The “Evidence-Based Practice” (EBP) is the concept of basing clinical care decisions on the best available knowledge or evidence, rather than on tradition, or past practice. It means finding the best available evidence to support a clinical decision for an individual client. To become “evidence-based” the program or practice must have its effectiveness evaluated in a large-scale research study, preferably using “randomized controlled trial” approach comparing outcomes for participants enrolled in a given EBP with those receiving no services or interventions. Other studies use pre-test and post-test studies to measure program outcomes.
To deliver effective services which accurately target individual client issues, Phoenix House has implemented many Evidence Based Practices and Programs that are proven to address specific issues and improve client outcomes. Phoenix House of California (PHCA) is committed to having highly skilled staff trained in a variety of EBPs to flexibly provide the best possible approach for each client’s unique circumstances and clinical needs. We are pledged to implement EBPs with fidelity while engaging in continuous quality improvement efforts to ensure a high standard of care.
The Federal Substance Abuse and Mental Health Administration (SAMHSA) maintains Evidence-Based Practices Resource Center to provide communities, clinicians, policy-makers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings. Ratings and descriptions of various EBPs may be found on the website of the California Clearinghouse of Evidence-Based Practices, the Office of Juvenile Justice and Delinquency Prevention of the U.S. Department of Justice also maintains a database of model programs. These databases describe individual EBPs, with information about their designated client populations, approaches, objectives, effectiveness, and the research basis.
The EBPs PHCA currently uses often combine the Motivational Interviewing approach to communicating with clients along with one or more Cognitive Behavioral Therapy curricula. This combination has been proven highly effective for Substance Use Disorder Treatment. Among the CBT curricula that our staff is trained on and implements across various settings are the following EBPs:
1.Cognitive-Behavioral Interventions for Substance Abuse (CBI-SA) has been developed by the Institute of Corrections at the University of Cincinnati in 2010 and has been introduced as required or highly recommended component in behavioral health programs by in-custody programs in California. CBI-SA uses a cognitive behavioral approach to help participants gain skills and strategies for avoiding substance abuse. CBI-SA focuses on helping clients learn how to identify high risk situations and respond to them as they arise. Emphasis is placed on practicing skill-building activities, so clients learn new behaviors and responses to challenges they may face. Based on its proven effectiveness, Phoenix House has used CBI-SA in all its correctional and community-based treatment programs for adults in six prison and probation institutions in Southern California, and in residential treatment programs for adults in Venice, Los Angeles County and Santa Ana, Orange County. Phoenix House staff currently includes certified CBI-SA trainers and therapists.
2. Seeking Safety is a present-focused, coping skills therapy to help people attain safety from trauma and/or substance abuse. The goals of the program are to: reduce trauma and/or substance abuse symptoms and to increase safe coping in relationships, thinking, behavior and emotions of participants. Phoenix House has used Seeking Safety for trauma in all its community-based substance abuse treatment programs since 2007, starting from women’s programs and adding men’s community-based programs in 2011. Seeking Safety is required by California in-custody treatment programs. Clients express high level of satisfaction with services received and the majority consider Seeking Safety as the most effective treatment service they have received during treatment at Phoenix House.
3. Phoenix House uses elements from the TCU Treatment System, i.e. a set of assessments and manual-guided interventions developed by the Institute for Behavioral Research at the Texas Christian University to target specific needs and status of clients at different stages of treatment. The TCU Treatment Process Model involves: induction into treatment, engagement in treatment, early recovery, adequate retention before treatment release, and preparation for community re-entry. TCU Brief and Comprehensive Interventions can be used in various combinations to supplement other treatment EBPs: Straight Ahead: Transition Skills for Recovery; Getting Motivated to Change, Ideas for Better Communication, and many more.
4.The Strengthening Families Program for children and families has been implemented as Behavioral Health Family Intervention by Phoenix House’s BHIS since 2013, as the highest tier for the most vulnerable youth and families in Orange County schools. The SFP is designed for parents and their children ages 0-17 who need skills to reduce family conflict and the risk of abuse or neglect. This 10- to 14-week parenting and family skills training program for high-risk and general population families is designed to significantly improve parenting skills and family relationships, reduce child maltreatment, children’s problem behaviors, delinquency and alcohol and drug abuse; and to improve social competencies and school performance.
5.Too Good For Drugs prevention curriculum has been used in Los Angeles County Prevention Services in Middle Schools since 2011. This school-based prevention program for youth ages 11 to 14, provides information about the negative consequences of drug use and the benefits of a nonviolent, drug-free lifestyle. Participation in the TGFD curriculum has shown to significantly reduce the proportion of students with intentions to drink alcohol or use marijuana, increase protective factors, improve social and peer resistance skills, improve goal setting and decision-making, increase self-efficacy, and reduce acceptance of substance use.
6. Since 2013, the Positive Action EBP has been used by Phoenix House in Orange County Behavioral Health Interventions and Support Services in up to 50 elementary, middle and high schools. Positive Action (PA) is a universal program created for students in school kindergartenâ€“eighth grade that provides an instructorâ€™s kit at each grade level. The program aims to motivate students intrinsically to be their best selves by teaching them that they feel good about themselves when they do positive actions. The program teaches the positive actions for the whole self: physical, intellectual social and emotional through six units, which are the same at each grade. This enables the entire school to be learning the same concept around the same time, thus providing the setting for use of the school wide climate development kit(s) to reinforce positive behaviors school wide daily. This reinforcement enables students to experience good feelings about themselves when they do positive actions. For students needing more intense support, there is a counselorâ€™s kit. All kits have a manual with scripted lessons, planned activities and colorful, engaging supplementary materials.Positive Action is a comprehensive youth development program with a very strong evidence base, assuring us of its effectiveness. This integrated and comprehensive program is designed to improve problem behaviors such as substance use, anger management, suspensions, disruptive behaviors, school drop out, and sexual behavior, and improve academic achievement and school attendance. All materials are based on the same unifying broad concept (one feels good about oneself when taking positive actions) with additional concepts (positive actions for the physical, intellectual, social, and emotional areas) that elaborate on the overall theme.
In addition to a variety of Evidence Based Practices, Phoenix House incorporates into its treatment approach Medication Assisted Treatment. According to SAMHSA, “Medication-assisted treatment (MAT) is the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.” Combining medication and therapy can be more successful in treating SUD disorders than therapy alone. MAT helps in recovery support and prevents/reduces opioid overdose, since it is primarily used to treat addiction to opioids such as heroin and prescription painkillers. MAT has been proven effective in reducing the need for inpatient detoxification and allows providers to better tailor treatment to individual needs and help patients lead a successful life in recovery. Medications include acamprosate, disulfiram, and naltrexone for alcohol use disorder. Buprenorphine, methadone, and naltrexone (Vivitrol) are used to treat opioid use disorders. Naloxone prevents opioid overdose by reversing the toxic effects of the ingested drug.
The systematic incorporation of effective Evidence-Based Practices across all Phoenix House California services over the past decade has improved client treatment success and long-term outcomes in their recovery journey. We enthusiastically embrace the use of proven EBPs and are proud of these accomplishments in the evolution of service models at Phoenix House California.