Evidence-Based Practice in Mental Health Care to Ethnic Minority Communities: Has Its Practice Fallen Short of Its Evidence?(Report‪)‬

Evidence-based practice (EBP) in the provision of mental health care for adults is a powerful mandate in the United States, where it has dramatically influenced and transformed mental health services in many communities and contributed significantly to the advancement of knowledge in the treatment and prevention of mental health disorders. A major impetus for EBP is the need to increase the effectiveness of mental health practices with clients through the use of standardized interventions based on rigorous scientific research (Drake et al., 2001). As primary agents in the delivery of mental health services to historically underserved and marginalized ethnic communities, social workers are committed to the provision and use of treatments and services known to promote the health and well-being of diverse populations of clients. This commitment impels social workers to examine and potentially expand current ideas of what constitutes evidence rather than to assume that scientific knowledge is superior to other sources of evidence, including cultural ways of knowing (Whitbeck, 2006). In the field of medicine, Sackett, Richardson, Rosenberg, and Haynes (1997) originally conceptualized EBP as being informed by the following types and sources of evidence: the current best evidence in making decisions about the care of the individual, clinical expertise, and the client's experiences and preferences. All three types of evidence were crucial and conjointly respected. Gambrill (2006) likewise noted that important sources of knowledge and evidence include clinicians' knowledge and experience of particular contexts and specific clients as well as qualitative findings on the beliefs, preferences, and practices concerning mental health care within diverse cultural communities. These perspectives support more inclusive approaches to EBP in the provision of mental health care. However, in practice they have been overshadowed by much narrower understandings of EBP that are based on a biomedical research model that sets a priority for evidence derived from well-designed and carefully implemented randomized controlled trials (RCTs) (Egger, Smith, & O'Rourke, 2001). In addition, meta-analyses of RCTs also contribute to the documentation and understanding of the accumulated evidence.