PSYCHOLOGY 9230: SEMINAR IN ADVANCED APPROACHES TO PSYCHOLOGICAL INTERVENTIONS: CHILD CLINICAL AND P

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PSYCHOLOGY 9230 SEMINAR IN ADVANCED APPROACHES
TO PSYCHOLOGICAL INTERVENTIONSCHILD CLINICAL
AND PEDIATRIC PSYCHOLOGY

• Lisa Armisted and Lindsey Cohen

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Introductions

• Go around the room, introduce yourself (name,
  year in program), and describe your experiences
  with child clinical and pediatric psychology
  therapy

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Syllabus review
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Evidence-based practice in psychology (EBPP)
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Evidence-based Practice in Psychology
EST vs. Clinical Expertise
EBP in Medical Fields
Public Policy/ Reimbursement
Quality and Accountability
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APA Policy Statement on Evidence-Based Practice
in Psychology (2005)

• Evidence-based practice in psychology is the
  integration of the best available research with
  clinical expertise in the context of patient
  characteristics, culture, and preferences.

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APA Policy Statement on Evidence-Based Practice
in Psychology (2005)

• Evidence-based practice in psychology is the
  integration of the best available research with
  clinical expertise in the context of patient
  characteristics, culture, and preferences.

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The EBP Model- The 3-Legged Stool
Best available research evidence
EBP
Patient preferences and values
Clinical expertise
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Continuum of care

• Nomothetic (decisions based on disorders,
  guidelines, treatment manuals, ESTs)
  
• Evidence-based practice
• Idiographic (decisions based on individual
  patients and circumstances)

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The EBP Model Best Available Research Evidence
Best available research evidence

• Adopt a scientific view of clinical psychology
• Knowledge of clinical research design and
  methods
  
• Strategies for accessing best available research
• Ability to evaluate relevant evidence

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Best Available Research Evidence
Creator
Best available research evidence
Synthesizer
C o n s u m e r
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Research Evidence Creator

• Design, conduct, and report research
• The 12 International Committee of Medical Journal
  Editors journals (e.g., JAMA, The Lancet) agreed
  to only accept RCTs if they registered in the
  public registry prior to recruitment (e.g.,
  http//www.who.int/ictrp/en/). Why?
• Randomized Controlled Trials (RCTs) and CONSORT
  http//www.consort-statement.org/?o1011 . Why?

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Example CONSORT Flow Chart
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Example CONSORT Checklist
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Research Synthesizer

• Locate, appraise, and synthesize research
• Systematic reviews standardized criteria
• Meta-analyses
• P.I.C.O.
• Population, Intervention, Comparison, Outcome
• Inclusion, exclusion, databases searched (e.g.,
  psycINFO, MEDLINE, EMBASE), dates of search,
  search terms, etc.

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Research Consumer

• Access, appraise, and integrate into practice
• Performing the 5 As (Strauss et al., 2005)
• Ask the question (e.g., PICO)
• Acquire the evidence
• Appraise the evidence
• Apply the results
• Assess the outcome

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Medical/Health Database Acquiring the evidence
Research Literature
PSYCINFO
EMBASE
MEDLINE
Note that Cochrane and some other databases are
not linked to PsycINFO
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Acquiring the evidence Smart searches

• A variety of search engines and databases are
  available or are being created to facilitate EBP,
  especially in medicine
  
• www.tripdatabase.com, www.ahrq.gov,
  http//sumsearch.uthscsa.edu/, www.york.ac.uk/inst
  /crd/crddatabases.htm, www.guideline.gov,
  www.cochrane.org,
• Lynn Thaxton, GSU Library, will discuss effective
  searching

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Appraising the Evidence
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The EBP Model Patient Preferences and Values

• Therapy is a collaborative endeavor,
  shared-decision making
  
• Knowledge of specific diverse groups
• Ability to ascertain patient values and
  preferences
  
• Respond effectively to patient preferences and
  values

Patient preferences and values
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The EBP Model Clinical Expertise

• Common factors/non-specific skills
• Awareness of limits of clinical judgment
• Relationship building
• Assessment and diagnostic skills
• Ability to implement treatments
• Integration of EST with client characteristics

Clinical expertise
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The EBP Model

• Evidence-based practice is the successful
  integrations of these three competencies

EBP
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The EBP Model

• Evidence-based practice is the successful
  integrations of these three competencies
  
• Clinical decisions should be guided by all three
  areas

CD
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Putting EBP into Practice

• Imagine you are a busy clinical student
  conducting therapy in the clinic. You are working
  with a mom who was previously but not currently
  depressed.
• She states she is pregnant with number two and is
  worried about postpartum depression. She wants
  help to prevent it.
  
• You let her know that you will provide additional
  information next session.

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What do you do?

• Ask your advisor, consult with others, and base
  your response on your clinical experience?
  
• Not likely to reflect current scientific
  evidence
  
• Google search
• Many websites, but the information might be
  inaccurate and outdated
  
• PsycINFO and Medline
• Overwhelming and conflicting information

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The EBP Answer

• Use the 5 As

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Ask Clinically-Relevant Questions

• Pose background and foreground questions
• Background questions
• Knowledge base Who, what, where, or how
  followed by a condition or situation
  
• How does postpartum depression differ from other
  depression?
  
• What are the risk factors for postpartum
  depression?

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Clinically-Relevant Questions (cont.)

• Foreground questions PICO format
• P (Patient group)
• I (Intervention)
• C (Comparison Group)
• O (Outcome measures)
• In a woman with a history of depression (P), is
  there evidence that CBT, delivered while pregnant
  (I), will be more effective than no prenatal
  treatment (C) in reducing postpartum depression
  (O)?

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Search for the Best Research Evidence

• Focus on the top of the pyramid systematic
  reviews if available
  
• A TRIP (www.tripdatabase.com) search using
  postpartum depression revealed 334 records that
  can be sorted by type of article, question, or
  specialty. Second systematic review, a cochrane
  review, concludes that there is no evidence that
  psyc interventions prevent postnatal depression,
  but support for at-risk mothers might be helpful

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How does this fit with our client?

• Sort TRIP search by etiology, risks factors based
  on 2 meta-analyses and studies with 10,000 other
  women
  
• Depression and anxiety during pregnancy, low
  social support, prior psychopathology, poor
  marital relationship
  
• A TRIP search on antidepressants leads to a
  Cochrane review, which concludes that evidence is
  weak for meds to prevent later postpartum
  depression

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Integrating research with client

• Given she has only 1 risk factor, there is
  limited evidence that psychological or
  pharmacological interventions would prevent
  postpartum depression. However, she should watch
  for depression after birth and CBT or
  interpersonal treatment should be helpful.
  Effectiveness of group CBT, light therapy, and
  psychoeducation for postpartum depression are
  unknown

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The EBP Model
Limited evidence for preventative interventions
risk factors monitor after birth CBT or
interpersonal for postpartum depression
Opposed to meds prefers interpersonal therapy
insurance pays for 10 sessions previously
depressed
Best available research evidence
EBP
Patient preferences and values
Clinical expertise
Appropriate assessment ability to perform
treatment integrate research and clinical
evidence
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Thank You