SAMHSA Issues Statement on Evidence, But Still No Word on Its Clearinghouse

Perhaps to mollify critics of its decision to stop work on its evidence clearinghouse, the Substance Abuse and Mental Health Services Administration (SAMHSA) today announced two new sources of technical assistance to help communities that are grappling with opioids and mental health problems. Combined, the assistance amounts to nearly $30 million in TA.

“Ensuring that communities across the nation have access to evidence-based services is critical to advancing the behavioral health of the nation,” said Dr. Elinore F. McCance-Katz, SAMHSA’s Assistant Secretary, in the announcement. “I am committed to ensuring that the implementation of evidence-based practices is a top priority.”

Still No Word on NREPP

Despite the assurance, however, today’s announced efforts are not a replacement for the agency’s clearinghouse, the National Registry of Evidence-based Programs and Practices (NREPP). SAMHSA is required to maintain a web-based version of the clearinghouse by law. Technically, it appears to be staying in compliance by keeping the current version online, although the web site has reportedly not been updated since last September.

Clearinghouses differ from technical assistance because they are intended to provide a rigorous third-party assessment of the often complex studies that support the purported effectiveness of various treatment programs. Such ratings, if done well, can help practitioners select an intervention that is backed by rigorous evidence, not one backed by the claims of vendors.

Clearinghouses have been criticized in the past, however, including by this comprehensive overview by Bridgespan in 2015. More recently, the What Works Clearinghouse at the U.S. Department of Education has drawn criticisms for the quality of its reviews and its slow pace.

In earlier announcements, SAMHSA’s administrator said she would assign oversight of the clearinghouse to the agency’s newly created Policy Lab, which launched earlier this month. However, the Lab is reportedly still staffing up, which suggests it may not be ready to update NREPP immediately.

Blowback on Capitol Hill

On Capitol Hill, five Senate Democrats sent McCance-Katz a letter saying they were concerned that NREPP had been discontinued before a replacement was fully implemented, according to a story in The Hill.

“We are concerned that freezing NREPP means individuals and communities that may benefit from these new programs will not be able to learn about them or access them, and that the freeze also may hamper the work being done around the country to develop important interventions at a time when we are in the midst of a heroin, fentanyl and opioid epidemic and we need them more than ever,” they said in the letter.

While maintaining strong support for evidence in general, McCance-Katz was sharply critical of NREPP in a statement issued last week, calling many of its program ratings questionable or “entirely irrelevant” to the disorders they were claimed to treat.

“We at SAMHSA should not be encouraging providers to use NREPP to obtain EBPs, given the flawed nature of this system,” she said in the statement.

Those sentiments were backed by a separate journal article published last summer that sharply criticized the clearinghouse for questionable reviews and failing to address possible conflicts of interest.


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