Transcript Evidence-Based, Empirically Supported, Best Practice: What

Evidence-Based, Empirically
Supported, Best Practice
Ronnie Detrich, Trina Spencer, Tim Slocum
Definition of Evidence-Based Practice
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Evidence-Based Practice is a process of making decisions
being informed by three sources of influence:
a) best available research evidence
b) professional judgment
c) client values
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Cf. Clinical Psychology: APA Task Force (2006)
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Cf. Medicine: Sackett et al (2000)
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Cf. Education: Whitehurst (2002)
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Cf. Communication Disorders: Schlosser & Sigafoos (2008)
Definition of Evidence-Based Practice
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One tool that is useful in this process is a list of
interventions that are well supported by research.
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These interventions are often called ‘evidence-based practices’.
This usage invites confusion between:
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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.
Definition of Evidence-Based Practice
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Interventions that are well supported by research
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Terms are not at all consistent.
Virtually all combinations have been used:
Evidence
Based
Practice(s)
Research
Validated
Treatment
Scientifically
Empirically
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Program
Supported
Intervention
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.
Definition of Evidence-based Practice
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Primary question of the symposium:
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How do we most effectively use the research base to guide
professional practice?
Requires generalization
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from a set of specific studies
to a range of practical situations
How broadly/narrowly shall we define
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The intervention?
The client characteristics?
The outcomes?
The contexts of practice?
What is to be validated?
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Interventions can be defined a various levels of specificity.
specific
Procedures
less
Tactics
more
general
Principles
This issue also applies to outcomes, clients, and contexts.
Definition of Evidence-based Practice
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The research base will never match our specific questions
regarding practice; therefore, we must address the
difficulties of generalizing beyond specific research studies.
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By reviewers of research on a particular topic
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Different styles of research reviews allow different ranges of
generalization
By practitioners
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This is part of ‘professional judgment’ that is included in the definition
of evidence-based practice.
What is “Professional Judgment”?
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Professional judgment
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Fills the gap between an imperfect research base and the
specifics of a clinical situation.
Includes rule-governed elements
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Knowledge of the research base
Knowledge of broader principles of behavior
Includes contingency-shaped elements
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Subtle discriminations of when and how to apply principles
Repertoire of shaped interactive behavior
Methods of Deriving Practice
Recommendations
1.
Empirically Supported Interventions (Slocum)
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2.
Best Practices (Detrich)
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3.
Using objective and operationalized procedures for
identifying the level of research support for particular
interventions.
Employing experts to review research and make critical
judgments and reasonable generalizations as a basis for
recommendations.
Research-Based Principles (Spencer)
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Drawing from basic principles to construct or adapt
interventions for individual settings or clients.
The nexus between ‘research base’ and ‘professional
judgment’
Methods of Deriving Practice
Recommendations
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We will argue:
1.
2.
3.
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.