EBP Exchange – UMB School of Social Work

For those of you who find that listening to a presentation makes the results more memorable than reading, I recommend Steve Ondersma’s two part video on substance abuse and child welfare research. Steve is a find scholar in this area and has clear slides and an engaging presentation style. He discusses a number of intriguing issues including the influence of: length of treatment, multi-problem treatment vs. single focused treatment; the size of benefit from treatment; the impact of pre-natal drug exposure on infants (results up through 8 years), motivational interviewing; and methamphetamines and treatment.  This is not a video that shows practice methods but it is a very good review by a scholar who has long been interested in the issue and is a good scientist (Steve is the Editor-in-Chief of Child Maltreatment).

http://www.researchchannel.org/prog/displayseries.aspx?fID=5431

This 76 page, 2008 report of the American Psychological Association Task Force on Evidence Based Practice is an update of an earlier paper and worth the reading–even if you have seen the earlier version.  This version sticks with the earlier defnitiion that EBP is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, adn preferences, also as per Sacket’s classic IOM definition.  They use the term Evidence Based Practice to refer to the entire enterprise of applying science to practice (see definition above) and uses the term Evidence Based Treatments (EBT) to refer to specific interventions. They don’t make decisions about which EBTs have strong enough evidence to justify the title but do refer the readers to many websites that have their own criteria for doing so.  They do endeavor to include a developmental framework. They discuss a concept that was not familiar to me, “Response to Intervention (RtI).  I quote at lengthe, here, from page 31,

The basic feature of an

RtI approach is the use of evidence-based interventions

implemented in a multitiered model of services, using

student outcomes in learning and behavior domains to make decisions about the need for subsequent and more intense interventions, including special education (National Association of State Directors of Special Education, 2005). Interventions used in this model have included both academic (e.g., direct instruction, peer-assisted learning strategies) and, less often, behavioral domains (e.g., second step, multisystemic family therapy). RtI as a model of mental health and educational services is the first federallyrecommended wide-scale preventive approach implemented in schools. Schools can serve students demonstrating early signs of learning problems and behavioral concerns without a designation of “special education” and with evidence-based prevention adn intervention”.  They do this while acknowledging that RtI does not have exensive research support, if underfunded, and not well integrated into general education!  So, this is truly a “promising practice” at best but one that the authors couldn’t help touting.

One other positive feature of this document is that they look at evidence based assessments which is an advance because we often think of assessments as something other than interventions but they are a key part of interventions and unless they are psychometrically sound they should be avoided as a waste of time and resources for clinicians and children, youth, and families.  They also provide a short discussion of evidence based treatment components including engagement components. THe final content is on dissemination and uptake and what we need to know about how information from research can best be transformed into practice changes.  A well-written, solid, hardly groundbreaking review, in all.  The pdf is below

http://www.apa.org/pi/cyf/evidencerpt.pdf

The Office of Juvenile Justice and Delinquency Prevention recently released a review of findings that bear on the question of what happens to youth who have been caught up in the recent movement to sentence them to adult courts–ostensibly when they commit very serious crimes. The legislation that supports or requires these transfers, in many states, was intended to be a deterrent to such crimes and to reduce the recidivism rate. Although most states did not build evaluations into their legislation there have been a range of efforts to clarify whether the youth have had lower recidivism rates after arrest and transfer to adult court and confinement.  The results do not follow the predictions of the legislators who and administrations that signed them into law.  Basically, the studies show that transfer increases the likelihood of reoffending and  of rearrest.  The reasons are less clear but interviews with youth suggest that, in part, this is because some youth who remained in the juvenile services sector–often following crimes that were no more severe than those of their peers who were transfered to adult courts and incarceration–do not receive any educational or employment training. It also appears that this may result from their exposure to hardening conditions that make them less amenable to reintegration into society.  We clearly don’t have definitive answers but it’s a good read.  http://www.ncjrs.gov/pdffiles1/ojjdp/220595.pdf

NIMH’s strategic plan is out and although it largely addresses research that needs to be done there are also important portions of this 39 page document that direct attention to issues related to evidence based practices. In one pithy section, NIMH Director Tom Insel indicates that research will be directed at the 4 Ps of research: “increasing the capacity to Predict who is at risk for developing disease; developing interventions that Preempt (or interrupt) the disease process; using knowledge about individual biological, environmental, and social factors for Personalized interventions; and ensuring that clinical research involves Participation by the diversity of persons involved in health care. (p. ii).  This presages much about the report with regard to the idea of developing personalized approaches that use genetic assessments and and psychometric developments to determine the best course of treatment for individuals. There is also a very brief but fascinating discusison of what they expect to happen with regard to the treatment of PTSD–treatments involving behavioral interventions and medical treatments that appear to be able to substantially reduce fearful responses.  If you are interested in the future of mental health research and treatment this is a good glimpse into the NIMH’s direction