Opening Presentation – May 16, 2013

Should EBPs be Locally Grown or Factory Farmed?

Presentation Slides  Video of Presentation

Presenter: Greg Simon, MD, MPH, Group Health Research Institute


Abstract:  Efforts to implement evidence-based psychosocial treatments have typically assumed that those treatments would be delivered by local providers.  Recent research regarding care management and structured psychotherapy programs for depression should cause us to question this assumption.  Effectiveness trials strongly support the fidelity and clinical effectiveness of centrally produced or “factory-farmed??? depression treatment programs.  The limited data available suggest that centrally produced treatments clearly out-perform “locally grown??? models of depression care.  For any specific treatment, the likelihood that a centralized delivery model will prove superior depends on two questions:  First, can this treatment be provided over distance (via telephone, video conference, or some other telehealth medium) without significant loss of clinical effectiveness?  Second, does local variation in this treatment lead to better outcomes or simply lower quality?  Ultimately, the choice between centrally produced and locally produced mental health treatments should depend not on the needs or preferences of providers or researchers, but on the clinical benefits and value they provide to patients or consumers.