Public mental healthcare faces several, often interrelated challenges, from inadequate funding and insurance coverage to paperwork overload and crippling stigma. One of the more remarkable hurdles, however, is simply getting veterans in the field to employ new academic findings in order to be more effective with clients. As it is now, studies show there is a two-decade lag between research and its day-to-day application.

"This 20-year gap is not acceptable," John Brekke, associate dean of research, USC School of Social Work, bluntly told an audience of professionals at a conference on March 26 in Pasadena. "This means our practitioners are lagging almost two generations behind the science that should be informing their practice."

He and his colleagues aim to speed things up by changing public health agencies "from the inside out" – first, by educating a new crop of professionals in the "translational science" of putting lab-tested techniques to work and, second, by building partnerships with the agencies themselves.

The conference reflected both goals. USC social work graduate students organized it as a capstone to a nine-month internship they served at Pacific Clinics, a major behavioral healthcare provider in southern California where they have already been applying their lessons in evidence-based practice (EBP).

"Transformation of public mental health service is an exciting concept but hard to do," said conference panelist Mikki Gress, assistant dean for field education, USC School of Social Work. "It's up to the new practitioners, today's students, to do it," Gress said, "because older hands tend to stick with what they're already comfortable doing and do best."

"The problem is not that clinicians don't want to learn," said Brekke. "We haven't figured out how to make these new interventions attractive to practitioners." The key, he said, is a collaborative cycle that brings empirically verified practices to the field and clinical experience with those practices back to the lab.

Central to the innovative partnership between USC and Pacific Clinics were eight MSW candidates organized in a first-of-its-kind field unit – Charles Evans, Veronica Fry, Meri-Louise Harrison, Carlos Moran, Darlene Sierra, Hannah Thomson, Miranda Walls and Krystal Williams. The pioneering interns were posted at different Pacific Clinics sites, learning from experienced pros while using new manual-based client interventions developed with the latest academic research.

"EBP is such a hot topic right now," said intern Hannah Thompson, explaining why she chose this internship over others. "This is the cutting-edge, and this internship was a great learning opportunity."

EBP itself is not a new concept, but its time has become more opportune. "The need to move evidence-based practices into clinics is crucial to our success within various cultural communities," Susan Mandel, chief executive of Pacific Clinics, told the conference audience of representatives from various area agencies including the Los Angeles County Departments of Mental Health and Probation. "It is no longer possible to say that one size fits all and be considered a competent organization."

Mandel said that instead of being based on recent science, mental health services have been traditionally provided based on the individual practitioner's skills, the organization's treatment philosophy and the requirements of specific grants.

Beyond cultural relevance, there is the all-important issue of funding, a perennial challenge in mental healthcare. "As dollars shrink," Mandel said, "we need to look for the ability to say these programs are effective and not related simply to symptom relief but related to the quality of life." Measurable outcomes are key, she said. Such measurements of client progress could include achieving goals, working, being in school or living independently (if that's a value in their culture).

State funding for mental healthcare not only fails to keep up with population trends, it is actually projected to fall because 85 percent to 90 percent of it comes from deteriorating sales taxes and vehicle license fees. There is a ray of hope, however: The Mental Health Services Act (MHSA), a landmark 2004 law that provides new money to the mental healthcare system from a special income tax on millionaires in California.

But to qualify for MHSA funding, a program must be new and focused on doing "whatever it takes" to help the client make progress (not just stabilize). That tilts in favor of wellness centers, full-service partnerships and other new programs that are more likely to feature newer, evidence-based interventions.

To prepare for the future, the inaugural class of the EBP Field Unit received a stipend from California's Social Work Education Center and yearlong training on how to use such EBP intervention models as "Motivational Interviewing" and "Illness Management and Recovery" for the treatment of individuals and groups.

Intern Carlos Moran said he appreciated the practicality of the training. "There's a huge difference between learning in the classroom and the field," he said in a panel discussion. "It was not just another lecture in a class."

Added intern Charles Evans, "We did a lot of role playing. It can be an awkward thing at first. But practice makes perfect."

How do these interns differ from other students? "I observe a significant difference in confidence and understanding of the material," said Erin Dorflinger, a field instructor at Pacific Clinics' Monrovia site, and a USC graduate herself. "It's very beneficial to our consumers [clients] too. They feel that confidence."

"We're able to see those 'a-ha!' moments earlier," concurred panelist Rodney Reed, director of social work at Pacific Clinics Training Institute. "The training has put them a little ahead of other student interns in terms of interventions."

Intern Charles Evans agreed that confidence was the biggest payoff of the internship, but noted it was "nerve-wracking" to use the manualized interventions at first. "You want to be effective and helpful, but at the same time you're fresh and new."

However inexperienced, the interns represent change that might threaten some veterans. But panelist Jim Wainwright challenged the thinking that an established technique was truly "working" if it wasn't showing client progress. "Stability is not the goal of our program," said the director of Pacific Clinics El Monte ACT Wellness Center. "We want to move clients along into recovery."

Newcomers can help show the way, Wainwright said. "The interns are learners, but in some ways they are experts in new techniques. It's a delicate balance."

To spread new thinking within agencies, it's important to hire as permanent staff MSWs who were trained in EBP, said Rodney Reed. Education of other staff and top-down support are crucial too, said panelist and presenter Betsy Phillips, clinical project manager from USC.

Success remains the best salesman. "One of the ways to get provider buy-in is when they can see change," Brekke said. With the help of clinicians, he is developing real-time feedback/outcome software.

EBP is not a magic solution to all of mental health's challenges. There remains a lack of parity between mental health insurance and physical health insurance. Provable "medical necessity" is still required to provide treatment. And tortuous paperwork continues to choke off service and drive professionals from the field.

But these soon-to-be newly minted MSWs left their elders feeling optimistic about the future of their profession. "If all the interns we get are as good as we've had this year," Brekke said, "we're going to be in great shape."