Evidence-based practice in clinical Psych

Nota:

• it is a transdisciplinary, idiographic (focus on the individual) approach tat promotes life-long learning.

1. Idiographic approaches
   1. Individual clinical decision making

      Nota:

      •  - decisions based on treatment are tailored specifically to individual patients.  -
2. EBP

   Nota:

   • Evidence-Based practice  - Cannot be reduced to Empirically based Treatment  - The conscienscious, judicious and explicit use of the most current research to best treat patients.
3. EST

   Nota:

   • Emprically-supported Treatment
4. Nomothetic Approaches
   1. Guidlines

      Nota:

      •  - Designed by agencies to specify the best and proper treatment for specific disorders or illnesses.  - Contemporary Guidlines are based on systematic and quantitative research that has been peer reviewed.  - Alternative practises are not punished  - Guidlines for intervention/treatment are nomothetic which means they are broad and hetereogenous (one-treatment-fits-mostly-all).
   2. Empirically Supported Treatments

      Nota:

      •  - Presented similarily to a guideline but is presented based on interventions rather than clinical problems.
5. The Three Circles
   1. Best Research Evidence

      Nota:

      •  - For etiology or prognosis the best type of study is a longitudinal cohort study.  - For Efficacy of Treatment the best is randomized clinical trial.  - Systematic review uses many different trials to synthesize findings
   2. Clinical Expertise

      Nota:

      •  - Criticized for being ambiguous  - much variance in success of psychotherapy comes from variation in therapists abilities not from the type of therapy but from the qualities of the therapists (warmth, empathy).  - main approach is to specify, operationalize, and train skills needed to be a good therapist.
   3. Patient Peferences

      Nota:

      •  - least developed circle.  - shared-decision making is intended to engage and encourage patients to become more involved in their healing process.  - success hinges on abandoning paternalistic care, and to adopt a more culturally-aware model.
6. Three Histories of Evidence Based Practice
   1. United States: Flexner report and Practice Variation

      Nota:

      •  - EBP movement probably started in the States  - Greater control of quality was needed in medical schools which led to Flexner having over 70 schools being shutdown.
   2. UK: EPidemiology, RCT, Cochrane Collaberation

      Nota:

      •  - Chocrane used populations as a standardized sample to regulate treatments  - believed that by using RCTs treatments and methodology would become more reliable
   3. Canadian: epidemiology at McMaster

      Nota:

      •  - wanted to develop a method of evidence based practice in real time, during the time of the clinical encounter to counter unconsious, automatic decision making biases.  - 5 A's    - Ask    - Acquire    - Appraise    - Apply    - Assess  - developed health informatics discipline which assesses the technological systems infrastructure that support decision making (algoruthms, programs etc)
7. Why it matters
   1. Quality and Accountability

      Nota:

      •  - use health services effectively and only use treatments deemed effective for the cost.
   2. Policy

      Nota:

      •  - policies supporting clinical treatments are increasingly being supported by reviews of research evidence  - it is important for behavioural treatments to be validated in a similar form of review if they are to become standardized.  - incomplete reporting, inadequacies in research design and implementation lead to behavioural clinical trials to be excluded from research review. -> basically most therapies are seen as unsuppoerted because they were not done properly for review.
   3. Growth of Behavioural Science Evidence Base

      Nota:

      •  - gaps in research literature are great problems
   4. Transdisciplinary Opportunities

      Nota:

      •  - in order for disciplines to properly communicate they must all adopt similar language as to be inclusive and avoid confusion. Also allows for people to practice different disciplines.
   5. Useful infrastructure

      Nota:

      •  - secondary synthesized research literature
   6. LifeLong Learning

      Nota:

      •  - just because you graduated does not mean you get to stop learning - keep with the times.
8. What You Need to Know
   1. Informal Snapshot: Psych training in EBP