+ 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 K H325K080308

+ Evidence Based Practice in Psychology APA Presidential Task Force on Evidence-Based Practice

+ Evidence-Based Practice in Medicine Works towards improved patient outcomes by informing practicing clinicians of current research “The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients”

+ Evidence-Based Practice in Psychology 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.

+ Efficacy Efficacy refers to the evaluation of the strength of evidence in determining causal relationships between interventions and disorders under treatment.

+ 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. Clinical Utility

+ Evidence-Based Practice in Psychology At a state level, Medicad programs are encouraged or required to use a specific list of evidence-based practices At a federal level, NIMH works on promoting, implementing, and evaluating evidence-based practices being implemented at a state level.

+ Goals of Evidence-Based Practice in Psychology Improve quality of care Make care more cost-effective Enhance accountability

+ Definition of Evidence-Based Practice “The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” Promote effective psychological services and enhance public mental health

+ Difference between Evidence-Based Practice in Psychology (EBPP) and Empirically Supported Treatments (EST) EST starts with a treatment and aims to determine if the treatment works with a certain disorder EBPP centers on the patient and aims to determine what research evidence will be most useful in producing the best patient outcome. 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.

+ Main Components of Evidence- Based Practice Best available research Clinical expertise Patient characteristics

+ Best Available Research A large body of research suggests that a particular psychological practice is effective and safe. Recent research has demonstrated that psychological treatments are more enduring than alternative approaches, such as medications (Hollen, Stweart, & Strunk, 2006). Research has demonstrated that psychological treatments often pay for themselves in terms of medical costs, productivity, and life satisfaction.

+ Issues in Integrating of Research into Practice How to evaluate different research methods? How representative are samples? At what level should research guide practice? (i.e. principles, strategies, or specific protocols) How generalizable are research settings to practice settings? How are treatments to be evaluated when the number of treatments tested is limited? How do results generalize to minority populations? 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.

+ Research Designs that Contribute to Best Research Available 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

+ Future Directions of Research Compare psychological treatments to pharmacological treatments Demonstrate generalizability of interventions to non- controlled settings Examine patient-treatment interactions Evaluate the efficacy of interventions with underrepresented groups Evaluate the efficacy of interventions with children at different developmental levels Identify factors as mechanisms of change

+ Future Directions of Research Identify psychologist characteristics that contribute to positive outcomes Empirically evaluate treatments that have yet to be evaluated Develop criteria for discontinuing treatments Evaluate cost-effectiveness of psychotherapy Development of practice research networks Research on prevention of psychological disorders and risk behaviors

+ Clinical Expertise Essential for identifying and incorporating best research evidence into practice

+ Components of Clinical Expertise Assessment, diagnostic judgment, and treatment planning Decision making, treatment implementation, and progress monitoring Interpersonal expertise Continual self-reflection and improvement of skills Use of evidence-based practice Understanding of the influence of cultural and individual differences in treatment Seeking available resources as needed Having a cogent rationale for treatment strategies

+ Assessment, Diagnostic Judgment, and Treatment Planning Ability to formulate a clear and coherent case conceptualizations, assess patient psychopathology, and make accurate diagnostic judgment Revise conceptualization as treatment proceeds, seeking confirming and disconfirming evidence Setting goals of treatment while taking into account the individuality of patient Goals are made in conjunction with the patient

+ Clinical Decision Making, Treatment Implementation, and Progress Monitoring Entails skillful and flexible delivery of treatment Ability to adapt the treatment to the patient Flexibility is demonstrated in tact, framing, timing, and pacing Monitoring patient situation (such as employment, illness, etc.) that may require changes in treatment Modify treatment if patient is making insufficient progress

+ Interpersonal Expertise 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 Individual therapist effects accounts for 5-8% of treatment variance

+ Continual Self-Reflection and Improvement/Acquisition of Skills The ability to reflect on one’s one experiences that influence treatment though knowledge, emotions, thoughts, or behaviors Clinical expertise is improved and maintained through: Research and theory Systematic observation and hypothesis testing Self-reflection Monitoring patient outcomes Continuing education opportunities

+ Use of Evidence-Based Practice Scientific expertise in central to effective practice of psychology 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 Entails awareness of individual, social, and cultural context of the patient 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

+ Seeking Available Resources as Needed The psychologist may find it necessary to seek consultation or make a referral

+ Having a Cogent Rationale for Treatment Strategies Clinicians should rely on case formulations, recent research, and clinical experiences to design a treatment to produce the desired outcome 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.

+ Future Directions of Clinical Expertise Study practices of clinicians who obtain the best results Identify technical skills used by clinicians to produce desired outcomes Improve reliability, validity, and clinical utility of diagnoses Studying conditions that maximize clinical expertise Determining the extent to which errors studied in the literature are linked to decrements in treatment outcome

+ Future Directions of Clinical Expertise Develop well-normed measures that clinicians can use to quantify their judgments, measure progress, and assess the therapeutic process Distinguish expertise related to common factors shared across most therapies and expertise specific to particular treatments Provide clinicians with real-time feedback and clinical support tools

+ Patient Characteristics, Culture, and Preferences Evidence-based practice in psychology involves considering each patient’s individual characteristics with the psychologist’s training and understanding of the best available research It is important to consider: Variations in presenting problems Age, developmental status, developmental history, and family history Sociocultural and familial factors Current environmental context, stressors, and social factors Personal preferences and vaules

+ Individual Differences It is important to know the person who has the disorder in addition to knowing the disorder the person has

+ Future Directions of Individual Differences Understand patient characteristics as moderators of treatment response Evaluate interventions widely studied in the majority population with other populations Evaluate the impact of stereotypes held by psychologists and interventions for reducing their impact Examine was to make information regarding culture more available to psychologists Maximize psychologist competence with diverse patients Identify effective treatment decision models with regard to patient preference

+ Conclusion 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)