EBP Exchange - UMB School of Social Work

This 10 page treatise is a succinct and useful summary of compencies for Evidence Based Behavioral Practice (EBBP) developed by the Council for Training in EBBP which the Institute of Medicine identifies as a core copetence for health professionals. The framework identifies three categories of skills:

Assessment skills pertain to the appraisal of clinical and community characteristics, problems, values and expectations, and environmental context. Competency in assessment also applies to the practitioner’s ability to assess in an unbiased manner his or her own level of expertise to implement behavioral techniques and the outcomes of those techniques once implemented.

Communication and collaboration skills entail the ability to convey information clearly and appropriately, and to listen, observe, adjust, and negotiate as appropriate to achieve understanding and agreement on a course of action.

Engagement and intervention skills involve proficiency at motivating interest, constructive involvement, and positive change from individuals, groups, organizations, communities, and others who may be affected by health decisions. Behavioral interventions vary in the degree of training and experience required to deliver them competently.

This is one of the first discussions of EBP, then, that I have seen that identifies collaborative decision making as a key competency. This is, of course, one of the fundamental activities of social workers but it is often left out in the discussion of EBPs, which tend to focus on ESIs and are considered to be the tool that follows decision making about the best ESI for the “case.” It’s a worthwhile read for many reasons, this being one of the foremost.

PDF FIle: ebbp_competencies_mar2008

This presentation was given as part of a more general talk about the importance of field instruction and field instructors in social work during the UM SSW Field instructor’s Appreciation Day.  Following an acknowledgement of the importance of field instruction to social work education and a thank you of field educators, Dean Barth presented an Introduction to Evidence Based Practice . This was followed by a panel coordinated by associate professor Kathryn Collins which also included assistant professors Shelly Wiechelt (UMBC), Debbie Gioia, and Melissa Bellin. Presentations looked at such topics as Demystifying EBP, Evidence Supported Treatments for Children Affected by Trauma and Their Families, Family Centered Care: Evidence-based Practice for Children with Special Health Care Needs, and A Real World Example Exploring the Implementation of EBPs in Community Mental Health: A 2-year Study of Practitioners, and EBP and PBE at UMB SSW. The presentations were followed by discussions and small group exercises.

field-liaison-welcome-2008-short [PowerPoint Presentation from the event] (more…)

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.

 

One of the challenges of keeping practice evidence-informed is the high cost of journal subscriptions, especially in agencies which do not have many resources for such purchases.  Building on work done at the University of Michigan, the University of Maryland School of Social Work has identified some resources that can be used by field instructors from publically available open access settings.  Fortunately a growing number of journals are open access and all articles published with the support of NIH will soon be available–after a 12-month delay–via pubmed central (PMC), http://www.pubmedcentral.nih.gov/. Some journals already deposit their materials in PMC