Evidence-Based Practice: Why RMAP?

Evidence Based Practice Why RMAP? Dr. Leonor Rodriguez Estrada Research & Practice “Irrespective of which profession you seek to enter there is one component of your education that will always appear in whatever course you undertake: research. This is necessarily the case b...

Evidence Based Practice Why RMAP? Dr. Leonor Rodriguez Estrada Research & Practice “Irrespective of which profession you seek to enter there is one component of your education that will always appear in whatever course you undertake: research. This is necessarily the case because no discipline or practice is static: new frontiers are always being opened; the envelope is always being extended; and past and present work must always be evaluated for usefulness for incorporation into new mechanisms, practices and policies in your profession of choice” (Clifford, 2013, p.17)  Finding answers to your professional and practice questions (Kumar, 2019, p.4) Role of Challenge different aspects of your work situation, to question their purpose, relevance and validity, to find their strengths Research and weaknesses (Kumar, 2019, p.4) Research develops this thinking inquisitive perspective in you” (Kumar, 2019, p.4) Applications Applications of Research Administrator Manager Service Provider Consumer Professional Planner 1. What are the needs of the 1. How many people are using the community? 1. Which is the most effective service or product? intervetion for a particular 2. What types of services are problem? 2. Why do some people use this needed by the community? 1. Am I , as a consumer, getting product and not others? value for money? 2. What is the relationship 3. how many service providers are between X and Y? How effective is the needed? service/product? 2. How good are the service 3. How valid is a particular theory 4. What are the training needs of in the present conditions? 4. How can the service be the staff? providers? improved? 4. what is the best way of 5. How many cases can a worker measuring X? 5. How satisfied or dissatisfied are handle in a day? 3. What are the long-term effects you with the product? of the product I am using? Where 5. What is the process through 6. How can the effectiveness of which people decide to adopt a 6.What are the problems with the each worker be evaluated? is the evidence? service/ product? programme? 7. How can the service be more popular? Relationship with research evidence: As researchers Design, conduct, analyse, and report research. Creating the evidence. As systematic reviewers Locate, appraise, and quantitatively (or qualitatively) synthesize research for evidence users. As research consumers Access research evidence, appraise its quality and relevance for their context, and integrate research into their practical decision-making. Characteristic of Research Controlled In real life, many factors impact an outcome or event. In a design study you want to link the cause and the effect and vice versa. In social sciences, however, external factors cannot be controlled, so you quantify them. Rigorous Procedures used to find answers to questions should be relevant, appropriate and justified. Systematic Procedures should follow a logical sequence. Some procedures have specific order. Valid and verifiable Your findings should be verifiable by you and others. Empirical Conclusions drawn are based on hard evidence gathered from information collected from real life experiences and observations. Critical Critical scrutiny of procedures used and methods is crucial. Methods and procedures should be able to withstand critical scrutiny. Psychological Data “Psychological data in general and data measuring clinical constructs specifically, are more often than not problematic” (Field & Wilcox, 2017, p. 21). Usual non-normal patterns e.g. clinical samples. Substantial skew: economic indicators, measure of quality of life, depression, mania and suicidal ideation (Field & Wilcox, 2017, p. 21). Practical consequences: low power, inaccurate confidence intervals, measures of effect sizes that miss important differences (Field & Wilcox, 2017). Possible solutions: Transforming data (e.g., log or square root). Transformations generally do not deal effectively with outliers. Adjusting standard errors (e.g., Bootstrap). Alternative estimators (e.g. standard deviation based trims, idiosyncratic deletion, etc.)  Psychological findings are nearly always in terms of probabilities “ No single method is rather than always best” (Field & absolutes, and are Wilcox, 2017, p. 23). therefore harder to grasp (Radford, 2013). What was Clinical psychology your idea “Yet clinicians already are researchers in the when you sense of hypothesizing that a particular chose treatment combination will have particular effects and testing this hypothesis with the psychology? individual case” (Kazdin, 2008, p.155).  Evidence-based practice Evidence-based practice means professionals seek to apply knowledge from research to improve their work (O’Reilly & Parker, 2014). Clinical decision-making must be anchored in rigorous scientific evidence (Lilienfeld et al., 2013) Why? (Spring, 2007) Quality and accountability. Improve quality of services. Policy. For example, National Institute of Clinical Excellence (NICE), insurance, NHS spend on a particular treatment. Increase the behavioural science evidence base. Address gaps in the research. Transdisciplinary opportunities. Lifelong learning. Replace older practices with better, modern ones.  EBP “three-legged stool” 1. Best available 2. Clinical expertise: 3. Client preferences research on whether clinical judgement and values. and why a treatment and clinical works. experience. Hierarchy of evidence: meta- Clinical skills and past experiences Can shape clinician’s selection of analysis, randomised controlled to identify patient’s health state interventions. trials (RCTs), systematic within- and diagnosis, as well as individual subject designs, quasi experimental risks and benefits of potential studies, correlation and interventions. uncontrolled studies. “…psychotherapy necessarily involves the incorporation of clinical expertise with scientific evidence, as data simply are not available to dictate every decision within a psychotherapy session” (Lilienfeld et al., 2013, p.886). “clinical expertise, including clinical experience, should not generally be granted equal weight to research evidence when making treatment decisions” (Lilienfeld et al., 2013, p.886). In child and adolescent therapy there may well be over 550 treatments in use and the number is growing. The majority of these treatment have never been studied in controlled or uncontrolled trials ( Kazdin, 2008). Knowing critical factors of treatment and the processes through which they operate can optimize therapeutic change. Knowing how therapy works will allow us to optimize the processes critical to change (…) we might be able to use multiple interventions to activate similar mechanisms once we know the mechanisms of change and learn how to optimize their use (Kazdin, 2008, p.152).  Criteria for 1. Outcome differs from no-treatment control or the usual condition. This is shown with statistical significance. deciding if a However, statistical significance does not mean there have treatment is been changes in everyday functioning. Statistical significance is also affected by sample size and variability evidence based within and between subjects (Kazdin, 2008). or empirically supported: 2. Changes on rating scales are difficult to translate into functioning in everyday life (Kazdin, 2008). As a response, indices of clinical significance have been created: a)high scores at pre-treatment fall into normative range of nonclinical samples b) large changes (two standard deviations) are achieved over the course of treatment c) clients no longer meet the criteria for a psychiatric diagnosis.  “Best” research depends on the question being addressed. What is the Etiology or prognosis: longitudinal best research cohort study. evidence? Efficacy and effectiveness of treatment: RCT. (Spring, 2007)  Scientific impotence excuse: tendency to conclude that when scientific findings contradict our beliefs, the science that generated these findings must be flawed. Thinking Naïve realism: erroneous belief that the external world is as we see it. “Seeing is believing”. Critically Placebo effect: improvement because of mere expectation of improvement. Spontaneous remission: diseases (in medicine) improve or resolve on their own. Thinking Critically Regression to the mean: extreme scores become less extreme when re-tested. Effort justification: clients spend time, energy, effort and money in treatment and need a justification for this. Multiple treatment inference: clients receive a combination of treatments and interventions simultaneously. Social desirability: participants attempt to present a public image of respectability (Clifford, 2013).