1. Evidence-based Practice in Psychology (EBPP)
Lindsey Cohen

2. Evidence-based Practice in Psychology
EBP in Medical Fields
EST vs. Clinical Expertise
Public Policy/ Reimbursement
Quality and Accountability

3. APA Policy Statement on Evidence-Based Practice in Psychology (2005)
“Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”

4. APA Policy Statement on Evidence-Based Practice in Psychology (2005)
“Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”

5. The EBP Model- The 3-Legged Stool
Best available research evidence
EBP
Patient preferences and values
Clinical expertise
In integrating EBP into our training, we rely on Sackett et al (2000) tripartite model:
Best available research evidence – clinicians must avail themselves of the best available research evidence when making treatment decisions. RCT is still the gold standard but other evidence may be considered as well, for example effectiveness data.
Patient preference and values – considering role of patients’ individual characteristics in treatment; includes a consideration of diversity issues as well as the need to involve the patient fully in treatment planning including analysis of the chances they will benefit or not from the evidence-based approach (using quantitative presentations when possible).
Clinical expertise - Advanced clinical skills to diagnose, assess, and treat clients. How does one translate the best available research evidence, which may have been developed for the average or a prototypical client, for use with a particular patient?

6. Continuum of care
Nomothetic (decisions based on disorders, guidelines, treatment manuals, ESTs)
Evidence-based practice
Idiographic (decisions based on individual patients and circumstances)

7. The EBP Model – Best Available Research Evidence
Adopt a scientific view of clinical psychology
Knowledge of clinical research design and methods
Strategies for accessing best available research
Ability to evaluate relevant evidence

8. Best Available Research Evidence
Creator
Best available research evidence
Synthesizer C o n s u m e r

9. Research – Evidence Creator
Design, conduct, and report research
The 12 International Committee of Medical Journal Editors journals (e.g., JAMA, The Lancet) agreed to only accept RCTs if they registered in the public registry prior to recruitment (e.g., Why?
Randomized Controlled Trials (RCTs) and CONSORT . Why?

10. Example CONSORT Flow Chart

11. Example CONSORT Checklist

12. Research – Synthesizer
Locate, appraise, and synthesize research
Systematic reviews – standardized criteria
Meta-analyses
P.I.C.O.
Population, Intervention, Comparison, Outcome
Inclusion, exclusion, databases searched (e.g., psycINFO, MEDLINE, EMBASE), dates of search, search terms, etc.

13. Research – Consumer Access, appraise, and integrate into practice
Performing the 5 A’s (Strauss et al., 2005)
Ask the question (e.g., PICO)
Acquire the evidence
Appraise the evidence
Apply the results
Assess the outcome

14. Medical/Health Database – Acquiring the evidence
Research Literature
PSYCINFO
EMBASE
Cochrane / others*
MEDLINE
*Note that Cochrane and some other databases are not linked to PsycINFO .

15. Acquiring the evidence – Smart searches
A variety of search engines and databases are available or are being created to facilitate EBP, especially in medicine

16. Appraising the Evidence

17. The EBP Model – Patient Preferences and Values
Therapy is a collaborative endeavor, shared-decision making
Knowledge of specific diverse groups
Ability to ascertain patient values and preferences
Respond effectively to patient preferences and values
Patient preferences and values
In integrating EBP into our training, we rely on Sackett et al (2000) tripartite model:
Best available research evidence – clinicians must avail themselves of the best available research evidence when making treatment decisions. RCT is still the gold standard but other evidence may be considered as well, for example effectiveness data.
Patient preference and values – considering role of patients’ individual characteristics in treatment; includes a consideration of diversity issues as well as the need to involve the patient fully in treatment planning including analysis of the chances they will benefit or not from the evidence-based approach (using quantitative presentations when possible).
Clinical expertise - Advanced clinical skills to diagnose, assess, and treat clients. How does one translate the best available research evidence, which may have been developed for the average or a prototypical client, for use with a particular patient?

18. The EBP Model – Clinical Expertise
Common factors/non-specific skills
Awareness of limits of clinical judgment
Relationship building
Assessment and diagnostic skills
Ability to implement treatments
Integration of EST with client characteristics
Clinical expertise
In integrating EBP into our training, we rely on Sackett et al (2000) tripartite model:
Best available research evidence – clinicians must avail themselves of the best available research evidence when making treatment decisions. RCT is still the gold standard but other evidence may be considered as well, for example effectiveness data.
Patient preference and values – considering role of patients’ individual characteristics in treatment; includes a consideration of diversity issues as well as the need to involve the patient fully in treatment planning including analysis of the chances they will benefit or not from the evidence-based approach (using quantitative presentations when possible).
Clinical expertise - Advanced clinical skills to diagnose, assess, and treat clients. How does one translate the best available research evidence, which may have been developed for the average or a prototypical client, for use with a particular patient?

19. The EBP Model
Evidence-based practice is the successful integrations of these three competencies
EBP
In integrating EBP into our training, we rely on Sackett et al (2000) tripartite model:
Best available research evidence – clinicians must avail themselves of the best available research evidence when making treatment decisions. RCT is still the gold standard but other evidence may be considered as well, for example effectiveness data.
Patient preference and values – considering role of patients’ individual characteristics in treatment; includes a consideration of diversity issues as well as the need to involve the patient fully in treatment planning including analysis of the chances they will benefit or not from the evidence-based approach (using quantitative presentations when possible).
Clinical expertise - Advanced clinical skills to diagnose, assess, and treat clients. How does one translate the best available research evidence, which may have been developed for the average or a prototypical client, for use with a particular patient?

20. The EBP Model
Evidence-based practice is the successful integrations of these three competencies
Clinical decisions should be guided by all three areas CD
In integrating EBP into our training, we rely on Sackett et al (2000) tripartite model:
Best available research evidence – clinicians must avail themselves of the best available research evidence when making treatment decisions. RCT is still the gold standard but other evidence may be considered as well, for example effectiveness data.
Patient preference and values – considering role of patients’ individual characteristics in treatment; includes a consideration of diversity issues as well as the need to involve the patient fully in treatment planning including analysis of the chances they will benefit or not from the evidence-based approach (using quantitative presentations when possible).
Clinical expertise - Advanced clinical skills to diagnose, assess, and treat clients. How does one translate the best available research evidence, which may have been developed for the average or a prototypical client, for use with a particular patient?

21. Putting EBP into Practice
Imagine you are a busy clinical student conducting therapy in the clinic. You are working with a mom who was previously but not currently depressed.
She states she is pregnant with number two and is worried about postpartum depression. She wants help to prevent it.
You let her know that you will provide additional information next session.

22. What do you do?
Ask your advisor, consult with others, and base your response on your clinical experience?
Not likely to reflect current scientific evidence
Google search
Many websites, but the information might be inaccurate and outdated
PsycINFO and Medline
Overwhelming and conflicting information

23. The EBP Answer
Use the 5 A’s

24. Ask Clinically-Relevant Questions
Pose background and foreground questions
Background questions
Knowledge base – Who, what, where, or how followed by a condition or situation
How does postpartum depression differ from other depression?
What are the risk factors for postpartum depression?

25. Clinically-Relevant Questions (cont.)
Foreground questions – PICO format
P (Patient group)
I (Intervention)
C (Comparison Group)
O (Outcome measures)
In a woman with a history of depression (P), is there evidence that CBT, delivered while pregnant (I), will be more effective than no prenatal treatment (C) in reducing postpartum depression (O)?

26. Search for the Best Research Evidence
Focus on the top of the pyramid – systematic reviews if available
A TRIP ( search using “postpartum depression” revealed 334 records that can be sorted by type of article, question, or specialty. Second systematic review, a cochrane review, concludes that there is no evidence that psyc interventions prevent postnatal depression, but support for at-risk mothers might be helpful

27. How does this fit with our client?
Sort TRIP search by etiology, risks factors based on 2 meta-analyses and studies with 10,000 other women:
Depression and anxiety during pregnancy, low social support, prior psychopathology, poor marital relationship
A TRIP search on antidepressants leads to a Cochrane review, which concludes that evidence is weak for meds to prevent later postpartum depression

28. Integrating research with client
Given she has only 1 risk factor, there is limited evidence that psychological or pharmacological interventions would prevent postpartum depression. However, she should watch for depression after birth and CBT or interpersonal treatment should be helpful. Effectiveness of group CBT, light therapy, and psychoeducation for postpartum depression are unknown

29. Best available research evidence Patient preferences and values
The EBP Model
Opposed to meds; prefers interpersonal therapy; insurance pays for 10 sessions; previously depressed
Limited evidence for preventative interventions; risk factors; monitor after birth; CBT or interpersonal for postpartum depression
Best available research evidence
EBP
Patient preferences and values
Clinical expertise
Appropriate assessment; ability to perform treatment; integrate research and clinical evidence