Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.     

Evidence-based practice implementation and staff emotional exhaustion in children's services

Understanding the implementation of evidence-based practice (EBP) in community service settings is critical for the successful translation of research to practice. However, we have limited research evidence about the impact of EBP implementation on the mental health and social service workforce. In a previous study we demonstrated reduced staff turnover where an EBP was implemented with fidelity monitoring in the form of supportive ongoing supervision and consultation. Other research has shown that staff burnout and emotional exhaustion in particular is associated with poor quality of care and increased staff turnover intentions and turnover. Current research, however, has focused less on the effects that EBP implementation may have on staff emotional exhaustion. The present study investigates the association of EBP implementation and fidelity monitoring with staff emotional exhaustion in a statewide EBP implementation study. The 21 case-management teams in this study were randomized in a 2 (EBP vs. services as usual [SAU]) by 2 (monitoring vs. no monitoring) design. The EBP in this study was SafeCare^®, a home-based intervention that aims to reduce child neglect in at-risk families. SafeCare was developed from a behavior analysis approach and is based in cognitive behavioral principles. In keeping with our previous research, we hypothesized that providers implementing SafeCare with monitoring would have the lowest levels of emotional exhaustion and those receiving additional monitoring not in the context of EBP implementation would have higher emotional exhaustion relative to the other groups. Results supported our hypotheses in that we found lower emotional exhaustion for staff implementing the EBP but higher emotional exhaustion for staff receiving only fidelity monitoring and providing SAU. Together, these results suggest a potential staff and organizational benefit to EBP implementation and we discuss implications of the findings relative to EBPs and to fidelity monitoring.     

Impact Challenges in Community Science-with-Practice: Lessons from PROSPER on Transformative Practitioner-Scientist Partnerships and Prevention Infrastructure Development

At present, evidence-based programs (EBPs) to reduce youth violence are failing to translate into widespread community practice, despite their potential for impact on this pervasive public health problem. In this paper we address two types of challenges in the achievement of such impact, drawing upon lessons from the implementation of a partnership model called PROSPER. First, we address five key challenges in the achievement of community-level impact through effective community planning and action: readiness and mobilization of community teams; maintaining EBP implementation quality; sustaining community teams and EBPs; demonstrating community-level impact; and continuous, proactive technical assistance. Second, we consider grand challenges in the large-scale translation of EBPs: (1) building, linking and expanding existing infrastructures to support effective EBP delivery systems, and (2) organizing networks of practitioner-scientist partnerships-networks designed to integrate diffusion of EBPs with research that examines effective strategies to do so. The PROSPER partnership model is an evidence-based delivery system for community-based prevention and has evolved through two decades of NIH-funded research, assisted by land grant universities' Cooperative Extension Systems. Findings and lessons of relevance to each of the challenges are summarized. In this context, we outline how practitioner-scientist partnerships can serve to transform EBP delivery systems, particularly in conjunction with supportive federal policy.     

Preparing psychologists for evidence-based school practice: lessons learned and challenges ahead

The evidence-based practice (EBP) movement has the potential to significantly advance the quality of psychological and educational services provided by psychologists working in schools. Training psychologists in EBP has challenged the profession and caused faculty in graduate programs to reevaluate and retool professional training curricula and instructional practices. Four domains of challenges in graduate training are identified: (a) integrating the EBP knowledge base into the curriculum, (b) expanding models of research training, (c) expanding training in prevention science, and (d) expanding training in problem-solving consultation and school contextual issues. For each of these, the author discusses the range and scope of the challenge and possible solutions for advancing graduate training in psychology relevant to school practice.     

Modernism,Postmodernism and (Evidence-Based) Practice

One dominant discourse in the mental health arena revolves around evidence-based practice (EBP). Although there is ongoing debate about the implementation of EBP in the mental health field, most of these discussions have been limited to modernist ideas. While discussions about EBP have occurred from alternate perspectives, particularly postmodernism, a lack of open dialogue has resulted in these two groups “talking past each other” (Levy in Family Process 45:55–73, 2006). In this article we discuss the positions of both modernism and postmodernism with consideration of their respective epistemologies and attitudes toward research and EBP. We argue that critical thinking about EBP needs to include mutual debate from both modern and postmodern perspectives.     

Evidence-Based Therapist Responsivity to Disruptive Clinical Process

Although a historically prominent model of evidence-based practice (EBP) privileges the faithful delivery of single empirically supported treatment (EST) packages, psychotherapy research demonstrates that therapist adherence to an EST is often unrelated to patient outcome. Additionally, perseverative adherence when facing disruptive clinical process can relate to worse outcomes. In contrast, unmanipulated within-case variability in adherence, or the natural incorporation of theoretically “off-brand” interventions into an EST, can associate with more improvement. Further supporting the value of therapist flexibility, treatments that intentionally integrate theory-informed departures (away from the foundational EST) vis-à-vis specific disruptive clinical processes can outperform the standard EST without such departures. Thus, responsively adjusting treatments, such as cognitive-behavioral therapy (CBT), to patients’ contextualized pathology, characteristics, and momentary interactions with the provider may represent a more empirically well-supported form of EBP. Consistent with these ideas, we present an overview of context-responsive psychotherapy integration (CRPI), an approach to EBP in an if-then key. CRPI frames common factors as typical and potentially disruptive clinical “if” situations that therapists will encounter and to which they “then” need to be responsive beyond strict adherence to any EST. Notably, such departures can be temporary, thereby supporting vs. replacing the primary EST interventions. To illustrate CRPI’s application to practice, we focus on one example of patient resistance to CBT as a contextual process marker and motivational interviewing as a theory- and evidence-informed departure response. We also discuss clinical, cultural, empirical, and training considerations from the CRPI perspective.     

Supervising Humanistic-Existential Psychotherapy: Needs, Possibilities

The competency movement within professional psychology, evidence-based practice concepts, and the trend toward incorporating psychological services as a component of an integrated care approach within health care settings are major developments in the changing landscape of psychotherapy practice that have important implications for psychotherapy supervision. This article examines each of these developments as they relate to conducting psychotherapy supervision from a humanistic-existential perspective. The current status of supervision guided by a humanistic-existential framework is described, followed by exploration of needs and possibilities for the future evolution of the supervision approach in light of developments in the field.     

Meta-Analysis of Single-Case Design Research: Introduction to the Special Issue

Single-case design (SCD) research focuses on finding powerful effects, but the influence of this methodology on the evidence-based practice (EBP) movement is questionable. Meta-analytic procedures may help facilitate the role of SCD research in the EBP movement, but meta-analyses of SCDs are controversial. The current article provides an introduction to the special issue on meta-analyses of SCD research by discussing concerns regarding the internal and external validity of these designs. Specific considerations for increasing the validity of SCD meta-analyses are provided, as are brief overviews of the articles included in the special issue.     

The Evidence-Based Practice of Applied Behavior Analysis

Evidence-based practice (EBP) is a model of professional decision-making in which practitioners integrate the best available evidence with client values/context and clinical expertise in order to provide services for their clients. This framework provides behavior analysts with a structure for pervasive use of the best available evidence in the complex settings in which they work. This structure recognizes the need for clear and explicit understanding of the strength of evidence supporting intervention options, the important contextual factors including client values that contribute to decision making, and the key role of clinical expertise in the conceptualization, intervention, and evaluation of cases. Opening the discussion of EBP in this journal, Smith (The Behavior Analyst, 36, 7–33, 2013) raised several key issues related to EBP and applied behavior analysis (ABA). The purpose of this paper is to respond to Smith’s arguments and extend the discussion of the relevant issues. Although we support many of Smith’s (The Behavior Analyst, 36, 7–33, 2013) points, we contend that Smith’s definition of EBP is significantly narrower than definitions that are used in professions with long histories of EBP and that this narrowness conflicts with the principles that drive applied behavior analytic practice. We offer a definition and framework for EBP that aligns with the foundations of ABA and is consistent with well-established definitions of EBP in medicine, psychology, and other professions. In addition to supporting the systematic use of research evidence in behavior analytic decision making, this definition can promote clear communication about treatment decisions across disciplines and with important outside institutions such as insurance companies and granting agencies.     

心理治疗循证实践中“证据”的四个基本问题

循证实践正在成为西方心理治疗发展的主流方向。但如何理解循证实践的"证据"仍是见仁见智。部分社会大众甚至心理学专家仅将"循证"当作一种"修辞"或"时尚",顾名思义地界定"证据",或按主观信仰随意地选择与应用"证据"。文章以"证据"为研究焦点,试图建构系统理解"证据"的全面图景,探讨了心理治疗循证实践中关于"证据"的4个基本问题:(1)从历史考察与理论分析的视角出发,探讨了"心理治疗为什么需要证据";(2)从证据的类型范围、生产者及存在形式三个视角,描述了"心理治疗存在哪些证据";(3)从证据的科学程度、研究设计的严谨程度及解决实践问题的契合程度出发,阐述了"哪些证据才是好的证据";(4)从6个步骤推广证据及创新研究设计两个方面展开,分析了"在现实世界中如何推广与应用证据"。     

Organizational Culture and Climate and Mental Health Provider Attitudes Toward Evidence-Based Practice

Mental health provider attitudes toward adopting evidence-based practice (EBP) are associated with organizational context and provider individual differences. Organizational culture and climate are contextual factors that can affect staff acceptance of innovation. This study examined the association of organizational culture and climate with attitudes toward adopting EBP. Participants were 301 public sector mental health service providers from 49 programs providing mental health services for youths and families. Correlation analyses and multilevel hierarchical regressions, controlling for effects of provider characteristics, showed that constructive culture was associated with more positive attitudes toward adoption of EBP and poor organizational climates with perceived divergence of usual practice and EBP. Behavioral health organizations may benefit from consideration of how culture and climate affect staff attitudes toward change in practice.     

Dynamic accountability in clinical training and supervision: Three orienting ideals

Despite the growing interest on making clinical practice accountable, research on how specific components of professional competence are relevant in actual training/supervision practice is as yet unspecified. This study explores this dynamic aspect of professional supervision. Three supervisory dyads, composed by an experienced supervisor and a doctoral counseling psychology student were used in the study. A qualitative, ethnomethodology-informed design was used to discursively analyze 16 significant episodes (SEs) in actual supervision meetings. This was complemented by 16 follow-up interviews. Three interpretative repertoires – ‘ideals’ – influencing participants’ accounting practices were identified: efficacy, responsiveness, and authenticity. The article discusses how structural (competency-based) and dynamic (practice-based) approaches to accountability can be combined to guide the appraisal of relevant professional competencies.     

Why ‘What Works’ Still Won’t Work: From Evidence-Based Education to Value-Based Education

The idea that professional practices such as education should be based upon or at least be informed by evidence continues to capture the imagination of many politicians, policy makers, practitioners and researchers. There is growing evidence of the influence of this line of thought. At the same time there is a growing body of work that has raised fundamental questions about the feasibility of the idea of evidence-based or evidence-informed practice. In this paper I make a further contribution to this discussion through an analysis of a number of assumptions that inform the discussion. I focus on the epistemological, ontological and praxeological dimensions of the discussion and in each domain identify a deficit. In the epistemological domain there is a knowledge deficit, in the ontological domain an effectiveness or efficacy deficit and in the practice domain an application deficit. Taken together these deficits not only raise some important questions about the very idea of evidence-based practice but also highlight the role of normativity, power and values. Against this background I outline the case for the idea of value-based education as an alternative for evidence-based education. As I am generally concerned about the expectations policy makers hold about what evidence can and should achieve in professional practices such as education, my contribution is primarily meant to provide educators and other professionals with arguments that can help them to resist unwarranted expectations about the role of evidence in their practices and even more so of unwarranted interventions in their practices.     

Enhancing professional competence through developmental approaches to supervision

There has been a recent increase in interest in defining and describing the competencies for professional practice in psychology. Perhaps the most important mechanism for enabling the acquisition of competencies is the process of supervision. This article takes the position, based on a review of relevant research in supervision and the author's experiences, that developmental theories of supervision have stimulated considerable research and provide a direction for future work in research and practice. It is argued that the most detailed of these theories, the Integrated Developmental Model, provides a useful framework for understanding how supervisees change over time and how various supervision environments (broadly) and supervision interventions (specifically) can enhance or detract from the development of professional competencies.     

Dissemination of therapist-assisted internet cognitive behaviour therapy: development and open pilot study of a workshop

There is considerable research suggesting that therapist-assisted Internet cognitive behaviour therapy (ICBT) is efficacious in the treatment of depression and anxiety. Given this research, there is a growing interest in training students in therapist-assisted ICBT in order to assist with the dissemination of this emerging modality into routine clinical practice. In this study, we developed, delivered, and evaluated a therapist-assisted ICBT workshop for clinical psychology graduate students (n?=?20). The workshop provided both research evidence and practical information related to the delivery of therapist-assisted ICBT. The workshop also incorporated an experiential component with students working on and discussing responses to client e-mails. Before and after the workshop, we measured knowledge of therapist-assisted ICBT research and professional practice issues, as well as attitudes towards and confidence in delivering therapist-assisted ICBT. Statistically significant changes were observed in all areas. Eighty-five per cent of students are now offering therapist-assisted ICBT under supervision. We conclude by discussing future research directions related to disseminating therapist-assisted ICBT.     

Ethical and Legal Guidance for Mental Health Practitioners Who Wish to Conduct Research in a Private Practice Setting

Mental health practitioners, even when they have research training, rarely contribute to the scientific literature. One reason for this may be that they need help addressing the ethical and legal issues they encounter as they contemplate undertaking research in a clinical practice setting. To address that need, we offer several types of guidance for conducting research in a private practice setting in a way that meets high ethical and legal standards. We describe the situations in which ethical review of a research proposal by a federally registered institutional review board (IRB) is legally required, and identify alternate mechanisms that practitioners can use to obtain an ethical review when a formal IRB review is not required by law. We discuss legal and ethical requirements of conducting single-case studies in a practice setting. We provide a rationale, and free and inexpensive options, for obtaining a formal certificate of training in human subjects research. And we offer guidance for obtaining informed consent and Health Insurance Portability and Accountability Act (HIPAA) authorization from research participants. We conclude with a brief discussion of other legal and professional issues to consider when conducting research in private practice.     

Parent Perspectives of an Evidence-Based Intervention for Children with Autism Served in Community Mental Health Clinics

Research suggests that improvements to community mental health (CMH) care for children with autism spectrum disorders (ASD) are needed. Recent research examining the feasibility of training CMH therapists to deliver a package of evidence-based practice intervention strategies (EBPs) targeting challenging behaviors for school-age children with ASD offers initial support for such efforts to improve care. Specifically, quantitative data from a recent pilot study indicate that CMH therapists with limited ASD experience can deliver an EBP intervention with fidelity and perceive it as useful to their practice. Further, client attendance is high and children demonstrate improvement on standardized measures. To further understand the feasibility and impact of training CMH therapists to deliver EBPs, this mixed-methods study examined parent perspectives of the process and impact of outpatient psychotherapy for 13 parents of children ages 5–13 with ASD whose therapists were trained to deliver the EBP intervention. Results complement and expand previously reported quantitative data on psychotherapy process indicating that parents are highly involved in treatment for their children, perceive a strong therapeutic alliance with their children’s therapist, and highlight that treatment was different once therapists began delivering the intervention. Results also indicate themes related to parents’ perceptions of positive child and parent outcomes that provide important details on the specific gains that were observed during treatment. Study findings underscore the importance of parent perspectives in understanding the process and impact of implementing EBPs in CMH settings for families of children with ASD.     

Evidence-based practice in stuttering: Some questions to consider

A recent forum in JFD (28/3, 2003) evaluated the status of evidence-based practice in fluency disorders, and offered recommendations for improvement. This article re-evaluates the level of support available for some popular approaches to stuttering therapy and questions the relative value placed on some types of programs endorsed by the forum. Evidence-based practice is discussed within the context of emerging concerns over its application to non-medical interventions and suggestions are made for grounding fluency interventions by reference to empirically supported principles of change. A popular, evidence-based intervention for stuttering in young children (the Lidcombe program) is evaluated within the suggested parameters. EDUCATIONAL OBJECTIVES: After reading this article, the reader will be able to: (1) evaluate the status of evidence-based practice in fluency disorders; (2) list concerns about the impact of narrow interpretation of EBP on research and practice in the field of fluency disorders and other non-medical domains; (3) articulate the role of theory and basic research in selecting among and evaluating therapy approach options.     

Evidence-Based Practice in Psychology: An Ethical Framework for Graduate Education,Clinical Training,and Maintaining Professional Competence

Evidence-based practice is often acknowledged as the future state of psychology, yet those graduate students who will soon be applying such practices tend to hold several misconceptions about the major components within this framework. This review highlights implications for graduate education, clinical training, and professional competence in light of the movement toward evidence-based practice in psychology. These implications are discussed in relation to the close parallel between the major components of the evidence-based framework and the current Ethical Principles of Psychologists and Code of Conduct. The evidence-based framework is discussed as an ideology that promotes lifelong learning and best prepares graduate students for ethical clinical practice throughout their careers as psychologists.     

What's new about evidence-based assessment?

A clear consensus has emerged around the world concerning the desirability and even the urgency of basing health care delivery systems on evidence. Among behavioral health care providers such as psychologists, evidence-based practice (EBP) has been focused largely on interventions. Psychologists have long emphasized a scientifically based psychometric approach to the development of assessment procedures. Nevertheless, the era of evidence-based assessment highlights 2 somewhat different issues. First, sophisticated assessment is closely integrated with our emerging conceptions of psychopathology, rather than standing separate from these conceptions. Second, broad-based ongoing outcomes assessment systems are increasingly required for EBP on the part of governments and health care policymakers. This article summarizes these developments and looks to the future.