Evidence-Based Mental Health Practice: Moving Forward With the Help of Our Friends Thomas R. Kratochwill, PhD Psychologist and Professor University of Wisconsin-Madison
Whom Are Our Friends In This Context? • Our Professional Colleagues • Contributors to Psychological and Educational Knowledge on Evidence-Base Practices
Goals of the Presentation • Review history and purpose of EBTs/EBPs in mental health with emphasis on applications in child/adolescent school-based practice; • Review EBT identification and selection strategies; • Provide examples of child/adolescent EBTs;
Goals (Cont.) • Provide an overview of a protocol for planning, monitoring, and evaluating EBTs; • Present considerations related to adoption of EBIs/EBPs; • Present some considerations for the use of Problem Solving Teams to implement EBTs; • Serve as an ongoing resource related to EBPs.
CAVEATOn Such a Full Sea THE PRESENTATION IS NOT DESIGNED TO PROVIDE SPECIFIC SKILLS IN IMPLEMENTATION OF EBTs. IT IS DESIGNED TO PROVIDE AN OVERVIEW OF, STRATEGIES TO ACCESS EBTs, ILLUSTRATIONS OF EBTs/EBPs, AND VARIABLES TO CONSIDER WHEN ADOPTING EBTs IN PRACTICE SETTINGS.
The Current Landscape of Evidence-Based Practice • Definitions • Origins and Historical Perspectives • Contemporary Perspectives
Definitions of Terms • Evidence-Based Treatments: Treatments that have been documented to be effective in research trials and that meet the criteria of one of more professional groups or organizations that provide formal designation. The evidence base is typically on a continuum varying on dimensions of type of methodology (e.g., randomized trials, single-case designs) and type of study (e.g., effectiveness, efficacy), among other characteristics.
Definitions of Terms • Evidence-Based Assessment: Use of measures in classification, screening, treatment planning and selection, progress monitoring, and treatment outcome assessment with high quality psychometric features (e.g., reliability, validity) as established in research.
Definitions of Terms • Outcome Assessment: A practice that is used to assess social/emotional behavior and evaluate the effectiveness of a treatment and often referred to as Progress Monitoring. Progress monitoring can be implemented with individual clients, groups, or systems.
Treatment Outcome Assessment (cont.) • An assessment process used to measure improvement in relation to benchmarks that provides frequent comparison of current to desired performance over a specified period of time; • Should be sensitive to small changes in client performance; • Should be relatively quick and simple to implement; • Can be used to analyze a client response to a particular treatment in an ongoing manner.
Definition of Terms • Evidence-Based Practice: Refers to a body of scientific knowledge defined with reference to research methods and designs about a range of service practices (e.g., screening, assessment, treatment). The practice is referenced to the research quality and validity brought to bear on these issues (Hoagwood & Johnston, 2003).
Evidence-Based Practice Professional judgments and practices are guided by two principles: • Practice is guided by prior empirical knowledge that certain actions performed will generate effective outcomes; • Client/student is evaluated to determine the extent to which the predicted results occur as a result of the practitioner’s actions (Cournoyer & Powers, 2003).
Historical Perspectives: The Rise in Popularity of the term “Evidence-Based” (from Medline) EBT EBP EBM 1900-1990 0 0 0 1990-1995 3 7 76 1995-2002 63 459 5,425
Number of Articles Retrieved Using "Evidence-Based" as a Keyword(Norcross, Hogan & Koocher, 2008) 5000 4000 Medline Cinahl 3000 Articles Retrieved PsycINFO 2000 1000 0 Year 1992 1994 1996 1998 2000 2002 2004 2006
Contemporary Perspectives on Evidence-Based Practice Evidence-Based Practice (EBP) is a Broad Term and Includes: • Evidence-Based Assessment • Evidence-Based Interventions • Evidence-Based Relationship Issues Surrounding Assessment and Intervention • Practices Characterized by Use of Scientific Knowledge Base in Diagnosis, Assessment, Intervention, and Evaluation of Services
Initiatives by APA, APA Divisions, and Other Professional Groups: • American Psychological Association Task Forces Promote EBPs: -Presidential Task Force on Evidence-Based Practice (2005) -Task Force on Evidence–Based Practice for Children and Adolescents (2006-2008) -Task Force on Translating Psychological Science into Classroom Practice (2006-2010) • Division Initiatives
For Example: APA BEA Task Force on Translating Psychological Science into Classroom Practice • Development of Web-Based Resources for School Professionals • Examples: -Classroom Management -Bullying in School -Promoting Student Cognitive Skills
Evidence-Based Practice Competencies Competencies needed for evidence-based practice: • Formulate an answerable question(s); • Search & find information using bibliographic databases; • Critically appraise research findings; • Interpret and apply results to practice situation; • Evaluate one’s own practice.
The Process Components of Evidence-Based Practice Begins with a framework for searching for information: • Background Questions • Foreground Questions • The SICOT Format • Locating the Best Available Research
Background Issues/Questions • Refers to the general situation or setting; • Generally refers to acquiring knowledge about the client’s/student’s problem; assessments/tests for diagnosis, etc.; • Referenced by “who, what, where, how, why,” and is followed by a particular condition or situation.
Foreground Questions • These questions have greater specificity and should be developed in searchable terms. • Should possess the following components: • Student, population, or problem of interest; • The intervention (includes assessment and treatment); • The comparison intervention; • Outcomes of interest; • The type of question being asked.
Foreground: SICOT • The SICO refers to: • Student (or Client) • Intervention • Comparison • Outcome 5.By adding the Type of question the format becomes SICOT
Example SICOT Questions: Student: Ask yourself: Who is your student? What is the student's population of interest? Also include: Your student’s primary complaint, gender, age, race, history (other factors that affect the search).
Example SICOT Questions Intervention: What are you planning to do for your student? Also include: Specifics of your planned assessment and/or treatment that you are considering.
Example SICOT Questions Comparison: Is there an alternative to the treatment? Also include: The alternatives (if they exist).
Example SICOT Questions Outcome: What do you think will occur after applying the treatment? Also include: Your desired outcomes.
Example SICOT Questions The Optional T in SICOT refers to the type of question and could include such areas as: • Etiology • Prevalence • Comorbidity • Prevention • Relationship issues
Activities You Can Do In Your School • See Appendix A
The Search Process and Information Resources • Textbooks • Physicians’ Information and Education Resource • eMedicine Clinical Knowledge Database • Web Sites (many are available) • Practice Guidelines • Filtered Information Resources
Example Filtered Information Resources • Cochrane Database of Systematic Reviews • Campbell Collaboration Reviews • Database of Abstracts of Review of Effects • BMJ Clinical Evidence • What Works Clearinghouse • Evidence-Based Journals
Unfiltered Information (raw data) • MEDLINE • PubMed Clinical Queries • Cumulative Index to Nursing and Allied Health Literature • Social Services Abstracts • PsychINFO • LexisNexis
Unfiltered Information (Cont.) • Cork Database • Campbell Social, Psychological, Education, and Criminological Trials Registry • Google Scholar • Cochrane Central Register of Controlled Trials (CENTRAL)
Assessments, Tests, and Measures -Test Information Databases The Educational Testing Service (ETS) Test Collection -Test Reviews Mental Measurements Yearbook -Test Publishers (some provide good information)
Examples of Web-Based Information • Examples from clinical adult psychology • Examples from clinical child/school • Examples from education
Society of Clinical PsychologyAmerican Psychological Association, Division 12 http://www.div12.org/PsychologicalTreatments/
APA Division 53 (Clinical Child) https://www.clinicalchildpsychology.org/ And available on the web site: http://effectivechildtherapy.fiu.edu/
What Works Clearinghouse http://ies.ed.gov/ncee/wwc/
Links for Finding Evidence-Based Treatments https://www-ucoll.fdu.edu/apa/lnksinter.html
Research and the Practicing Clinician: A Perspective • Research alone will never suffice to make clinical decisions; • Client preferences and characteristics must be considered; • Relationship issues must be considered; • Contextual factors must be considered; • Cultural diversity factors must be considered.
The Importance of Treatment Outcome Monitoring • An important component of EBP is the evaluation of treatment and treatment outcomes; • In a survey reported by Hatfield and Ogles (2004) only about 37% of respondents noted that they used some form of outcome assessment in practice; • Goodman, McKay, and DePhilippis (2013) review progress monitoring in mental health and addiction treatment.