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Evidence-based Practice is a Verb not a Noun

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Evidence-based practice (EBP).  What is it?  Take a look at the graphic above.  According to American Psychological Association and the Institute of Medicine, there are three components: (1) the best evidence; in combination with (2) individual clinical expertise; and consistent with (3) patient values and expectations.  Said another way, EBP is a verb.  Why then do so many treat it as a noun, continually linking the expression to the use of specific treatment approaches?  As just one example, check out guidelines published for the treatment of people with PTSD by the National Institute for Clinical Excellence (NICE)–the U.K.’s equivalent to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).  Despite the above noted definition, and the lack of evidence favoring one treatment over another, the NICE equates EBP with the use of specific treatment approaches and boldly recommends certain methods over others.

Not long ago, ICCE Senior Associate, and U.K.-based researcher and clinician, Bill Andrews, addressed the problems with the guidelines in a presentation to an audience of British practitioners.  He not only addresses the inconsistent use of the term, evidence-based practice, in the development of guidelines by governing bodies but also the actual research on PTSD.  After watching the clip, take some time to review the articles assembled below, which Bill cites during his presentation.  The main point here is that clinicians need not be afraid of EBP.  Instead, they need to insist that leaders and officials stick to the stated definition–a definition I’m perfectly content to live with mas are most practitioners I meet.  To wit, know what the evidence says “works,” use my expertise to translate such findings into practices that fit with the values, preferences, and expectations of the individual consumers I treat.

Click here to read the meta-analysis that started it all.  Don’t stop there, however, make sure and read the response to that study written by proponents of the NICE guideliness.  You’ll be completely up-to-date if you finish with our response to that critique.

Feedback Informed Treatment as Evidence-Based Practice

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Back in November, I blogged about the ICCE application to SAMSHA’s National Registry for consideration of FIT as an official evidence-based approach (EBP).  Given the definition of EBP by the Institute of Medicine and the American Psychological Association, Feedback Informed Treatment seems a perfect, well, FIT.  According to the IOM and APA, evidence-based practice means using the best evidence and tailoring services to the client, their preferences, culture, and circumstances.  Additionally, when evidence-based, clinicians must monitor “patient progress (and of changes in the patient’s circumstances—e.g.,job loss, major illness) that may suggest the need to adjust the treatment. If progress is not proceeding adequately, the psychologist alters or addresses problematic aspects of the treatment (e.g., problems in the therapeutic relationship or in the implementation of the goals of the treatment) as appropriate.”

In late Summer 2011, ICCE submitted 1000’s of pages of supporting documents, research studies, as well as video in support of the application.  This week, we heard that FIT passed the “Quality of Research” phase of the review.  Now, the committee is looking at the “Readiness for Dissemination” materials, including the six detailed treatment and implementation manuals on feedback informed treatment.  Keep your fingers crossed.  We’ve been told that the entire process should be completed sometime in late fall.

In the meantime, we are preparing for this summer’s Advanced Intensive and Training of Trainer workshops.  Once again, clinicians, educators, and researchers from around the world will be coming together for cutting edge training.  Only a few spots remain, so register now.