Clarification and elaboration on evidence-based practice in psychology.

Responds to comments by D. C. Wendt and B. D. Slife (see record 2007-13085-019), P. H. Hunsberger (see record 2007-13085-020), and R. B. Stuart and S. O. Lilienfeld (see record 2007-13085-021) regarding the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. The goal of the task force was to create a scheme that would suggest how evidence should be used to design and offer services that will benefit patients and to assure the public and the health care system that psychologists are providing evidence-based services. There were and will continue to be many scientific and philosophical issues inherent in any such enterprise, and agreement by all psychologists with every aspect of EBPP may not be possible. Nevertheless, the APA's EBPP policy and the report that accompanied it are remarkably inclusive of various perspectives while remaining unambiguous about the need to use evidence in a way that leads to effective services. What is needed at this point are clinically relevant evidence and investigations of how such evidence can be used to best benefit those served by psychological interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evidence missing from evidence-based practice.

Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. Regrettably, the task force report was largely silent on three critical issues. As a consequence, it omitted much of the evidence necessary for a complete picture of evidence-based practice. First, the task force report did not operationalize "evidence." Second, the task force report did not address the crucial problem of iatrogenic treatments. Third, the task force report said little about the necessity for ongoing objective evaluation of clinical cases, which is critical to ethically responsible services. Current debate centers on how research findings should be factored into interventions, not on whether it is necessary to do so. Rather than waiting for the resolution of competing views on the matter, psychologists bear an ethical obligation to offer evidence-informed services. Three critical steps that were largely neglected by the task force report can go far toward helping psychologists honor that commitment: (a) providing a clearer operationalization of scientific evidence, (b) using current research to rule out the use of potentially harmful methods, and (c) using objective criteria to evaluate all of their cases on an ongoing basis. These steps, in turn, clarify the menu of options available to therapists, help protect clients from harm, and offer the advantage of allowing clinicians to contribute to the growing body of knowledge about what does and does not work in psychotherapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Is evidence-based practice diverse enough? Philosophy of science considerations.

In its policy rationale for evidence-based practice in psychology (EBPP), the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) claims to have constituted itself with "scientists and practitioners from a wide range of perspectives and traditions, reflecting the diverse perspectives within the field" (p. 273). We applaud this attention to diversity but contend that an entire perspective of the debate was omitted in the Task Force's newly approved policy and its underlying report. The failure to consider a philosophy of science perspective led the Task Force to make a number of epistemological assumptions that are not based on evidence or rationale and that thus violate the very spirit of evidence-based decision making. In this comment, we reveal a few of these assumptions and discuss their detrimental consequences. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reestablishing clinical psychology's subjective core.

Comments on the report by the APA Presidential Task Force on Evidence-Based Practice (see record 2006-05893-001) entitled Evidence-based practice in psychology. The Task Force is to be commended for their report valuing evidence from "clinical expertise" on a par with "research data" (p. 272) in guiding psychological practices. The current author suggests that the APA not only should make a place at psychology's policymaking table for "clinical expertise" but should prioritize clinical and subjective sources of data--the essence of the psychological--and set policies to ensure that objective data, such as behaviors and DSM diagnoses, are considered in their subjective context. The APA should also encourage researchers to devise ways to preserve as much as possible the personal "feel" of the clinical encounter in their data analysis and published conclusions. The APA also needs to assign priority to subjective emotional and relational skills on a par with academic and analytic skills in the selection and training of clinical psychology students. Reconnecting clinical psychology with its subjective evidentiary roots in ways such as these should help to bring us out from under the dominance of medicine, to the benefit of our profession and our clients. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based practice in psychology.

This article focuses on the 2005 American Psychological Association Presidential Task Force on Evidence-Based Practice in Psychology. After describing the rationale and results of this task force, the authors review the literature that has appeared following the approval of the Policy Statement on Evidence-Based Practice in Psychology by the American Psychological Association Council of Representatives, with reference to the implications for practitioners. Finally, the authors discuss the implications of the Policy Statement on Evidence-Based Practice in Psychology for graduate students and early career professionals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Research and practice in health psychology.

The task force on research and practice in health psychology responded to three presentations on important issues. It was posited that clinical health psychology may represent the ideal specialty for scientist-practitioner training. There are exciting, important questions regarding health problems, health policy, and health treatment systems needing interdisciplinary research. Health psychologists are uniquely prepared to take a leadership role due to their training in both research and service delivery. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bridging science and practice to improve patient care.

Replies to the comments by Tyron (see record 2009-06923-008), Silverstein and Auerbach (see record 2009-06923-009), and Raps (see record 2009-06923-010) on the authors original article (see record 2008-03389-001). I was very pleased to read these comments about the priority of bridging research and clinical practice and to have the benefit of further perspectives on how this goal might be achieved. The article to which these comments were addressed suggested changes in both clinical research and practice that might develop or strengthen such a bridge. Suggestions for clinical research included evaluating the mechanisms of change in psychotherapy so we know what is critical to include in practice, evaluating who responds to treatment in ways that can be integrated into practice, and increasing the use of qualitative research. Suggestions for practice included using systematic measures to evaluate patient progress, codifying the experiences of practitioners so they contribute to our accumulated knowledge base, and promoting direct collaborations of researchers and practitioners. The above commentaries emphasized specific points about research on mechanisms, qualitative research methods, and the challenges of providing treatments given the nature and scope of the problems that clients present. These commentaries add to the discussion in novel ways and also illustrate the obstacles that may compete with bridging. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Using qualitative research to develop culturally competent evidence-based practice.

Kazdin (see record 2008-03389-001) pointed out that the requirement for evidence-based practice (EBP) has made the long-standing gap between research and practice in clinical psychology even more salient. He offered several strategies for bridging this gap: investigating mechanisms and moderators of therapeutic change, and qualitative research. We agree that qualitative research can be useful in bridging the gap between research and clinical practice (Silverstein & Auerbach, 2007; Silverstein, Auerbach, & Levant, 2006). In this comment we discuss using qualitative research to develop EBP that is culturally competent. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Addressing key challenges in evidence-based practice in psychology.

With its promise of enhancing the effectiveness of services, evidence-based practice in psychology (EBPP) appears to offer much to psychologists, patients, and policymakers. The purpose of this article is to examine some of the key challenges facing psychologists who wish to provide evidence-based treatment services, including how research evidence is used in EBPP, whether the results of the treatment research literature can be generalized to typical clinical practice, and how effective evidence-based treatments are in clinical practice. On the basis of recent evidence-based initiatives and treatment research, there is a solid scientific basis for EBPP, although much more research is necessary on the treatment of relatively mild, but common, clinical conditions and on the transporting of evidence-based treatments into clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based treatment and practice: New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care.

The long-standing divide between research and practice in clinical psychology has received increased attention in view of the development of evidence-based interventions and practice and public interest, oversight, and management of psychological services. The gap has been reflected in concerns from those in practice about the applicability of findings from psychotherapy research as a guide to clinical work and concerns from those in research about how clinical work is conducted. Research and practice are united in their commitment to providing the best of psychological knowledge and methods to improve the quality of patient care. This article highlights issues in the research- practice debate as a backdrop for rapprochement. Suggestions are made for changes and shifts in emphases in psychotherapy research and clinical practice. The changes are designed to ensure that both research and practice contribute to our knowledge base and provide information that can be used more readily to improve patient care and, in the process, reduce the perceived and real hiatus between research and practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidentiary pluralism as a strategy for research and evidence-based practice in rehabilitation psychology.

Objective: This article examines the utility of evidentiary pluralism, a research strategy that selects methods in service of content questions, in the context of rehabilitation psychology. Hierarchical views that favor randomized controlled clinical trials (RCTs) over other evidence are discussed, and RCTs are considered as they intersect with issues in the field. RCTs are vital for establishing treatment efficacy, but whether they are uniformly the best evidence to inform practice is critically evaluated. Conclusions: The authors argue that because treatment is only one of several variables that influence functioning, disability, and participation over time, an expanded set of conceptual and data analytic approaches should be selected in an informed way to support an expanded research agenda in which therapeutic and extratherapeutic influences on rehabilitation processes and outcomes is investigated. The benefits of evidentiary pluralism are considered, including those that help close the gap between the narrower clinical rehabilitation model and a public health disability model. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Family psychology specialty practice.

The specialty of family psychology prepares practitioners to work systemically with individuals, couples, families, and larger social organizations. The specialty is defined, and a rationale is provided for its relevance to professional practice. Key concepts, competencies, and practice dimensions (e.g., assessment, case conceptualization, and intervention) are detailed, as are training and board certification in the specialty. Applications to specific problems and specialty niches are described. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Missing mechanism information.

The first recommendation Kazdin (see record 2008-03389-001) made for advancing the psychotherapy research knowledge base, improving patient care, and reducing the gulf between research and practice was to study the mechanisms of therapeutic change. He noted, “The study of mechanisms of change has received the least attention even though understanding mechanisms may well be the best long-term investment for improving clinical practice and patient care” (p. 151). He clarified what he meant by mechanism by stipulating what it was and what it was not, and he provided examples. The point of this comment is to note that Kazdin (2008) omitted mention of an extensive and rapidly expanding literature on parallel distributed processing– connectionist neural network (PDP-CNN) models of cognition, affect, and behavior that provides psychologically relevant information on causal mechanisms. Kazdin’s (2008) conclusion that learning more about causal mechanisms may best provide long term benefits to the science and practice of clinical psychology, including substantially mending the research–practice schism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based interventions in school psychology: Opportunities, challenges, and cautions.

Describes opportunities, challenges, and cautions in response to T. R. Kratochwill and K. C. Stoiber's vision and other critical issues for the evidence-based intervention (EBI) movement in school psychology. The authors' position can be summarized as follows: (1) the EBI Task Force in School Psychology presents the field with an unparalleled opportunity to influence school psychology training and practice; (2) the challenges presented by the actual coding of existing studies will spur improvements in the research methodology training of school psychology students and improvements in the design of future school-based research; and (3) the field is cautioned to consider carefully the unique context presented by the schools when evaluating intervention effectiveness. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evidence-based practice and the culture of adolescence.

Evidence-based practice requires attention to the client context, including client culture. We propose that the developmental period of adolescence is characterized by a unique culture that has important implications for evidence-based practice. Specifically, this paper explores three features of adolescent culture (importance of technology, centrality of peers, and the ongoing challenge of identity formation and individuation) that may be especially salient when treating adolescents. We then provide recommendations for how these features can be addressed in adapting existing evidence-based protocols and designing new interventions for adolescents, using examples from the literature to illustrate innovative applications. Overall, we argue that considering adolescent culture and thoughtfully tailoring treatment to that culture is consistent with the evidence-based practice framework and could enhance therapeutic outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based interventions in school psychology: An illustration of task force coding criteria using group-based research design.

Applies the criteria in the Procedural and Coding Manual for Review of Evidence-Based Interventions, established by the Task Force on Evidence-Based Interventions (EBIs) in School Psychology, to a group-based design intervention study. Specifically, the School Psychology EBI group-based criteria were applied to a research study conducted by the Conduct Problems Prevention Research Group (CPPRG, 1999a, 1999b) that examined the effects of the Fast Track intervention program on Grade 1 students. The group-based coding criteria are explicated and described through demonstrating the basis for coding decisions. In general, the application of the Procedural and Coding Manual criteria to the CPPRG investigation of the Fast Track program suggested promising evidence in support of the program. Considerations for interpreting the results of the coding process are discussed with particular attention to implications for practitioners and researchers. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Evidence-based parent and family interventions in school psychology: Conceptual and methodological considerations in advancing best practices.

Major national, state, and local systems reform efforts are under way to close the gap between science and service through implementation of a range of evidence-based practices (EBPs). A set of rhetorical distinctions and ensuing debates about the relevance of science versus service and efficacy versus effectiveness threatens to widen rather than close the gap. However, methodological and conceptual approaches, drawing upon strong theory-driven models, offer considerable promise for an integrated science on implementation effectiveness. This paper outlines some of the major scientific and policy challenges in strengthening the link between science and service in school psychology within the context of the papers in this series. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Lesbian and gay psychology: Theory, research, and clinical applications.

Reviews the book, Lesbian and gay psychology: Theory, research, and clinical applications by Beverly Greene and Gregory M. Herek (1994). This volume is a collection of theoretical, research, and clinical articles which share in common only their focus of a psychological approach to gay and lesbian issues. Particularly admirable is the handling of a variety of lesbian issues including sexual pride and shame, physical appearance, and feminist politics of sexual orientation. There are also good articles on stereotypes and attitudes toward lesbians and gay men. This volume moves the psychological study of lesbian and gay issues beyond being merely gay affirmative into looking at hard issues, and reconnecting gay studies with the larger body of psychological theory, research, and clinical practice. As a psychological potpourri of articles, it suggests what can be accomplished in lesbian and gay psychology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making psychology a household word.

[Correction Notice: An erratum for this article was reported in Vol 61(8) of American Psychologist (see record 2006-21079-021). This erratum clarifies the APA Council of Representatives response to the the PENS Task Force Report at its August 2005 meeting.] This article addresses Ronald F. Levant's four APA presidential initiatives for 2005. "Making Psychology a Household Word" was both the general theme for his presidency as well as an initiative in its own right. The other three initiatives were "Promoting Health Care for the Whole Person," "Enhancing Diversity Within APA," and "Developing an APA Position on Evidence-Based Practice in Psychology." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based parent and family interventions in school psychology: A commentary.

Do the authors provide us with convincing evidence that parent and family interventions change children's behavior and learning at school? The answer is not a simple or straightforward one. First off, there appears to be more support for interventions that are part of a multi-component program, that are highly focused in scope, and that entail active collaboration between parents, students, and the schools; hence, more support appears to be available for family/parent consultation and family-school collaboration/partnership programs than for the more unidirectional and limited parent education and parent involvement programs. Second, although 100 studies are examined, it is readily apparent that the studies reported on in the various reviews are characterized by numerous methodological shortcomings that compromise their scientific integrity and the conclusions we can safely draw from them. Third, it is evident that nearly all of the efficacious treatments are behavior or cognitive-behavioral ones. Fourth and finally, it will be important to begin to identify the students, families, and schools that are most likely to benefit from the various interventions and to examine the specific mechanisms of change in each of the proposed interventions. In sum, it seems safe to conclude that evidentiary support for the effectiveness of parent and family interventions in school psychology is mixed at best. (PsycINFO Database Record (c) 2011 APA, all rights reserved)