The dissemination and implementation of evidence-based psychological treatments: A review of current efforts.

Recognizing an urgent need for increased access to evidenced-based psychological treatments, public health authorities have recently allocated over $2 billion to better disseminate these interventions. In response, implementation of these programs has begun, some of it on a very large scale, with substantial implications for the science and profession of psychology. But methods to transport treatments to service delivery settings have developed independently without strong evidence for, or even a consensus on, best practices for accomplishing this task or for measuring successful outcomes of training. This article reviews current leading efforts at the national, state, and individual treatment developer levels to integrate evidence-based interventions into service delivery settings. Programs are reviewed in the context of the accumulated wisdom of dissemination and implementation science and of methods for assessment of outcomes for training efforts. Recommendations for future implementation strategies will derive from evaluating outcomes of training procedures and developing a consensus on necessary training elements to be used in these efforts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Do haphazard reviews provide sound directions for dissemination efforts?

Comments on The dissemination and implementation of evidence-based psychological treatments: A review of current efforts (see record 2010-02208-010) by Kathryn R. McHugh and David H. Barlow. The lead article in the February–March issue by McHugh and Barlow (2010) emphasized the need for “dissemination and implementation of evidence-based psychological treatments.” The authors identified a number of intervention programs as evidence based and in need of dissemination. One is multisystemic therapy (MST). They claimed that this program is among “the most successful dissemination efforts . . . pursued by treatment developers” (p. 79). McHugh and Barlow’s (2010) discussion of the implementation of MST in Hawaii is troubling, because it neglected to mention concerns about the perceived lack of cultural sensitivity of the MST program in that state. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Advancing the implementation of evidence-based practices into clinical practice: How do we get there from here?

How does an individual practitioner, agency, or treatment system get from making a decision or being mandated to adopt an evidence-based practice (EBP) to successfully implementing and using the EBP? Research and theory on factors that help or hinder putting new treatments into practice focus on individual, organizational, and external levels. Although several factors have been identified that affect implementation, the level and specificity of evidence do not warrant the term evidence-based implementation strategies. Yet steps must be taken now to start using EBPs. This article includes a review of research and theory on implementation, a case example of statewide implementation, and recommendations for psychologists across multiple roles to assist in advancing the implementation of EBPs into clinical practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Meta-analyses and systematic reviews of psychological treatments for chronic pain: Relevance to an evidence-based practice.

As evidence-based practitioners become more reliant on systematic reviews to inform treatment, it becomes important to systematize reporting details as well as improve the quality of the primary studies that will later be incorporated into this secondary literature. In this article, the authors consider several specific factors that can serve this function in the area of chronic pain: (a) adhering to a standardized set of reporting standards; (b) measuring a standardized set of short- and long-term outcome variables; (c) providing information about individual differences; and (d) providing detailed, easily accessible documentation of the treatment program (or progams). The article also highlights ways that practitioners and researchers can collaborate on treatment outcome research, thereby improving the ability to discover and disseminate effective treatments for patients who suffer from chronic pain. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Facilitating practice changes in mental health clinics: A guide for implementation development in health care systems.

For more than a decade, health care systems have attempted to implement evidence-based practices and guidelines. These efforts have demonstrated the difficulty in making practice changes in complex systems of care. Many health care systems, including the Department of Veterans Affairs (VA) and state community mental health systems, have made adoption of evidence-based treatments, especially psychotherapies, a priority. Psychologists, as behavioral change experts and clinical leaders, are positioned to aid local implementation efforts but may have limited knowledge of the “implementation science” literature. This article provides a brief introduction to the implementation literature and offers a guide for developing an implementation plan to adopt evidence-based psychotherapies in local health care settings illustrated by a hypothetical example. Challenges to implementation are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Introduction to the Special Section on Dissemination: Dissemination Research and Research Dissemination: How Can We Close the Gap?

One of the greatest challenges facing health promotion and disease prevention is translating research findings into evidence-based public health and clinical practices that are actively disseminated and widely adopted. Despite the tremendous strides made in developing effective disease prevention and control programs, there has been little study of effective dissemination of evidence-based programs to and adoption by community, public health, and clinical practice settings. This special section provides a venue in which to highlight exemplary dissemination research efforts while also identifying limitations in research to date and framing important future research questions. This issue establishes a resource for investigators interested in dissemination research, with relevance to health psychology. In this sense, it can serve as a benchmark by which to examine subsequent progress. The 6 articles reflect the state of the science in dissemination research for the promotion and adoption of health behavior change interventions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adopting a public health approach to the delivery of evidence-based parenting interventions.

A public health perspective to the delivery of parenting programs has the potential to greatly increase the impact of evidence-based psychological interventions targeting parents and families. However, a population-level benefit is unlikely to be achieved unless sustained programmatic efforts are undertaken to further increase the reach of efficacious interventions. In addition, such programs need to be adapted to local circumstances, be delivered in a culturally relevant manner, and be used in a sustained way by adoptee organisations if the potential benefits of these interventions are to be realised. The multilevel Triple P system of parenting interventions is used as an example to illustrate the benefits and challenges involved in delivering a comprehensive system of parenting interventions, services, and programs. Practical implications for large-scale implementation and possible future directions for research are identified. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Challenges and opportunities in public health perspectives on family interventions: Introduction to the special section.

This introduction to the special section frames the idea of a public health approach to couple and family interventions as focusing upon the impact of interventions on outcomes at the population level. It notes the importance of looking at how evidence-based interventions can be used more effectively at the population level. It also stresses that the goals for population-level studies are different from randomized clinical trials. Public health interventions need evidence that the interventions can be used in widespread practice, that the interventions are cost effective when used as designed, and that monitoring and evaluation tools are available for adopting agencies. Finally, this introduction introduces the three articles of the series. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Handbook of evidence-based psychodynamic psychotherapy: Bridging the gap between science and practice.

Reviews the book, Handbook of evidence-based psychodynamic psychotherapy: Bridging the gap between science and practice by Raymond A. Levy and J. Stuart Ablon (see record 2008-14828-000). This book presents a lucid and timely review of research advances assessing the efficacy and effectiveness of psychodynamic psychotherapies in treating many psychological disorders. From research on broad-based meta-analyses of the effectiveness of psychodynamic psychotherapy to close process analysis of therapist and patient interactions, the invited contributors of this volume translate complex research findings into clinically relevant information for clinicians working in the field. The volume is organized to lead the reader from broad-based reviews of psychodynamic psychotherapy outcome studies to examining in-session processes of patient– therapist interactions that affect the patient’s well-being, improvement, and personality change. In all, it lives up to its title and should be added to any clinician’s library. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evidence-based treatments and delivery of psychological services: Shifting our emphases to increase impact.

Evidence-based psychological treatments (EBTs) have made enormous gains in the range of techniques that are available and the scope of problems to which they can be applied. Debates about the advances focus on issues related to applicability of the evidence to clinical work, limits of highly controlled studies, and decision making in clinical practice. Less often discussed is arguably the more salient issue, namely, that most people in need of psychological treatment do not receive services, whether evidence based or not. This article discusses EBTs as currently studied in relation to an overarching goal of our interventions, namely, to reduce the burden of mental illness and the full range of social, emotional, and behavioral problems leading to impairment. The diversity of clients, the range of settings in which treatments must be delivered, and the models of delivery ought to receive greater attention in developing evidence-based interventions. In the context of treatment of children and adolescents, this article discusses service needs and how EBTs can better align with these needs to exert broad impact. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarification on Psychological Treatments and Psychotherapy.

In this article, the author responds to a set of comments (see record 2005-11834-009; 2005-11834-010; 2005-11834-011) on his original article, "Psychological Treatments" (see record 2004-21168-001). The author responds to each comment. Hal Arkowitz (2005) misread the proposed distinction between "psychological treatments" and "psychotherapy" by presuming that the author was implying that the former is evidence based and the latter is not. Kwekkeboom et al. (2005), representing the nursing profession, noted quite correctly that nurses often deliver psychological treatments on the frontlines of primary care and are independently licensed to provide nursing services, including many approaches that could be categorized as "psychological." Ahmed and Boisvert (2005) agreed that psychological treatments are a core strength of psychology and also go on to provide additional interesting examples and to identify other areas of practice in which psychologists may be uniquely qualified. Overall, the author notes that only certain well-defined pathologies will be included in any health care system, and treatment for these conditions will increasingly need to be based on evidence. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A guiding framework and approach for implementation research in substance use disorders treatment.

This paper introduces readers to the concepts of implementation science, implementation theory, and implementation frameworks and models. A wide range of models has been published in the literature related to implementation. The paper will present an overview of the Consolidated Framework for Implementation Research (CFIR), which is a comprehensive typology that unifies and consolidates the array of constructs that influence implementation from the perspective of these models. The CFIR is then used to evaluate implementation models used in studies of substance use disorder (SUD) treatments. Implementation research is scarce, with few prospective studies of theory-driven implementation. We assert that future research in SUD needs to meet three overarching objectives to promote wider implementation of evidence-based practices: (a) differentiation of core versus adaptable components of evidence-based interventions need; (b) development of methods to design implementation strategies, effectively adapted to the broad context; and (c) design and testing of predictive models to assess likelihood of effective implementation and prospects for sustainability while taking into account salient contextual factors. A recommended strategy for accomplishing these objectives is described. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A review of psychokinesis (PK).

"Few of the PK reports fulfill the basic requirement of a psychological experiment. To have psychological justification, there must be a controlled comparison such as wish for versus wish against, or wish for versus no wishing, or Believers versus Disbelievers… . Evidence of PK as a psychological phenomenon is therefore totally lacking. And this deficiency will persist until the effect is produced in the presence of a specified psychological variable, and the effect does not appear in its absence." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Reconceptualizing Health: A Response to Romanow and Marchildon (2003).

The Commission on the Future of Health Care in Canada (CFHCC) is to be congratulated for addressing the tension among various levels of government regarding health-care funding. The CFHCC also took the progressive step of creating the National Health Council, a body charged with ensuring greater accountability in health care. Psychologists have argued for decades that treatment decisions should be guided by a consideration of what works for whom and under what conditions. In our response to Romanow and Marchildon (see record 2003-09748-001), we argue that funding of health services in Canada has failed to heed this recommendation and the scientific evidence in support of the efficacy of psychological interventions for a wide range of health conditions. Despite remarkable advances in healthcare delivery, Canada's health-care system continues to be funded based on an outdated model of disease and illness. Romanow and Marchildon are to be applauded for their broad conceptualization of health and the role of various health professionals in advancing the health of Canadians. Unfortunately, this recognition did not make its way into the report of the CFHCC to the extent needed to make Canada's health system truly progressive. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discredited psychological treatments and tests: A Delphi poll.

In the context of intense interest in evidence-based practice (EBP), the authors sought to establish consensus on discredited psychological treatments and assessments using Delphi methodology. A panel of 101 experts participated in a 2-stage survey, reporting familiarity with 59 treatments and 30 assessment techniques and rating these on a continuum from not at all discredited to certainly discredited. The authors report their composite findings as well as significant differences that occurred as a function of the experts' gender and theoretical orientation. The results should be interpreted carefully and humbly, but they do offer a cogent first step in consensually identifying a continuum of discredited procedures in modern mental health practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

William A. Hunt (1903–1986).

William A. Hunt was one of our country's early scientist-clinicians. He began his career with study of a psychology that was a meld of Titchener's structuralism and Harvard's functionalism and completed it 50 years later in the field of health psychology. Hunt spent all but a few of those 50 years as a full-time teacher, at schools that included Dartmouth College, Connecticut College for Women, and Northwestern University. While doing his dissertation, he had mastered and used the structuralist's experimental method of introspection, applying it to the study of human emotion, specifically the James-Lange theory. In 1941, Hunt entered the Navy. He discerned that the screening for military duty of some 15 million women and men required an approach suited to the rapid, albeit individual, screening of large numbers of such personnel. His teaming up with a psychiatrist, Cecil Wittson, led to their joint development of a screening interview lasting one to two minutes that, with continued refinement, proved remarkably effective. Their goals as the mental health specialists participating in the medical examination conducted at this intake station were twofold: (a) to improve the efficiency of the Navy by removing those neuropsychiatric high-risk recruits who were potential psychiatric casualties if they continued in the Navy and (b) by such removal, to save these recruits the disastrous personal experience of subsequent breakdown during military duty. In his own still active research in the 1960s and 1970s Hunt continued to apply the same methods he earlier had used (in his Navy research) to the judgmental processes clinical psychologists used to identify psychological test responses that were pathognomonic of schizophrenia, mental retardation, and related forms of psychopathology. Hunt remained, until his death at age 82, an active scientist-clinician. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correction to Ford and Collins (2010).

Reports an error in "Self-esteem moderates neuroendocrine and psychological responses to interpersonal rejection" by Máire B. Ford and Nancy L. Collins (Journal of Personality and Social Psychology, 2010[Mar], Vol 98[3], 405-419). This article contained a misspelling in the last name of the first author in the below reference. The complete correct reference is included. The online version of the article has been corrected. (The following abstract of the original article appeared in record 2010-02829-005.) In this study, the authors investigated self-esteem as a moderator of psychological and physiological responses to interpersonal rejection and tested an integrative model detailing the mechanisms by which self-esteem may influence cognitive, affective, and physiological responses. Seventy-eight participants experienced an ambiguous interpersonal rejection (or no rejection) from an opposite sex partner in the context of an online dating interaction. Salivary cortisol was assessed at 5 times, and self-reported cognitive and affective responses were assessed. Compared with those with high self-esteem, individuals with low self-esteem responded to rejection by appraising themselves more negatively, making more self-blaming attributions, exhibiting greater cortisol reactivity, and derogating the rejector. Path analysis indicated that the link between low self-esteem and increased cortisol reactivity was mediated by self-blame attributions; cortisol reactivity, in turn, mediated the link between low self-esteem and increased partner derogation. Discussion centers on the role of self-esteem as part of a broader psychobiological system for regulating and responding to social threat and on implications for health outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway": Correction to Nordgreen and Havik (2011).

Reports an error in "Use of self-help materials for anxiety and depression in mental health services: A national survey of psychologists in Norway" by Tine Nordgreen and Odd E. Havik (Professional Psychology: Research and Practice, 2011[Apr], Vol 42[2], 185-191). The authors' affiliations were listed incorrectly. The correct affiliations are provided in the erratum. (The following abstract of the original article appeared in record 2011-08009-010.) How do psychologists in clinical practice perceive and use self-help materials for clients with anxiety and depression? The use of self-help materials with guidance from a therapist has been suggested as a way of meeting the increasing need for mental health services. The present study investigated factors relevant to the use of self-help materials for the treatment of anxiety and depression among psychologists employed in mental health services. Among 1863 eligible clinical psychologists in Norway, 815 (43.7%) participated in a national survey. A total of 93.5% of the participants had recommended self-help materials to clients, and approximately half (55.1%) had received requests from their clients regarding self-help materials. Self-help materials were recommended as an adjunct and not as an alternative to therapist contact by 73.0% of respondents, by 16.6% for relapse prevention, and by 1.2% to clients on a waiting list. Internet/computer-based programs were recommended by 2.2% of the participants. The practitioner's previous use of self-help materials to enhance his or her therapy skills and knowledge of self-help materials was related to use of self-help materials with clients. Psychologists working in child mental health services recommended self-help less often than those working in adult services. These results have implications for future efforts to disseminate effective self-help materials through increased attention toward self-help interventions in training and clinical practice. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

"The practice of forensic psychology: A look toward the future in light of the past": Comment on Otto and Heilbrun (2002).

Comments on the article by R. K. Otto and K. Heilbrun (see record 2002-10575-001) discussing the state of the field of forensic psychology. The current author objects to what he perceives as Otto and Heilbrun's attempt to discredit all but closely protected American Psychological Association (APA) affiliated organizations, and their subsequent biased comments based on poor research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)