Evidence-Based, Empirically Supported, Best Practice

1. Evidence-Based, Empirically Supported, Best Practice Ronnie Detrich, Trina Spencer, Tim Slocum

2. Definition of Evidence-Based Practice • Evidence-Based Practice is a process of making decisions being informed by three sources of influence: • best available research evidence • professional judgment • client values • Cf. Clinical Psychology: APA Task Force (2006) • Cf. Medicine: Sackett et al (2000) • Cf. Education: Whitehurst (2002) • Cf. Communication Disorders: Schlosser & Sigafoos (2008)

3. Definition of Evidence-Based Practice • One tool that is useful in this process is a list of interventions that are well supported by research. • These interventions are often called ‘evidence-based practices’. • This usage invites confusion between: • the process of making decisions and • a list of some of the possible intervention choices • This confusion could trivialize a complex decision making process by treating it as a simple menu choice.

4. Definition of Evidence-Based Practice • Interventions that are well supported by research • Terms are not at all consistent. • Virtually all combinations have been used: • Do not use “evidence-based practice” to refer to an intervention • As a speaker and listener, remember: The verbal community is NOT consistent in usage. • We cannot assume anything from the term alone. We must attend to the procedures, not the label.

5. Definition of Evidence-based Practice • Primary question of the symposium: • How do we most effectively use the research base to guide professional practice? • Requires generalization • from a set of specific studies • to a range of practical situations • How broadly/narrowly shall we define • The intervention? • The client characteristics? • The outcomes? • The contexts of practice?

6. What is to be validated? • Interventions can be defined a various levels of specificity. specific less Research Specificity more general This issue also applies to outcomes, clients, and contexts.

7. Definition of Evidence-based Practice • The research base will never match our specific questions regarding practice; therefore, we must address the difficulties of generalizing beyond specific research studies. • By reviewers of research on a particular topic • Different styles of research reviews allow different ranges of generalization • By practitioners • This is part of ‘professional judgment’ that is included in the definition of evidence-based practice.

8. What is “Professional Judgment”? • Professional judgment • Fills the gap between an imperfect research base and the specifics of a clinical situation. • Includes rule-governed elements • Knowledge of the research base • Knowledge of broader principles of behavior • Includes contingency-shaped elements • Subtle discriminations of when and how to apply principles • Repertoire of shaped interactive behavior

9. Methods of Deriving Practice Recommendations • Empirically Supported Interventions (Slocum) • Using objective and operationalized procedures for identifying the level of research support for particular interventions. • Best Practices (Detrich) • Employing experts to review research and make critical judgments and reasonable generalizations as a basis for recommendations. • Research-Based Principles (Spencer) • Drawing from basic principles to construct or adapt interventions for individual settings or clients. • The nexus between ‘research base’ and ‘professional judgment’

10. Methods of Deriving Practice Recommendations • We will argue: • Each of these methods can be employed with a range of quality and rigor. • Each has distinct strengths and limitations. • The three methods can work together to inform practice.