Multicultural Issues in Evidence-Based Interventions

SUMMARY

School psychologists involved in the delivery of psychological and educational interventions face the challenge of identifying interventions that will work within their schools. The evidence-based intervention (EBI) approach has received attention as a promising way to identify effective interventions. The national Task Force on Evidence Based Interventions in School Psychology (sponsored by the American Psychological Association Division 16 and the Society for the Study of School Psychology, and endorsed by the National Association of School Psychologists) has developed coding criteria to review, evaluate, and identify efficacious interventions. This paper expands the work of the Multicultural and Diversity Committee of the EBI Task Force and offers direction for school psychologists in selecting and implementing interventions appropriate for their settings. We explore the meaning of EBIs in the context of a diverse world and discuss the cultural considerations that are necessary to responsibly adopt an EBI perspective. The paper is organized into three sections where we (a) examine EBIs from a multicultural perspective, (b) describe recent advances in infusing a multicultural perspective into EBI work and the Procedural and Coding Manual for Review of EBIs, and (c) offer a set of guidelines for making decisions about implementing an EBI in a new setting.     

Translating close-up research into action: a critical reflection

This paper argues that simple dissemination models do not work. One of the strengths of close-up research, with its emphasis on depth and understanding, is that it can identify why things are as they are and, by extension, when we identify wrongs seek to challenge them. The paper suggests, however, that making a difference is fraught with contradictions and that the translation from research to action is far from straightforward. We illustrate these tensions by reflecting on our experiences of conducting two projects for the UK Higher Education Academy. At the same time as exploring the slippages of translation and loss of criticality, however, we want to defend notion of praxis as theoretically informed change for critical social purposes. This involves a view of making a difference and research that moves beyond thinking of research as a discrete act and invokes the significance of corporate agency and the possibilities of acting collectively.     

Three Conceptual Models of Patient and Public Involvement in Standard-setting: From Abstract Principles to Complex Practice

Clinical practice guidelines have been critiqued for prescribing standardized care that neglects patients’ personal circumstances and knowledge in health care decisions. To make care more patient centred, standard-setters are urged to involve patients and the public in guideline development and use. Despite widespread principled support for such Patient and Public Involvement (PPI), the underlying principles guiding PPI in standardization of care are mired on confusion and contradiction. Based on the PPI literature in general, and informed by empirical research on guideline development, it is possible to identify three rationales that justify PPI in clinical standard setting. Each rationale gives rise to a conceptual model which outlines a distinct purpose of participation, who is to be included, and what they are expected to contribute. The Consumer Choice model aims to involve autonomous consumers to personalize clinical care. The Democratic Voice model aims for health care recommendations to better reflect collective values of citizens. The Lay Expertise model aims to re-contextualize universal evidence by including experiential patient knowledge. However, these models can and should not function as ‘Gold Standards’ to be consistently followed in practice. First, the models rely on two distinct types of representation, resulting in contradictory notions of how to be a good representative. Second, imposing models on practice requires a top-down control that is practically and politically problematic. Not only is control difficult to achieve, it may compromise the participatory ideal of participants co-determine practice, and may result in excluding the values and views of ‘real’ patients and public entirely.     

用循证医学证据丰富经验医学内涵——谈临床医生如何面对医学实践模式改变

从具体病例分析入手谈临床医生实践循证医学既需要思维模式转变、又要求掌握实际应用方法,即要敢于分析循证医学证据的实用性、又要善于用循证医学证据丰富经验医学内涵。新医学模式的普及将是临床医生群体认识史上一次具有深度和广度的飞跃。     

Are psychodynamic and psychoanalytic therapies effective?: A review of empirical data

There is a need for empirical outcome research in psychodynamic and psychoanalytic therapy. However, both the approach of empirically supported therapies (EST) and the procedures of evidence‐based medicine (EBM) have severe limitations making randomised controlled trials (RCTs) an absolute standard. After a critical discussion of this approach, the author reviews the empirical evidence for the efficacy of psychodynamic psychotherapy in specific psychiatric disorders. The review aims to identify for which psychiatric disorders RCTs of specific models of psychodynamic psychotherapy are available and for which they are lacking, thus providing a basis for planning further research. In addition, results of process research of psychodynamic psychotherapy are presented. As the methodology of RCTs is not appropriate for psychoanalytic therapy, effectiveness studies of psychoanalytic therapy are reviewed as well. Studies of psychodynamic psychotherapy published between 1960 and 2004 were identifed by a computerised search using Medline, PsycINFO and Current Contents. In addition, textbooks and journal articles were used. Twenty‐two RCTs were identifed of which 64% had not been included in the 1998 report by Chambless and Hollon. According to the results, for the following psychiatric disorders at least one RCT providing evidence for the efficacy of psychodynamic psychotherapy was identifed: depressive disorders (4 RCTs), anxiety disorders (1 RCT), post‐traumatic stress disorder (1 RCT), somatoform disorder (4 RCTs), bulimia nervosa (3 RCTs), anorexia nervosa (2 RCTs), borderline personality disorder (2 RCTs), Cluster C personality disorder (1 RCT), and substance‐related disorders (4 RCTs). According to results of process research, outcome in psychodynamic psychotherapy is related to the competent delivery of therapeutic techniques and to the development of a therapeutic alliance. With regard to psychoanalytic therapy, controlled quasi‐experimental effectiveness studies provide evidence that psychoanalytic therapy is (1) more effective than no treatment or treatment as usual, and (2) more effective than shorter forms of psychodynamic therapy. Conclusions are drawn for future research.     

从量变到质变--浅谈经验医学到循证医学的转变

循证医学是近十年来国际医学界倡导的一种新的医学模式,强调用科学的方法寻求最佳研究证据以指导临床决策.经验医学到循证医学的转变,是从量变到质变的过程,体现了事物发展的一般规律.     

国内循证医学人才资源分布研究

目的了解国内循证医学人才资源分布情况.方法采用描述性统计分析方法,对循证医学文献进行调查,统计分析区域分布、著者单位分布、著者分布.结果循证医学文献区域分布遍布全国26个省市,分布极不均衡,其中四川省著者最多,几乎占了1/3;四川大学循证医学文献产出最多,接近总产出的1/3;高产著者中多数著者均为四川大学华西医院著者.结论国内循证医学人才资源分布严重失衡,不利于国内循证医学研究的全面开展和循证医学水平的普遍提高.     

Psychologists in Academic Health Settings: Key Contributors to Dynamic Interplay Among Research, Clinical Practice, and Policy Domains

Psychologists in academic health systems are in a unique position to impact the dynamic interplay among research, clinical practice, and policy domains. In addition to their specialty expertise in psychopathology, particular types of physical illness and disease, and health promotion, psychologists have substantial knowledge of human behavior, refined scientific skills, knowledge and experience in the effective delivery of clinical services, strengths in written expression, and a collaborative orientation. This combination of strengths makes psychologists extremely well-suited for (a) interdisciplinary efforts to develop and implement evidence-based assessment and intervention strategies with biological, psychological, behavioral, and social components, and (b) leadership and advocacy efforts that impact the quality and availability of health care services.     

第六讲：肿瘤学研究中循证医学的应用

病人的治疗结果取决于医生治疗方案选择的好坏,然而,为获得最佳的治疗方案,医务工作者需要有可靠的研究证据支持。循证医学以及Cochrane协作网和其它多种循证资源,作为一种新的获得高质量医学证据的方法和途径,在肿瘤学研究中起到了重要作用。在循证肿瘤学领域有很多组织提供高质量的指南,然而,循证肿瘤学以及基于循证证据的指南仍可能是有暇疵的。