EBP Exchange – UMB School of Social Work

This is a wide ranging paper by the President of the American Psychological Association—one that I highly recommend to you–but I wanted to highlight some of the clinical concerns that Kazdin raises.  First is a concern about the way to implement EBPs consonant with the need to “tailor treatment to meet the needs of individuals” (p. 149) which is always complicated and which has not had much research. (I am a bit surprised that he does not cite the work of Bruce Chorpita, here, because this is much of what Bruce works on.)  Second is the issue of generalizing results of controlled studies to our work with individuals when we still have little information about what factors that differentiate our clients are also likely to have a differential (moderating) effect on our outcomes). Third, Kazdin expresses his concern that we do not consistently evaluate our practice and that this keeps us from better understanding how our practice with individuals might vary from the average outcomes of a more general trial. 

 

He proposes three strategies for moving forward in developing our effective clinical work. First, he suggests the use of systematic measure to evaluate progress in treatment in order to be sure that the implementation of an ESI is resulting in high quality care.  This would allow for the monitoring of treatment effects in an ongoing way. (Kazdin distinguishes this from point one because assessments can also be used just at the beginning and end of treatment, which is not what he is recommending.)  Third, systematic evaluation should be used to understand the likely impact of treatment. (I note with pride that the first resource he cites on systematic evaluation is the great evaluation text that is now 25 years old: Bloom and Fisher, 1982). He recommends the use of the OQ-45 (see related references below)  for routine assessment during the course of treatment—it’s new to me, but sounds promising as a means for determining whether treatment is on a positive path.  Overall, a very good read, this is.

 

Kazdin also includes, in this article,  a parallel argument about challenging issues in research and some related remedies that are worth reviewing.

 

Kazdin, A. E. (2008). Evidence-based treatment and practice – New opportunities to bridge clinical research and practice, enhance the knowledge base, and improve patient care. American Psychologist, 63(3), 146-159.

 

Ellsworth, J. R., Lambert, M. J., & Johnson, J. (2006). A comparison of the Outcome Questionnaire-45 and Outcome Questionnaire-30 in classification and prediction of treatment outcome. Clinical Psychology & Psychotherapy, 13(6), 380-391.

 

Harmon, S. C., Lambert, M. J., Smart, D. M., Hawkins, E., Nielsen, S. L., Slade, K., et al. (2007). Enhancing outcome for potential treatment failures: Therapist client feedback and clinical support tools. Psychotherapy Research, 17(4), 379-392.

 

Lambert, M. J., Whipple, J. L., Vermeersch, D. A., Smart, D. W., Hawkins, E. J., Nielsen, S. L., et al. (2002). Enhancing psychotherapy outcomes via providing feedback on client progress: A replication. Clinical Psychology & Psychotherapy, 9(2), 91-103.

 

The 45 items of the 0Q 45 are shown below (each is rated on a five point scale from never to almost always). to use this you need a license which can be obtained at: http://www.oqmeasures.com/site/Products/PaperLicense/tabid/83/language/en-US/Default.aspx. The point is, though, that this method–which is not unlike Patti Chamberlain’s Parent Report Form–can probably be replicated in other ways and other formats as long as the information can be digested quickly so that the therapist and client can better identify and discuss what is going on…

 

Complete Set of OQ45 Items

1. I get along with others.

2. I tire quickly.

3. I feel no interest in things.

4. I feel stressed at work/school.

5. I blame myself for things.

6. I feel irritated.

7. I feel unhappy in my marriage/significant relationship.

8. I have thoughts of ending my life.

9. I feel weak.

10. I feel fearful.

11. After heavy drinking, I need a drink the next morning to get going. (If you do not

drink mark “never”).

12. I find my work/school satisfying.

13. I am a happy person.

14. I work/study too much.

15. I feel worthless.

16. I am concerned about family troubles.

17. I have an unfulfilling sex life.

18. I feel lonely.

19. I have frequent arguments.

20. I feel loved and wanted.

Validation of OQ45 Scores 9

21. I enjoy my spare time.

22. I have difficulty concentrating.

23. I feel hopeless about the future.

24. I like myself.

25. Disturbing thoughts come into my mind that I can’t get rid of.

26. I feel annoyed by people who criticize my drinking (or drug use). (If not

applicable mark “never”).

27. I have an upset stomach.

28. I am working/studying less well than I used to.

29. My heart pounds too much.

30. I have trouble getting along with friends and close acquaintances.

31. I am satisfied with my life.

32. I have trouble at work/school because of drinking or drug use. (If not applicable

mark “never”).

33. I feel that something bad is going to happen.

34. I have sore muscles.

35. I feel afraid of open spaces, or of driving, or being on buses, subways, etc.

36. I feel nervous.

37. I feel my love relationships are full and complete.

38. I feel that I am not doing well at work/school.

39. I have too many disagreements at work/school.

40. I feel something is wrong with my mind.

41. I have trouble falling asleep or staying asleep.

42. I feel blue.

43. I am satisfied with my relationships with others.

44. I feel angry enough at work/school to do something I might regret.

45. I have headaches.