After writing about telemental health last week, I found myself wondering what it will take to get practitioners to consider using remote connectivity with their clients as a regular way of providing treatment. Some of you seem to do this, but it appears that very few do so, in spite of developing evidence that treatment provided by Skype or other remote service can be just as effective as in-person treatment.
These discussions are not that unusual in the world of behavioral health. In fact, implementing new research into practice—even interventions that have demonstrated efficacy and effectiveness—presents major challenges. It takes up to 20 years for new knowledge from clinical trials to be incorporated into practice (see Crossing the Quality Chasm: A New Health System for the 21st Century and Mental Health). A study of research adoption found that it took “17 years to turn 14 percent of original research findings to the benefit of patient care” (see From Science to Service: A Framework for the Transfer of Patient Safety Research into Practice and Clinical Research to Clinical Practice — Lost in Translation?). This situation means that in the intervening two decades that it takes for new discoveries to make their way to consumers, there is a lot of unnecessary human suffering and a lot of unnecessary cost.
When I practiced as a psychologist, I attended continuing education training regularly. When I came across new ideas, I tried to implement them in my practice. My move toward Cognitive Behavioral Therapy came after an extensive training in this modality. But try as I might, it was very difficult to maintain and continue to provide what I learned. The pull of clients to just talk about what is going on in their lives rather than to do something concrete about it was difficult to overcome. It is like entropy in any system; the tendency is to move back toward that which was initially learned. If a career lasts 30 – 40 years, it is possible that new evidence-based methods will be incorporated only once during a clinician’s lifetime.
What do you find in your own work? Are you an early adopter of new methods? Are you able to pull them off over the long-term, or are they just flashes in the pan?
Please share your comments and observations below.