Evidence-Based, Empirically Supported, Best Practice Ronnie Detrich, Trina Spencer, Tim Slocum

Definition of Evidence-Based Practice  Evidence-Based Practice is a process of making decisions being informed by three sources of influence: a)best available research evidence b)professional judgment c)client values  Cf. Clinical Psychology: APA Task Force (2006)  Cf. Medicine: Sackett et al (2000)  Cf. Education: Whitehurst (2002)  Cf. Communication Disorders: Schlosser & Sigafoos (2008)

Definition of Evidence-Based Practice  One tool that is useful in this process is a list of interventions that are well supported by research.  These interventions are often called ‘evidence-based practices’.  This usage invites confusion between:  the process of making decisions and  a list of some of the possible intervention choices  This confusion could trivialize a complex decision making process by treating it as a simple menu choice.

Definition of Evidence-Based Practice  Interventions that are well supported by research  Terms are not at all consistent.  Virtually all combinations have been used:  Do not use “evidence-based practice” to refer to an intervention  As a speaker and listener, remember: The verbal community is NOT consistent in usage.  We cannot assume anything from the term alone. We must attend to the procedures, not the label. EvidenceBasedPractice(s) ResearchValidatedTreatment ScientificallyProgram EmpiricallySupportedIntervention

Definition of Evidence-based Practice  Primary question of the symposium:  How do we most effectively use the research base to guide professional practice?  Requires generalization  from a set of specific studies  to a range of practical situations  How broadly/narrowly shall we define  The intervention?  The client characteristics?  The outcomes?  The contexts of practice?

What is to be validated?  Interventions can be defined a various levels of specificity. Specificity general specific less more Research This issue also applies to outcomes, clients, and contexts.

Definition of Evidence-based Practice  The research base will never match our specific questions regarding practice; therefore, we must address the difficulties of generalizing beyond specific research studies.  By reviewers of research on a particular topic  Different styles of research reviews allow different ranges of generalization  By practitioners  This is part of ‘professional judgment’ that is included in the definition of evidence-based practice.

What is “Professional Judgment”?  Professional judgment  Fills the gap between an imperfect research base and the specifics of a clinical situation.  Includes rule-governed elements  Knowledge of the research base  Knowledge of broader principles of behavior  Includes contingency-shaped elements  Subtle discriminations of when and how to apply principles  Repertoire of shaped interactive behavior

Methods of Deriving Practice Recommendations 1. Empirically Supported Interventions (Slocum)  Using objective and operationalized procedures for identifying the level of research support for particular interventions. 2. Best Practices (Detrich)  Employing experts to review research and make critical judgments and reasonable generalizations as a basis for recommendations. 3. Research-Based Principles (Spencer)  Drawing from basic principles to construct or adapt interventions for individual settings or clients.  The nexus between ‘research base’ and ‘professional judgment’

Methods of Deriving Practice Recommendations  We will argue: 1. Each of these methods can be employed with a range of quality and rigor. 2. Each has distinct strengths and limitations. 3. The three methods can work together to inform practice.