Evidence-based practice in psychology: perceptions of graduate students in scientist-practitioner programs

The evidence-based practice movement in psychology (EBPP) is a relatively recent initiative to improve client care by integrating the best available research evidence with clinicians' expertise in the context of patient values and preferences. As this movement gains momentum in the field of psychology, training programs will likely need to modify their curricula to include training in the process of EBPP. An online survey was conducted of clinical psychology graduate students in programs that identified themselves as having a scientist-practitioner or clinical science model (N = 1,195). Understanding of, experiences with, attitudes towards, and training in EBPP was assessed. Students had a generally favorable view of psychology's move toward EBPP. Although students reported a moderate amount of exposure to and experiences with EBPP, misunderstandings about the principles of EBPP were prevalent. Compared to students planning primarily clinical practice careers, students planning primarily clinical research careers were more favorable towards EBPP, expected EBPP to be more influential in their future careers, and were more likely to use research, but less likely to use client preferences to guide treatment planning. Recommendations for modifying training programs to promote EBPP are discussed.     

Autism Spectrum Disorder and Evidence‐Based Practice in Psychology

The article discusses current empirical evidence, also identifying gaps and areas for future research, for the three critical elements of evidence‐based practice in psychology (EBPP) (evidence‐based practice; client characteristics, preferences, and culture; and clinical expertise) as applied to autism spectrum disorder (ASD). We contrast EBPP to a pure EBP approach, outline issues in specifying criteria and sources for defining EBP, and identify gaps in the evidence base (e.g., treatments for adults with ASD). We review the impact on treatment of specific client characteristics (client age, ASD severity, intellectual and language ability, diagnostic comorbidity, cultural/family factors) and outline critical issues affecting clinical expertise and decision making when choosing and adapting treatments. Implications for policy, training, and research are discussed.     

Evidence-based practice in psychology

Evidence-based practice is a growing topic of interest in the field of psychology. In 2006, the American Psychological Association (APA) developed a formal policy statement on evidence-based practice in psychology (EBPP). It is now important for the profession to come to a better understanding about what EBPP is (and is not), and to develop a skill set associated with EBPP. The next seven articles explore the history of EBPP, elaborate the definition and present uses of the term, and provide information relevant to the skill set regarding a practice consistent with the evidence-based approach. Many of the articles were derived from the 2007 midwinter meeting of the Council of University Directors of Clinical Psychology, where the program topic was "Evidence-based Practice: What it is, Why It's Important, and What you Need to Know."     

Evidence-based practice in psychology: implications for research and research training

In this article, the author discusses the implications of evidence-based practice (EBP) for research and research training in clinical psychology. It is argued that EBP provides a useful framework for addressing some heretofore ignored problems in clinical research. Advancing evidence-based psychological practice will require educators to inject significant new content into research, design, and methodology courses and to further integrate research and practicum training. The author believes this to be an exciting opportunity for the field, not only because it will further psychologists' integration into the interdisciplinary health care and research environment, but also because it will provide new tools to educate students for capable, not just competent professional activity.     

Implementing elements of evidence-based practice into scientist-practitioner training at the University of Nebraska-Lincoln

Evidence-based practice (EBP) has become the predominant model of training and is emerging as a common model of practice for many non-psychology health care professions. Recognizing the relevance of EBP to psychology, the American Psychological Association (APA) developed and endorsed an official policy statement on EBP for the practice of professional psychology. There is now a pressing need to consider ways that EBP can inform scientist-practitioner training. The present article proposes clinical competencies associated with the practice of EBP, and describes initial efforts to implement elements of EBP into training at the University of Nebraska-Lincoln. These efforts have occurred in both the classroom and practicum training experiences, and are geared toward helping students become more effective users of the evidence base through their clinical work. Challenges to the implementation of EBP in clinical psychology training are discussed as well.     

Multicultural competence and evidence-based practice in group therapy

The multicultural competence (MC) and evidence-based practice (EBP) initiatives have each generated healthy debates in the mental health field, with ample implications for clinical training and practice. Using two case illustrations, we highlight practical challenges and prospects in the intersection of MC and EBP. To facilitate complementary practice of MC and EBP, we offer strategies for the group therapist as a "local clinical scientist" to deliver culturally responsive treatments. We stress the importance of cultural adaptation of EBP models, namely, modifying evidence-based interventions that involve changes in service delivery, in the nature of the therapeutic relationship, or in components of the treatment itself to accommodate the cultural beliefs and behaviors of racial-cultural minority clients. Cultural adaptation of EBP in group therapy needs to be grounded in developmental contextualism and social justice. We discuss the two cases with an eye toward advancing multicultural competence in group therapy.     

Novel tools and resources for evidence-based practice in psychology

Given the vast proliferation of scientific research in the behavioral and social sciences, there is a growing need for psychologists to be able to access the most current, clinically relevant research quickly and efficiently and integrate this information into patient care. In response to a similar need within the field of medicine, evidence-based medicine took hold in the early 1990s to provide both a framework and set of skills for translating research into practice. Since then, this method has been adopted by every major health care profession including psychology, and is now widely known as evidence-based practice (EBP). In this article, the authors present a general overview of the skills required for EBP along with an introduction to some of the tools and resources that have been developed in other health care professions to support EBP. Using a case example, we illustrate how these tools and resources can be applied in psychological settings.     

Advancing the Scientific Foundation for Evidence-Based Practice in Clinical Child and Adolescent Psychology

Evidence-based practice (EBP) has become a central focus in clinical child and adolescent psychology. As originally defined, EBP in psychology is the integration of the best available research evidence, patient characteristics, and clinical expertise. Although evidence-based perspectives have garnered widespread acceptance in recent years, there has also been some confusion and disagreement about the 3-part definition of EBP, particularly the role of research. In this article, we first provide a brief review of the development of EBP in clinical child and adolescent psychology. Next, we outline the following 4 points to help clarify the understanding of EBP: (a) knowledge should not be confused with epistemic processes, (b) research on clinician and client factors is needed for EBP, (c) research on assessment is needed for EBP, and (d) the 3-part conceptualization of EBP can serve as a useful framework to guide research. Based on these principles, we put forth a slightly revised conceptualization of EBP, in which the role of research is expanded and more clearly operationalized. Finally, based on our review of the literature, we offer illustrative examples of specific directions for future research to advance the evidence base for EBP in clinical child and adolescent psychology.     

Effectiveness of the tailored EBP training program for Filipino physiotherapists: A randomised controlled trial

Background  

Evidence implementation continues to challenge health professionals most especially those from developing countries. Filipino physiotherapists represent a group of health professionals in a developing country who by tradition and historical practice, take direction from a doctor, on treatment options. Lack of autonomy in decision-making challenges their capacity to deliver evidence-based care. However, this scenario should not limit them from updating and up-skilling themselves on evidence- based practice (EBP). EBP training tailored to their needs and practice was developed to address this gap. This study will be conducted to assess the effectiveness of a tailored EBP-training program for Filipino physiotherapists, in improving knowledge, skills, attitudes and behaviour to EBP. Participation in this program aims to improve capacity to EBP and engage with referring doctors to determine the most effective treatments for their patients.     

Barriers and facilitators of evidence-based practice perceived by behavioral science health professionals

Progress in implementing evidence-based behavioral practices has been slow. A qualitative study was performed to characterize the major facilitators and barriers to evidence-based practice (EBP) perceived by behavioral professionals. Members of professional e-mail listservs were queried and 84 barriers and 48 facilitators were nominated by 37 respondents. Thematic analysis revealed seven themes to describe both barriers and facilitators: (a) training, (b) attitudes, (c) consumer demand, (d) logistical considerations, (e) institutional support, (f) policy, and (g) evidence. Most frequently cited barriers included negative attitudes about EBP and lack of training. Barriers also reflected confusion between EBP and the products of EBP (i.e., empirically supported treatments [ESTs]). Main facilitators included a growing evidence base. Results suggest that uptake of EBP may be facilitated by education and training.     

Evidence-based practice in clinical psychology: what it is, why it matters; what you need to know

The history and meaning of evidence-based practice (EBP) in the health disciplines was described to the Council of University Directors of Clinical Psychology (CUDCP) training programs. Evidence-based practice designates a process of clinical decision-making that integrates research evidence, clinical expertise, and patient preferences and characteristics. Evidence-based practice is a transdisciplinary, idiographic approach that promotes lifelong learning. Empirically supported treatments (ESTs) are an important component of EBP, but EBP cannot be reduced to ESTs. Psychologists need additional skills to act as creators, synthesizers, and consumers of research evidence, who act within their scope of clinical expertise and engage patients in shared decision-making. Training needs are identified in the areas of clinical trial methodology and reporting, systematic reviews, search strategies, measuring patient preferences, and acquisition of clinical skills to perform ESTs.     

Integrating information technology into the evidence-based practice of psychology

Information technology (IT) is increasingly being used to facilitate, complement, and support the implementation of evidence-based practices (EBP) in psychology. This article reviews recent randomised trials that evaluate the integration of IT applications into the process of delivering EBP. More specifically, we review 11 studies that illustrate how IT has been successfully integrated into traditional clinician-delivered psychotherapy to promote the adoption of EBP. Advantages and disadvantages of this approach are discussed. The paper concludes with practical recommendations for clinicians who are interested in integrating IT into their practice.     

Treating chronic migraine headaches: an evidence-based practice approach

Psychologists and other mental health care professionals are generally trained to incorporate empirical evidence into clinical practice, but few have been taught formal techniques for doing so. Given the rapidity of progress in the clinical sciences, there is a growing need among practitioners to access current, clinically relevant research and have strategies for integrating these research findings into the clinic. In the field of medicine, evidence-based medicine took hold in the early 1990s to provide a framework and skill set for translating research into practice. This method is now widely known as evidence-based practice (EBP) to reflect its applicability to multiple disciplines. In this article, we present a general overview of EBP, illustrate how we used this approach to develop a treatment plan for a patient who had chronic migraine headaches, and discuss some of the opportunities and challenges EBP presents to mental health professionals.     

Overcoming barriers to implementation of evidence-based practice concepts in athletic training education: perceptions of select educators

Context:

The need to include evidence-based practice (EBP) concepts in entry-level athletic training education is evident as the profession transitions toward using evidence to inform clinical decision making.

Objective:

To evaluate athletic training educators'' experience with implementation of EBP concepts in Commission on Accreditation of Athletic Training Education (CAATE)-accredited entry-level athletic training education programs in reference to educational barriers and strategies for overcoming these barriers.

Design:

Qualitative interviews of emergent design with grounded theory.

Setting:

Undergraduate CAATE-accredited athletic training education programs.

Patients or Other Participants:

Eleven educators (3 men, 8 women). The average number of years teaching was 14.73 ± 7.06.

Data Collection and Analysis:

Interviews were conducted to evaluate perceived barriers and strategies for overcoming these barriers to implementation of evidence-based concepts in the curriculum. Interviews were explored qualitatively through open and axial coding. Established themes and categories were triangulated and member checked to determine trustworthiness.

Results:

Educators identified 3 categories of need for EBP instruction: respect for the athletic training profession, use of EBP as part of the decision-making toolbox, and third-party reimbursement. Barriers to incorporating EBP concepts included time, role strain, knowledge, and the gap between clinical and educational practices. Suggested strategies for surmounting barriers included identifying a starting point for inclusion and approaching inclusion from a faculty perspective.

Conclusions:

Educators must transition toward instruction of EBP, regardless of barriers present in their academic programs, in order to maintain progress with other health professions'' clinical practices and educational standards. Because today''s students are tomorrow''s clinicians, we need to include EBP concepts in entry-level education to promote critical thinking, inspire potential research interest, and further develop the available body of knowledge in our growing clinical practice.     

Why many clinical psychologists are resistant to evidence-based practice: Root causes and constructive remedies

Psychotherapists are taught that when a client expresses resistance repeatedly, they must understand and address its underlying sources. Yet proponents of evidence-based practice (EBP) have routinely ignored the root causes of many clinical psychologists' reservations concerning the use of scientific evidence to inform clinical practice. As a consequence, much of the resistance to EBP persists, potentially widening the already large scientist–practitioner gap. Following a review of survey data on psychologists' attitudes toward EBP, we examine six sources underpinning resistance toward EBP in clinical psychology and allied domains: (a) naïve realism, which can lead clinicians to conclude erroneously that client change is due to an intervention itself rather than to a host of competing explanations; (b) deep-seated misconceptions regarding human nature (e.g., mistaken beliefs regarding the causal primacy of early experiences) that can hinder the adoption of evidence-based treatments; (c) statistical misunderstandings regarding the application of group probabilities to individuals; (d) erroneous apportioning of the burden of proof on skeptics rather than proponents of untested therapies; (e) widespread mischaracterizations of what EBP entails; and (f) pragmatic, educational, and attitudinal obstacles, such as the discomfort of many practitioners with evaluating the increasingly technical psychotherapy outcome literature. We advance educational proposals for articulating the importance of EBP to the forthcoming generation of clinical practitioners and researchers, and constructive remedies for addressing clinical psychologists' objections to EBP.     

Examination of the analytic quality of behavioral health randomized clinical trials

Adoption of evidence-based practice (EBP) policy has implications for clinicians and researchers alike. In fields that have already adopted EBP, evidence-based practice guidelines derive from systematic reviews of research evidence. Ultimately, such guidelines serve as tools used by practitioners. Systematic reviews of treatment efficacy and effectiveness reserve their strongest endorsements for treatments that are supported by high-quality randomized clinical trials (RCTs). It is unknown how well RCTs reported in behavioral science journals fare compared to quality standards set forth in fields that pioneered the evidence-based movement. We compared analytic quality features of all behavioral health RCTs (n = 73) published in three leading behavioral journals and two leading medical journals between January 2000 and July 2003. A behavioral health trial was operationalized as one employing a behavioral treatment modality to prevent or treat an acute or chronic physical disease or condition. Findings revealed areas of weakness in analytic aspects of the behavioral health RCTs reported in both sets of journals. Weaknesses were more pronounced in behavioral journals. The authors offer recommendations for improving the analytic quality of behavioral health RCTs to ensure that evidence about behavioral treatments is highly weighted in systematic reviews.     

Principles for Training in Evidence‐Based Psychology: Recommendations for the Graduate Curricula in Clinical Psychology

We argue that the evidence‐based practice (EBP) model represents an evolution in integrating science and practice and synchronizes well with broader trends in health care. Because the curriculum for EBP training involves explicit emphasis on the best empirical evidence within Clinical Psychology, it can be utilized by all programs, irrespective of theoretical orientation or training mission. We articulate four principles that speak to core training and foundational clinical supervision, to guide training using an EBP model. These principles can be integrated within the larger rubric of a program and can encourage more consistent curricular reliance on EBP. This approach to doctoral training could lead to greater consistency across training programs and bring science and practice closer together within Clinical Psychology.     

Overcoming our resistances to "doing" evidence-based group practice: a commentary

This commentary focuses on how the articles in the group therapy issue of the Journal of Clinical Psychology: In Session can address the resistances that many group practitioners exhibit to "doing" evidence-based practice (EBP). The articles attempt to overcome the resistances to practicing evidence-based group therapy through a process of education and skills training. A major issue cutting across the articles is the narrow focus of incorporating empirical findings only from studies specifically examining psychotherapy groups. The author argues that incorporating research from the whole field of group dynamics research can increase the empirical basis for evidence-based practice.     

Commentary: Organizational Culture and Practice Epistemologies

Hemmelgarn, Glisson, and James (2006) provide an excellent review of the impact of organizational culture and climate for the implementation of evidence-based practice (EBP) models within social and mental health services systems. As their article makes clear, the implementation process should address the organizational context, and effectiveness and services research should consider organizational factors in outcome and EBP transport research. This commentary extends discussion of one aspect of organizational culture—the extent to which organizations are driven by an empirical scientific epistemology—and how this may contribute to establishing a context for EBP design, selection, implementation, and sustained evolution in field settings.