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Evidence-Based Assessment

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  1. Evidence-Based Assessment July 19, 2007

  2. Two Key “Special Issues” • Adults: Psychological Assessment, 2005, 17(3). (Hunsley & Mash) • Children: Journal of Clinical Child and Adolescent Psychology, 2005, 34(3). (Mash & Hunsley)

  3. Main Points • Need evidence-based assessment to support evidence-based practice in psychology • Importance of assessment-treatment dialectic • Assessment (identification of distinguishing features of cases, problems, and disorders) related to taxonomy (organization of cases, problems, and disorders according to their distinguishing features) • Purposes of assessment (nomothetic v. idiographic) • General purpose ‘off-the-shelf’ vs. theoretically driven assessment • “For whom”? and “for what purpose”? are key questions

  4. Theoretical Roots of Assessment • “Just as water cannot rise naturally above its source, and just as a measure’s reliability sets an upper limit on its potential validity, the utility of a psychological test or measure is limited by the theoretical and measurement models it serves.” (McFall, 2005) • “What have we learned from the (7) data analysis of the (6) summary statistics (5) generated by the measurement model (4) of the responses gathered by the instrumental methods (3) designed to sample the referents (2) for the formal theoretical constructs (1) supported by the basic assumptions?” (McFall, 2005)

  5. What is an EBA?(Hunsley & Mash, 2005) • Some use “EBA” to refer to a systematic review • Some use “EBA” to refer to the use of assessment instruments with known reliability and validity • Still others describe “EBA” in terms of clinical utility of assessment (e.g., to predict treatment outcome or suitability) • Additional factors • Cost-effectiveness • Increased precision (e.g., reduction in dx errors) • Reduced economic and psychological cost associated with errors

  6. Elements of EBA’s(Hunsley & Mash, 2005) • EBA’s are problem or disorder-specific • screening, diagnosis, prognosis, treatment planning, treatment monitoring, and treatment evaluation • Literature should elucidate main constructs relevant to a particular area • EBA’s should be sensitive to ethnic, gender, and cultural factors • Evidence for concurrent and discriminant validation • Evidence for utility and incremental validity is desirable • Empirical basis of clinician judgment needs to be independently validated (partly the goal of the “clinical expertise” lecture)

  7. Benefits of Assessment • Incremental validity in diagnosis • Assessment of treatment worthiness • Assessment of treatment response • Identifying “successful” therapists • Identifying need for further treatment • Increased patient satisfaction • Provide basis for decision for service delivery • Others?

  8. Issues in EBA’s • Gaps in psychometric information • Clinical utility • Training in EBA’s • Using EBA’s doesn’t insure evidence-based decision-making • Assessment process v. assessment methods

  9. EBA’s for Anxiety Disorders (Antony & Rowa, 2005)

  10. How EBA’s could be reviewed or established Mash & Hunsley (2005) 0=nonexistent, 1=limited, 2=adequate, 3=well-established

  11. Future Directions Achenbach, 2005

  12. Barriers to Dissemination(Antony & Rowa, 2005)

  13. Barriers (cont’d)

  14. Barriers (still more)