Introduction Outcome-Informed Evidence-Based Practice (EBP)

Contemporary Conceptual Definition of EBP “…a process for making practice decisions in which practitioners integrate the best research evidence available with their practice expertise and with client attributes, values, preferences, and circumstances” Rubin, 2008, p. 7

EBP Decision-Making Oliver et al. (

EBP Philosophy of practice Ethical principle that clients deserve most effective interventions possible Process Process by which we find and implement the best empirically supported interventions (ESI) Practices Interventions and other practices with empirical evidence of their effectiveness in practice for specific problems

Not Only Clinical Interventions Assessment Risk/Prognostic indicators Prevention Community and organizational level programs Policy

From Authority to Evidence Rejection of… Authority, intuition, rules of thumb, tradition, and anecdote as the basis for selecting interventions Acceptance of… Rational, transparent, systematic process based on evidence from scientific research as the basis for selecting interventions

Scary Thought about Authority… “Half of what we have taught you is wrong. Unfortunately, we don’t know which half.” Dr. C. Sidney Burwell, Dean Harvard Medical School Commencement Address

EBP Starts with the Client Asks what research evidence will assist in achieving the best outcomes for this particular client

EBP Involves Lifelong Learning “Placing the client’s benefits first, evidence- based practitioners adopt a process of lifelong learning that involves continually posing specific questions of direct practical importance to clients, searching objectively and efficiently for the current best evidence relative to each question, and taking appropriate action guided by evidence.” Gibbs, 2003, p. 6

Mark Twain on Lifelong Learning “I have never let my schooling interfere with my education.”

Spirit of EBP Search for disconfirming evidence with the same determination as for confirming evidence

Critical Thinking Application of logical principles, rigorous standards of evidence, and careful reasoning to the analysis and discussion of data, claims, beliefs, or issues

Bias Tendency to see and interpret information consistently with an emotional preference or preconceived expectation

Falsification Deliberate process of seeking information to discount or disprove a hypothesis or theory

Confirmation Bias Tendency to gather evidence that confirms one’s preconceptions by emphasizing or pursuing supporting evidence while dismissing or failing to seek contradictory evidence

Mark Twain on Confirmation Bias “It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so.”

Seemed like a good idea… Examples of potentially harmful interventions Critical incident stress debriefing “Scared Straight” interventions Attachment therapies (e.g., rebirthing) Recovered-memory techniques Grief counseling for individuals with normal bereavement reactions Boot-camp interventions for conduct disorder DARE programs Lilienfeld (2007)

Steps in the EBP Process Develop an answerable question Locate relevant evidence Critically analyze the evidence Combine evidence with client attributes, values, preferences, and circumstances and with your practice expertise Apply to practice Measure and monitor client outcomes, and adjust intervention as needed

Steps in the EBP Process (cont’d) Alternative (slightly) characterization of EBP steps: Ask Acquire Appraise Apply Analyze and Adjust

EBP Iterative Process Oliver et al. (

Moving from Research to Practice What you might know… How does the intervention work when implemented under ideal conditions (i.e., efficacy)? How does the intervention work when implemented under routine practice conditions (i.e., effectiveness)?

Moving from Research to Practice (cont’d) What you need to know… How does the intervention work when you implement it with your particular client in your practice setting? No guarantee that ESI will be effective with your client, in your practice setting, when you implement it

Measuring and Monitoring Client Progress “However beautiful the strategy, you should occasionally look at the results.” Sir Winston Churchill

Outcome-Informed Practice (OIP) Practice in which you: Measure your client’s outcomes at regular, frequent, pre-designated intervals, in a way that is sensitive to and respectful of the client Monitor these outcomes at regular, frequent, pre-designated intervals to determine if your client is making satisfactory progress Modify your intervention plan as needed along the way by using this practice-based evidence, in concert with evidence-based practice, to improve your client’s outcomes

Benefits of OIP Improve client outcomes through more informed decision making May be especially pronounced for clients who are not doing well Conduct practice as a problem solving experiment in which little is assumed Especially important when no ESIs available Learn from experience Practitioners tend to overestimate improvement and underestimate deterioration

Can I practice without measuring and monitoring client outcomes? No Measuring and monitoring client outcomes is an inherent part of practice All practitioners measure and monitor client outcomes—the question is how best to do it

What will I be able to do at the end of this course? Provide more effective and humane practice by learning how to measure and monitor client outcomes and using this information to modify your interventions as needed