1. What Really Works (and What Doesn’t) for Challenging Kids
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.

2. Welcome!
A little bit about your speaker
A little bit about you

3. Agenda (open to modifications)
What is Evidence-based Practice? And what it is not.
Clinical Assessment
Treating Children and Adolescents
Treating those who have experienced trauma
Addressing the unique needs of persons with developmental disabilities
Evaluating and selecting sound practices and discouraging pseudoscience

4. So
What do YOU think of when you hear the term “evidence-based practice” (EBP)?

5. Why the buzz about EBP?
“Social workers should base practice on recognized knowledge, including empirically based knowledge, relevant to social work and social work ethics” (NASW Code of Ethics, 401(c) “Psychologists’ work is based upon established scientific and professional knowledge of the discipline” (APA Code of Ethics, 2.04)

6. Why the buzz about EBP?
“Clients have a right to effective treatment (i.e., based on the research literature and adapted to the individual client. Behavior analysts always have the obligation to advocate for and educate the client about scientifically supported, most effective treatment procedures” (Behavior Analysts Certification Board, 2016, p. 8)

7. Why the buzz about EBP?
Certainly EBP is consistent with these ethical standards.
It could even be plausibly contended that to NOT practice EBP is a violation of our Code of Ethics.
See
Myers, L. L. & Thyer, B. A. (1997). Should social work clients have the right to effective treatment? Social Work, 42,

9. Note the equivalent importance of ALL these factors in the EBP process

10. What is ‘Best Research Evidence’?
Clinically relevant research from basic and applied scientific investigations, especially drawing from intervention research evaluating the outcomes of social work services, and from studies on the reliability and validity of assessment measures.

11. How is Evidence Valued in EBP?
Higher End of Internal Validity (in terms of causal inference)
Systematic Reviews (highest form of evidence)
Meta-analyses
Multi-site Randomized Clinical Trials
Individual RCTs
Quasi-experiments
Pre-experiments
Single Subject Studies
Correlational Studies/Epidemiological Studies
Qualitative Research
Narrative Case Studies
Basic Science Studies
Expert or consensus opinion, Theory
(lowest form of evidence, but potentially valuable)
Lower End of Internal Validity

12. ‘Best Evidence’ Means Best Available
Look for relevant systematic reviews, then meta-analyses, then RCTs, then quasi-experiments, etc. Integrate this best available evidence into your decision-making practice. EBP does NOT depend on having a large body of RCT’s available to consult. It does depend on one examining the best available evidence.
There is ALWAYS evidence, even if it is of low quality.

13. What are Client Values?
The unique preferences, concerns and expectations each client brings to a clinical encounter with a social worker, and which must be integrated into practice decisions if they are to serve the client.
A thorough consideration of ethical considerations and client considerations is integral to the EBP model.

14. What is Clinical Expertise?
Our ability to use our education, interpersonal skills and past experience to assess client functioning, diagnose mental disorders and/or other relevant conditions, including environmental factors, and to understand client values and preferences.
Clinical expertise factors, costs, available resources, etc. are integral to the EBP model.
Research findings are NOT accorded greater weight. All are compellingly important.

15. Many Interventions Might Have Strong Research Support but Not be Acceptable
Client may not wish it
May be religiously objectionable
(e.g., Jehovahs’ Witnesses may decline blood,
or a Muslim may decline a pig valve implant)
May be illegal or unethical
Costs too much
So a lesser research-supported intervention may
be provided, and still be consistent with EBP!

16. My client with OCD did not want behavior therapy because she believed her obsessions were caused by demons. So I arranged a meeting with a Priest who took over the case. This is COMPLETELY consistent with EBP.

17. What are the Major Steps of Evidence-based Practice?
Convert the need for information into an answerable questions(s).
2. Track down the best available evidence to answer each question.
Critically evaluate this evidence in terms of its validity, impact, and potential relevance to our client.
4. Integrate relevant evidence with our own clinical expertise and client values and circumstances.
5. Evaluate our expertise in conducting Steps 1-4 above, and evaluate the outcomes of our services to the client, especially focusing on an assessment of enhanced client functioning and/or problem resolution.

18. What are the Major Steps of Evidence-based Practice?
IMPORTANT! Note that EBP is a five step process of clinical decision-making, occurring between a practitioner and a client!
No one tells you what to do, in the EBP model. You and the client make that choice.
Having higher-ups decide what services
practitioners must provide is the antithesis
of real EBP. EBP is NOT top-down decision-
making. It is bottom-up.

19. Where is the ‘Boss’ in Evidence-based Practice?

20. Step 1 -What are ‘Answerable Questions’?
1. A question with a verb, as in
What has been shown to help….? Or
What psychosocial treatments work….?
What community-based interventions reduce….?
What group therapies improve….?
2. A question including some aspect of the client’s life or condition. As in
What psychosocial interventions reduce the risk of teenage pregnancy?
What individual therapies are the most successful in getting clients to stop abusing crack cocaine?
How can schools reduce student absenteeism?
What treatments are effective in improving prenatal care adherence?
To complete the Dale Carnegie Training® Evidence – Action – Benefit formula, follow the action step with the benefits to the audience. Consider their interests, needs, and preferences. Support the benefits with evidence; i.e., statistics, demonstrations, testimonials, incidents, analogies, and exhibits and you will build credibility.

21. Step 2 - How Can You Track Down the Best Available Evidence?
There are LOTS of resources!
Practice-research journals, as in
Research on Social Work Practice
Journal of Consulting and Clinical Psychology
Evidence-based Mental Health
(look for outcome studies!)
To close, restate the action step followed by the benefits. Speak with conviction and confidence, and you will sell your ideas.

22. Evidence-based Textbooks, as in
Social Work in Mental Health: An Evidence-based Approach
Effective Interventions for Child Abuse and Neglect: An Evidence-based Approach to Planning and Evaluating Interventions
Evidence-based Social Work Practice with Families
Clinical Applications of Evidence-based Family Interventions
Substance Abuse Treatment for Criminal Offenders: An Evidence-based Guide for Professionals
A Guide to Treatments that Work,

23. Step 2 –Tracking down the best available evidence
“Social work education must including searching the literature for research-supported treatments” (Myers & Wodarski, 2014, p.707)
“…the success of engaging in the EBP process hinges largely on the ability of practitioners to locate the best available evidence both easily and quickly…practitioners must learn about existing high quality web-based resources…Without this information, and these skills, the search for evidence will be fruitless, time-consuming, and frustrating.” (Rubin & Parrish, 2015, p. 1205)
To complete the Dale Carnegie Training® Evidence – Action – Benefit formula, follow the action step with the benefits to the audience. Consider their interests, needs, and preferences. Support the benefits with evidence; i.e., statistics, demonstrations, testimonials, incidents, analogies, and exhibits and you will build credibility.

24. But the BEST source And the worst) is the INTERNET!
Specifically, non-proprietary organizations which summarize available evidence pertaining to selected interventions, psychosocial and biological.
We will review a number of the more credible internet resources which can be useful in this regard. Many of these are summarized in my recent paper:
Thyer, B. A. et al. (2017). Locating research-supported interventions for child welfare practice. Child and Adolescent Social Work Journal, 34,
Available in your handouts.

25. 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)
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.