How can we determine the value of recovery-oriented services if these are not evidence based?
This blog series addresses the top ten service concerns in our industry about drug and alcohol recovery. In part eight, we propose that recovery-oriented services need not be evidence based.
It makes sense for health services which are evidence based to attract an air of legitimacy and where evidence is lacking this undermines the legitimacy of interventions. Medical practices where progress is widely evidenced are perceived to be more accountable, and so held up to be deserving of additional funds. This ties us to the interventions of the past.
There is an expectation that evidence based services can ensure budget is streamlined to interventions which demonstrably 'work'. Conversely, it seems that where evidence is deemed absent, so too is value.
We respond to the problem of evidence with our recovery-oriented ethos:
Recovery cannot be measured in the same way as
While recovery has existed in its present recognisable form for some decades, it is a relatively new field compared with other forms of care. As such, recovery-oriented services are not yet geared toward the more traditional evidentiary base this concern requires.
Newness, rather than an inability to undertake research, is the main barrier here, but this too is changing. As an increasing number of insurance companies (and notably managed care insurance based companies in America) begin to fund rehabilitative and recovery-orientated practices, we will continue to see a rise in evidence to support the work of recovery.
changing definition of 'evidence' for drug and alcohol rehabilitation
At present, evidence appears to be evaluated according to whether or not recovery orientation contributes to an intervention's success. This is wrong-thinking, and, a better approach would be to position evidence of effectiveness around a particular intervention's contribution to recovery, where recovery is the primary outcome (not just a contributor to a different primary goal).
Reassessing what constitutes 'evidence' in this way might mean treatments that do not contribute to recovery can be stopped, and their funds redistributed to better support services that demonstrate relevance. In this country Payment by results (PbR) and Outcomes Framework schemes (QoF) are looking for outcomes to attract payments and recovery is a primary goal that fits into this new funding framework very easily.
At Delphi we are increasingly looking at interventions that support a recovery outcome. Our soon-to-be published report on Wellbeing will act as a guide for our ongoing development an future innovation.
This series refers to 'A practical Guide to Recovery Orientated Practice' by Davidson et al, published by Oxford University Press 2009.