Background In 2010 our organisation began creating evidence-based clinical practice guidelines for behavioural health, focusing initially on depression, PTSD, and obesity, following emerging IOM standards.
Context Selected challenges in five areas: 1. Terminology. For many years, our organisation used guideline terminology that was inconsistent with the field. 2. Representation. Given the diverse types of professionals in behavioural health and the breadth/depth of each topic, attaining sufficiently diverse panel membership has been challenging. 3. Stakeholders. Obtaining the patient perspective has been challenging, particularly given the stigma and privacy concerns often associated with mental health. 4. Systematic Reviews. The high cost of developing de novo systematic reviews, especially for large scope topic areas, is limiting. 5. Education. Professionals have varying knowledge and lexicons for the process, requiring education, particularly surrounding non-financial conflicts of interest.
Description of Best Practice •Terminology- Implemented organisation-wide systemic change in lexicon via change in organisation policy and routine dissemination. •Representation- Used multi-step consensus nomination process to assemble multidisciplinary panels. •Stakeholders- Using multi-tiered approach to involve stakeholders via Consultation, Participation, and Communication models and outreach to mental health peer support programmes. •Systematic Reviews- Applied Delphi poll method in topic scoping/refinement to work within organisational resources. Other mechanisms to enhance resources include topic nominations to AHRQ, possible organisational partnerships, and developing products from guidelines. •Education- Creating a series of self-study educational modules on guideline development.
Lessons for Guideline Developers and Others Our challenges and resolutions could be helpful to others in guideline development.
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