Transcript Tough Kids: Practical Behavior Management

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Evidence Based
Practice
University of Utah
Training School Psychologists to be Experts in Evidence Based Practices for Tertiary Students with
Serious Emotional Disturbance/Behavior Disorders
US Office of Education 84.325K
H325K080308
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Evidence Based Practice in
Psychology
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APA Presidential Task Force on Evidence-Based Practice
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Evidence-Based Practice in
Medicine
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Works towards improved patient outcomes by informing
practicing clinicians of current research
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“The conscientious, explicit, and judicious use of current best
evidence in making decisions about the care of individual
patients”
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Evidence-Based Practice in
Psychology
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Template for Developing Guidelines: Interventions for Mental
Disorders and Psychosocial Aspects of Physical Disorders
states that evidence should be evaluated on two dimensions:
efficacy and utility.
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Efficacy
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Efficacy refers to the evaluation of the strength of evidence in
determining causal relationships between interventions and
disorders under treatment.
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Clinical Utility
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Consideration of available research evidence and
perceptions of generalizability, patient acceptance, ability of
the practitioner to carry out the intervention, and costs and
benefits of the intervention.
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Evidence-Based Practice in
Psychology
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At a state level, Medicad programs are encouraged or
required to use a specific list of evidence-based practices
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At a federal level, NIMH works on promoting, implementing,
and evaluating evidence-based practices being
implemented at a state level.
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Goals of Evidence-Based Practice
in Psychology
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Improve quality of care
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Make care more cost-effective
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Enhance accountability
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Definition of Evidence-Based
Practice
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“The integration of the best available research with clinical
expertise in the context of patient characteristics, culture,
and preferences”
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Promote effective psychological services and enhance
public mental health
+ Difference between Evidence-Based Practice
in Psychology (EBPP) and Empirically
Supported Treatments (EST)
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EST starts with a treatment and aims to determine if the
treatment works with a certain disorder
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EBPP centers on the patient and aims to determine what
research evidence will be most useful in producing the best
patient outcome.
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In general, EPBB involves a broader range of clinical
activities, resulting in a decision-making process that works
to integrate multiple sources of research evidence.
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Main Components of EvidenceBased Practice
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Best available research
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Clinical expertise
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Patient characteristics
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Best Available Research
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A large body of research suggests that a particular
psychological practice is effective and safe.
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Recent research has demonstrated that psychological
treatments are more enduring than alternative approaches,
such as medications (Hollen, Stweart, & Strunk, 2006).
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Research has demonstrated that psychological treatments
often pay for themselves in terms of medical costs,
productivity, and life satisfaction.
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Issues in Integrating of Research
into Practice
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How to evaluate different research methods?
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How representative are samples?
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At what level should research guide practice? (i.e. principles,
strategies, or specific protocols)
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How generalizable are research settings to practice settings?
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How are treatments to be evaluated when the number of treatments
tested is limited?
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How do results generalize to minority populations?
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It is important not to assume that interventions not yet evaluated
through randomized trials are ineffective. However, they should be
empirically evaluated in a timely manner.
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Research Designs that Contribute
to Best Research Available
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Clinical observation
Qualitative research
Systematic case studies
Single-case experimental designs
Public health and ethnographic designs
Process-outcome studies
Random controlled trials
 These are a more stringent way of evaluating treatment
efficacy because they are able to rule out threats to internal
validity
Meta-analyses
It is important that strengths and weaknesses be recognized in
any research
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Future Directions of Research
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Compare psychological treatments to pharmacological
treatments
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Demonstrate generalizability of interventions to noncontrolled settings
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Examine patient-treatment interactions
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Evaluate the efficacy of interventions with underrepresented
groups
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Evaluate the efficacy of interventions with children at
different developmental levels
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Identify factors as mechanisms of change
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Future Directions of Research
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Identify psychologist characteristics that contribute to
positive outcomes
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Empirically evaluate treatments that have yet to be evaluated
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Develop criteria for discontinuing treatments
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Evaluate cost-effectiveness of psychotherapy
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Development of practice research networks
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Research on prevention of psychological disorders and risk
behaviors
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Clinical Expertise
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Essential for identifying and incorporating best research
evidence into practice
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Components of Clinical Expertise
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Assessment, diagnostic judgment, and treatment planning
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Decision making, treatment implementation, and progress monitoring
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Interpersonal expertise
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Continual self-reflection and improvement of skills
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Use of evidence-based practice
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Understanding of the influence of cultural and individual differences in
treatment
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Seeking available resources as needed
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Having a cogent rationale for treatment strategies
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Assessment, Diagnostic Judgment,
and Treatment Planning
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Ability to formulate a clear and coherent case
conceptualizations, assess patient psychopathology, and
make accurate diagnostic judgment
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Revise conceptualization as treatment proceeds, seeking
confirming and disconfirming evidence
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Setting goals of treatment while taking into account the
individuality of patient
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Goals are made in conjunction with the patient
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Implementation, and Progress Monitoring
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Entails skillful and flexible delivery of treatment
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Ability to adapt the treatment to the patient
Flexibility is demonstrated in tact, framing, timing, and pacing
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Monitoring patient situation (such as employment, illness,
etc.) that may require changes in treatment
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Modify treatment if patient is making insufficient progress
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Interpersonal Expertise
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Involves forming a therapeutic relationship, reading verbal
and nonverbal cues, and providing an environment in which
the client may experience realistic expectations and
empathetic understanding
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Individual therapist effects accounts for 5-8% of treatment
variance
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Continual Self-Reflection and
Improvement/Acquisition of Skills
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The ability to reflect on one’s one experiences that influence
treatment though knowledge, emotions, thoughts, or
behaviors
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Clinical expertise is improved and maintained through:
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Research and theory
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Systematic observation and hypothesis testing
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Self-reflection
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Monitoring patient outcomes
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Continuing education opportunities
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Use of Evidence-Based Practice
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Scientific expertise in central to effective practice of
psychology
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It is necessary to be able to evaluate treatment magnitudes
and apply relevant research to practice
+ Understanding of the Influence of Cultural
and Individual Differences in Treatment
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Entails awareness of individual, social, and cultural context of
the patient
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May include age, ethnicity, culture, race, gender, sexual
orientation, religious preference, and socioeconomic status
Treatments must be adapted to fit each patient while
respecting the patient’s worldview
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Seeking Available Resources as
Needed
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The psychologist may find it necessary to seek consultation
or make a referral
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Having a Cogent Rationale for
Treatment Strategies
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Clinicians should rely on case formulations, recent research,
and clinical experiences to design a treatment to produce
the desired outcome
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Where evidence-based practice is sparse, clinical expertise
should be used to apply the best available evidence, while
closely monitoring the progress of the patient.
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Future Directions of Clinical
Expertise
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Study practices of clinicians who obtain the best results
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Identify technical skills used by clinicians to produce desired
outcomes
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Improve reliability, validity, and clinical utility of diagnoses
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Studying conditions that maximize clinical expertise
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Determining the extent to which errors studied in the
literature are linked to decrements in treatment outcome
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Future Directions of Clinical
Expertise
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Develop well-normed measures that clinicians can use to
quantify their judgments, measure progress, and assess the
therapeutic process
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Distinguish expertise related to common factors shared
across most therapies and expertise specific to particular
treatments
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Provide clinicians with real-time feedback and clinical
support tools
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Patient Characteristics, Culture,
and Preferences
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Evidence-based practice in psychology involves considering
each patient’s individual characteristics with the
psychologist’s training and understanding of the best
available research
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It is important to consider:
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Variations in presenting problems
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Age, developmental status, developmental history, and family
history
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Sociocultural and familial factors
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Current environmental context, stressors, and social factors
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Personal preferences and vaules
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Individual Differences
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It is important to know the person who has the disorder in
addition to knowing the disorder the person has
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Future Directions of Individual
Differences
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Understand patient characteristics as moderators of treatment
response
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Evaluate interventions widely studied in the majority population
with other populations
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Evaluate the impact of stereotypes held by psychologists and
interventions for reducing their impact
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Examine was to make information regarding culture more
available to psychologists
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Maximize psychologist competence with diverse patients
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Identify effective treatment decision models with regard to
patient preference
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Conclusion
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Evidence-based practice in psychology is designed to
enhance the treatment of patients within an “atmosphere of
mutual respect, open communication, and collaboration
among all stakeholders, including practitioners, researchers,
patients, health care managers, and policymakers” (APA,
2006)