Evidence-based practices have not been widely implemented in real-world treatment settings for several reasons, including existing state laws, administrative policies, funding priorities, advocates' concerns, and program staffing. Dissemination strategies focus largely on program staffing and the question of why treatment teams that are responsible for assisting people with serious mental illness fail to use evidence-based practices. In a review of the research literature, two barriers to staff dissemination emerge: individual service providers lack the necessary knowledge and skills to assimilate these practices, and certain organizational dynamics undermine the treatment teams' ability to implement and maintain innovative approaches. Three sets of strategies are useful for overcoming these barriers and fostering dissemination: packaging evidence-based practices so that specific interventions are more accessible and user-friendly to service providers; educating providers about relevant knowledge and skills; and addressing the organizational dynamics of the team to facilitate the implementation of innovations. Research on dissemination is relatively new and is less well developed than the clinical and services research enterprise that has led to evidence-based practices. Implications for future studies are discussed.

Evidence-based practice (EBP) is an orientation to practice that values evidence as a resource for clinical decision making while recognizing that evidence alone is never sufficient to make a clinical decision. Critics of EBP typically ignore, negate, or misrepresent the role of practitioner thinking processes and expertise in clinical settings. The authors believe that, far from being a mechanistic process that ignores practitioner expertise, reflection and critical thinking are essential to implementing EBP in real-world clinical practice. The purpose of this article is to provide guidance for how practitioners bring their expertise to bear when engaging in the process of EBP. The authors use a social work practice scenario to illustrate the application of practitioner expertise in each of the five steps of EBP.

The medical model has promoted a train-place model for psychiatric rehabilitation. This model carefully trains people with psychiatric disabilities on a range of skills so they can handle real-world demands before placing them in work and independent living situations. More consistent with a social work perspective are place-train programs, which rapidly place people with psychiatric disorders in real-world settings so they can experience the benefits, as well as the challenges of these situations, and then provide the necessary training and support to successfully maintain these placements. This article compares the two models and shows that place-train approaches can help people with serious mental illness attain many of their work and housing goals without increasing the frequency of relapse.

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