Persisting without Evidence is a Problem: Suicide Prevention and Other Well-Intentioned Interventions.

摘要: The proposition that an intervention without evidence of effectiveness for a targeted health problem should be continued to offered until such time with is available replace it problematic. persistence offerings has been identified as one type research-practice gap (McLennan, Wathen, MacMillan, & Lavis, 2006). Nevertheless, this appears the recommended approach suicide prevention suggested in editorial journal response review paper finding no compelling two marketed school-based programs, Signs Suicide (SOS) and Yellow Ribbon (YR) (Ickowicz Schachar, 2015; Wei, Kutcher, LeBlanc, 2015). More precisely, concluded “rejection initiatives under scrutiny would only justified when if something better can offered” (p.4, Ickowicz While understandable why wants do order address issue serious suicide, may counterproductive continue supporting failed demonstrate effectiveness. The authors raise potential adverse impacts from rejecting interventions One concern hidden within group null effect are some children benefit given intervention. However, case, overall then reflect few who might actually counterbalanced by harmed intervention, assuming study adequately powered. It certainly possible underpowered studies or otherwise flawed miss true positive effects, example Type II error. error also go other way missed. It could argued effects secondary participation more problematic than treatment existing disorder latter situation willing take on greater risk alleviation suffering whereas harm come someone pre-existing condition. Despite there be, paradoxically, lower standard offering perhaps driven belief “it can’t hurt” “better nothing.” Certainly very challenging conduct typical need look at small differences among large samples followed over significant periods time. Perhaps these demands lead apparent waiver for, least limited of, prior their dissemination. Even direct comes interventions, consequences still through opportunity costs. Opportunity cost, fundamental economic concept, means “by choosing use resources way, we forgo opportunities same resources” (p. 153; Gafni Birch, 2003). There real resource costs implementation including purchase training costs, ongoing personnel student staff have considered light how consumed (or be) used what effect. A net not free. The block adoption another additional extended cost. For example, school purchases, commits to, implements like SOS YR, quite likely they will pursue other, potentially effective, issue. even resistance change sunk emotional investment This mechanisms impeded movement forward effective substance abuse programs. case point Drug Abuse Resistance Education (DARE) program most widely disseminated its kind world despite weak evidence-base (Singh et al., 2011). proposed adopted DARE unlikely adopt second substance-abuse DARE) existence programs Life Skills Training (Botvin Griffin, 2014). In scenario, essentially blocks evidence-based well removes “press” else. check box indicates doing prevent drug alcohol abuse. It countered scenario applicable absence robust ought instead YR. reduces else about issue, case. When asked, able say “yes” believe already addressed and, unaware base, recognize looking additionally does appear any particularly strong requirement those schools otherwise, provide met threshold cause good. Certainly call halt efforts pressing mental problems matter initiatives. fact, acknowledging lack many our field spur attempts, less rigorously deficits. needs much clearer process whereby novel initiatives, appropriately rolled out wide spread dissemination lacking acceptable. Wei al.’s (2015) article includes schematic flag notion acceptable level dissemination. Similar arguments made others. An Schoenwald Hoagwood (2001) informative child consider complex considerations rolling particular articulate transportability bridge steps between efficacy, effectiveness, Such systematic strategic require different business current, seemingly haphazard, Canada. al. propose role independent/regulatory arm Health Canada national research center issues related recent reviews youth recommends research-to-practice network linking researchers decision-makers current gaps (Bennett strategies help currently low-placed bar.