November 4, Saginaw Max System of Care Faith Based Partnership Initiative

Transcription

1 November 4, 2013 Saginaw Max System of Care Faith Based Partnership Initiative

2 Define Evidence Based Practice

3 No single definition or set of criteria has been used to designate treatments as evidence based. - Alan Kazdin, November 2011 in American Psychologist Terms are used inconsistently in research and daily practice Additional confusion is generated from evidence-based interventions and modalities that aren t treatment Different disciplines and settings (e.g. mental health, criminal justice, prevention, schools) have different objectives for evidence Research is advancing so rapidly that even if a single definition were agreed upon to create a master list, the list would seldom be up-to-date

4 According to the American Psychological Association s Policy Statement on Evidence-Based Practice in Psychology (2005), Evidence-Based Practice is the integration of: 1. Best research evidence, 2. With clinical expertise, 3. In the context of patient characteristics, culture, and preferences.

5 Are decision-making processes by which treatment decisions are made. Are not one-size-fits all. Consider how to apply ALL best-known research to the care of the individual.

6 Interventions that have achieved statistically significant results in replicated randomized controlled trials (RCT s) Manualized interventions for specific disorders and populations that have been shown to be effective through controlled research. When used in practice EBT s replicate RCT s ( manualized ) precisely ( with fidelity ) for individuals who match characteristics of the population that participated in the RCT s

7 Dialectical Behavioral Therapy (DBT) Functional Family Therapy (FFT) Motivational Interviewing (MI) Multidimensional Treatment Foster Care (MTFC) Multisystemic Therapy (MST) Parent Management Training (PMT/PMTO)

8 They offer a tried and true format for achieving desired outcomes They have demonstrated both that they help achieve desired outcomes and can be reproduced outside of a laboratory They provide accountability In short, we know that they work and they work relatively quickly. Even though implementation is often expensive, they are typically cost-effective compared to treatment-as-usual.

9 Anything less than providing people with the most effective methods relevant to their situation is harmful by: unnecessarily prolonging problems creating more associated effects of the problems wasting time, energy, and money Using non-evidenced based assessments can have damaging effects. In more extreme cases there are ineffective and even harmful interventions.

10 Scared straight programs Developed 1970s Over 30 states and several foreign countries created, mandated, or legislated similar programs Controlled studies indicated 1 to 30% negative effects Schizophrenogenic mother A schizophrenic is always one who is reared by a woman who suffers from a perversion of the maternal instinct. Confrontation in substance abuse treatment Poor retention rates Treatment studies indicate no better than no treatment Group Therapy for Delinquents Peers were found to be more influential than adults. Significant numbers of youth exhibit worse behavior after treatment. Peer aggregation during early adolescence inadvertently reinforces problem behavior. - Dishion, McCord, Poulin (1999) from Walking the Talk, Date and Wale (2006)

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13 Leman Books The Birth Order Book Sheet Music Making Children Mind without Losing Yours Sex Begins in the Kitchen 7 Things He'll Never Tell You... But You Need to Know What Your Childhood Memories Say About You Running the Rapids What a Difference a Daddy Makes The Way of the Shepherd (written with William Pentak) Home Court Advantage Becoming the Parent God Wants You to Be Becoming a Couple of Promise A Chicken's Guide to Talking Turkey with Your Kids about Sex (with Kathy Flores Bell) First-Time Mom Keeping Your Family Strong in a World Gone Wrong Step-parenting 101 The Perfect Match Be Your Own Shrink Say Good-bye to Stress Single Parenting That Works When Your Best Isn't Good Enough Pleasers Have a New Kid by Friday: How to Change Your Child's Attitude, Behavior & Character in 5 Days Kazdin Publications Kazdin s approximately 700 publications include 48 books that focus on interventions for children and adolescents, cognitive-behavioral treatment, parenting and child rearing, interpersonal violence, and methodology and research design. In addition to his own published work, Kazdin has been editor of six journals: Behavior Therapy ( ), Journal of Consulting and Clinical Psychology ( ), Psychological Assessment ( ), Clinical Psychology: Science and Practice ( ), Current Directions in Psychological Science ( ), and Clinical Psychological Science (since 2012). He was editor-in-chief of the eight-volume Encyclopedia of Psychology (2000, APA/Oxford University). Also, he has edited two book series: Developmental Clinical Psychology and Psychiatry (Sage Publications, ) and Current Perspectives in Psychology (Yale University Press, ), and co-edited a book series Advances in Clinical Child Psychology (with Benjamin Lahey, ).

14 It s Not Just for Nerds

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16 1. Decide what the objectives are 2. Choose a program that provides evidence that it can meet the objectives 3. Provide training and support so the program can be delivered the same way by anyone at any time 4. Implement the program and check to make sure it looks the same in reality as planned 5. Measure progress toward the objectives 6. Share and use the results

17 1. Decide what the objectives are 2. Choose a program that provides evidence that it can meet the objectives 3. Provide training and support so the program can be delivered the same way by anyone at any time 4. Implement the program and check to make sure it looks the same in reality as planned 5. Measure progress toward the objectives 6. Share and use the results

18 Best Research Evidence Clinical Expertise Patient Characteristics, Culture, and Preferences

19 Need to be MEASURABLE

20 Based on Haynes, Devereaux &Guyantt (2002) State and circumstances Clinical Expertise Individual s characteristics, preferences and actions Research evidence

21 1. Decide what the objectives are 2. Choose a program that provides evidence that it can meet the objectives 3. Provide training and support so the program can be delivered the same way by anyone at any time 4. Implement the program and check to make sure it looks the same in reality as planned 5. Measure progress toward the objectives 6. Share and use the results

22 Measuring what you intended to measure

23 The boot camp facility significantly reduced anxiety for Native American youth. Gover, Angela R. Native American Ethnicity and Childhood Maltreatment as Variables in Perceptions and Adjustments to Boot Camp vs. "Traditional" Correctional Settings. Journal of Offender Rehabilitation Vol 40(3-4) (2005): Overall, from the perspective of the juveniles, boot camps appear to provide a more positive environment conducive to effective rehabilitation considering almost all of the conditions measured. Styve, Gaylene J., MacKenzie, Doris Layton, Gover, Angela R., Mitchell, Ojmarrh Perceived conditions of confinement: A national evaluation of juvenile boot camps and traditional facilities. Law and Human Behavior Vol 24(3) (Jun 2000): Results of the evaluation revealed that although the program had a relatively small impact on recidivism, perceptions garnered from parents, teachers, and STAR participants were quite favorable for the program overall. Trulson, Chad, Triplett, Ruth, Snell, Clete Social control in a school setting: Evaluating a school-based boot camp. Crime & Delinquency Vol 47(4) (Oct 2001):

24 1. Decide what the objectives are 2. Choose a program that provides evidence that it can meet the objectives 3. Provide training and support so the program can be delivered the same way by anyone at any time 4. Implement the program and check to make sure it looks the same in reality as planned 5. Measure progress toward the objectives 6. Share and use the results

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26 Let s try this What percentage of the time do children without behavioral problems comply with adult requests without arguing or needing to be reminded?

27 1. Decide what the objectives are 2. Choose a program that provides evidence that it can meet the objectives 3. Provide training and support so the program can be delivered the same way by anyone at any time 4. Implement the program and check to make sure it looks the same in reality as planned 5. Measure progress toward the objectives 6. Share and use the results

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29 Fidelity to either the EBT or to the plan outlined at the beginning of treatment of how best science will be applied. Without fidelity, when expected outcomes aren t achieved we don t know if it s because we did the treatment wrong OR because we used the wrong treatment.

30 1. Decide what the objectives are 2. Choose a program that provides evidence that it can meet the objectives 3. Provide training and support so the program can be delivered the same way by anyone at any time 4. Implement the program and check to make sure it looks the same in reality as planned 5. Measure progress toward the objectives 6. Share and use the results

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32 Measuring progress toward the objectives Outcome measures need to be both reliable and valid The best programs measure outcomes not as autopsy reports but as health check-ups

33 1. Decide what the objectives are 2. Choose a program that provides evidence that it can meet the objectives 3. Provide training and support so the program can be delivered the same way by anyone at any time 4. Implement the program and check to make sure it looks the same in reality as planned 5. Measure progress toward the objectives 6. Share and use the results

34 Where Data Often Goes in Organizations

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37 Each stakeholder likely will want different things from the data Identify what will be useful for each Determine how we will share information Create flowchart to detail continuous flow of data information no black holes or falling off a cliff! 37

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39 Program discourages interventions and decisions based primarily on "common sense" or past experience. Program stays current with scientific research and makes program changes if research shows previous practices to be ineffective or obsolete. Interventions are chosen to deliberately impact desired goals. Outcomes are systematically collected and reviewed as part of a quality improvement cycle from Walking the Talk, Date and Wale (2006)

40 All interventions are based on current scientific evidence. Program can explain to all stakeholders the reasons for choosing an intervention and expected outcomes based on known data. If no known data is available to address target goals, program is developed around scientific theories and includes methods for careful assessment of outcomes. Program interventionists support each other in applying scientific methods to practice and are scientifically skeptical when introduced to a new method. from Walking the Talk, Date and Wale (2006)

41 What evidence do you have that this is a good intervention for me and my situation? Where could I get more information about the intervention? Have you used this intervention before? What were the results? How will we be measuring our outcomes? What kind of outcomes should I expect?

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43 The more that behaviors are reinforced in natural settings or as closely simulated to natural settings as possible, the more likely the behavior is to occur across settings or to generalize. Parent involvement It s much easier to learn what TO do than what NOT to do. The more attention given to a behavior, the more likely the behavior will occur again. So Catch Them Being Good!

44 Minutes of Good Behavior Attention

45 Bad Behavior

46 Questions? Heidi Wale, MS, LLP