mhs6069_m12_lecture

MHS6069 Child and Adolescent Behavioral Health Cathy Sowell, LCSW

Evidence-based practice in context

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Index

Facilitative Inhibitating Factors

9.

Overview

1.

Attitudes of Providers

10.

Model of Evidence Based Research

2.

Complex Needs

11.

Specificity of Disorders

3.

Characteristics of Usual Practice

12.

Efficacy Research

4.

Organizational Factors

13.

Criticisim of EBPs

5.

Resource Availability

14.

Delays in Treatment

6.

Common Pratice Elements

15.

Fidelity of Practice

7.

16.

Benefits and Concerns of Common Practice Approach

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Assessment of Contexts

8.

17.

Summary

Overview

• Explore evidence-based practice and its application across the behavioral health care continuum.
• Review factors aiding and hindering effective use, along with evidence-based interventions for children and adolescents.

Model of Evidence-Based Research

Evidence-based interventions are couched within a broader evidence-based practice movement.

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The Institute of Medicine defines evidence-based practice as the integration of best research evidence with clinical expertise and patient values, characteristics, culture, and preferences to achieve optimum care.

Definition: Evidence-Based Interventions

The goal of the movement was that “clinical decisions would be supported by accurate, timely, and up-to-date clinical information, reflecting the best available evidence”.

Specificity of Disorders

• Research shows effectiveness of interventions for psychosocial concerns in children/adolescents.
• Evidence-based literature focuses on treating well-defined disorders.
• Youth psychosocial problems often categorized as externalizing/internalizing, substance use, suicidality, traumatic stress.

Efficacy Research

• Some interventions, like CBT and Psychodynamic Therapy, show efficacy across multiple disorders.
• Multisystemic Therapy is effective for substance use and behavioral challenges.
• DBT is promising for addressing trauma-related issues like suicidality, substance use, and mood disorders.

Criticism of EBPs

• Increased use of Evidence-Based Practices (EBPs) in children's services agencies.
• Criticisms from providers, resistance from researchers and policymakers.

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Practitioner Perspective of EBPs

Implementation Science

• Research explores adaptation of intervention models by practitioners in practice settings.
• Modifications made due to varying characteristics, needs of clients, and contextual differences.

Fidelity of Practice

• Recent emphasis on high-fidelity implementation for interventions.
• The question arises: Can manualized treatments, implemented with high fidelity, achieve outcomes comparable to controlled clinical trials?
• Research shows therapies can be successful in community settings, but process evaluation highlights challenges and costs.

Assessment of Contexts

• Research involves assessing communities and service settings, and adjusting implementation to match context.
• Approach extends beyond individual-provider interactions to interactions within and across service systems.
• Programs for broad adoption require structured needs assessments, stakeholder partnerships, community engagement, and strategic planning for responsiveness and flexibility.

Facilitative or Inhibiting Factors

• Factors influencing EBP implementation: provider attitudes, population characteristics, usual practice, organizational factors, resource availability.
• Difficulty achieving fidelity to treatment model highlights need for integrative approach to implementation.
• Integrative approach beneficial for applying evidence in practice amidst various influencing factors.

• The prefrontal cortex, responsible for behavioral control, is immature in adolescents, leading to limited ability to inhibit impulsive, pleasure-seeking behaviors and engage in logical reasoning.

Attitudes of Providers

• Service providers' attitudes crucial to successful implementation of evidence-based interventions.
• Efficacious treatments in research settings may not be perceived as practical in real-world settings.
• Practitioner attitudes vary based on treatment nature, organizational context, clinician experiences/preferences; skepticism towards highly structured programs.

Complex Needs

• Practices often developed and tested with homogeneous populations, leading to perceived limited appropriateness for families with complex needs.
• Decision-makers must understand circumstances for adapting interventions to match specific child/family needs.

Characteristics of Usual Practice

• Characteristics of usual practice influence implementation success.
• Service settings valuing provider freedom, autonomy, and eclecticism may resist manualized models.
• Organizational cultures endorsing person-centered approaches may resist prescriptive practices.
• A good fit between new treatment model and current practice can lead to successful adoption and implementation.

Organizational Factors

The key organizational factors that have received the most attention are organizational culture, organizational climate, mission and philosophy of the organization, leadership, and network connectedness.

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Organizational Climate

Resource Availablity

• Effective implementation requires extensive training and ongoing support for practitioners.
• Sustaining implementation necessitates adequate funding, resources, incentives, staffing, administrative support, and organizational changes.

Common Practice Elements

• Strategy: Focus on effective practice elements across interventions rather than specific treatment models.
• Emphasize core/common practice elements for flexibility and effectiveness.
• Effective strategies applicable across various conditions, irrespective of intervention model.

Common effective strategies, applicable across various conditions and intervention models, prioritize:

• Problem-Solving Skills
• Connection Between Thoughts, Feelings, and Behavior
• Self or Parent Behavior Monitoring and Reward
• Future Planning

• Building a Working Alliance, Rapport or Relationship
• Providing Psychoeducation
• Cognitive Restructuring
• Treatment Goal Discussion and Consensus

Common Practice Elements Approach

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Benefits of Common Practice Elements Approach

Concerns About Common Practice Approach

Whether we are utilizing an evidence-based strategy or specific evidence-based intervention approach, best practice involves the integration of the best available evidence with clinical expertise and individual community context and needs.

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Definition of Evidence-Based Interventions

One of the most common models describes simply “discrete treatments for particular disorders that are supported by empirical evidence.”

A significantly looser application of the term would refer to “treatments supported by empirical evidence” or “interventions showing beneficial effects in outcome research.”

Benefits of Common Practice Elements Approach

• Common practice elements approach allows for varied use in evidence-based treatments across diverse concerns, stages, age groups, and cultural contexts.
• Providers gain flexibility to identify effective strategies tailored to specific individuals, families, or groups based on successful treatment frequencies and matching variables.
• Adaptability may alleviate barriers to EBP implementation, including provider attitudes and complex client characteristics.

Organizational Climate

• Positive organizational climate linked to positive outcomes for children and families.
• Fit between organizational mission and intervention goals is crucial.
• Leadership associated with provider attitudes towards evidence-based treatment; commitment and preparedness important.

Practitioner Perspective on EBPs

• Critics argue EBP model is too narrow, and undervalues clinician expertise and client preferences.
• Advocates for integrated approach: research, practical wisdom, individualized care.

Concerns About Common Practice Approach

• Limitation of practice elements approach: Breaking down treatment protocols may compromise effectiveness; doesn't address sequencing.
• Specific strategies may not cover process factors like frequency, duration, assessment protocols, and provider training.
• Importance of integrating therapeutic content, techniques, and effective program characteristics for a comprehensive approach.