further defined or elaborated, the majority were defined using numerous and different types of external sources or references. Three approaches were found in the mandates defining EBIs: “single definition,” “hierarchies of evidence levels,” and “best available evidence”; the states differed considerably in the approaches used in their mandates. Conclusions The variations in EBI-related terminology across states and within states, coupled with a lack of elaboration on the meaning of important terms and the predominant use of external rather than internal guidelines, may be a source of confusion for behavioral health provider agencies that seek direction about what constitutes an EBI. Prior studies indicate that many agencies may lack staff with the technical ability to adequately evaluate what constitutes an EBI. Thus, lack of clear guidance from official state government mandates may impede the implementation of EBIs within states.

Utilization of Evidence-based Intervention Criteria in U.S. Federal Grant Funding Announcements for Behavioral Healthcare

“…However, a recent study which examined how state agencies define EBIs found a similar lack of elaboration of EBI-related terms at the state level, indicating that federal funding announcements may need to be more prescriptive about what constitutes an EBI. 27 …”

“…However, a recent study which examined how state agencies define EBIs found a similar lack of elaboration of EBIrelated terms at the state level, indicating that federal funding announcements may need to be more prescriptive about what constitutes an EBI. 27 The use of external elaborations of alternative EBI terms can be considered to be beneficial, if those external sources have research credibility and remain accessible throughout the life-cycle of the grant. 27 Most of the external sources of elaboration include references to EBPRs, which generally are based on accepted hierarchies of research evidence 30 and thus are credible.…”

“…27 The use of external elaborations of alternative EBI terms can be considered to be beneficial, if those external sources have research credibility and remain accessible throughout the life-cycle of the grant. 27 Most of the external sources of elaboration include references to EBPRs, which generally are based on accepted hierarchies of research evidence 30 and thus are credible. Internal elaborations can also be useful, although prior research has shown that legislators and funding agency staff may not have the expertise necessary to develop guidelines that capture essential criteria for what constitutes evidence-based interventions.…”

“…25 , 26 A recent study of state-level mandates for the use of evidence-based interventions found that the majority of mandates included in the study simply mentioned key terms related to evidence-based interventions, but did not elaborate on them to any degree. 27 This appears to indicate that clear communication about what constitutes an evidence-based intervention is often lacking at the state level.…”

Discrepancies in Ratings of Behavioral Healthcare Interventions Among Evidence-Based Program Resources Websites

“…Definitions of what constitute an evidence-based intervention vary depending on who or what agency defines them. 3 , 10 , 11 Likewise, variations in the criteria used by EBPRs to construct those rating categories are examined in several studies. For example, the Pew-MacArthur Charitable Trusts (PEW) found that specific details about the way different EBPRs construct their rating categories make it difficult to compare the ratings given to the same interventions.…”