Transcript SW 563 - Outcome-Informed Evidence

Introduction
Outcome-Informed
Evidence-Based Practice (EBP)
Contemporary Conceptual
Definition of EBP
“…a process for making practice decisions in
which practitioners integrate the best
research evidence available with their
practice expertise and with client attributes,
values, preferences, and circumstances”
Rubin, 2008, p. 7
EBP Decision-Making
Oliver et al.
(http://www.ebbp.org/training.html)
EBP
 Philosophy of practice
 Ethical principle that clients deserve most
effective interventions possible
 Process
 Process by which we find and implement the
best empirically supported interventions (ESI)
 Practices
 Interventions and other practices with
empirical evidence of their effectiveness in
practice for specific problems
Not Only Clinical Interventions
 Assessment
 Risk/Prognostic indicators
 Prevention
 Community and organizational level
programs
 Policy
From Authority to Evidence
 Rejection of…
 Authority, intuition, rules of thumb, tradition,
and anecdote as the basis for selecting
interventions
 Acceptance of…
 Rational, transparent, systematic process based
on evidence from scientific research as the
basis for selecting interventions
Scary Thought about Authority…
“Half of what we have taught you is wrong.
Unfortunately, we don’t know which half.”
Dr. C. Sidney Burwell, Dean
Harvard Medical School
Commencement Address
EBP Starts with the Client
Asks what research evidence will assist in
achieving the best outcomes for this
particular client
EBP Involves Lifelong Learning
“Placing the client’s benefits first, evidencebased practitioners adopt a process of
lifelong learning that involves continually
posing specific questions of direct practical
importance to clients, searching objectively
and efficiently for the current best evidence
relative to each question, and taking
appropriate action guided by evidence.”
Gibbs, 2003, p. 6
Mark Twain on Lifelong Learning
“I have never let my schooling interfere with
my education.”
Spirit of EBP
Search for disconfirming evidence with the
same determination as for confirming
evidence
Critical Thinking
Application of logical principles, rigorous
standards of evidence, and careful reasoning
to the analysis and discussion of data, claims,
beliefs, or issues
Bias
Tendency to see and interpret information
consistently with an emotional preference or
preconceived expectation
Falsification
Deliberate process of seeking information to
discount or disprove a hypothesis or theory
Confirmation Bias
Tendency to gather evidence that confirms
one’s preconceptions by emphasizing or
pursuing supporting evidence while dismissing
or failing to seek contradictory evidence
Mark Twain on Confirmation Bias
“It ain't what you don't know that gets you
into trouble. It's what you know for sure
that just ain't so.”
Seemed like a good idea…
 Examples of potentially harmful
interventions
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Critical incident stress debriefing
“Scared Straight” interventions
Attachment therapies (e.g., rebirthing)
Recovered-memory techniques
Grief counseling for individuals with normal
bereavement reactions
Boot-camp interventions for conduct disorder
DARE programs
Lilienfeld (2007)
Steps in the EBP Process
 Develop an answerable question
 Locate relevant evidence
 Critically analyze the evidence
 Combine evidence with client attributes,
values, preferences, and circumstances and
with your practice expertise
 Apply to practice
 Measure and monitor client outcomes, and
adjust intervention as needed
Steps in the EBP Process (cont’d)
 Alternative (slightly) characterization of
EBP steps:
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Ask
Acquire
Appraise
Apply
Analyze and Adjust
EBP Iterative Process
Oliver et al.
(http://www.ebbp.org/training.html)
Moving from Research to Practice
 What you might know…
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How does the intervention work when
implemented under ideal conditions (i.e.,
efficacy)?
How does the intervention work when
implemented under routine practice
conditions (i.e., effectiveness)?
Moving from Research to Practice
(cont’d)
 What you need to know…
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How does the intervention work when you
implement it with your particular client in
your practice setting?
 No guarantee that ESI will be effective
with your client, in your practice setting,
when you implement it
Measuring and Monitoring Client
Progress
“However beautiful the strategy, you should
occasionally look at the results.”
Sir Winston Churchill
Outcome-Informed Practice
(OIP)
 Practice in which you:
 Measure your client’s outcomes at regular,
frequent, pre-designated intervals, in a way
that is sensitive to and respectful of the client
 Monitor these outcomes at regular, frequent,
pre-designated intervals to determine if your
client is making satisfactory progress
 Modify your intervention plan as needed along
the way by using this practice-based evidence,
in concert with evidence-based practice, to
improve your client’s outcomes
Benefits of OIP
 Improve client outcomes through more
informed decision making
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May be especially pronounced for clients who
are not doing well
 Conduct practice as a problem solving
experiment in which little is assumed
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Especially important when no ESIs available
 Learn from experience
 Practitioners tend to overestimate
improvement and underestimate deterioration
Can I practice without measuring
and monitoring client outcomes?
 No
 Measuring and monitoring client outcomes
is an inherent part of practice
 All practitioners measure and monitor
client outcomes—the question is how best
to do it
What will I be able to do at the
end of this course?
Provide more effective and
humane practice by learning
how to measure and monitor
client outcomes and using this
information to modify your
interventions as needed