By William ODonohue amp Kyle E Ferguson University of Neveda Reno Summarized by Chloe Ruebeck High Incidence Grant University of Utah History EBP Movement Clinical practice guidelines CPG were created 20 years ago to help standardize the decisionmaking process for treatment ID: 272755
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Evidence-Based Practice in Psychology and Behavior Analysis
By William
O’Donohue
& Kyle E. Ferguson
University of
Neveda
, Reno
Summarized by Chloe Ruebeck
High Incidence Grant University of UtahSlide2
History- EBP Movement
Clinical practice guidelines (CPG) were created 20 years ago to help standardize the decision-making process for treatment planning by using valid and empirical treatments
APA began developing CPGs, in 1991, to assist in the decision making processes in the psychiatric field
Psychiatrists created a pharmacological bias, even though neither medication or alternative treatments were shown to be superior
Slide3
History Cont.
APA
addressed concerns about bias
with the Division 12 Task Force on Promotion and Dissemination of Psychological Procedures (
Chambless
et al.,1996)
This task force came up with criteria for efficacious treatments
Therapies can fall into two groups, well-established treatments or probably efficacious treatmentsSlide4
Criteria for EBP
Well-Established Treatments
I. At least two good between group design experiments demonstrating efficacy in one of two ways:
A. The treatment is statistically significant to the placebo
B. The treatment is = to already established treatment with a sufficent sample size
ORSlide5
Criteria for EBP Cont.
II. More than a series of 9 single subject experiments demonstrating efficacy.
III. Experiments must have treatment manuals.
IV. Participant criteria must be stated.
V. Results must be replicated by at least two different research projects. Slide6
Criteria for EBP Cont.
Probably Efficacious Treatments
I. Two experiments that show the treatment is statistically significant to a waiting-list control.
OR
II. One or more experiments meeting all the criteria except criterion V.
III. Three or fewer single subject designs otherwise meeting all previous requirements for well-established treatments.
Slide7
Weaknesses of EBP
The studies on the list were chosen because of statistical significance and not clinical significance.
They were selected based on efficacy not effectiveness.
Many heterogeneous patient populations clinicians work with from day-to-day were excluded.
Bias for group design over signal subject and analytical methods. Slide8
Statistical significance vs. clinical significance
Statistical significance
merely means that the observed difference between means was not due to chance.
Clinical significance
refers to the extent to which the treatment is meaningful. If a treatment is clinically significant an individual can move from an undesirable category to a more desirable category.
Chambless et al. did not take clinical significance into consideration.Slide9
Efficacy vs. Effectiveness
EBP pertains to efficacy
NOT
effectiveness.
Effectiveness refers to the extent to which the treatment can generalize to other settings. Slide10
Participant characteristics: Heterogeneity vs. homogeneity
In many instances, co-morbid patients are excluded from research.
This is a major problem because co-morbid patients are more the rule than the exception.
It is very important to find treatments that serve co-morbid populations. Slide11
Group design and inferential statistcal bias.
It only takes two between group designs experiments to be considered well-established, whereas it takes 9 or more single subject experiments.
Signal subject rarely use inferential statistics and they usually compare treatment to baseline conditions and not a placebo. These factors exclude them from established treatment consideration. Slide12
Well-established and probably efficacious treatments with a behavior analytic focus
See Article for full list.
ee article for full listSlide13
Causes for Concern
Old
School vs. New School Behavior Analysis
Certainly The Law of Effect Does Work
Developmental Disabilities are Conquered, What about all the other problems?
Leaving Quality Improvement behind
Beating the competitionSlide14
Old School vs. New School
Most of the contributions to this field were made by first generation behavioral analysis. There have been fewer recent contributions.
What is the rate of discovery of new behavioral principles?
What is the rate of using these new applications successfully in new ESTs?Slide15
The Law of Effect
There is a constant repetition of studies in the Journal of Applied Behavioral Analysis.
There needs to be new studies done on new behavioral analysis techniques.Slide16
What About Other Problems?
JABA has an overwhelming focus on developmental disabilities.
It is thought that behavior analysis could greatly benefit the healthcare sector by helping to manage the aging population and chronic disease.Slide17
Leaving Quality Improvement Behind
The healthcare field is too stuck on the role of science.
More focus needs to be put on implementing sound quality improvement systems.
The “Theory of Bad Apples” is used in the healthcare world, but the “Theory of Continuous Improvement” would be more efficient. Slide18
Suggestions to Improve EBP
Basic education in quality improvement
Technologies to further understand consumer needs
Understanding service delivery and how it affects outcomes
Consistent use of quality indicators
Reliable, affordable, information systems that capture quality indicators.Slide19
Suggestions Cont.
6. Learning trials and EPB that is continually improved
7. Incentive systems for meeting or exceeding quality goals and making new suggestions that work
8. Benchmarking
9. Report cards so the purchasers can be educated on the service providedSlide20
Beating the Competition
What should be done about the practice that is not evidence based?
What is deemed bad behavioral health practice?
These are the difficulties behind those ?’s
Lack of consensus of treatment standards
Little prior orientation to this sort of question in the fieldSlide21
Beating the Competition Cont.
3. Reliance on “Bad Apple” theory which looks down upon errors
4. A relativistic ethic, where all perspectives are seen as equal
5. An idiographic view of case formulation
6. Ignoring bad practice rather than fighting itSlide22
What Can Be Done About Unethical Treatments?
Behavior analysts need to educate the public
Filing unethical charges against practitioners using these interventions
Educating watchdog groups
Work with district attorneys and other law enforcement agencies
Working with government agencies to pass laws criminalizing these actsSlide23
Quality Improvement
Is continuously “upgrading” products and services in keeping with consumers’ ever changing demands and expectations
Needs Improvement
Improve productivity
Utilize interesting technologies
Improve value of services
Sensitive to unintended negative effects
Shift from short-term to long-term goalsSlide24
Improving the System
“You can’t improve a process or outcome without measuring it” and “don’t waste time and effort measuring it if you aren’t going to try and improve it”
Take home message
- the behavior analysis system needs improvement!