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Committee halts bill on 'evidence-based' behavioral health services

Proponents of an initiative to change the candidate nomination process in Utah filed ballot language Wednesday that follows a controversial compromise they made with state lawmakers in 2014.
The House Health and Human Services Committee on Wednesday opted not to recommend a bill that promotes evidence-based practices in mental health and substance abuse treatment.
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SALT LAKE CITY — The House Health and Human Services Committee on Wednesday opted not to recommend a bill that promotes evidence-based practices in mental health and substance abuse treatment.

Instead, the committee voted 10-2 to request the Legislature's Health Reform Task Force study the contents of HB199 later this year.

In its original iteration, the bill, titled Division of Substance Abuse and Mental Health amendments, gives lawmakers the authority to withhold funds from local health agencies beginning in 2020 if a specified proportion of the individual and group therapy behavioral health treatments offered aren't considered evidence-based.

The original version of HB199 would require that 66 percent of local health authorities' group behavioral health programs be defined as evidence-based, with 40 percent of individual health treatment meeting the same criteria by 2022.

A substitute to HB199 scales back the bill's ambitions significantly, after "we quickly realized that requirement might not be the best" due to forceful feedback from health providers, said the measure's sponsor, Rep. Kelly Miles, R-Ogden.

But the committee decided not to adopt the substitute, with Rep. Paul Ray, R-Clearfield, saying he wants the full implications of the original bill examined by the Health Reform Task Force.

The bill also requires that local health authorities identify in reports to the state which of their programs are evidence-based. It defines what an evidence-based treatment is and creates a task force made up partly of lawmakers that analyzes which performance metrics from treatment should be highest priority to the state.

Miles told the committee he wanted to pursue the legislation out of a desire "help us as a Legislature play a more engaged role in helping the most vulnerable and lost members of our society."

"I would dare say that we probably don't have a good idea on ... what type of outcomes are coming out, what kind of treatments are being produced to provide beneficial outcomes (in state-funded programs)," Mills said.

Darin Carver, clinical practice administrator at Weber Human Services, spoke to the committee in support of Miles' substitute bill, saying "right now there are no agreed-upon outcomes on behavioral health in the state."

"As a field, we struggle understanding specifically what it is that the Legislature would at times want us to focus on and what are meaningful outcomes for use of the public dollar. ... (This) allows us as behavioral health centers to be transparent about what we're doing," Carver said.

Carver said a push for more evidence-based treatment has been succesful in other states. He also pointed to Weber Human Services' improvement in patient outcomes since it embraced using more evidence-based treatment methods in 2012, during which time it has beaten the state average consistently in the proportion of clients considered to be in recovery.

"Every year on average, 200 additional individuals are getting better because of the use of these treatments," Carver said.

Of 54,000 clients treated by state-funded behavioral health programs in 2016, 23,000 were considered to be improving or in recovery, Carver said. He believes that number could be closer to 35,000 if the state focuses on promoting the use of evidence-based treatments.

Miles' bill describes an evidence-based treatment as being "based upon a written manual or protocol that specifies the nature of the services" and "supported by scientific research" subjected to "randomized control trials or quasi-experimental studies."

That definition received sharp criticism from the Utah Association of Addiction Treatment Providers, which was at the meeting to say it was arbitrary, limiting and inflexible.

Rep. Steve Eliason, R-Sandy, also worried over the definition of evidence-based being too strict to include treatments or preventions that are clearly successful. He cited the SafeUT app, designed to provide crisis intervention help for Utah teenagers, as an example of an effective program that doesn't currently meet the criteria.

"I've seen the data and we have a tremendous number, thousands of students using it, and I could speak for hours probably about the success stories that we've seen," Eliason said. "However, it's not evidence based nor is there a budget to obtain that qualification (via new research)."

Richard Nance, director of the Utah County Department of Drug and Alcohol Prevention and Treatment who was at the hearing to represent the Utah Behavioral Health Committee, said the other 12 local health authorities belonging to the committee besides Weber Human Services oppose the bill.

Nance disputed Miles' notion that the state doesn't have a clear idea of which of the programs that it helps fund are getting results.

"The Division of Substance Abuse and Mental Health produces a very lengthy annual report and it goes into great detail about the sources of funds that we have, how those are used, how they're used (by) individual local authorities," Nance said.