What Really Works (and What Doesn’t) for Challenging Kids Part 2 Bruce A. Thyer, Ph.D., LCSW, BCBA-D College of Social Work, Florida State University Presented at the Annual Professional Workshop sponsored by Formed Families Forward Fairfax, VA on 28 April 2017 Selling your ideas is challenging. First, you must get your listeners to agree with you in principle. Then, you must move them to action. Use the Dale Carnegie Training® Evidence – Action – Benefit formula, and you will deliver a motivational, action-oriented presentation.

Lets take a look at some of these resources 3. How Can You Critically Evaluate the Available Evidence? Develop critical appraisal skills in evaluating research yourself. (a bottom-up search) Seek out and rely on credible groups which have already done this (e.g. Cochrane and Campbell Collaboration, APA’s Division 12’s lists of ESTs, SAMSHA, California Clearing House…etc.) (a top-down search) Lets take a look at some of these resources Next, state the action step. Make your action step specific, clear and brief. Be sure you can visualize your audience taking the action. If you can’t, they can’t either. Be confident when you state the action step, and you will be more likely to motivate the audience to action.

The Cochrane Collaboration www.cochrane.org

Sample Cochrane Systematic Reviews Dealing with Youth Group-based parent training programmes for improving emotional and behavioural adjustment in young children Social skills groups for people aged 6 to 21 years with autism spectrum disorders (ASD) Parenting programmes for teenage parents and their children Parenting programmes for the treatment of physical child abuse and neglect

Lets Try it Out! Go to www.cochrane.org Look in Cochrane Library Look in Completed Reviews Do a search, using a term/problem of interest to you. (hint – try Autism) Let me know if you found something pertinent

The Campbell Collaboration www.campbellcollaboration.orh Go to www.campbellcollaboration.orh Look in Campbell Library Look in Completed Reviews, social work welfare and education groups most likely to yield something of interest Do a search, using a term/problem of interest to you. (hint – try Autism, or depression) Let me know if you found something pertinent

The National Registry on Evidence-Based Programs and Practice https://www.samhsa.gov/nrepp Go to https://www.samhsa.gov/nrepp Search for ADHD See what we find. Go back and search using VIEW ALL (over 400 programs) Do a search, using a term/problem of interest to you. Let me know what you find. Look at Review Process and how they score programs.

The California Evidence-based Clearinghouse for Child Welfare http://www.cebc4cwHouse.org/ Go to link Go to Program Registry Go to List of Programs Check out ‘Acceptance and Commitment Therapy Next, go back and enter a problem of interest to you Let me know if you find something interesting Let me know if you found something pertinent

The California Evidence-based Clearinghouse for Child Welfare http://www.cebc4cwHouse.org/ Go to link Go to Program Registry Go to List of Programs Check out ‘Acceptance and Commitment Therapy Next, go back and enter a problem of interest to you Let me know if you find something interesting Let me know if you found something pertinent

What are Research Supported Psychological Treatments and Where Do They Come From? Division 12 (Clinical Psychology of the APA) organized a “Task for on Promotion and Dissemination of Psychological Procedures” in the early 1990s. Its purpose was to “publish information for both the practitioner and the general public on the random assignment, controlled outcome study literature of psychotherapy and of psychoactive medications.” Open your presentation with an attention-getting incident. Choose an incident your audience relates to. The incidence is the evidence that supports the action and proves the benefit. Beginning with a motivational incident prepares your audience for the action step that follows.

The Task Force had Two Sequential Tasks: To develop evidentiary standards to be used to designate a given treatment/assessment methods as “empirically validated” (later changed to “empirically supported”. To review the literature and publish lists of treatments that met or did not meet these evidentiary standards. Open your presentation with an attention-getting incident. Choose an incident your audience relates to. The incidence is the evidence that supports the action and proves the benefit. Beginning with a motivational incident prepares your audience for the action step that follows.

What Evidentiary Standards Did They Develop? They (APA, Division 12)came up with two sets of standards or evidence benchmarks, one to designate an treatment as ‘empirically supported”(hence ESTs) or well supported, and another, less stringent one, used to designate an intervention as promising or probably efficacious. Open your presentation with an attention-getting incident. Choose an incident your audience relates to. The incidence is the evidence that supports the action and proves the benefit. Beginning with a motivational incident prepares your audience for the action step that follows.

OK – Where are these lists of ‘approved’ treatments? Two major publication pathways emerged from the Task Force’s efforts: Initially, one book - Nathan, P. E. & Gorman, J. M. (Eds.) (2007). A Guide to Treatments That Work (third edition). New York: Oxford University Press

See also: A new Division 12 developed, edited and supported book series titled “Keeping up with the Advances in Psychotherapy: Evidence-based Practice”, published by Hogrefe & Huber. Note the crucial terminology change from ‘empirically supported to “evidence- based” This is a problem. These are different things.

How can this website be used? Look up DISORDERS Look up PTSD Look up TREATMENTS Look up Interpersonal Psychotherapy for Bulimia Look up a treatment or disorder of interest to you Open your presentation with an attention-getting incident. Choose an incident your audience relates to. The incidence is the evidence that supports the action and proves the benefit. Beginning with a motivational incident prepares your audience for the action step that follows.

How can this website be used? Look up DISORDERS Look up PTSD Look up TREATMENTS Look up Interpersonal Psychotherapy for Bulimia Look up a treatment or disorder of interest to you Open your presentation with an attention-getting incident. Choose an incident your audience relates to. The incidence is the evidence that supports the action and proves the benefit. Beginning with a motivational incident prepares your audience for the action step that follows.

WARNING! Folks who wish to intelligently discuss evidence-based practice should be very familiar with the primary source readings on EBP. It is NOT the SAME as Empirically Supported Treatments!

EBP is a PROCESS of learning, it is NOT A LISTING OF EFFECTIVE TREATMENTS! Crucial Definitional Terms such as “Best Research Evidence”, “Clinical Expertise” “Patient Values” and “Patient Circumstances” are all operationalized reasonably well.

What Should Social Work Do and NOT Do? When we talk about interventions that are supported by credible research, please use the language of research-supported treatments, or perhaps empirically-supported treatment and call these ESTs. When we are talking about evidence-based practice, lets keep in mind that this is a process, not a listing of interventions.

There is no such thing as EVIDENCE-BASED PRACTICES It is mixing apples and oranges to refer to evidence- based practices, when we really mean research supported treatments! See Thyer & Pignotti (2011). Evidence-based practices do not exist. Clinical Social Work Journal, 38, 328-333.

In fact, nowhere in the Campbell or Cochrane Collaborations do you see lists of endorsed treatments. Such lists would actually be antithetical to EBP, since these ignore clinical variables, ethics, and clinical expertise, other elements valued equally with scientific support.

The EST program is less scientifically and professionally credible than EBP. When we talk about EBP in terms only of lists of approved therapies, we tar EBP with the deficiencies of the EST model, distorting EBP.

Some Problems with lists of ESTs “One legitimate criticism is that the EST list is based on an overly simple “all or none” model of effectiveness: A treatment is either empirically supported or it is not. Yet the true state of affairs is likely far more more complex” (ABCT website, on ESTs) Such lists of ESTs ignore ethical considerations, client preferences, resource consideration and the adequacy or clinical expertise. They also focus on positive studies and ignore negative outcome studies. (a treatment with two positive studies and 8 negative ones could be considered empirically supported!) They are based on p-values in determining effectiveness and ignore effect sizes of treatments.

Also, the EBP Process does NOT involve recourse to Practice Guidelines Also, the EBP Process does NOT involve recourse to Practice Guidelines. Some Problems with Practice Guidelines include They are usually created by members of one discipline, and fail to adequately take into account interdisciplinary literature. Disciplinary prejudices are rife (PGs prepared by psychiatrists tend to ignore effective psychosocial treatments) ‘Expert consensus’ sometimes overrules scientific considerations. They are usually not too comprehensive, and ignore the ‘gray’ literature. See criticisms of practice guidelines in Straus, S. E. et al. (2011). Evidence-based medicine: How to practice and teach it (pp. 128-129). New York: Churchill Livingston. or Thyer, B. A. (2003). Social work should help develop interdisciplinary evidence-based practice guidelines, not discipline-specific ones. In A. Rosen & E. K. Proctor (Eds.). Developing practice guidelines for social work interventions (pp. 128-139). New York; Columbia University Press.

See, for example, “As a distinctive approach to patient care, EBM involved two fundamental principles. First, evidence alone is never sufficient to make a clinical decision. Decision makers must always trade the benefits and risk, inconvenience and costs associated with alternative management strategies and in doing so consider the patient’s values.” (emphasis added) cited from Guyatt, G. & Rennie, D. (Eds.) (2002). Users’ guides to the medical literature: Essentials of evidence-based clinical practice (p. 8). Chicago, IL: American Medical Association.

See, for example, “ In addition to clinical expertise, the clinician requires compassion, sensitive listening skills, and broad perspectives from the humanities and social sciences. These attributes allow understanding of patient’s illnesses in the context of their experience, personalities and cultures…For some of the patients and problems, this discussion should involve the patient’s family.” cited from Guyatt, G. & Rennie, D. (Eds.) (2002). Users’ guides to the medical literature: Essentials of evidence-based clinical practice (p. 15). Chicago, IL: American Medical Association.

See, for example, “Understanding and implementing the sort of decision-making process patients desire and effectively communicating the information they need requires skills in understanding the patient’s narrative and the person behind that narrative.” cited from Guyatt, G. & Rennie, D. (Eds.) (2002). Users’ guides to the medical literature: Essentials of evidence-based clinical practice (p. 16). Chicago, IL: American Medical Association.

Summary It is possible that the EBP process model represents a significant positive step in the professional maturation of social work and in our ability to genuinely help clients, and to implement effective social policies and programs. It is also possible that it represents simply another conceptual fad which will enjoy a brief flurry of interest, and then fade from view. We have had many examples of this latter scenario. Time will tell.

Summary When the primary sources describing EBP are consulted, it is troubling to see the numerous misconceptions that are being promulgated about this potentially useful model. Social workers are urged to acquaint themselves with this approach, make their own informed decisions as to its usefulness, and take steps to adopt it, if moved to do so. EBP represents the most sophisticated model to date that has been developed to guide our practice and improve the services we provide.

I hope you have an improved understanding of the EBP process Questions and Discussion? Lets move on now to the topic of pseudoscientific therapies!