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What do we mean by “evidence-based practice?”. Evidence-Based Practice. Resource Materials for implementation at St. John’s Where do we go from here? . APA Policy Statement adopted August 2005.

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evidence based practice
Evidence-Based Practice
  • Resource Materials for implementation at St. John’s
  • Where do we go from here?
apa policy statement adopted august 2005
APA Policy Statement adopted August 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.”

-adapted from

IOM, 2001 & Sackett, 2000

Source: Bonnie Spring, CUDCP, 2007

the 5 step ebm model for evidence users consumers source spring 2007 cudcp
The 5 Step EBM Model for Evidence Users (Consumers) Source: Spring, 2007 CUDCP
  • Ask: formulate the question
  • Acquire: evidence - search for answers
  • Appraise: the evidence for quality and relevance
  • Apply the results
  • Assess the outcome
core beliefs of ebp chambless 2007 cudcp
Core Beliefs of EBP(Chambless, 2007 CUDCP)
  • Opinion based on clinical experience is an insufficient basis for practice.
  • Positive evidence trumps lack of evidence.
  • Graduate Students should learn to base treatment on the highest empirical ground possible.
  • Students should learn to routinely incorporate on-going assessment into practice.
the ebp model dilillo 2007 cudcp
The EBP Model(DiLillo, 2007 CUDCP)

Best available research evidence

EBP

Patient preferences and values

Clinical expertise

the ebp model
The EBP Model
  • Relevant Abilities:
  • Adopt a scientific view of clinical/counseling/school psychology
  • Knowledge of applied research design and methods
  • Strategies for accessing best available research
  • Ability to
  • evaluate relevant evidence

Best available research evidence

the ebp model8
The EBP Model
  • Relevant Abilities:
  • View Psychological interventions as a collaborative endeavor
  • Knowledge of specific culturally diverse groups
  • Ability to ascertain client/patient values and preferences
  • Respond effectively to client/
  • patient preferences and values

Patient preferences and values

the ebp model9
The EBP Model
  • Relevant Abilities:
  • Understand role and limits of clinical judgment
  • Skills in relationship building
  • Assessment and diagnostic skills
  • Skills to implement EST’s (e.g., specific therapeutic techniques)
  • Integration of EST with client characteristics

Clinical expertise

slide10

Evaluation

  • Clinical interview
  • Assessment tools
  • Observation

Source: Walker, CUDCP 2007

  • Case conceptualization
  • Diagnosis
  • Appropriate EST?
  • Impressions
  • Hypotheses
  • Clinical decision
secondary synthesized evidence aka evidence based capitulation
Secondary Synthesized Evidence(AKA “evidence-based capitulation”)
  • Research proliferates rapidly. Clinical performance demands increase. Practicing clinicians too busy to use all EBM steps will all patients.
  • Increased focus on pithy clinical practice guidelines, synopses, and structured abstracts
    • MD Consult
    • ACP Journal Club
    • Cochrane Database of Systematic Reviews
    • “Up-to-date”
    • InfoPOEMS (Patient Oriented Evidence that Matters)
slide12

Best available research evidence

Clinical Decision-Making

Patient’s values, characteristics, and circumstances

Clinical Expertise

slide13

Synthesizer

Locate &

Critically appraise

Meta-analysis

Consumer

Locate &

Appraise quality & relevance

Integrate

Researcher

Design

Conduct

Analysis

Reporting

Best available research evidence

Clinical Decision-Making

Patient’s values, characteristics, and circumstances

Clinical Expertise

Psychologist

Communicates

Assess client

Deliver EBP

Client/

Patient

Understanding

Preferences

Access

slide14

The Evidence Pyramid for

Treatment Effectiveness Questions

(Bonnie Spring, 2007)

***USE THE BEST EVIDENCE AVAILABLE***

clinical decision making
Clinical Decision-Making
  • Clinical epidemiology discipline
    • study of determinants and consequences of clinical decisions
    • apply EBP/5A’s/critical appraisal at clinical encounter to overcome automatic, unconscious decision-making biases (aka bad clinical intuition)
    • Source: Bonnie Spring, 2007
ests a component of ebp chambless cudcp 2007
ESTs: A Component of EBP(Chambless, CUDCP, 2007)
  • ESTs are not a substitute for training in building a relationship with the client.
  • EST evidence is not the sole sort of evidence important to practice (Their role is the controversial part).
    • Effectiveness research
    • Acceptability research
    • Alliance and other process research
psychology introduces ebp
Psychology introduces EBP

Best research available

Clinical Expertise

CD

Client/Patient characteristics, culture and preferences

The integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (became policy of the American Psychological Association in August, 2005)

continuum of evidence chambless 2007
Continuum of Evidence(Chambless, 2007)
  • Case studies with data
  • Quasi-experiments
  • Experiments (randomized clinical trials or single-case experiments)

_____________________________________

  • Uncontrolled effectiveness studies (e.g., benchmarked)
  • Quasi-experimental effectiveness studies
  • Randomized, controlled effectiveness studies
slide19

Evaluation

  • Clinical interview
  • Assessment tools
  • Observation
  • Evidence - Based Practice
  • 5 STEPS:
  • Formulate Questions
  • Find the evidence
  • Appraise the evidence
  • Integrate the evidence
  • Evaluate the outcome
  • Case conceptualization
  • Diagnosis
  • Appropriate EST?
  • Impressions
  • Hypotheses
  • Questions (ours and patients’)
  • Staying up to date; tools for lifelong learning
  • Offers tools for teaching
  • EBM- other health care professions
  • Clinical decision
slide20

Case Presentations = Clinical data + case conceptualization +… (Walker, 2007: Integrating Evidence-Based Practice into Graduate Practica)

  • What were your foreground and background questions?
  • What search strategies did you use to find relevant research & literature ;and what did you find?
  • What is your critical appraisal of the best evidence available?
  • How did you integrate this evidence with your particular patient and what we call “clinical expertise”?
  • What is your evidence - based treatment plan?
  • Did you create a CAT for this topic?
  • What research studies could be done that would improve your ability to care for clients/patients similar to this one?
the 5 step process
The 5-step process:
  • Convert information needs into a clear question.
  • Search for the best evidence in the literature.
  • Critically appraise the evidence.
  • Integrate with a patient’s needs, preferences, circumstances, and values.
  • Evaluate the outcome.
our challenge
Our Challenge
  • Integrating EBP across the curriculum.
  • Integrating EBP across professional practice: Assessment, consultation, interventions.
  • Ideas?